The power of facial feminization surgery: A prospective study of validated patient-reported outcomes measures

Facial feminization surgery (FFS) has been shown to improve mental health-related quality-of-life measures among transgender and nonbinary (TGNB) individuals. However, there is a lack of validated tools to evaluate long-term satisfaction and psychosocial well-being after FFS. This study aimed to address this gap using the FACE-Q patient-reported outcomes measure (PROM) in a TGNB cohort.

Patients seeking FFS over a 4-year period within an integrated healthcare system were enrolled prospectively. Facial satisfaction and psychosocial well-being were assessed before or after FFS using FACE-Q. Iterative survey occurred preoperatively and at 3, 6, and 12 months postoperatively. The minimal important difference (MID) was calculated to interpret the clinically meaningful change in PROM over time. Two-tailed paired t-tests allowed an outcome comparison before or after FFS.

The final analysis included 65 patients. Satisfaction with overall facial appearance increased from 34.3±12.4 preoperatively to 83.0±15.7 at 3 months, 83.1±16.2 at 6 months, and 92.2±11.9 at 12 months postoperatively (p<0.001). Average scores increased by at least 33 points for lips (p<0.001), 34 points for lower face (p<0.001), and 23 points for aging appearance (p<0.001). Social and psychological function increased by at least 35 and 39 points, respectively (p<0.001). The mean MID estimate was 3 for facial appearance and 4 for psychosocial function and outcome satisfaction.

FFS can have a large impact on patient-reported outcomes. Using a validated PROM, this study demonstrated significant improvements in facial esthetics satisfaction and psychosocial functioning while maintaining low adverse effects. To the authors' knowledge, this study is one of the first to incorporate the MID into gender-affirming surgery PROM.