Maximizing Operative Efficiency in Facial Feminization Surgery: A Structured Team-Based Approach

Facial feminization surgery (FFS) reduces gender dysphoria and improves psychosocial well-being in transfeminine patients, but its multiprocedural nature leads to long operative times, increasing anesthetic risk, and limiting daily surgical output. This study analyzes operative times across FFS procedures and describes a comprehensive approach that maximizes efficiency during multiprocedural FFS. 55 patients who underwent FFS from August 2024 through October 2025 were included. A four-person operating team was utilized in all cases. Fourteen patients (25.5%) underwent full FFS, 22 (40.0%) underwent near-full FFS, and 19 (34.5%) underwent partial FFS, totaling 267 procedures (mean: 4.9 procedures per patient). The mean operative time for full FFS was 196.4±39.4 minutes. Frontal sinus setback averaged 50.0±19.1 minutes, compared with 24.4±7.8 minutes for frontal sinus contouring with egg burr alone. Thyroid cartilage reduction averaged 31.6±8.9 minutes, genioplasty averaged 25.7±9.9 minutes, mandibular angle reduction averaged 25.1±9.6 minutes, lip augmentation averaged 8.2±2.2 minutes, fat grafting to the cheeks averaged 5.0±2.3 minutes, and open septorhinoplasty averaged 75.5±22.6 minutes. No intraoperative complications occurred. Two patients (3.6%) developed minor intraoral infections one month postoperatively, both resolving with oral antibiotics. Through deliberate procedural sequencing, concurrent task execution, and a well-trained team, full FFS can be completed efficiently without compromising patient outcomes or trainee education. This approach reduces anesthetic exposure and enables multiple FFS cases within a single day, expanding access in a field where surgical demand exceeds available capacity.