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

Sydney Barone¹, Eric Bao¹, Stephanie Rothberg²

¹Division of Plastic and Reconstructive Surgery, Northwell Health.

The Journal of Craniofacial Surgery

|June 16, 2026

Summary

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Facial feminization surgery (FFS) can be performed more efficiently with strategic planning and a skilled team. This approach reduces operative time and anesthetic exposure, increasing patient access to FFS procedures.

Area of Science:

Plastic Surgery
Gender-Affirming Care

Background:

Facial feminization surgery (FFS) is crucial for reducing gender dysphoria in transfeminine individuals.
The complexity and duration of FFS increase anesthetic risks and limit surgical capacity.

Purpose of the Study:

To analyze operative times for various FFS procedures.
To describe an efficient, multiprocedural FFS approach to maximize surgical output.

Main Methods:

A retrospective analysis of 55 patients undergoing FFS between August 2024 and October 2025.
Utilized a four-person surgical team and optimized procedural sequencing for concurrent task execution.

Main Results:

The mean operative time for full FFS was 196.4 minutes.

Keywords:

Facial feminization surgery operative efficiency patient access sex-affirming care surgical access transfeminine surgery

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Individual procedures varied in duration, e.g., frontal sinus setback (50.0 min) vs. contouring (24.4 min).

High efficiency was achieved with no intraoperative complications and minor postoperative infections (3.6%).

Conclusions:

Multiprocedural FFS can be completed efficiently through strategic planning, teamwork, and procedural sequencing.
This optimized approach reduces anesthetic exposure and increases the number of FFS cases performed daily.
The findings suggest a method to expand access to FFS, addressing the high demand for these procedures.