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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
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.
- 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.
