Facial Gender-Confirmation Surgery: A Systematic Mapping Review of Surgical Growth and Outcome Gaps

Background and Objectives: Facial gender-confirmation surgery (FGCS) has expanded rapidly but remains uneven across procedures, specialties, and outcome domains, limiting clinically useful interpretation for surgeons. The aim is to characterize how FGCS evidence has developed and to identify gaps relevant to surgical reporting and patient-centered outcome evaluation. Materials and Methods: Systematic searches were conducted without date restriction in PubMed, Scopus, Web of Science, LiLACS, and EBSCOhost through June 2025. Eligible studies included original clinical research, systematic reviews (SR), technical notes, and economic evaluations. Two reviewers independently screened and extracted data. PROSPERO: CRD420251041192. Results: Among 338 included studies, the literature was concentrated on feminization procedures (78%) and hard-tissue interventions (51%). Outcome reporting was dominated by surgical technique (36%) and complications (29%); patient-centered domains were less represented, including satisfaction (25%), preferences (7%), recovery (2%), and ethics (3%). Masculinization and soft-tissue procedures were less frequently studied. Methodological quality of the 36 included SRs was predominantly critically low (72%) or low (28%). Conclusions: Procedural reporting in FGCS has developed asymmetrically relative to standardized patient-centered outcome measurement, a pattern consistent with the formative stages observed in other surgical fields. For surgeons, this limits comparability across procedures and weakens the evidence base for counseling, multidisciplinary planning, and postoperative evaluation. Future research should prioritize more consistent and validated patient-reporting frameworks.