New study evaluates facial feminization outcomes, benefits for transgender women
Previous studies have reported improved quality of life and mental health in transgender women undergoing facial feminization surgery (FFS) surgery to provide a more feminine facial appearance. But there is still limited evidence on these and other benefits of facial gender confirmation surgery.
A new study from two leading centers documents improved outcomes after FFS, including subjective and objective evidence of a more feminine appearance, leading to improved quality of life. "Facial feminization achieved improved quality of life, feminized cephalometries, feminine gender appearance, good overall aesthetics, and high satisfaction that were present at one month and stable at greater than six months," write lead authors Shane Douglas Morrison, MD, MS, of University of Washington, Seattle; Thomas Satterwhite, MD, Align Surgical Associates, San Francisco, CA; and Fermín Capitán-Cañadas, Ph.D., of the FACIALTEAM Surgical Group at HC Marbella International Hospital, Spain.
The researchers analyzed the outcomes of 66 consecutive patients undergoing FFS at their two centers. The patients' average age was 39 years; two-thirds had begun their gender-affirmation process within the previous five years. The study appears in the June issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).
As is typical for FFS, the patients underwent a range of different procedures designed to provide a more feminine facial appearance: an average of 4.2 procedures per patient. The most common procedures focused on reducing and reshaping the underlying bone of the forehead, jaw, and chin—identified by patients as "most masculine" features of their faces.
Before-and-after evaluations showed improvement in several key outcomes. On a 100-point facial feminization score (with 100 denoting complete satisfaction), median score increased from 47.2 before FFS to 80.6 at six months after surgery. The facial feminization score has previously been shown to be correlated with a standard quality-of-life assessment (Short Form-36 scale).
The study also included cephalometry - a set of computerized measurements to assess whether the facial structure had more typically feminine or masculine characteristics. Although the differences in these objective measurements were small, "their synergistic effects to overall alteration of the face are substantial," the researchers write.
On subjective observer ratings in a subgroup of patients, average score on a range from one (most feminine) to five (most masculine) was 1.83 in transgender women after FFS, compared to 1.25 in a group of cisgender women. On a ten-point general aesthetic outcome scale, average scores were 6.09 for the FFS patients and 7.63 for cisgender women. "Our cohort of FFS patients had feminine gender appearance and good overall aesthetic outcomes," the researchers write. "However, their gender appearance and general aesthetic outcomes were still not equal to those of cisgender women controls."
Facial feminization surgery is one of the fastest-growing areas in plastic surgery and is increasingly recognized as a medically necessary treatment for gender dysphoria. The new report is one of the first prospective studies of FFS, using standard assessments performed before and after surgery.