Initial Facial Feminization Surgery Experience in a Multicenter Integrated Health Care System

Objective: There are few large studies on facial feminization surgery (FFS). We provide the largest comprehensive report to date of an FFS cohort regarding the safety of multilevel surgery, patient-specific considerations with FFS procedures, and complications of surgery.

Study Design: Retrospective cohort study.

Setting: Multicenter integrated health care system.

Subjects And Methods: We examined all patients undergoing FFS within our institution from April 2016 to October 2018. Patients over the age of 18 with a diagnosis of gender dysphoria underwent any combination of scalp advancement, cranioplasty, brow lift, rhinoplasty, upper lip lift, mandibuloplasty, chondrolaryngoplasty, and/or additional cosmetic procedures. Medical records were reviewed for preoperative characteristics, FFS procedures undergone, and postoperative complications.

Results: In total, 121 patients underwent a total of 594 FFS procedures. Seventy-five percent of patients had only 1 or no comorbidities, and 90% of patients underwent cranioplasty, scalp advancement, and brow lift. African American patients (n = 5) less commonly underwent cranioplasty compared to those of other ethnicities (white, < .001; Asian, = .022; Hispanic, = .014; multiracial, = .006). Asian patients less commonly underwent rhinoplasty than white patients (38% vs 73%, = .023). Only 8 (6.6%) patients experienced a significant complication after surgery.

Conclusions: The population undergoing FFS is generally healthy, the upper third of the face is most commonly addressed, there are age and ethnic considerations in FFS, and major complications after multilevel surgery are uncommon.