Comparative Outcomes of Partial and Full Facial Feminization Surgery: A Retrospective Cohort Study

Abstract

Background:The demand for facial feminization surgery (FFS) amongst transgender women is on the rise, and requests for a singlestage full FFS (F-FFS) are becoming more frequent. The specific aim of this article is to present our institutional experience with both partial-FFS (P-FFS) and F-FFS with a specific emphasis on safety of each approach. Methods: We examined the electronic medical record of all patients with the diagnosis of gender dysphoria that were referred to the senior author for FFS consultation at our institution, between June 2017 and October 2020. Patients were sub-grouped into those who underwent F-FFS (upper, middle, and lower facial thirds in a single anesthetic event) and those who underwent P-FFS. Univariate analysis was used to assess for difference in postoperative complications. Results: We identified 77 patients who underwent 382 total procedures. The mean follow-up time was 7.5 months (Sd ¼ 7.3) (interquartile range 1.75-12.0 months). Fifty-one (71.4%) patients underwent F-FFS and 21 (28.6%) patients underwent P-FFS. Compared to P-FFS, F-FFS was not associated with an increase in postoperative complication (1 out of 21 [4.8%] versus 4 out of 51 [7.8%]) ( P < 0.556). When comparing characteristics of patients with postoperative complications to patients with no postoperative complications, the average body mass index was significantly higher (30.9 versus 25.4, respectively). ( P < 0.029). Conclusions: Full-FFS is a set of procedures that has gained increased popularity among male-to-female transgender patients. Our results support the understanding that F-FFS is a safe and reliable approach, which may be preferable to patients and providers alike.

Secondary Surgery in Facial Feminization

“…These patients were distinct from those who underwent partial FFS with a plan for staged surgery 10 . The secondary surgery cohort was subdivided into 2 non–mutually exclusive groups: patients who underwent additional surgery, defined as unplanned additional feminization surgery on previously unoperated facial units (as previously defined 10 ), and those who underwent revision surgery, defined as a redo surgery on previously operated facial units. Patients who underwent surgery exclusively for additional fat grafting were excluded, given known variable fat retention and expectation for subsequent rounds of fat grafting to achieve desired volume 11 .…”

“…Patients who underwent secondary surgery were isolated from this cohort based on medical record review. These patients were distinct from those who underwent partial FFS with a plan for staged surgery 10 . The secondary surgery cohort was subdivided into 2 non–mutually exclusive groups: patients who underwent additional surgery, defined as unplanned additional feminization surgery on previously unoperated facial units (as previously defined 10 ), and those who underwent revision surgery, defined as a redo surgery on previously operated facial units.…”

Gender Affirmation Surgery of the Face for the Transfeminine Patient

“…Full FFS refers to facial feminization surgery that "addresses the upper, middle, and lower facial thirds in a single anesthetic event." 7 Some of the surgeries that may be addressed include forehead cranioplasty, burring of the supraorbital ridge, blepharoplasty, rhinoplasty, upper lift lip, mandibular angle reduction, and tracheal shave. Single-stage FFS has not been shown to incur additional risk to the patient.…”

“…Single-stage FFS has not been shown to incur additional risk to the patient. 7 Additionally, patients and physicians alike may be This article is protected by copyright. All rights reserved.…”

Comparative Outcomes of Malar Implants Versus Fat Transfer to Cheeks Among Transfeminine Individuals Undergoing Malar Augmentation

“…Therefore, in comparison with the classically masculine midface, the feminine midface typically exhibits fuller and more anteriorly positioned malar prominences. 1,2 Achieving a harmonious feminine appearance through FFGAS typically requires multiple interventions. In the case of the inverted triangle, reduction in mandibular width and notably, augmentation of the anterior and lateral projection of the malar prominences plays a crucial role.…”