Effect of Gender-affirming Facial Feminization Surgery on Psychosocial Outcomes

Caprini, Rachel M.; Oberoi, Michelle K.; Dejam, Dillon; Chan, Candace H.; Potemra, Hi'ilani M K; Morgan, Bradley J; Weimer, Amy K.; Litwin, Mark S.; Mendelsohn, Abie H.; Lee, Justine C.

doi:10.1097/sla.0000000000005472

Cited by 28 publications

(20 citation statements)

References 35 publications

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“…A total of 17 380 records were identified from the search, with 286 studies 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 ...…”

Section: Resultsmentioning

confidence: 99%

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

et al. 2023

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ImportanceGender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy.ObjectiveTo identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation.Evidence ReviewIn this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080).FindingsIn total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate.Conclusions and RelevanceIn this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.

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Section: Resultsmentioning

confidence: 99%

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

et al. 2023

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“…This differed from the findings of Caprini et al, which showed positive effects in social relations through improvements in social isolation after FFS. 5…”

Section: Discussionmentioning

confidence: 99%

“…7 FFS has been shown to improve mental health outcomes, with transgender patients reporting significantly reduced rates of anxiety, depression, anger, and social isolation. 5 Although FFS plays an important role in gender-affirmation, there remains limited accuracy and heterogenous methods of reporting the quality of surgical outcomes related to patient satisfaction of facial appearance. 8,9 The FACE-Q instrument is a validated patient-reported outcome measure (PROM) that has become increasingly widespread in clinical and research practices to assess facial outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying Facial Feminization Surgery’s Impact: Focus on Patient Facial Satisfaction

Alper,

Almeida,

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Facial feminization surgery (FFS) has been associated with improving gender dysphoria in transgender patients. This study aimed to quantify the impact of surgery on patient facial satisfaction, using the FACE-Q and a quality-of-life (QoL) survey. Methods: Transgender female patients were recruited to complete the FACE-Q and the World Health Organization’s QoL Scale-Short Form (WHOQOL-BREF) if they were planning to or had undergone FFS at our institution. FACE-Q modules completed included “Satisfaction with Facial Appearance Overall,” individual facial attributes (forehead/eyebrows, nose, cheeks, cheekbone, chin, jawline, and neck), and the WHOQOL-BREF, which assesses patient QoL through four domains (physical, psychological, social relations, and environment). Both matched and unmatched analyses of preoperative versus postoperative cohorts were performed. Results: Overall, 48 patients participated in our study and completed 31 FACE-Q surveys preoperatively and 37 postoperatively. On average, patients were 37.2 ± 12.5 years old. FACE-Q scores increased significantly for all facial attributes and for Satisfaction with Facial Appearance Overall between cohorts (P < 0.05). The facial attribute with the greatest increase in satisfaction was the jawline, followed by the nose. The WHOQOL-BREF’s psychological and physical domains both improved significantly (P < 0.05). Wait time for surgery of less than 6 months (b = 22.42, P = 0.02) was associated with higher overall facial satisfaction, whereas age at surgery (b = −1.04, P < 0.01) was associated with lower overall facial satisfaction. Conclusions: Transgender female patients experienced significant improvements in facial satisfaction and QoL after FFS. Undergoing surgery at a younger age and shorter wait times for surgery were associated with increased overall facial satisfaction.

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“…8 Such care has been shown to be related to improved mental health, decreased suicidal thoughts, and improved quality of life. [9][10][11][12][13][14] Thus, gender-affirming care is a life-saving and life-changing treatment.…”

mentioning

confidence: 99%

Needs Assessment of Gender‐Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria

Ziltzer

Lett

Su-Genyk

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo assess the needs of transgender and nonbinary (TNB) adults for gender‐affirming face, neck, and voice procedures.Study DesignCross‐sectional survey.SettingOnline, February to May 2022.MethodsPrimary outcomes included utilization of otolaryngologists and speech‐language pathologists; gender dysphoria felt from the face, neck, and voice self‐reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender‐affirming face, neck, and voice procedures. We used ordinal logistic and linear regression to assess relationships between site‐specific dysphoria and the desire for relevant procedures.ResultsTNB participants (N = 234) infrequently sought gender‐affirming care with speech‐language pathologists (23%), facial plastic surgeons (8%), or laryngologists (3%). Participants experienced the strongest dysphoria from the voice (median 7/10), jawline/chin (4/10), and neck (3.5/10). Transmasculine and nonbinary participants typically seeking masculinization (n = 83) frequently desired voice therapy (want = 35%, had = 8%). Transfeminine and nonbinary participants typically seeking feminization (n = 145) frequently desired voice therapy (want = 52%, had = 23%), chondrolaryngoplasty (want = 45%, had = 5%), and hair removal/electrolysis (want = 43%, had = 44%). Many desired at least 1 facial feminization surgery procedure (65%), especially mandible reduction (want = 42%, had = 3%), rhinoplasty (want = 41%, had = 1%), and forehead reduction (want = 37%, had = 4%). Dysphoria ratings were associated with desiring relevant procedures (p < .05 for all), notably voice therapy (odds ratio [OR] = 1.50), chondrolaryngoplasty (OR = 1.46), mandible reduction (OR = 1.38), rhinoplasty (OR = 1.59), and forehead reduction (OR = 1.82).ConclusionGender dysphoria from the face, neck, and voice can be severe for TNB people and is associated with the desire for gender‐affirming procedures. The high demand yet low reported access to these procedures highlights the need for providers of gender‐affirming face, neck, and voice care.

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Effect of Gender-affirming Facial Feminization Surgery on Psychosocial Outcomes

Cited by 28 publications

References 35 publications

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

Quantifying Facial Feminization Surgery’s Impact: Focus on Patient Facial Satisfaction

Needs Assessment of Gender‐Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria

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