Facial Feminization Surgery: A Systematic Review of Perioperative Surgical Planning and Outcomes

Abstract

Background: Facial feminization is a critical step in a transfeminine patient's surgical transition. However, the existing literature on the various types of feminization surgeries suffers from inadequate reporting on perioperative aspects of care, such as preoperative evaluation and postoperative outcomes. The aim of this study is to evaluate facial feminization surgery (FFS), preoperative planning, and patient reported outcomes after various types of procedures. Methods: An electronic database search of Ovid MEDLINE was completed according to PRISMA guidelines for articles pertaining to FFS. Study characteristics, operative information, and patient demographics were collected. Data concerning preoperative imaging, virtual simulation, postoperative complications, and patientreported outcome measures (PROMs) were collected and analyzed for patterns. Results: A total of 22 papers representing 1302 patients were included for analysis. The most commonly discussed operations included upper face procedures, particularly of the forehead (17 studies, 77%). When discussed, preoperative planning for FFS included standard photography in 19 (86%) studies, advanced imaging, such as cephalometry or computed tomography, in 12 (55%) studies, and virtual simulation of surgical outcomes in four (18%) studies. Patient-centered outcomes, such as postoperative satisfaction, were described in 17 (77%) studies. Standardized PROMs were heterogenous across included studies with only 11 (50%) including at least one PROM. Conclusions: FFS is common, safe, and highly satisfying for transfeminine patients seeking surgical intervention for identity actualization. Future research concerning transgender care must evaluate advanced surgical planning and 3D simulation combined with more standardized assessment of PROMs to ensure high-quality analysis of patient satisfaction.

Lip lifting as a Supporting Technique in the Facial Feminization Process of Transgender Patients: Case Report

“…Recently there has been an increase in the prevalence of transgender women seeking surgeons to perform changes to facial features through Facial Feminization Surgery (FSC). CFF, in turn, is defined as a combination of bone and soft tissue surgeries of the face that aims to modify the main differences related to sexual dimorphism, with the aim of improving the patient's self-esteem and contributing significantly to the development of their quality of life in society [9][10][11][12][13]. When talking about transvestites and/or transgenders and transsexual women [14,15], seeking an "adequacy" of the body to gender identity through the feminization of body appearance, they can use various resources throughout the transition process, such as hormones, plastic surgery, laser hair removal, use of industrial liquid silicone (SLI); which, in turn, can result in various health problems, such as infections, migration of the product to other areas of the body, deformities, siliconomas, tissue necrosis, pulmonary embolism and even death [5,8,16].…”

Facial Anthropometric Analysis of Gender-Related Characteristics in Computed Tomography

“…According to the review article, FFS could be categorized based on the performing area: upper face, middle face, lower face, and neck region. 4 Among these facial areas, the case number in the neck region is the least. The forehead, nose, and mandibular region recorded the highest number of procedures conducted.…”

“…3 The procedures involved in FFS may vary depending on the individual's needs and goals but usually include forehead contouring, rhinoplasty, chin and jaw contouring, and lip lift or augmentation. 4,5 There have been many studies focusing on preoperative evaluation and postoperative outcomes of FFS. 5 Analysis of facial characteristics and differences between sexes among White individuals have also been established for application to FFS.…”

“…Facial feminization surgery is a series of cosmetic and reconstructive procedures that are used to modify masculine facial features into feminine ones 3 . The procedures involved in FFS may vary depending on the individual's needs and goals but usually include forehead contouring, rhinoplasty, chin and jaw contouring, and lip lift or augmentation 4,5 …”

Who Is the Fairest of Them All? Facial Feminization Surgery and Surgical Regret

“…The primary objectives of FFS include providing comfort by addressing the incongruence experienced by the individual, improving the overall quality of life, and reducing the risk of depression and suicidality. However, it is crucial to acknowledge that transwomen may encounter challenges in achieving their desired level of feminization because of inherent differences in craniofacial anatomy between males and females 2 ; this is known as the principle of uniqueness, resulting in a diverse array of facial shapes and structures (Fig. 1), thus, how the complexity of FFS varies based on the underlying and intrinsic male facial features.…”