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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, and Fermín Capitán-Cañadas, PhD, 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.

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study"

Article: "Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study" (doi: 10.1097/PRS.0000000000006837)

About Plastic and Reconstructive Surgery

For more than 70 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

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The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 8,000 member surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 93 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.

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