58 posters, 14 topics, 4 sessions, 188 authors, 62 institutions
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PSRC 69th Annual Meeting 2024
May 16-19, 2024 | The Westin Copley Place, Boston, MA
EP29
Facing Forward: A Comparative Analysis Of Outcomes In Partial And Full Facial Feminization Surgery
Poster Presenter
Authors
Affiliations
Part of Topic
Gender Affirmation Medicine/Surgery
Facing Forward: A Comparative Analysis of Outcomes in Partial and Full Facial Feminization Surgery
Kirsten A Schuster MD JD, Maria J Escobar-Domingo MD, Iulianna C Taritsa BA, Daniela Lee BS, Angelica Hernandez Alvarez MD, Jose Foppiani MD Samuel Lin MD MBA
Beth Israel Deaconess Medical Center, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, MA
BACKGROUND
•Demand for facial feminization surgery (FFS), which seeks to align secondary sex characteristics and gender identity, continues to rise.1
•FFS includes a group of craniomaxillofacial procedures including supraorbital ridge burring, hairline advancement, blepharoplasty, rhinoplasty, anterior frontal wall setback, malar augmentation, genioplasty, chondrolaryngoplasty, and mandibular angle reduction.2-5
•Research emphasizes focus on the brows, nose, mandible, and chin as these are most influential in gender perception.5-6
•Individual surgical plans vary based on baseline facial features, patient priorities, and surgeon expertise and experience.3
•Initially performed as staged procedures, full facial feminization surgery (F-FFS) which performs multiple procedures involving aspects of the upper, middle, and lower facial thirds concurrently has become more popular.7
PURPOSE
•To date, studies analyzing the safety of F-FFS have been limited by small sample sizes and single-institution designs.7-10
•This study aimed to assess post-operative outcomes, specifically complication rates, in partial- versus full-FFS using a national surgical database to evaluate relative safety.
METHODS
Search Strategy
•Database: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for 2016 to 2021
•International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify patients with primary diagnosis of transgenderism or gender identity disorder
•Current Procedural Terminology (CPT) codes used to isolate patients who underwent FFS. Tracheal and laryngeal procedures were not included in analysis.
Patient Stratification
•Identified cohort was stratified by number and location of concurrent procedures
•Full-FFS was defined as augmentation of the upper, middle, and lower facial thirds in a single anesthetic event
•Partial-FFS was defined as surgery on only one or two facial thirds in a single anesthetic event
•Multi-site surgery included patients with any facial procedure performed concomitantly with any non-facial surgery.
Additional Variables
•Sociodemographic, clinical characteristics, perioperative variables, and complications
Statistical Analysis
•Stata statistical software used to conduct t-, Fisher’s Exact, and analysis of variance tests to evaluate baseline characteristics.
•Multiple logistic regression models assessed differences in overall wound complications, systemic complications, and reoperation rates between groups
RESULTS
DISCUSSION
•Performance of multiple procedures during a single anesthetic event has several potential benefits including decreased overall operative time, recovery time, and cost.
•Despite initial concerns including disrupted blood supply and prolonged surgical duration,10 this study demonstrates that concurrent procedures involving all three anatomic segments of the face may be performed safely.
•Overall complication rates for both partial and full-FFS were lower than those previously reported by most smaller, single-institution studies.7-8,10
•Of the procedures involving multiple sites, 9 involved breast augmentation and 5 involved genital reconstruction or dilation. Despite the potential risk of cross contamination between surgical sites, these patients did not demonstrate increased infection rates.
LIMITATIONS
•The low overall complication rates and relatively small populations of the full-FFS and multi-site groups may have led to under-detection of differences that may become more apparent with larger sample sizes. This is important as these are the groups theoretically more likely to experience complications.
•Due to database limitations, we were unable to examine other factors including the use of multiple surgeons, complications occurring outside the 30-day window, history of prior facial feminization procedures, patient age at the time transition was begun, and hormone therapy use.
•Assumed based on ICD-10 code that all procedures were performed as part of gender affirmation surgery, but it is possible that some interventions were performed for other reasons.
REFERENCES
1.Hauc SC, Mateja KL, Long AS, et al. Limited Access to Facial Feminization Geographically Despite Nationwide Expansion of Other Gender-Affirming Surgeries. Plast Reconstr Surg Glob Open. 2022;10(9):e4521.
2.Capitán L, Sanamaría JG, Simon D, et al. Facial Gender Confirmation Surgery: A Protocol for Diagnosis, Surgical Planning, and Postoperative Management. Plast Reconstr Surg 2020; 145:818e-828e.
3.Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature. Plast Reconstr Surg 2015; 137:1759-1770.
4.Spiegel JH. Facial Feminization for the Transgender Patient. J Craniofac Surg. 2019;30(5):1399-1402.
5.Spiegel JH. Facial Determinants of Female Gender and Feminizing Forehead Cranioplasty. Laryngoscope. 2011 Feb; 121(2): 250-261.
6.Brown E, Perrett DI. What gives a face its gender? Perception 1993; 22:829-840.
7.Chaya BF, Boczar D, Rodriguez Colon R, et al. Comparative Outcomes of Partial and Full Facial Feminization Surgery: A Retrospective Cohort Study. J Craniofacial Surg. 2021; 32(7):2397-2400.
8.Peleg O, Kleinman S, Ianculovici C, et al. Risk Factors for Postsurgical Infection in Facial Feminization Surgery. Aesth Plast Surg 2023; 47(5):2130-2135. Gupta N, Wulu J, Spiegel JH. Safety of Combined Facial Plastic Procedures Affecting Multiple Plans in a Single Setting in Facial Feminization for Transgender Patients. Aesth Plast Surg 2019; 43:993-999.
9.Alcon A, Badiee RK, Barnes LL et al., Gender-Affirming Facial Feminization Surgery at a Public, Safety-Net Hospital: A Single-Center Early Experience. J Craniofac Surg 2023; 34:1010-1014.
10.Gupta N, Wulu J, Spiegel JH. Safety of Combined Facial Plastic Procedures Affecting Multiple Planes in a Single Setting in Facial Feminization for Transgender Patients. Aesth Plast Surg 2019; 43:993-999.