Initial Facial Feminization Surgery Experience in a Multicenter Integrated Health Care System

Chou, David W. MD
Tejani, Nizar MD
Kleinberger, Andrew MD
Shih, Charles MD

¹Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
²Department of Head and Neck Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA

David W. Chou, MD, Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA. Email: [email protected]

Received November 13, 2019

Accepted April 16, 2020

Otolaryngology - Head & Neck Surgery 163(4):p 737-742, October 2020. | DOI: 10.1177/0194599820924635

Objective

There are few large studies on facial feminization surgery (FFS). We provide the largest comprehensive report to date of an FFS cohort regarding the safety of multilevel surgery, patient-specific considerations with FFS procedures, and complications of surgery.

Study Design

Retrospective cohort study.

Setting

Multicenter integrated health care system.

Subjects and Methods

We examined all patients undergoing FFS within our institution from April 2016 to October 2018. Patients over the age of 18 with a diagnosis of gender dysphoria underwent any combination of scalp advancement, cranioplasty, brow lift, rhinoplasty, upper lip lift, mandibuloplasty, chondrolaryngoplasty, and/or additional cosmetic procedures. Medical records were reviewed for preoperative characteristics, FFS procedures undergone, and postoperative complications.

Results

In total, 121 patients underwent a total of 594 FFS procedures. Seventy-five percent of patients had only 1 or no comorbidities, and 90% of patients underwent cranioplasty, scalp advancement, and brow lift. African American patients (n = 5) less commonly underwent cranioplasty compared to those of other ethnicities (white, P < .001; Asian, P = .022; Hispanic, P = .014; multiracial, P = .006). Asian patients less commonly underwent rhinoplasty than white patients (38% vs 73%, P = .023). Only 8 (6.6%) patients experienced a significant complication after surgery.

Conclusions

The population undergoing FFS is generally healthy, the upper third of the face is most commonly addressed, there are age and ethnic considerations in FFS, and major complications after multilevel surgery are uncommon.