Follow-up Rate Post Gender-Affirming Facial Feminization Surgery

Introduction: Gender-affirming facial feminization surgeries (FFS) are becoming more common. The typical procedures performed during FFS include rhinoplasty, rhytidectomy, and malar augmentation. Due to actual or perceived barriers to care that affect transgender people, we examined the difference in postoperative follow-up rates between patients undergoing gender-affirming rhinoplasty surgery and those undergoing cosmetic rhinoplasty surgery.

Methods: A retrospective chart review of patients undergoing facial feminization rhinoplasty surgery or cosmetic rhinoplasty surgery between January 2018 and December 2022 was undertaken. For both groups, all postoperative visits were scheduled preoperatively at select time points up to one-year post-operation. The ratio of completed visits to scheduled visits was calculated. Standard statistical tests were performed to compare the groups.

Results: Sixty age-matched patients were included. The age range of the patients was 21 to 62 years of age. 30 patients had undergone surgery for cosmetic rhinoplasty, and 30 had undergone gender-affirming facial feminization rhinoplasty surgery. The follow-up rate for patients undergoing gender-affirming surgeries was 64% compared to 53% in patients with cosmetic rhinoplasties (p= .15). Since facial feminization is a relatively newer procedure at this clinic, many have not reached their one-year visit. When comparing the total number of visits in the first three months following the surgery, patients who received cosmetic rhinoplasties had an average of 2.9 visits compared to 2.4 in the facial feminization rhinoplasty cohort (p= .07). Although there was a decrease in the follow-up rate post the Covid-19 pandemic in the facial feminization group, it was not statistically significant.

Conclusions: Despite acknowledged barriers to care, postoperative transgender women’s follow-up rate is comparable to cis-gendered patients undergoing cosmetic facial procedures. Future large multicentric studies are needed to evaluate the follow-up rates for other gender-affirming surgeries to address any disparities that may be uncovered.