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Facial Plastic and Reconstructive Surgery

Long-term Outcomes From Gender-Affirming Surgery of the Upper Facial Third

Monday, October 2, 2023
9:21 AM - 9:27 AM East Coast USA Time
Location: 205ABC

    Presenting Author(s)

  • Habib Khoury, MD

    Resident Physician
    University of North Carolina - Chapel Hill, Department of Otolaryngology/Head and Neck Surgery
    Durham, NC, United States

    • Co-Author(s)

  • Sarah M. Russel, MD, MPH

    Resident Physician, Postdoctoral Research Fellow
    University of North Carolina - Chapel Hill, Department of Otolaryngology/Head and Neck Surgery
    Chapel Hill, North Carolina, United States

    • Senior Author(s)

  • Adam J. Kimple, MD/PhD

    Associate Professor
    UNC School of Medicine
    Chapel Hill, North Carolina, United States

Disclosure(s):
Sarah M. Russel, MD, MPH: No relevant relationships to disclose.
Adam J. Kimple, MD/PhD: No relevant relationships to disclose.
Introduction: Facial Gender Confirmation Surgery (FGCS) offers a definitive option for transgender and gender-nonconforming patients (TGNC) to assume a facial structure that is compatible with their gender identity. The long-term outcomes and complications associated with FGCS on the upper facial third have not been fully characterized.

Methods: A systematic review between January 2008 and October 2018 was conducted. Search terms were generated in two categories - FGCS procedures performed on the upper facial third, and transgender and gender-nonconforming terms. Studies were included if they described FGCS operations on the upper facial third and if they discussed postoperative outcomes beyond only aesthetics. Papers were excluded if they were books, reviews, did not contain outcome data, or described aesthetic procedures performed for purposes other than gender affirmation. Data extraction focused on length of follow-up and postoperative complications.

Results: Eighty-three studies were identified from four databases. After duplicates were removed, 37 papers underwent title and abstract screening, 15 underwent full-text review, and 6 were included in the final analysis. A total of 448 patients with an average age of 38.7 years underwent upper facial third FGCS between January 2008 and October 2018. Surgeries involved forehead contouring, scalp advancement, orbital contouring, brow lift, and/or hair transplantation. There were no intraoperative complications or mortality following surgery. The most common postoperative complaint was hypoesthesia. Ten (2.3%) major postoperative complications were identified, which included surgical site infections, pulmonary embolism, cerebrospinal fluid fistula, conjunctivitis, keratitis, and corneal injury. All postoperative complications resolved following intervention. Length of follow up ranged from 1 to 65 months, averaging 16.2 months. Patients were overwhelmingly satisfied with the results of surgery.

Conclusions: FGCS on the upper facial third has proven to be safe and satisfactory for transgender and gender-nonconforming patients.