Trends in Revision Facial Feminization Surgery

Facial feminization surgery (FFS) can be an important part of an individual's transition; however, outcomes have not been well explored in the literature. This study aims to elucidate trends in FFS with a focus on drivers of secondary FFS to further improve care for TGNB patients. A manual chart review was conducted on patients from a single institution from 2012 to 2023 with a diagnosis of transsexualism (F64) who had undergone one or more surgeries associated with any 1 or more of 95 CPT codes related to gender-affirming surgery. Patients who underwent >1 FFS procedure were separated into staged, unplanned, and revision FFS. Three hundred twenty-seven patients were included in the analysis, with 111 of these patients undergoing FFS. Those who underwent FFS were significantly older ( P <0.001), had a lower BMI ( P <0.001), and began socially transitioning and hormone therapy at an older age ( P <0.001 and P =0.001) than those who did not undergo FFS. 44.1% of patients who underwent FFS also underwent secondary FFS, with 26.1% of FFS patients undergoing unplanned secondary FFS. Patient factors, including BMI, age at first FFS, smoking status, race, ethnicity, and order of FFS in relation to other gender-affirming surgeries, were not significantly associated with differences in rates of unplanned secondary FFS. These findings highlight the importance of tailoring the surgical approach to a patient's transition to their unique situation, as well as the need for future studies to identify factors influencing the need for revision FFS and to enhance surgical outcomes for patients undergoing gender-affirming procedures.