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Comparative Outcomes of Malar Implants Vs Fat Transfer to Cheeks among Transgender Women Undergoing Malar Augmentation
Bachar F. Chaya, Ricardo Rodriguez Colon, Gustave K. Diep, Hilliard Brydges, Jorge Trilles, Daniel Boczar, Ogechukwu C. Onuh, Eduardo D. Rodriguez
Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY

Background: Malar augmentation is a key procedure sought out by transgender women seeking to feminize their facial appearance. Different surgical techniques have been described in the literature including fat transfer to the cheeks and malar implant placement. Due to the paucity of information in the literature, there is no consensus on best practices for this procedure and the decision on which technical approach to perform remains largely surgeon- and patient-dependent. The objective of our study is to determine the effectiveness and safety of malar implants as compared to fat transfer to the cheeks in transgender women.
Methods: We examined all patients with the diagnosis of gender dysphoria that were referred to the senior author seeking consultation for feminizing facial procedures between June 2017 and October 2021. Patients who underwent fat transfer to the cheeks or malar implant placement were included in our study. Patients who underwent both procedures at the same time were excluded from our study. We reviewed the electronic medical record of each patient and we retrieved and analyzed data regarding demographics, past medical and surgical history, operative dictations, clinic notes and postoperative follow up. Univariate analysis was used to assess for differences in postoperative complications between these two groups.
Results: We identified 161 patients who underwent feminizing facial procedures. Of which 105 patients met our inclusion criteria. Seventy-nine patients underwent malar implant placement and 26 underwent fat transfer to the cheeks. Mean age was 34.1 years +/- 9.9 and 39.7 +/- 12.4 respectively (P=0.045). Mean BMI was 26.3 +/- 6.0 and 26.2 +/- 4.8 respectively (P=0.98). Patient satisfaction was reported higher in the malar implant group. The complication rate between the 2 groups was 3 (3.8%) vs 0 (0%), P-value=0.573 respectively. In the malar implant group, 2 patients had implant infection necessitating washout and removal and 1 patient had asymmetrical implants necessitating revision. In the fat transfer group 5 patients came back for cheek implant placement due to dissatisfaction with the fat transfer result.
Conclusion: Our findings support the contention that malar implants are a safe alternative for malar augmentation among transgender women. While autologous fat transfer to the cheek is an indispensable option in patients requiring minor malar enhancement, malar implants offer a more permanent option with a better aesthetic outcome in patients requiring major malar enhancement. In order to minimize post-operative complications, surgeons should emphasize patient compliance with postoperative directions.


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