Quantifying Facial Feminization Surgery's Impact: Focus on Patient Facial Satisfaction
David P. Alper*, Mariana Almeida, Heloise M. de Baun, Vikram Mookerjee, John Persing, Michael Alperovich
Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
Facial feminization surgery (FFS) has been associated with improving gender dysphoria in transgender patients. This study aims to quantify the impact of surgery on patient facial satisfaction using the FACE-Q and a quality-of-life (QoL) survey.
Transfeminine patients were recruited to complete the FACE-Q and the World Health Organization's QoL Scale-Short Form (WHOQOL-BREF) if they were planning to or had undergone FFS at our institution. FACE-Q modules completed included "Satisfaction with Facial Appearance Overall," individual facial attributes (forehead/eyebrows, nose, cheeks, cheekbone, chin, jawline, and neck), and the WHOQOL-BREF, which assesses patient QoL through four domains (physical, psychological, social relations, and environment). Statistical analyses were performed comparing preoperative and postoperative cohorts, as well as subanalyses of patients that completed survey preoperatively and postoperatively.
Overall, 48 patients participated in our study and completed 31 FACE-Q surveys preoperatively and 37 postoperatively. FACE-Q scores increased significantly for all facial attributes and for "Satisfaction with Facial Appearance Overall" between cohorts (p<0.05). The facial attribute with the greatest increase in satisfaction was the jawline, followed by the nose. The WHOQOL-BREF's psychological and physical domains both improved significantly (p<0.05). Wait time for surgery of less than six months (β=22.42, p=0.02) and undergoing surgery at a younger age (β=1.04, p<0.01) were associated with higher overall facial satisfaction.
Transfeminine patients experienced significant improvements in facial satisfaction and QoL following FFS. Undergoing surgery at a younger age and shorter wait times for surgery were important factors in patients' overall facial satisfaction.
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