Middle and lower-facial feminization surgery in East Asian transgender and cisgender women: Surgical techniques and outcomes

Abstract

Purpose

Facial feminization surgery (FFS) is a group of surgical procedures for transgender or cisgender women with masculine facial characteristics. This study aimed to investigate the cosmetic outcomes of middle and lower FFS including reduction malarplasty and mandibular angle ostectomy in East Asian transgender and cisgender women.

Methods

A retrospective study was conducted using the clinical notes and records of transgender women (Group I) and cisgender women (Group II) who underwent FFS, incorporating reduction malarplasty and mandibular angle ostectomy at the West China Hospital of Stomatology, Sichuan University. Outcomes were assessed using computed tomography (CT) images, which were supplemented by medical records and photographs. Data were collected preoperatively and at intervals of at least 1 year postoperatively, focusing on mid- and lower-facial width, mandibular angle, and patient-reported complications. FACE-Q reports of facial appearance and psychosocial parameters were also compared between the 2 groups.

Results

Thirty-four transgender women and 39 cisgender women were enrolled in the study. Significant reductions in mid- and lower-facial width, and mandibular angle, were observed in all patients (P <.001). Transient nerve weaknesses were the primary complications noted. Group I exhibited a more pronounced improvement in FACE-Q scores pre- and postsurgery compared to Group II (P <.001).

Conclusion

FFS using reduction malarplasty and mandibular contouring procedures is an effective technique for feminizing the facial skeleton. Remarkably, transgender women experienced a more significant enhancement in facial appearance and psychosocial well-being following FFS when compared to cisgender women.