Purpose: Facial feminization surgery (FFS) is a gender-affirming reconstructive paradigm of the face aimed at establishing a “feminine” appearance. Despite notable quality of life (QOL) improvements secondary to FFS, there is yet to be a standardized framework for evaluating patient-reported outcome measures (PROMs). This study aimed to examine different PROMs reported in the literature and advocate for optimizing QOL metrics for post-FFS patients.
Methods: An electronic database search of Ovid MEDLINE, PubMed, Scopus, and Cochrane was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies about FFS and QOL. Inclusion criteria were original studies published in English through January 2025 that contained QOL survey data. We considered QOL to be assessed by postoperative satisfaction, revisions, regrets, and subjective surveys.
Results: A total of 31 studies met inclusion criteria and were selected from the 3,971 studies identified from our literature search. A total of 3,731 patients underwent FFS procedures. Eight studies exclusively used nonvalidated satisfaction rating questionnaires, 4 exclusively used nonvalidated QOL surveys, 15 studies exclusively used validated surveys, and 3 used both a nonvalidated QOL survey and validated surveys. One study used an open-text interview approach to collect data.
Conclusion: Overall, there remain inconsistencies in PROMs across studies assessing QOL in patients who have undergone FFS. Questionnaires such as GENDER-Q are promising tools for addressing limitations. Standardizing QOL metrics is crucial for enabling meaningful peer benchmarking and will be a necessary step toward improved outcomes and the inclusion of FFS as a reconstructive surgery under insurance.
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