Evaluating Consistency in Reporting of Gender Dysphoria Before and After Facial Feminization Surgery: A Systematic Review

Abstract

Background: Facial Feminization Surgery (FFS) plays a significant role in gender-affirming care for transgender women. However, gender dysphoria (GD) levels after FFS are poorly quantified. In this systematic review, we evaluated the impact of FFS on GD. Methods: Search terms including “facial feminization surgery,” “FFS,” “Gender dysphoria,” and related key words were used to identify articles in PubMed and Scopus. Two independent evaluators reviewed studies, with conflicts resolved by a third evaluator. Included studies discussed adult transgender female patients or patients with GD undergoing FFS on their cranium, examining outcomes such as GD, patient satisfaction, or quality of life (QOL). Exclusion criteria included studies on pediatric patients, cadavers, or soft tissue-only FFS. Data discussing FFS procedures performed, subjective and objective analyses of postoperative outcomes, and parameters examining GD, patient satisfaction, and QOL were extracted and analyzed using descriptive statistics. Results: Of 660 studies identified, 18 met inclusion criteria. A total of 1301 patients underwent FFS, with the most performed FFS procedures being facial bone contouring (15 cases) and rhinoplasty (14 cases). Seventeen studies used postoperative surveys to evaluate FFS outcomes. Subjective parameters evaluated included direct assessment of GD (2 studies), indirect assessment of GD (9 studies), psychosocial well-being (11 studies), QOL (11 studies), and patient satisfaction (13 studies). Objective measures assessed included physical examinations (6 studies), independent raters (4 studies), patient photographs (9 studies), cephalometric measurements (5 studies), and medical imaging (5 studies). Sixteen articles reported patients were satisfied with FFS, while improved psychosocial well-being and QOL were both noted in 10 studies. Improvement of GD due to FFS was noted in 3 studies. Conclusion: Postoperative GD is not frequently evaluated in patients undergoing FFS. As gender-affirming surgery is central to treating GD, it is essential to develop validated and standardized measures to assess the efficacy of FFS.