PURPOSE: This study investigates facial satisfaction, gender dysphoria and their associated correlation in transgender patients before and after receiving feminizing gender-affirming surgery (FFS).
METHODS: Our institution participates in an international initiative to field-test the GENDER-Q survey, a novel instrument designed to measure the outcomes of gender-affirming care. In conjunction with the GENDER-Q, we utilized the Gender Preoccupation and Stability Questionnaire (GPSQ) to evaluate gender dysphoria. We collected data from patients both preoperatively and at a minimum of 6 months post-operatively. We compared the overall GPSQ score and GENDER-Q item responses using both unpaired and paired t-tests. Furthermore, Spearman’s correlation coefficients to assess the relationship between individual GENDER-Q items and GPSQ scores were calculated.
RESULTS: Survey data from 35 transgender patients are included, with 8 patients providing data both pre- and postoperatively, resulting in 29 preoperative and 14 postoperative surveys. The mean follow-up time was 6.5 months (SD=1.5) All patients received FFS procedures in their upper, middle and lower face. The average age of patients was 33.0 years (SD= 8.2).
Unpaired analysis of the Gender Q for overall satisfaction showed significantly higher values post-operatively than pre-operatively for all parts of the face. The highest pre and post-operative difference in mean Likert scores (out of a maximum of 6) was observed for upper face by 2.6 points (p<0.001) and the lowest for cheeks by 1.12 (p=0.02).
This trend held for paired analysis with significant differences between pre and post-operative satisfaction scores; with largest and smallest pre and post-operative mean of differences belonging to upper face (2.8, p<0.001) and cheeks (0.11, p=0.85), respectively.
GPSQ scores (out of a maximum of 56) were significantly lower, indicating improved gender dysphoria, with both paired and unpaired comparisons showing a decrease of 7.12 points (p<0.05). The negative correlation between gender dysphoria interference with mental health and postoperative satisfaction was strongest for the upper face (r=-0.63, p=0.02) and eyebrows (r=-0.66, p=0.01). While age did not significantly correlate with pre- and post-operative facial satisfaction scores individually, it was positively correlated with an increase in eyebrow (r=0.77, p=0.03) and nose (r=0.84, p=0.01) scores after FFS.
CONCLUSION: The findings of this study underscore a significant enhancement in facial satisfaction and a concomitant reduction in gender dysphoria among transgender patients, post-facial feminization surgery. Notably, satisfaction with the upper face and eyebrows was closely linked to improvements in gender dysphoria, aligning with existing literature that emphasizes the importance of these features in perceptions of femininity. These results endorse the implementation of a comprehensive outcomes evaluation framework for facial feminization procedures and underscore the aesthetic and psychological benefits conferred by these surgeries to the transgender community.