From the Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine; the FACIALTEAM Surgical Group, HC Marbella International Hospital; the Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine at Northwestern University; New York University School of Medicine; the Division of Plastic Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Section of Plastic Surgery, University of Michigan School of Medicine; and Brownstein and Crane Surgical Services.
Plast Reconstr Surg. 2020 Jun;145(6):1499-1509. doi: 10.1097/PRS.0000000000006837.
No data exist on the prospective outcomes of facial feminization surgery. This study set out to determine the effects of facial feminization surgery on quality-of-life outcomes for gender-diverse patients.
A prospective, international, multicenter, cohort study with adult gender-diverse patients with gender dysphoria was undertaken. Facial feminization outcome score was calculated preoperatively and postoperatively (1-week to 1-month and >6 months). Photogrammetric cephalometries were measured at the same time points. Self-perceived preoperative masculinity and femininity were recorded. Externally rated gender appearance (scale of 1 to 5, with 1 being most feminine) and general aesthetics (scale of 1 to 10, with 10 being very good) for 10 facial feminization surgery patients were compared with those of five cisgender controls. Univariate linear regression analyses were used to predict outcomes from facial feminization surgery.
Sixty-six consecutive patients were enrolled. Patients noted that their brows, jaws, and chins were the most masculine aspects of their faces (54.5 percent, 33.3 percent, and 30.3 percent, respectively). Median facial feminization outcome score increased from 47.2 preoperatively to 80.6 at 6 months or more postoperatively (p < 0.0001). Mean satisfaction was excellent (3.0 at both 1-month and ≥6-month follow-up; p = 0.46). Cephalometric values were significantly more feminine after surgery. Gender appearance was feminine to very feminine (1.83 ± 0.96) and general aesthetics were good (6.09 ± 2.01) but different from those of cisgender women controls (1.25 ± 0.49 and 7.63 ± 1.82, respectively; p < 0.001 for each).
Facial feminization achieved improved quality of life, feminized cephalometries, feminine gender appearance, good overall aesthetics, and high satisfaction that were present at 1 month and stable at more than 6 months.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
目前尚无关于面部女性化手术预期结果的相关数据。本研究旨在确定面部女性化手术对性别认同障碍患者生活质量的影响。
对患有性别焦虑的成年跨性别患者进行了一项前瞻性、国际性、多中心队列研究。在术前和术后（1 周到 1 个月和 >6 个月）计算面部女性化手术的结果评分。同时测量摄影头颅测量值。记录术前自我感知的男性化和女性化程度。10 名接受面部女性化手术的患者的外部性别外观（1 到 5 分，1 分为最女性化）和一般美学（1 到 10 分，10 分为非常好）评分与 5 名顺性别对照者进行了比较。使用单变量线性回归分析预测面部女性化手术的结果。
共纳入 66 例连续患者。患者认为他们的眉毛、下巴和下巴是他们面部最男性化的部位（分别为 54.5%、33.3%和 30.3%）。面部女性化手术结果评分从术前的 47.2 分中位数增加到术后 6 个月或以上的 80.6 分（p<0.0001）。平均满意度为优秀（1 个月和≥6 个月随访时均为 3.0；p=0.46）。手术后的头影测量值明显更女性化。性别外观为女性化到非常女性化（1.83±0.96），整体美学为良好（6.09±2.01），但与顺性别女性对照组不同（分别为 1.25±0.49 和 7.63±1.82；p<0.001）。
面部女性化手术改善了生活质量，使头影测量值更具女性化，性别外观更具女性化，整体美学良好，满意度高，这些结果在 1 个月时就已显现，并在 6 个月以上时保持稳定。
临床问题/证据水平：治疗性，IV。
