Gender-affirming facial surgery in racially, ethnically, and socioeconomically diverse individuals: Variations and consistencies in procedures and outcomes in a large cohort.

[BACKGROUND] Gender-affirming facial surgery (GAFS) is an integral part of the gender-affirming care continuum, but access to surgery is limited, and only 7% of transgender women have undergone GAFS. The intersection of race/ethnicity and insurance coverage significantly impacts access to GAFS. Many insurance plans exclude GAFS, and a vast majority of GAFS operations in the United States have been performed on White patients. Accordingly, there are limited data on GAFS in diverse individuals.

[METHODS] A retrospective chart review identified transgender women who underwent GAFS at the University of California, San Francisco (UCSF) between 2019 and 2023. Data were collected via retrospective chart review, and statistical analyses were performed using R.

[RESULTS] 168 transgender women had GAFS during the study period. The cohort was racially/ethnically diverse, with 39.9% Hispanic, 30.4% White, 6.5% Asian, 6% Black, and 17.3% Other/Multiple/Unknown. Insurance type was also diverse, with 71.9% MediCal, 12% Medicare, 11.4% Private, and 4.8% Other/Unknown. The rate of medical complications was 11.3% and the rate of revisions was 22.6%, with no differences observed across different racial/ethnic groups. However, Black and Hispanic patients were more likely to undergo rhinoplasty and soft tissue procedures than other groups. Neither the total number of procedures nor the number of stages was found to be a significant predictor of medical complications or future revision operations.

[CONCLUSIONS] This study demonstrated that GAFS is safe and effective in racially, ethnically and socioeconomically diverse individuals, and that racial and ethnic background influences the specific GAFS procedures performed.