A Comparative Analysis of Full and Partial Gender-Affirming Facial Surgeries Surgical Complications and Trends: Insights from a NSQIP Study.

[BACKGROUND] Gender-affirming facial surgery (GAFS) can be performed as a full, single-staged procedure (F-GAFS) or in multiple, partial stages (P-GAFS). P-GAFS addresses either the upper, middle, or lower facial thirds, while F-GAFS includes procedures performed on multiple facial regions during a single anesthetic event. This study assesses the safety profile of GAFS, comparing surgical complications between F-GAFS and P-GAFS.

[METHODS] Data from the NSQIP databases spanning 2012-2022 were analyzed. Surgical complications included return to the operating room, hospital readmission, urinary tract infection, surgical site infection, and wound dehiscence. T-tests and chi-square tests were used to assess the relationship between complications and patient and surgical characteristics.

[RESULTS] A total of 552 patients underwent GAFS, with 193 (35.0%) undergoing P-GAFS and 359 (65.0%) undergoing F-GAFS. The prevalence of GAFS increased by 1725% over the ten-year study period. Nineteen patients (3.4%) had surgical complications. Fifteen patients had surgical site infections, three had bleeding requiring transfusion, and one had a pulmonary embolism. There were complications in 2.1% of P-GAFS patients (n = 4) and 4.2% of F-GAFS patients (n = 15). No statistically significant difference in complication rates was observed between F-GAFS and P-GAFS. Undergoing genioplasty was associated with increased complication risk (p = 0.02).

[CONCLUSIONS] Our findings underscore the increasing popularity of GAFS while also highlighting the safety of both F-GAFS and P-GAFS for transgender and gender-diverse patients. These results support informed decision-making to optimize aesthetic goals and mitigate complications. Insurers should guarantee coverage for both approaches, providing surgeons and patients the most flexibility in choosing a surgical strategy.

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