After facial feminization surgery, transgender people report better psychosocial health

A UCLA study offers the first evidence that transgender patients who have received gender-affirming facial feminization surgery report better mental health after their procedures.

The study was published in the journal Annals of Surgery.

According to Dr. Justin Lee, UCLA’s Bernard G. Sarnat Professor of Craniofacial Biology, facial gender-affirming surgery is often classified by insurers as a cosmetic procedure, in part because of a lack of evidence that the procedure improves a person’s quality of life. the patients.

“Access to gender confirmation surgery under health insurance coverage in the US is more limited than gender confirmation surgery for other anatomical regions due to a lack of data on mental health quality of life outcomes,” said Lee, who was lead author of the study and is an associate professor of surgery at the David Geffen School of Medicine at UCLA. “Our findings have the potential to change health insurance policies for the better for transgender patients.”

The researchers compared the mental health scores of 107 patients awaiting surgery with those of 62 people who had already completed it, an average of just over 6 1/2 months after their procedures.

They found that people who had the surgery reported higher scores on seven of 11 measures of psychosocial health — anxiety, anger, depression, general mental health, positive affect, social isolation, and meaning and purpose — than those who they haven’t had surgery yet.

The study suggests that gender confirmation surgery is one of the most important treatments for patients with gender dysphoria, the psychological distress that results from a mismatch between the sex assigned at birth and gender identity. Among transgender patients assigned male at birth, facial features are reported to be one of the greatest sources of dysphoria.

Lee said the majority of patients seeking gender-affirming facial reconstruction were assigned male at birth and identify as female or non-binary.

Facial feminization surgery involves procedures typically used to correct the anatomical differences between a person’s assigned gender at birth and their current gender identity, to reconstruct the anatomical parts of the face that cause dysphoria in the patient.

Common procedures include feminization of the brow area, reduction of the jaw area, cheek augmentation and reshaping of the nose.

The new study found that — even after adjusting for the effects of factors such as the duration of gender-affirming hormone therapy, whether the patient had undergone previous gender-affirming surgery, existing mental health diagnoses and the quality of the patients’ social relationships — facial surgery alone is an independent predictor of higher psychosocial outcomes.

“Going forward, providers may want to consider including psychosocial assessments over a period of time as a standard of care in the treatment of gender dysphoria,” Lee said.

Financial support for the research was provided by the Bernard G. Sarnat Foundation for Craniofacial Biology and the Jean Perkins Foundation. Lee is a medical education consultant for Stryker, maker of the medical equipment used in the surgeries described in the study.

Other study authors include Rachel Caprini, Ph.D. Michelle Oberoi, Dylan Dejam, Candice Chan, Potemra Hilary; Amy Weimer, Ph.D. Mark Litwin and Dr. Abby Mendelsohn, all UCLA; and Dr. Catherine Morgan of UC San Francisco.

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