Facial Gender Dysphoria

Plastic surgeons, and in particular facial plastic surgeons, have a unique opportunity to help transgender patients attain more harmony with their outward appearance. A recent study published just this month by Nuyen et al. published in Facial Plastic Surgery and Aesthetic Medicine found that facial feminization surgery has a positive impact on health utility and mental health states of transfeminine individuals. In order to understand the results of this study, it is important to understand the transition process, the possible impacts on one’s mental and physical health, and the implications of gender confirmation surgery.

The starting point in the process of transitioning from male to female is awareness of the internal conflict of gender identity. This awareness can then transition to identification with the female gender and may be associated with emotional distress. Individuals may undergo hormone therapy to better allow social adjustment to the identified gender. At some point during this period, there is usually a coming out to family and friends, and eventually, there is the legal process of changing one’s gender designation. The role of surgery can come at different points along this spectrum, and depending on the state of residence, may actually be required before the legal sex change can occur.

Unfortunately, transgender and other gender minority people are often the targets of discrimination, social marginalization, and both physical and verbal abuse. This can contribute to the development of a variety of mental health issues. One study demonstrated that transgender individuals seeking gender-affirming care were six times more likely to have a mood or anxiety disorder than the general public, three times more likely to be prescribed antidepressants or anti-anxiety medications, and more than six times as likely to attempt suicide. In the recently published study, Nuyen et al. found that the individuals with gender dysphoria would sacrifice up to 10 years of their remaining life to cure the condition. These alarming statistics highlight the dramatic impact that gender dysphoria can have on one’s mental health.

Facial Feminization Surgery Is Linked to Improved Mental Health

Facial feminization surgery is a set of surgical procedures that alter the male facial features to provide a more feminine appearance to better align with the self-identified gender. Procedures can include common facial plastic procedures like brow lift, rhinoplasty, cheek implantation, and lip augmentation. However, other procedures, including scalp advancement, frontal cranioplasty, and reduction mandibuloplasty, are more unique to facial feminization surgery. One study found that transgender women who had facial feminization surgery reported significantly higher ratings of mental health-related quality of life when compared to transgender females prior to surgery. Another study found that the likelihood a trans female would receive mental health treatment for depression and anxiety disorders was reduced by 8 percent for each year after undergoing facial feminization.

Transfeminine gender dysphoria can arise from a conflict between facial appearance and gender identity. While facial feminization surgery is not necessary or recommended for all transgender women, it can be an important part of the transition process for many. For those considering surgery, it is important to choose a surgeon who is experienced in gender confirmation procedures, aware of the psychosocial complexities of gender dysphoria, and with whom they feel fully comfortable expressing their appearance goals.