A. Hall1, C.T. Cascavita2, N.H. Nguyen2, J.C. Chevalier2, K.X. Huang3, J.C. Lee2,4 1University of California, David Geffen School of Medicine, Division Of Plastic And Reconstructive Surgery, Los Angeles, CA, USA 2University Of California – Los Angeles, Division Of Plastic And Reconstructive Surgery, Los Angeles, CA, USA 3Stanford University, Palo Alto, CA, USA 4University Of California – Los Angeles, UCLA Gender Health Program, Los Angeles, CA, USA
Introduction:
There has been an increase in access to gender-affirming surgeries, allowing transgender and non-binary (TGNB) patients to seek gender-affirming care, such as facial feminization surgery (FFS). FFS techniques have been driven by an understanding of sexually dimorphic facial characteristics. Yet, there remains limited literature surrounding surgical preferences and outcomes of gender-diverse individuals within the TGNB community. This study examines surgical preferences and outcomes in binary versus non-binary populations.
Methods:
This study included patients assigned male at birth who underwent FFS at the University of California, Los Angeles, between 2018 and 2024. Patient charts were retrospectively reviewed for patient characteristics. Additionally, the Patient-Reported Outcomes Measurement Information System (PROMIS) instrument assessing global health was prospectively collected before FFS. Descriptive statistics were performed, and chi-square tests were used to compare categorical variables between cohorts. Logistic regression models evaluated the association between gender identity and revision surgeries. Models were adjusted for age, years of hormone therapy, preoperative global health PROMIS scores, mental health diagnosis, and history of prior gender-affirming surgery.
Results:
A total of 183 patients were included in the study population, of whom 164 (89.6%) identified as binary while 19 (10.4%) identified as non-binary. The median age of non-binary patients was 27.0 years (interquartile range: 20-34), while the median age for binary patients was 30 years (interquartile range: 18-42), p=0.02. Most patients underwent forehead contouring (88.5%), browlift (86.9%), rhinoplasty (81.4), and genioplasty (79.8%). There was no significant difference in completed FFS procedures between binary and non-binary individuals. Eight (42.1%) non-binary patients underwent revision surgery, with a majority being rhinoplasties (21.2%). In comparison, 19 (11.6%) of binary patients underwent revision surgery, with revisions being primarily rhinoplasties (5.5%) or fat grafting (4.3%). There was a significant difference in revision surgeries between the binary (11.6%) and non-binary (42.1%) groups (p=0.002). Adjusted logistic regression models showed that non-binary patients were 4.5 times more likely to undergo revision surgery than binary patients (odds ratio:4.53, 95% confidence interval: 1.3-16.1, p=0.02).
Conclusion:
We found a positive association between non-binary gender identity and the likelihood of undergoing revision surgery. Gender identity can be fluid, and non-binary individuals may experience changes in how they perceive their identity over time. As their understanding of their own identity evolves, they may seek revisions to better align with their current sense of self.