FACE-Q satisfaction following upper third facial gender-affirming surgery using custom bone-section guides

Abstract

Postoperative satisfaction after facial gender-affirming surgery (FGAS) has not yet been assessed using a validated questionnaire. There is currently no postoperative satisfaction questionnaire specific to transgender patients concerning facial surgery. The contributions of three-dimensional planning in fronto-orbital surgery in trans women and the use of bone cutting guides for facial feminization surgery have been demonstrated. The primary objective of this study was to evaluate postoperative satisfaction with the upper third of the face in trans women using a validated questionnaire – FACE-Q – after fronto-orbital surgery using custom-made bone cutting guides. The secondary objective was to determine predictive factors of satisfaction. Forty-two patients who underwent frontoplasty with frontal sinus impaction osteotomies using custom bone cutting guides between May 2018 and September 2020 were included. Three-dimensional preoperative computed tomography planning was performed for each patient. Evaluations were performed preoperatively and at 1 year postoperative using FACE-Q items relating to the upper third of the face (fronto-orbital area) and general questionnaire items. At 1 year, the following FACE-Q scales had improved significantly in comparison to the preoperative evaluation: overall facial appearance (33.6 ± 19.4 vs 70.1 ± 21.1; P < 0.001), forehead and eyebrow appearance (38.3 ± 19.7 vs 80.1 ± 15.9; P < 0.001), wrinkles between the eyebrows (54.1 ± 26.7 vs 82.6 ± 19.9; P = 0.001), appearance-related psychological distress (58.1 ± 18.1 vs 24.6 ± 24.5; P < 0.001). No factors predictive of postoperative satisfaction were found for the included frontal FGAS. In the absence of a validated questionnaire specific to facial feminization surgery in transgender patients, the FACE-Q questionnaire showed an improvement in patient satisfaction after FGAS of the upper third using custom-made cutting guides.