P110. FACIAL FEMINIZATION IN THE UNITED STATES FROM 2015-2017

Abstract

PURPOSE: Facial feminization surgery (FFS) is an integral aspect of gender affirming surgery (GAS) for individuals seeking to align secondary sex characteristics with their expressed gender identity. Despite robust evidence for its role in helping treat gender dysphoria, trends, and prevalence of FFS remain unknown. We sought to examine trends in FFS and investigate the payer status of facial feminization procedures in the United States. METHODS: Data from the 2015-2017 National Inpatient Sample collected using ICD-10 diagnosis codes for gender identity disorder were analyzed for FFS procedure codes. RESULTS: 110 of 1,490 (9.1%) GAS patients had FFS. 66.7% were non-Hispanic White, 23.8% Black, and 4.8% Asian and Native American, respectively. 50% of FFS occurred in the West, followed by the Northeast (31.8%), South (13.6%), and Midwest (4.8%) (p = 0.015). 36.4% of cases were self-pay, 31.8% by Medicaid, and 27.3% by private insurance (p < 0.0001). 36.4% were in the bottom 25th percentile of income, 13.6% in the 25th-50th percentile, 18.2% in the 51st-75th percentile, and 22.7% in the top 25th percentile (p = 0.440). CONCLUSION: Roughly 18% of transgender women in our sample received FFS despite its high costs. Unlike GAS, FFS is often considered cosmetic and remains uncovered by most insurance providers. Self-pay remains the most common payer status and rates of FFS are highest in the West. With continued expansion of anti-discrimination policies under the Affordable Care Act, it is critical to monitor trends in FFS to ensure equitable access for transgender patients across the nation.