Multiprocedural Facial Feminization Surgery: A Review of Complications in a Cohort of 31 Patients

Objective: Facial feminization surgery (FFS) is instrumental in gender affirmation for transgender patients. Multiprocedural FFS, the combination of multiple facial feminization procedures across multiple depths and planes during one surgery, crosses sterile and nonsterile planes in the oropharynx, nose, and frontal sinus. A closer look at the prevention and management of resulting complications of such reconstruction is necessary. Methods: We performed a retrospective review of patient demographics, operative variables, and postoperative complications on 31 FFS patients. Patients who underwent FFS between January 2020 and June 2021 were eligible for inclusion. Associations between prevention methods, procedure type, and complications were assessed by the Fisher exact test. The main effect of patient age and number of procedures on complication rate was assessed via the nonparametric Kruskal-Wallis test. Results: A total of 31 patients, with a mean age of 37 years (range: 19-65 y, SD: 13.3 y), underwent 257 procedures. Patients underwent a mean of 8 procedures (SD: 2.2) lasting 3.5 to 6 hours (mean: 5.0 h, SD: 0.9 h). Overall, 68% of patients experienced no complications. Six patients experienced a postoperative infection; 4 of these patients required return for a washout. Preventative measures implemented include: preoperative dental check, intraoperative antibiotic irrigation, locking sutures, and postoperative antibiotics. After measures were implemented, there were no further procedure-related infections recorded. Conclusions: Patients do not suffer from major complications after multiprocedural FFS. Factors such as age, irrigation method, and dental history may be important variables affecting FFS outcomes.