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Meta-Analysis
. 2025 Mar-Apr;36(2):600-604.
doi: 10.1097/SCS.0000000000010840. Epub 2024 Nov 4.

The Effects of Perioperative Gender-affirming Hormone Therapy on Facial Feminization Surgery Adverse Events, Facial Features Addressed, and Esthetic Satisfaction: A Multimodal Analysis

Matteo Laspro  1 , Alexandra Hoffman  2 , Sachin Chinta  1 , Jasmina Abdalla  3 , David Tran  1 , Cheongeun Oh  4 , Isabel Robinson  1 , Eduardo D Rodriguez  1
Affiliations
Meta-Analysis

The Effects of Perioperative Gender-affirming Hormone Therapy on Facial Feminization Surgery Adverse Events, Facial Features Addressed, and Esthetic Satisfaction: A Multimodal Analysis

Matteo Laspro et al. J Craniofac Surg. 2025 Mar-Apr.

Abstract

Objective: Facial feminization surgery (FFS) treats gender dysphoria in transfeminine patients by addressing the facial bony and soft tissue components. Individuals seeking FFS may be taking gender-affirming hormone replacement therapy [gender-affirming hormone therapy (GAHT)]. This study aims to better characterize the GAHT's impact on venous thromboembolism (VTE) risk, surgical planning, and outcomes.

Methods: A systematic review and meta-analysis of the literature were carried out to assess the effect of perioperative GAHT continuation on VTE. Cochrane Q and I2 statistics measured study heterogeneity with the following meta-regression exploring these results. Simultaneously, a retrospective review of the senior author's FFS cohort was conducted to investigate GAHT duration's impact on FFS revision rate, complication incidence, and facial structures operated on.

Results: Eleven articles were included: 602 patients stopped GAHT, of whom 3 VTEs were recorded (0.49%). This is compared with one episode among the 925 who continued GAHT perioperatively (0.11%). Study heterogeneity was low (0%), but limited VTE sample size precluded meta-analytic conclusions. Gender-affirming hormone therapy duration does not impact the incidence of all-cause complications ( P = 0.478), wound infection ( P = 0.283), hematoma ( P = 0.283), or VTE ( P = 1). The only procedures significantly less associated with higher GAHT were tracheal shaving ( P = 0.002) and mandibuloplasty ( P = 0.003). Finally, the FFS revision rate was not associated with GAHT duration ( P = 0.06).

Conclusion: There is a paucity of data to assess the safety or harm of continuing GAHT in the FFS perioperative period. Thus, a shared provider-patient decision-making process examining the risks and benefits of GAHT perioperative continuation is warranted. As patients seeking gender-affirming care are diverse, a "one-protocol-fits-all" is not appropriate.

Keywords: Estrogen; facial feminization surgery; gender-affirming hormone therapy; preoperative management; thromboembolism.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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