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Review
. 2025 Aug 21:12:1587708.
doi: 10.3389/fsurg.2025.1587708. eCollection 2025.

Impact of sex hormones on postoperative outcomes in plastic surgery: a narrative review

Xiong Lv  1 , Chun Xiang  1 , Yan Zheng  1 , Xuling Lv  1 , Wanxuan Zhou  1 , Jiajun Zhu  1
Affiliations
Review

Impact of sex hormones on postoperative outcomes in plastic surgery: a narrative review

Xiong Lv et al. Front Surg. .

Abstract

Background: Since 1929, when scientists first identified estrogen in urine and coined the term "sex hormones," these vital steroid hormones have been recognized for their critical role in tissue repair and wound healing. This is particularly evident in the postoperative recovery of plastic surgery patients. While the effects of sex hormones differ between males and females, their mechanisms in wound healing, angiogenesis, and collagen regulation have drawn significant attention.

Methods: This narrative review synthesizes key literature from four databases including PubMed (up to 2024) focusing on the effects of sex hormones on healing after plastic surgery.Key terms such as "sex hormones," "tissue repair," and "postoperative recovery" were used. The analysis highlights the differential roles of estrogen and testosterone in skin healing, angiogenesis, and inflammatory responses. Additionally, it explores the effects of sex, age, and hormone replacement therapy (HRT) in transgender patients on surgical outcomes.The main target audience of this article is professional surgeons and endocrinologists, medical students and scientific researchers.

Results: Existing evidence suggests that estrogen enhances wound healing by upregulating vascular endothelial growth factor (VEGF), stimulating angiogenesis, and playing a pivotal role in collagen regulation. Testosterone may influence fibroblast proliferation and angiogenesis, although its effects vary by sex and age. Postmenopausal women exhibit diminished healing capacity due to decreased estrogen levels, whereas transgender patients undergoing HRT show improved postoperative recovery.

Conclusion: Sex hormones significantly influence postoperative recovery in plastic surgery. The distinct mechanisms of estrogen and testosterone in wound healing provide valuable insights for personalized medical approaches, optimizing surgical outcomes across diverse patient populations.

Keywords: estrogen; plastic surgery; skin healing; testosterone; transgender patients.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Mechanistic pathways of sex hormones in skin healing. Dashed lines indicate effects, while arrows with “+” and “−” symbols represent enhancement and weakening. Estrogen and testosterone promote healing through distinct mechanisms, though capacity declines with age. ECM, extracellular matrix; VEGF, vascular endothelial growth factor; ERE, estrogen response element.
See this image and copyright information in PMC

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