UCSF Facial Plastic Surgeons Perform and Research Outcomes to Optimize Facial Feminization Surgery (FFS)

When it comes to gender affirmation for transgender and nonbinary individuals, a facial plastic surgeon can make a world of difference. P. Daniel Knott, MDRahul Seth, MD and Andrea Park, MD, faculty in the UC San Francisco Department of Otolaryngology – Head and Neck Surgery (UCSF OHNS) use their expertise as facial plastic surgeons to accomplish something of fundamental importance for patients with gender dysphoria: Drs. Knott, Seth and Park perform facial feminization surgery (FFS) and facial masculinization surgery (FMS) to help patients experience the world and themselves as the gender with which they associate. Specifically, FFS transforms patients' facial features from male to female, while FMS alters facial features from female to male.

"Many of the techniques we commonly employ in cosmetic, craniofacial, and reconstructive facial surgery – whether it is to make a nose look better or to make a patient look younger or repair a complex facial fracture – can be applied to make the face appear more feminine or more masculine," says Dr. Seth, a member of the UCSF OHNS Division of Facial Plastic and Reconstructive Surgery. "We are able to alter the appearance of the face to reflect externally what a patient feels internally."

Surgeons with expertise and board certification in both Otolaryngology- Head and Neck Surgery and Facial Plastic and Reconstructive Surgery are ideally suited to perform gender-affirming facial surgery, according to Dr. Knott. "Our training marries the functional and cosmetic of the entire face, including the bones and soft tissues. So, for example, in shaping the nose, we balance nasal breathing and dynamics with appearance."

The procedures that Drs. Knott, Seth and Park use at UCSF to increase perceived femininity with FFS include hairline advancement, brow lifting and contouring/setback cranioplasty, jaw reduction, rhinoplasty, face lift, neck lift, placement of implants, facial fat injection, lip lift and augmentation, and facial liposuction. Learn more about Facial Feminization Surgery (FFS) at UCSF.

Overall, gender-affirming facial surgery (GFS) is becoming more widely available for transgender and nonbinary individuals, but data and outcomes on surgical approaches continues to require further research to optimize results. Drs. Knott and Seth, along with colleagues in the Division of Facial Plastic and Reconstructive Surgery, recently co-authored a co-led a retrospective analysis of surgical outcomes among their consecutive GFS cases performed between March 2016 and August 2020. They analyzed nearly 500 gender-affirming procedures they performed. Their analysis found that there is a logical sequence and collection of surgical procedures essential for GFS, which can be safely performed with low complication and readmission rates. Understanding these approaches and outcomes will help guide patients and clinical decision making.

Findings were published in Facial Plastic Surgery & Aesthetic Medicine, the premier journal in facial plastic surgeryThe full team of authors includes Madeleine Salesky, UCSF medical student; Aaron Zebolsky, UCSF research fellow; Tania Benjamin, MD, UCSF OHNS resident physician; Jacqueline Wulu, MD, former UCSF OHNS fellow and Andrea Park, MD, surgeon.

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