Gender-Affirming Facial Feminization Surgery at a Public, Safety-Net Hospital: A Single-Center Early Experience : Journal of Craniofacial Surgery

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Gender-Affirming Facial Feminization Surgery at a Public, Safety-Net Hospital: A Single-Center Early Experience

Alcon, Andre MD*; Badiee, Ryan K. BA, BS*; Barnes, Laura L. MD*; Pardo, Seth T. PhD; Zevin, Barry MD; Pomerantz, Jason H. MD*

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The Journal of Craniofacial Surgery 34(3):p 1010-1014, May 2023. | DOI: 10.1097/SCS.0000000000009057



Facial feminization surgery (FFS) remains inaccessible to many transgender patients. Zuckerberg San Francisco General Hospital (ZSFG) was among the first public, safety-net hospitals to perform FFS. The purpose of this study is to examine the postoperative outcomes of patients who underwent FFS at ZSFG and describe barriers to providing FFS in a public hospital setting.


A retrospective review identified patients who underwent FFS at ZSFG. Demographic data, comorbidity profiles, postoperative outcomes, and hospital utilization data were collected from the medical records. FACE-Q modules (scored 0–100) were used to survey patient satisfaction at least 1 year postoperatively.


Seventeen patients underwent comprehensive FFS surgery at ZSFG. The median age was 41 years [interquartile range (IQR): 38–55], median body mass index was 26.4 (IQR: 24.1–31.3). Patients underwent a median of 9 procedures, the most common of which included frontal cranioplasty (n=13, 77%), open brow lift (n=13, 77%), rhinoplasty (n=12, 71%), and mandible contouring (n=12, 71%). There were no complications, readmissions, or reoperations within 30 days. Patients reported high satisfaction with the surgical outcome (median: 87, IQR: 87–100), excellent postoperative psychological functioning (median: 100, IQR: 88–100), and low levels of appearance-related distress (median: 3, IQR: 0–35). An estimated 243 operating room hours and 51 inpatient bed days were required to cover all FFS procedures.


Performing FFS in a public, safety-net hospital was associated with zero postoperative complications, few revision procedures, and excellent patient satisfaction. Limited operating room hours and inpatient availability represented barriers to providing FFS in this setting.

Copyright © 2022 by Mutaz B. Habal, MD

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