Facial Feminization Surgery Changes Perception of Patient Gender

The goal of facial feminization surgery (FFS) is to feminize the sexually dimorphic characteristics of the face and enable transwomen to be correctly gendered as female. Studies have demonstrated high patient satisfaction with FFS. However, the correct gendering of patients after FFS has never been objectively studied. The aim of this study was to determine if FFS changed the perceived gender of patients in the public eye. An online survey platform with control photographs of cis-gender males and cis-gender females as well as preoperative and postoperative FFS patients was created. Respondents were asked to identify patients as "male" or "female" and to assign a confidence score ranging from -10 (masculine) to +10 (feminine) (n = 802). Cis-gender male and female controls were gendered correctly 99% and 99.38% of the time and with a confidence metric (CM) of -8.96 and 8.93, respectively. Preoperative FFS patients were gendered as female 57.31% of the time with a CM of 1.41 despite hormone therapy, makeup, and hairstyle. Postoperative FFS patients were gendered as female 94.27% of the time with a CM of 7.78. Ninety-five percent of patients showed a significant improvement in CM after FFS. This study illustrates that FFS changes the social perception of a patient's gender. Patients after FFS are more likely to be identified as female and with greater confidence than before surgery. This is despite preoperative female hormone therapy, and nonsurgical methods that patients use to feminize their appearance.