Facial Feminization Surgery and Quality of Life in Transgender Women: Protocol for a Cohort Study on Morphological and Psychosocial Outcomes (Preprint)

Abstract

Transgender women frequently encounter structural and social barriers to accessing gender-affirming surgical care, adversely affecting their mental health and overall well-being. Facial feminization surgery is a critical intervention that aligns facial features with female anatomical norms and gender identity. Although international studies suggest facial feminization surgery improves psychosocial outcomes, most have emphasized aesthetic results or relied on generic quality-of-life instruments not validated for this population. In Chile, no prior research has assessed the multidimensional impact of facial feminization surgery using patient-centered measures—such as self-perceived and third-party assessments of femininity—integrated with objective cephalometric and photometric analyses. Additionally, there is no validated Spanish-language quality-of-life instrument specifically tailored to transgender women undergoing this kind of surgery.

This study aims to (1) develop and validate a culturally appropriate quality-of-life questionnaire for transgender women undergoing facial feminization surgeryin Chile, and (2) evaluate postoperative changes in quality of life, perception of facial femininity, and cephalometric and photometric parameters.

The study will include two methodological phases: a cross-sectional validation study and a longitudinal cohort study. In Phase 1, a novel questionnaire will be developed through literature review, expert consultation, and pilot testing. It will then be validated in a sample of 200 Spanish-speaking transgender women. In Phase 2, a cohort of 30 transgender women undergoing facial feminization surgery t a public hospital in Santiago will be followed for 12 months. Outcomes will include pre- and postoperative quality-of-life scores, third-party and self-perceived femininity ratings, and cephalometric changes measured through cone beam computed tomography and clinical photography. Data will be analyzed using exploratory and confirmatory factor analysis, t-tests or Wilcoxon signed-rank tests, and regression models.

Data collection is currently ongoing. Validation of the questionnaire is expected to conclude in late 2025. Postoperative data collection will extend through 2026, with final analysis anticipated by early 2027. We expect to demonstrate significant improvements in both quality of life and perception of femininity following facial feminization surgery. Cephalometric and photometric analyses are anticipated to reveal key anatomical changes associated with increased femininity perception. The study will also identify specific facial features most strongly correlated with positive psychosocial outcomes in the study population.

This study will provide evidence on the impact of facial feminization surgery on transgender women’s quality of life and perceived femininity in a Latin American context. It also introduces a validated, culturally adapted instrument for future clinical and research use. Findings are expected to inform gender-affirming healthcare policies and support equitable access to surgical care.

Not applicable.