Complication Rates in Facial Feminization Surgery: A Systematic Review.

BACKGROUND: Facial feminization surgery (FFS) is vital for the well-being of transgender women and nonbinary individuals. FFS procedures involve different surgical techniques that are accompanied by a broad range of complications. This article aims to identify the complication risks of surgical procedures applied in FFS following the Clavien-Dindo classification. METHODS: A systematic review was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. PubMed, Embase, Cochrane, and Web of Science databases were queried. Data were acquired and divided into 6 subgroups, covering all feminization features of the face and neck, including combined procedures. RESULTS: Forty-eight studies were included in the systematic review. The cohorts ranged from 4 to 1049 patients. The follow-up ranged from 3 weeks to 110 months. The overall risk incidence of complications, including infection, nonunion of bony fragments, and deep venous thrombosis after surgery, was less than 5% across all subgroups regarding the face and neck. The complication rate for combined surgery was 5.3%. CONCLUSIONS: This article describes a low incidence of complications following FFS, suggesting that these are safe procedures with minimal risks to patients. The identified risk ratios can aid clinicians and patients in making informed decisions regarding the selection of appropriate surgical techniques in FFS.