Insights Into Facial Surgery Trends in the United States in the Setting of Gender Dysphoria: A National Analysis From 2012 to 2019

Chandler Hinson; Christian Palacios; Justin M Camacho; Victoria Stoffel; Heli Patel; Joshua Kohan; Michael G Brandel; Chris M Reid; Amanda A Gosman

doi:10.1097/SCS.0000000000010841

Insights Into Facial Surgery Trends in the United States in the Setting of Gender Dysphoria: A National Analysis From 2012 to 2019

J Craniofac Surg. 2024 Nov 6. doi: 10.1097/SCS.0000000000010841. Online ahead of print.

Authors

Chandler Hinson¹, Christian Palacios², Justin M Camacho³, Victoria Stoffel³, Heli Patel², Joshua Kohan⁴, Michael G Brandel⁵, Chris M Reid⁶, Amanda A Gosman⁶

Affiliations

¹ Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL.
² Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, FL.
³ Drexel University College of Medicine, Philadelphia, PA.
⁴ The University of Vermont Robert Larner College of Medicine, Burlington, VT.
⁵ Department of Neurosurgery, University of California San Diego, School of Medicine.
⁶ Department of Surgery, Division of Plastic Surgery, University of California San Diego, School of Medicine, La Jolla, CA.

PMID: 39504406
DOI: 10.1097/SCS.0000000000010841

Abstract

Introduction: Over the past decade, there has been an improvement in access to gender-affirming surgical care for the transgender population. Even with improvements, this population continues with a high level of inequity among access to specialized surgical care. While multiple studies have previously focused on trends among top and bottom surgery, this study provides trends specifically among facial gender affirmation surgery (FGAS) within the United States.

Methods: The National Inpatient Sample (NIS) was utilized to identify patients who underwent FGAS from 2012 to 2019. The diagnostic codes for gender identity disorder and gender dysphoria were used to identify the desired patient population. CPT coding released in a medical policy for transgender care coverage was used to identify those who underwent FGAS. Frequency distributions from the patient population were analyzed to determine differences among characteristics.

Results: In total, 660 patients underwent FGAS from 2012 to 2019. The incidence of FGAS has increased by 1433%. Geographically, FGAS was more likely to be performed in the West and Northeast geographical regions (P<0.0001). There was a statistically significant difference in hospital length of stay and the total number of charges when stratified by race (P<0.0001 and P=0.0003), hospital location (P<0.0001 and <0.0001), and insurance type (P<0.0001 and <0.0001). The largest cohort of patients paid out-of-pocket (P<0.0001).

Conclusions: FGAS is one of the fastest-growing GAS procedures. Currently, FGAS procedures are not equally distributed, with higher concentrations occurring among wealthier, white individuals in certain geographical regions. Future studies are warranted to understand further trends within FGAS.