Grants Funded

Abstract

Project Summary: Facial feminization surgery assists transgender patients with gender affirming care, but the underlying structural changes, objective aesthetic outcomes, and subjective patient satisfaction have received limited study. Our study seeks to quantify the underlying structural anatomic changes using CT imaging analysis. CT imaging data will be compared to pre-operative CT imaging as well as the medically modeled virtual surgical planning. Recruited patients will complete pre-operative patient-reported questionnaires (FACE-Q and GENDER-Q) followed by repeat testing an average of 6 months after surgery. Patient-reported questionnaires will provide data regarding patients' satisfaction with the face, each component of the reconstruction, and to conform with their gender. Finally, pre-operative 2D and 3D photographs will be compared to post-operative 2D and 3D photographs using artificial intelligence to assess femininity. We aim to correlate structural anatomic changes, patient satisfaction, and relative femininity rating scores. The underlying goal is to provide better insight regarding the anatomic changes in surgery as well as the anecdotally improved patient satisfaction and quality of life benefits from facial feminization surgery. Long-term we hope that by demonstrating the goals and outcomes of facial feminization surgery we can increase current insurance coverage and overcome limited access to care for the transgender population.

Impact Statement: This study seeks to objectively quantify the degree of femininization achieved through surgery, the goal of gender affirming facial surgery in transgender women. We hope to quantify the degree of satisfaction subjectively afforded to the patient using existing patient-reported outcome questionnaires. If there is widespread clinical data that support the long-term mental health benefit, then hopefully more state and commercial insurers will provide coverage. Understanding the anatomic changes to the bone, predictability of these changes relative to virtual surgical planning, and correlating anatomic changes to patient satisfaction will help improve the surgical approach. In aggregate, this study can help improve surgeon accuracy, inform surgical planning and lead to improved access to care.

Biography
I have been an Assistant Professor at Yale University since 2016 and Co-Director of Craniofacial Surgery since 2019. Prior to Yale, I trained in plastic surgery and craniofacial surgery at NYU and was educated at Harvard, Oxford, and the Johns Hopkins School of Medicine. I am committed to a career as an academic craniofacial surgeon and have appreciated the invaluable support of academic societies and my institution. In 2019, I received the ASMS CRANIO traveling fellowship for promising young faculty in craniofacial surgery. In 2020, I received the Yale Department of Surgery’s Academic Development Award. My research interests are centered on understanding the relationship between brain function and craniosynostosis. I have analyzed neurocognitive function in patients with craniosynostosis by morphologic severity, laterality, and varying surgical techniques. To date, the research projects have resulted in over 100 peer-reviewed publications with a primary focus in craniosynostosis. In 2018, I partnered with CHOP to study the morphologic and neurocognitive outcomes of adolescents with unilateral coronal synostosis. In 2019, we completed a study with Wake Forest comparing cognitive outcomes between cranial vault remodeling and spring-assisted surgery for sagittal synostosis. In 2020, I became site-director of a multi-institutional collaboration to study the functional MRI profiles of patients with craniosynostosis.