Title
Nonsurgical Interventions for Gender-Affirming Facial Feminization: A Scoping Review
Sarah Elhachimi, BS University of Cincinnati College of Medicine, Cincinnati, Ohio; David Liao, MD. Department of Otolaryngology, Icahn School of Medicine at Mount Sinai; Mingyang L. Gray, MD, Joshua Rosenberg, MD. Department of Facial Plastic and Reconstructive Surgery, Mount Sinai
Introduction
While the growing body of literature detailing techniques involving gender affirmation for increases, there is a scarcity of literature available regarding these non-operative treatments, particularly for non-surgical interventions for facial feminization. Non-surgical interventions, particularly injectables, have a broad and necessary appeal to the transgender population. As surgery is highly invasive, nonsurgical procedures can serve as a viable bridge within the World Professional Association for Transgender Health’s recommended 12-month continuous social transition, an option for patients who are unsure, or patients who may not be surgical candidates. The purpose of this scoping review is to examine the existing literature regarding nonsurgical management of facial feminization in the transgender population. The results of this scoping review will be used to contribute towards bridging any potential gaps of knowledge providers may have in this new area so they can be familiar with the needs of this patient population for the aim of providing trans-competent care.
Methods
A scoping review was conducted using the Arksey and O'Malley framework. The scoping review began by establishing a research team of individuals with expertise in facial plastic surgery and gender affirmation. Alongside an institution librarian, the team identified search terms and relevant databases. A comprehensive search was conducted in four bibliographic databases and the gray literature to identify the nature and extent of current nonsurgical management of facial feminization. Keywords specific to the transgender population and nonsurgical techniques were used. Review selection and characterization were performed by two independent reviewers. Data on techniques, outcomes, complications, patient satisfaction, provider satisfaction and future direction were collected.
Results
The scoping search identified 264 literature sources. 49 were found to be potentially relevant publications and met the inclusion criteria for full text review. Nonsurgical management in gender-affirming facial feminization includes injectables such as neurotoxin to reduce masseter muscle hypertrophy and fillers for lateral brow elevation and lip and malar augmentation.
Conclusions
The majority of data reported in these sources included techniques used on cisgender patients that were adapted for the purpose of gender-affirmation for transgender patients. There is a lack of high-quality randomized, controlled trials specific to the transgender patient population that evaluate outcomes, patient satisfaction, or complications. Such studies would be needed to inform evidence-based practices.