Abstract
Facial feminization surgery (FFS) improves gender dysphoria. The brows and eyes are
crucial in perceived gender, yet brow and eyelid surgeries are relatively underutilized.
This study aimed to determine rates of brow and eyelid surgeries as part of FFS and
characterize pre- and postoperative periocular features. We conducted a retrospective
review to identify all patients with the diagnosis of gender dysphoria who underwent
FFS at a single academic institution from 2019 to 2022. Thirty-four patients comprising
38 surgical cases were included. Twelve (35%) eyelid surgeries and 27 (79%) brow lifts
were performed. Baseline eyelid measurements did not differ between brow lift and
nonbrow lift cases. Those undergoing brow lift and eyelid surgery were older in age
(p = 0.022), had a higher rate of negative canthal tilt (p = 0.050), and smaller baseline margin-reflex distance 1 (p = 0.014) than patients who had brow lift alone. Brow lift increased tarsal platform
show (p ≤ 0.001) and lash-to-brow distance (p ≤ 0.001), and upper blepharoplasty increased tarsal platform show (p = 0.01). Rates of brow lift are high at our institution, and patients are appropriately
selected for eyelid surgery in FFS. Brow lift and upper blepharoplasty can feminize
anatomical features when using standards described for cisgender cohorts. The impact
of periocular features on gender perception in transgender patients warrants further
study.
Keywords
facial feminization surgery - gender-affirming surgery - brow lift - blepharoplasty
- eyelid
