Patient satisfaction following gender affirming facial surgery: a GENDER-Q and gender preoccupation and stability questionnaire study (GPSQ)

Helia C Hosseini; Thayer J Mukherjee; Paula Flores-Perez; Melanie Vassallo; Jacqueline Ihnat; Sasha Wood; Kevin Hu; Neil Parikh; Omar Allam; Michael Alperovich

doi:10.1186/s41687-026-01016-1

Patient satisfaction following gender affirming facial surgery: a GENDER-Q and gender preoccupation and stability questionnaire study (GPSQ)

J Patient Rep Outcomes. 2026 May 4. doi: 10.1186/s41687-026-01016-1. Online ahead of print.

Authors

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, Connecticut, USA.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, Connecticut, USA. Michael.alperovich@yale.edu.

^# Contributed equally.

PMID: 42082789
DOI: 10.1186/s41687-026-01016-1

Abstract

Background: Gender-affirming facial surgery (GAFS) addresses gender dysphoria by aligning facial features with gender identity, with historical emphasis on refining the upper facial third to render patients more attractive and feminine. The GENDER-Q, a novel patient-reported outcome measure (PROM), evaluates aesthetic, functional, and psychosocial outcomes, complementing the Gender Preoccupation and Stability Questionnaire (GPSQ) to assess effects of GAFS in this study.

Methodology: Survey data from 86 patients was analyzed using GENDER-Q and GPSQ scores. Higher GENDER-Q scores indicated improved outcomes, whereas lower GPSQ scores reflected reduced gender dysphoria. Pre- and post-operative outcomes were compared using paired and unpaired t-tests. Spearman's correlation coefficients assessed relationships between the parameters assessed.

Results: Significant improvements in post-operative GENDER-Q scores were observed across facial features, with upper face appearance (r = 0.54, p = 0.001), jaw (r = 0.49, p = 0.001), and chin (r = 0.48, p = 0.004), showing greatest gains. GPSQ scores decreased significantly (-7.77 ± 1.61, p < 0.001). Pre- to post-operative changes of dysphoria, as measured by the GENDER-Q were associated with overall face (r = 0.62, p < 0.001), upper face (r = 0.64, p < 0.001), and chin (r = 0.51, p = 0.08) score improvement. Furthermore, increased overall facial satisfaction strongly correlated with improvement in satisfaction with the upper face (r = 0.54, p = 0.001), jaw (r = 0.49, p = 0.001), and chin (r = 0.48, p = 0.004).

Conclusions: An individualized approach to gender-affirming facial surgery that prioritizes overall facial harmony, rather than isolated subunit changes, improves gender congruence, facial satisfaction, and alleviates gender dysphoria in transgender patients. In addition, this study advocates for the use of tailored PROMs for the transgender population to more precisely capture and quantify the impact of population-specific interventions and conditions such as gender-affirming surgery and gender dysphoria respectively.

Keywords: GENDER-Q; Gender dysphoria; Gender-affirming facial surgery; Patient-reported outcomes; Transgender health.