Scientific Abstract Presentations: Top Residents Abstract Session 4 (Craniomaxillofacial, Research & Technology) Thursday, September 26 Thu, Sep 26 8:00-9:30 a.m. PDT

Background There are few studies to date describing costs associated with the treatment of craniosynostosis from initial workup through post-surgical recovery. This study aims to describe the comprehensive financial burden of surgical treatment of craniosynostosis on the patient and hospital system using distraction osteogenesis (DO), open cranial vault remodeling (CVR) and endoscopic-assisted craniectomy (EAC) techniques.

Methods A retrospective review of all patients who underwent surgical treatment of craniosynostosis at a single institution between February 2014 and July 2019 was performed. Patients were included if they underwent surgical treatment of craniosynostosis, had at least 5 years of follow-up, and no prior surgical intervention. Medical records were reviewed for demographic and clinical variables including length of stay, blood loss, transfusion requirement, 30-day complications and 5-year reoperations. Hospital billing records and vendor financial databases were reviewed for charges incurred during surgery and hospitalization, and estimates were made of indirect costs to patient for mileage and missed days of work. Wilcoxon rank sum tests were used for comparison.

Results Seventy-nine patients met inclusion criteria. Twenty-two underwent EAC, 35 underwent open CVR, and 22 underwent DO. The median total hospital charges incurred for repair of craniosynostosis ranged from $65,342 to $211,235 based on affected suture(s) ($13,124 to $207,657 was paid after insurance adjustment). Charges for surgical implants alone contributed to 20.7 - 36.2% of total hospitalization cost. Median total direct and indirect costs incurred by patients ranged from $2,605 to $4,913, with greatest contribution from cost due to missed wages. Short- and long-term clinical outcomes for CVR versus DO were similar.

Conclusions This study highlights the comprehensive financial burden associated with surgical treatment of craniosynostosis, including hospital charges, costs of surgical implants, and direct and indirect costs to patients. Relative to other techniques, patients incur greater out-of-pocket costs following DO due to frequent outpatient visits. Implant costs represent a significant proportion of total charges and must be considered when comparing surgical approaches. It is prudent to weigh both short-term clinical outcomes and long-term financial implications when considering different surgical techniques for the treatment of craniosynostosis.

Detection and characterization of subtle changes in facial dynamics are key components to identifying cranial neuromuscular disorders and prognosticating resultant patient outcomes. In this paper, we introduce the Interactive Rendering and Integration System (IRIS), a novel augmented reality (AR) assessment platform for precise and objective measurement of facial and eye motion. Whereas traditional methods often rely on subjective observations and/or manual measurements, which may require specialized equipment, suffer from intra- and inter-rater variability, and lack precision, IRIS leverages AR technology to overlay digital markers or grids directly onto a patient's face and eyes for consistent and real-time measurements. Preliminary testing of the IRIS system demonstrates good sensitivity to a wide spectrum of eye, face, and jaw movements.

Our findings indicate a strong equivalence between clinical assessment, as conducted both in the traditional setting, and remote virtual evaluation via IRIS, with a consistent agreement rate of 98.6% (71/72) across eye, facial, and jaw movement metrics. As such, IRIS demonstrates good functionality and accuracy when compared to the current gold standard. Furthermore, the consistently low standard deviation of less than 0.1 across IRIS measurements underscores the platform's reproducibility and reliability. Notably, IRIS successfully identified pre-existing TMJ mobility limitations in one of the subjects, showcasing its diagnostic potential.

In a pre-clinical setting, IRIS has the potential to provide valuable insight into the underlying muscular and neuropathic etiology of facial disorders. By providing real-time visualization and quantifiable data, IRIS empowers clinicians to make informed decisions regarding treatment strategies and monitor progress over time. Moreover, its portability and accessibility make IRIS suitable for use in various clinical settings, including in the context of telehealth, enhancing access to care, particularly for patients in rural and remote communities.

In conclusion, IRIS represents a groundbreaking advancement in clinical assessment technology, offering a novel remote and accessible method for evaluating facial and eye movement. Future research will focus on further validation and clinical testing to integrate IRIS into routine clinical practice.

Purpose: Facial feminization surgery (FFS) is a gender-affirming operation designed to help patients achieve an appearance that is congruent with their gender identity, facilitate social transition, and improve psychosocial function. A few studies have assessed mental health-related quality-of-life measures after FFS but there are no studies in the literature analyzing the association of age and patient-reported outcomes measures after FFS. This is a prospective, cohort study using a validated patient-reported outcomes instrument (FACE-Q) to assess differences in surgical outcomes between older and younger patients who underwent FFS.

Methods: All patients scheduled for FFS between the years of 2018 and 2024 at a single integrated healthcare system were prospectively enrolled for inclusion in the study. Patients with prior facial surgeries, patients who chose not to participate, and those lost to follow up were excluded. Facial appearance, satisfaction, and psychosocial wellbeing were assessed before FFS and at 3 months, 6 months, and 12 months post-operatively using the FACE-Q validated patient-reported outcome measure. The scales included those for facial appearance, lips, lower face and jawline, aging appraisal, psychological function, social function, decision satisfaction, and outcome satisfaction. Correlations and independent samples t-tests were used to evaluate associations of patient-reported outcomes with patient age at surgery. For comparisons with t-tests, patients were divided into two groups with age ≤30 years and >30 years.

Results: A total of 53 patients who met inclusion criteria and provided preoperative and postoperative FACE-Q scores were included in the final study. Changes between preoperative and postoperative scores were comparable between younger (n=18) and older (n=35) age groups for all outcomes including overall facial appearance, lips, lower face, aging appraisal, psychological function, social function, and outcome satisfaction (p>0.05) with statistically significant improvements in all measures. However, increasing patient age was found to negatively correlate with postoperative scores for lower face and jawline (r=-0.35, p=0.01) as well as their aging appraisal (r=-0.54, p<0.001). Despite comparable improvements after FFS between age groups, results from independent samples t-tests show that patients ≤30 years of age scored significantly higher for aging appraisal compared to patients >30 years of age (97.9±4.9 vs. 79.6±21.9 respectively, p<0.001) at their most recent postoperative assessment.

Conclusions: Overall, patients reported significant improvements in facial appearance, psychosocial outcomes, and age assessments after FFS. However, improvements in lower face aesthetics and age assessment fell behind with increasing patient age at the time of surgery. Furthermore, older patients reported worse aging appraisal measures before and after surgery. While FFS remains a highly-effective treatment option for gender dysphoria with very high satisfaction and patient-reported outcomes, special counseling and consideration should be given to older patients, particularly when it comes to discussions regarding contouring of the lower face.

Introduction: Bilobed flaps for nasal alar defects are a workhorse reconstructive option but can be associated with characteristic changes in nasal shape and symmetry, including nasal tip deviation and alar flattening/retraction. Alar rim and subalar cartilage grafts have been documented to improve nasal symmetry in rhinoplasty (1,2). We sought to investigate whether the prophylactic use of an alar rim graft in conjunction with a bilobed flap improves nasal symmetry after reconstruction.

Methods: Retrospective review of patients presenting to a single institution between April 2018 and March 2023 who had a unilateral nasal alar reconstruction using a bilobed flap after Mohs resection. A total of 27 patients with documented pre-operative and post-operative photographs of both frontal and base views were included in the final analysis (10 with only a bilobed flap, 17 with a bilobed flap and alar rim graft). Alar rim grafts were non-anatomically placed into an alar-vestibular pocket underlying the defect prior to flap inset. Measurements were obtained using Adobe Photoshop. The Submental Nasal Appearance Scale (SNAS) was used to evaluate all photographs (3). Wilcoxon Signed Rank Paired-T tests were used for within-technique pre/post test result comparison and Mann-Whitney U tests were used to compare the mean pre/post test change between techniques in each of the five scored SNAS categories. All analyses were conducted in R version 4.2.2.

Results: The majority of patients were Caucasian (93%) and female (67%). Mean follow-up time was 4 months. The bilobed flap without an alar rim graft was associated with a significant change in SNAS score post-operatively for nasal outline symmetry (P=0.008) and nostril outline symmetry (P=0.016), indicating an overall decline in aesthetic result from pre-operative appearance. The post-operative changes in symmetry observed in this group included nasal tip deviation towards the side of reconstruction and unilateral alar flattening/retraction. By contrast, there was no significant difference in post-operative SNAS scores observed in the bilobed flap with alar rim graft group.

Conclusion: This study found that the use of an alar rim graft in conjunction with a bilobed flap was associated with a better aesthetic outcome than the use of a bilobed flap alone according to SNAS scores. This suggests that alar rim grafts could be used prophylactically to improve nasal symmetry and minimize the deformities associated with local flaps for nasal alar reconstruction.

References: 1. Rohrich RJ, Raniere J Jr, Ha RY. The Alar Contour Graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg. 2002 Jun;109(7):2495-505; discussion 2506-8. 2. Lee YH, Lee JY, Luo J, Lawson W, Westreich R. The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty. Plast Reconstr Surg 2021;147: 1063-1069. 3. Tan RA, Isaac KV, Ganske IM, Mosmuller DGM, de Vet HCW, Don Griot JPW, Mulliken JB. Development of the Submental Nasal Appearance Scale for the Assessment of Repaired Unilateral Complete Cleft Lip: A Pilot Study. Cleft Palate Craniofac J 2019 Jul; 56(6):791-798.

Background The overall rate of death in the general facial trauma population is <1%, however this figure increases significantly in the elderly, with estimates as high as 15 times greater than the general population.(1) While the majority of facial fractures occur in young males, there is a dearth of literature with regards to morbidity and mortality trends associated with elderly populations. Here, our group analyzes the complication rates and mortality data of elderly patients receiving care for facial fracture. This study aims to identify prominent risk factors contributing to increased rates of mortality in this patient demographic.

Methods Included patients were aged 65 and older at Loyola University Medical Center from January 2007 - December 2023. To evaluate the overall survival of our population as a whole and by demographics, comorbidities, postoperative comorbidities, and medications, we present Kaplan-Meier estimates, which give the survival rate of the population remaining at risk at a certain time point, e.g., 1-, 2-, and 5-years. Lastly, we employed the log-rank test to assess differences in survival rates between populations with different demographics, between populations with and without comorbidities, between populations with and without postoperative comorbidities and between populations with and without certain medications.

Results 237 patients met inclusion criteria; mean age at time of facial trauma was 76. Of the included patients, 15% (n = 36) expired during the analyzed follow-up period. Results indicate that a history of cerebral vascular accident (CVA) was associated with significantly lower survival rates (p = 0.01). Similarly, a history of malignancy with metastases was associated with significantly lower survival rates (p = 0.002). In the post-trauma follow-up period, incidence of CVA (p = 0.008), malignancy with metastases (p = 0.01), and diagnosis of peptic ulcer disease (p = 0.01) were all associated with significantly lower survival rates. Conversely, use of acetaminophen at any time was associated with significantly higher survival rates (p = 0.001). Finally, the use of cortisone was associated with significantly lower survival rates, albeit there were only 3 patients in the cortisone use group (p = 0.015). There was no significant difference in mortality trends when comparing race or sex.

Conclusions This study aimed to look at survival rates in elderly facial trauma patients. Patients with pre- and post-trauma diagnoses of CVA and metastatic disease were found to have significantly lower survival rates. Similarly, patients with a post-trauma diagnosis of peptic ulcer disease had lower survival rates. Finally, patients taking acetaminophen were found to have significantly higher survival rates than those who did not. By identifying existing risks in older adults presenting with facial trauma, we hope to optimize management strategies in the treatment of facial trauma and proactively identify patients who may be at a disproportionately high risk of mortality from their injury.

References 1 Yadollahi, M., Behzadi Seyf-abadi, M., & Pazhuheian, F. (2019). Pattern of maxillofacial injuries and determinants of outcome in a large series of patients admitted to a level-I trauma center. Bulletin of Emergency and Trauma, 7(2), 176–182. https://doi.org/10.29252/beat-070214

Purpose: As trends in healthcare focus on decreased hospital stays and improved patient outcomes it is important to provide protocols that address both. The authors aim to describe an enhanced recovery after surgery (ERAS) protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital.

Methods: After IRB approval, all patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were included. Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and Independent t-tests were utilized to determine significance (p < 0.05).

Results: During the time period examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged. These results remained true when strip craniectomy procedures were excluded.

Conclusion: This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for methods to minimize hospital expenses for these procedures, as well as potentially improve outcomes.

Orbital roof fractures are among the most common types of facial fractures in pediatric patients secondary to a child's proportionally large cranium to body ratio and evolution of pneumatization of the frontal sinus. Orbital muscle entrapment, however, is uncommon in children in the setting of pediatric orbital roof fractures (1,2). Here, we introduce the case of a 4-year-old female presenting with marked superior rectus (SR) entrapment following a traumatic orbital roof fracture and detail the successful operative release of the SR muscle and orbital reconstruction via an endoscopic approach. To our knowledge, this case represents the second report of SR entrapment in the setting of an orbital roof fracture and the first report of successful endoscopic repair among existing literature (3). With four months of close postoperative observation, we review her gradual improvement in globe position, visual acuity, edema and ptosis and overwhelmingly positive surgical outcome. This rare case presentation and literature review illustrates the intricacies of traumatic, pediatric orbital roof fractures and the favorable results of endoscopic surgical intervention for fractures complicated by entrapment of the ocular musculature.

1. Chapman VM, Fenton LZ, Gao D, Strain JD. Facial fractures in children: unique patterns of injury observed by computed tomography. J Comput Assist Tomogr. 2009;33(1):70-72. doi:10.1097/RCT.0b013e318169bfdc
2. Koltai PJ, Amjad I, Meyer D, Feustel PJ. Orbital fractures in children. Arch Otolaryngol Head Neck Surg. 1995;121(12):1375-1379. doi:10.1001/archotol.1995.01890120033006
3. Yalamanchili SP, Ibrahim ZA, Wladis EJ. Traumatic Orbital Roof Fracture With Superior Rectus Entrapment in a Pediatric Patient. Ophthalmic Plast Reconstr Surg. 2024;40(2):e45-e48. doi:10.1097/IOP.0000000000002550

Introduction Keloids have a significant impact upon patients' physical and mental health, and present considerable therapeutic challenges. Many treatment options are available, with highly varying and unpredictable success. Intralesional cryosurgery (ILC, CryoShape®, Life By Ice Inc) is known to reduce keloids' size and improve associated symptoms with a single treatment, although multiple treatments may be required in some cases. We present the largest case series of ILC, with objective treatment outcomes.

Methodology The authors present a retrospective review of a prospectively maintained database of 288 consecutively treated keloids in 119 patients, over 9 years in a single surgeon's practice. ILC was performed using 2mm diameter disposable needles and liquid nitrogen cooling. Patients were followed up from 2 to 100 months. The primary outcome measure was change in volume. Secondary outcome measures included: changes in symptoms; complications; recurrence and requirement for repeat procedure.

Results Mean scar volume reduction was 83% at mean 6.7 months. Overall complication rate was 5.9% and predominantly consisted of post-operative pain. One patient encountered minimal tissue loss (auricular cartilage). 87.9% of patients with associated pain and/or pruritis reported improvement or complete resolution. Keloid recurrence was 3.8%. Depigmentation was seen in 58.5% of patients. Almost complete re-pigmentation occurred by 1-year post-treatment in all cases in which depigmentation had occurred following the procedure.

Conclusion ILC is highly-effective and well-tolerated. Results in size, symptom reduction and recurrence rates may be comparable to, or better than other modalities. Depigmentation is a prominent feature, but is transient and well-tolerated. This study was limited by variability in presenting features of keloids and in its nature as a simple series. Objective scar assessment using Patient and Observer Scar Assessment Scales proved unreliable and was ceased early in the series. Well-constructed randomised controlled trials may provide higher level evidence of benefit and inform clinical guidelines. 30 patients required further ILC procedures, due to incomplete reduction, unsatisfactory reduction, or recurrence. Of these, 27/30 required only a second procedure. Two patients had 3 procedures and one patient had 5 procedures over 9 years.

Applicability to Clinical Practice Intralesional cryosurgery should be considered a first-line modality for keloid treatment. It provides simple, safe, effective, and predictable treatment. For a subset of patients with aggressive, recurrent keloid, the treatment may be viewed as a means of effective control, rather than of cure.

Introduction Skin integrity loss poses a significant challenge to the healthcare system, particularly in cases of scarring, burns, and cutaneous losses. Acellular Dermal Matrix (ADM) stands as an effective option, yet its efficacy may be compromised due to low vascularization (1). Approaches such as combining it with stem cells hold potential for enhancing wound healing (2,3). The Stromal Vascular Fraction (SVF) of adipose tissue could also be a promising addition to ADM, although studies exploring this possibility are lacking.

Objective For evaluating the effects of SVF combined with ADM on skin wound healing in rabbits.

Methods: This is an experimental, in vitro and in vivo, primary, interventional, analytical, prospective, longitudinal, comparative study conducted at a single center in the Cell Culture and Tissue Engineering Laboratory - Federal University of São Paulo (UNIFESP). The study was approved by the UNIFESP Animal Ethics Committee. It involved a sample of 24 rabbits, divided into four groups. Three 20 x 20 mm skin wounds were made on the dorsum of the animals, with the only procedure performed in the Control Group. In the ADM group, the wounds were covered with Acellular Dermal Matrix. In the SVF group, 2 x 106 autologous SVF cells were injected at the wound margins, and in the ADM/SVF group, SVF cells were injected, and the wounds were covered with ADM. The wounds were photographed for 21 days, and biopsies were performed at 3, 14, and 21 days to evaluate skin thickness, collagen quantification, and assess blood vessel formation and diameter. All samples were evaluated by an independent and blinded evaluator regarding the groups.

Results: There was no difference in wound healing time between groups. The ADM/SVF group showed greater dermal and epidermal thickness, higher amounts of collagen types I and III, and a greater number and diameter of blood vessels when compared to the control, ADM, and SVF groups individually.

Discussion: The analysis of results revealed significant differences between groups, with the group receiving both interventions (ADM/SVF) demonstrating better outcomes in terms of skin thickness, collagen density, and vascularization. These findings underscore the therapeutic potential of SVF in conjunction with ADM in skin regeneration. Further studies to understand the biochemical, genetic, and cellular aspects of SVF may aid in comprehending its molecular-level interaction in skin healing.

Conclusion: SVF associated with ADM increased vascularization, collagen quantity, and skin thickness during skin wound healing in rabbits, without altering wound closure time.

References: 1- Castagnoli C, et al. Preparation and characterization of a novel skin substitute. J Biomed Biotechnol. 2010; 22(1). 347-53 2- Egan. et al Use of human mesenchymal cells to improve vascularization in a mouse model for scaffold-based dermal regeneration. Tissue Eng Part A. 2009b;15(5):1191-200. 3- Liu S, et al. Synergistic angiogenesis promoting effects of extracellular matrix scaffolds and adipose-derived stem cells during wound repair. Tissue Eng Part A. 2011;17(6):725-39.

Introduction:The American Board of Surgery (ABS) plays a vital role in certifying surgeons in the United States, with ABSITE serving as a crucial assessment tool for general surgery residents seeking certification. This study aims to compare the performance of international medical graduates (IMG) to domestic counterparts and evaluate the impact of different medical degrees on ABSITE scores. It's noteworthy that ABSITE scores often play a pivotal role in determining the trajectory of a surgical career, including opportunities for fellowship placements in specialized fields such as plastic surgery. Methods:The study focused on general surgery residents enrolled at Marshall University from 2014 to 2022. Data encompassing ABSITE scores, TrueLearn quiz percentages (quiz), and TrueLearn mock exam results (exam 1 and exam 2) were collected for analysis. Descriptive statistics summarized sample characteristics, and data were analyzed using linear mixed models to address correlations. Statistical analyses were conducted using SAS (version 9.4), with significance defined by a two-sided test with p < 0.05. Results:Among the 48 participants, 24 were non-international medical graduates (nIMG), and the remaining 24 were international medical graduates (IMG). IMG demonstrated higher quiz percentages compared to nIMG (67% vs. 61%; β = 7.29, 95% CI [2.58, 12], p = 0.0029). Similarly, they outperformed nIMG in mock Exam 1 (64% vs. 58%; β = 7.43, 95% CI [2.79, 12.06], p = 0.0021) and mock Exam 2 (66% vs. 58%; β = 8.95, 95% CI [3.54, 14.37], p = 0.0015). Regarding ABSITE performance, IMG obtained significantly higher scores compared to nIMG (560 vs. 505; β = 70.3, 95% CI [17.26, 123.34], p = 0.010). This trend was consistent when analyzing ABSITE percentages (74% vs. 68%; β = 7.93, 95% CI [2.16, 13.7], p = 0.0077).
Analysis of quiz percentages, mock exam scores, and ABSITE performance was conducted between Doctor of Osteopathic Medicine (DO) and Doctor of Medicine (MD) participants. Among the 48 participants, 6 held DO degrees, while 42 held MD degrees. There were no statistically significant differences between DO and MD participants in quiz percentages (62% vs. 65%; β = 4.31, 95% CI [-3.45, 12.07], p = 0.27), mock Exam 1 scores (57% vs. 62%; β = 6.72, 95% CI [-0.72, 14.17], p = 0.076), mock Exam 2 scores (60% vs. 64%; β = 2.74, 95% CI [-6.57, 12.05], p = 0.56), ABSITE scores (498 vs. 542; β = 46.12, 95% CI [-39.33, 131.57], p = 0.29), and ABSITE percentages (68% vs. 72%; β = 5.37, 95% CI [-3.94, 14.69], p = 0.25). Conclusion:This study highlights the superior performance of IMG over nIMG in ABSITE examinations. The findings emphasize the pivotal role of ABSITE scores in shaping surgical careers, with higher scores correlating with enhanced opportunities for coveted fellowship placements, particularly in specialized fields like plastic surgery. Understanding these dynamics is vital for resident training and navigating the competitive landscape of surgical sub-specialization. Future research can delve deeper into factors influencing ABSITE performance, aiding in the development of targeted interventions to support residents in achieving their career aspirations.

Strategies for skin regeneration have been developed and dermal substitutes have been used to cover the lesion to facilitate cell proliferation, although very little is known about the application of novel matrix obtained from marine collagen. The mutable collagenous tissue (MCT) of echinoderms possesses biological peculiarities that facilitate native collagen extraction and employment for biomedical applications such as regenerative purposes for the treatment of skin wounds. From food waste we isolated eco-friendly collagen, naturally enriched with glycosaminoglycans, to produce an innovative marine-derived biomaterial assembled as a novel bi-layered skin substitute (Marine Collagen Dermal Template or MCDT). The study aimed to compare the regenerative efficacy and biocompatibility of Marine Collagen Dermal Template (MCDT) with Integra Dermal Regeneration Template (IDRT) in an in vivo rat model of skin wounds. Results showed that MCDT promoted accelerated wound closure compared to IDRT at 5 days post-surgery, with similar closure rates at 10 days. Histological analysis revealed higher inflammation in MCDT-treated wounds at 5 days, followed by similar patterns at 10 days. MCDT-treated wounds exhibited an earlier and more extensive angiogenesis process at 10 days, supported by higher gene expression levels of pro-angiogenic factors VEGF and PDGF-B. MCDT-treated wounds also displayed an increased presence of mature collagen (COL1A1) at both time points, suggesting enhanced tissue maturation. Therefore, the two dermal templates used in this study displayed similar biocompatibility and outcome with focus on full-thickness skin wounds, although a peculiar cellular behavior involving the angiogenesis process was observed for the MCDT. Despite the promising results, the study acknowledged limitations such as the small sample size and the preliminary nature of the findings. These exploratory results suggest the potential of MCDT as a novel biomaterial for skin wound treatment, warranting further investigation with larger sample sizes.

Purpose: Mental health conditions are known to disproportionately impact transgender individuals. Gender-affirming surgeries (GAS) aim to alleviate both gender dysphoria and psychiatric comorbidities. (1) The purpose of this study is to evaluate quality of life, mental health, and gender satisfaction before and after GAS.

Methods: Patients 18 years and older, enrolled from December 2021 through the present, who underwent the following gender-affirming surgeries were included: breast augmentation, female-to-male (FTM) chest wall reconstruction, and facial feminization. Patients completed the Transgender Congruence Scale, PHQ-9, and GAD-7 questionnaire preoperatively and at 6 months postoperatively.

Results: In total, 102 pre-operative surveys were completed and 46 were completed at 6 months post-operative. The majority of patients underwent chest masculinization (n = 39; 79.6%), followed by breast augmentation (n = 7; 14.7%), and facial feminization (n = 3; 6.1%). When compared to pre-operative scoring, at 6 months post-operative GAD-7 and PHQ-9 scores decreased in each operative group to varying degrees. TGS scores significantly increased signaling less gender dysphoria in each operative group (p<0.001).

Conclusion: Gender-affirming surgery, specifically chest masculinization, breast augmentation, and facial feminization, improves depression and anxiety scores and significantly decreases gender dysphoria scores at 6 months postoperatively.

1. Javier C, Crimston CR, Barlow FK. Surgical satisfaction and quality of life outcomes reported by transgender men and women at least one year post gender-affirming surgery: A systematic literature review. Int J Transgend Health. 2022;23(3):255-273. Published 2022 Mar 18. doi:10.1080/26895269.2022.2038334