24. Facial Feminization Surgery: Region-specific Importance Recognized by Artificial and Human Intelligence Gender Recognition Correlates with Patient Satisfaction

PURPOSE: Facial Feminization Surgery (FFS) has emerged as an important aspect of social gender confirmation for trans-women; however, it is not known which of the many FFS procedures are the most important. To determine this, individual FFS procedures or regional changes were compared using gender typing from artificial intelligence and public opinion. METHODS: The outcome of 12 different individual FFS procedures or regions (n=303 patients) was compared based on four neural networks and crowd sourcing public opinion of gender type (n=917). The nasofrontal region preoperative severity and change was compared for success in FFS. FACE-Q surveys were used to measure patient-reported facial aesthetic outcome. RESULTS: For all four neural networks, cis-male, cis-female gendered correctly (98%, 99%); Preoperative FFS misgendered 52%. With postoperative FFS, a combination of all the procedures followed by the nasofrontal region had superior outcomes (98%, 96% correct gendering) compared to other regions (range 68-86%). With public opinion, similar results were recorded with a combination of all the procedures followed by the nasofrontal region having superior outcomes (97%, 95% correct gendering with improved confidence level 8.9 + 1.2 and 8.1 + 2). For the nasofrontal region, improved outcome was seen with a more severe preoperative state and increased change in measured nasofrontal angle. FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (75.1 + 8.1) and quality of life (82.4 + 8.3). CONCLUSION: For FFS feature changes, both all and nasofrontal regions should be considered the most important for less misgendering by artificial and human intelligence; these outcomes positively correlated with patient satisfaction.