Aesthetic Plastic Surgery

, Volume 43, Issue 4, pp 993–999 | Cite as

Safety of Combined Facial Plastic Procedures Affecting Multiple Planes in a Single Setting in Facial Feminization for Transgender Patients

  • Nikita GuptaEmail author
  • Jacqueline Wulu
  • Jeffrey H. Spiegel
Original Article Genital Surgery



The objective is to evaluate the safety of performing multiple combined facial plastic surgical procedures affecting various planes of the face including rhytidectomy, forehead contouring with browlift, cheek implants, rhinoplasty, and mandible contouring in a single setting.


This is a retrospective study of patients undergoing facial plastic surgery with the senior author at Boston Medical Center from 2005 to 2017. Patients were included if they underwent all of the above procedures in one setting and had not had previous facial surgery. The primary outcome measure was local postoperative complications of tissue necrosis and wound dehiscence. The secondary outcome measures were general postoperative complications of venous thromboembolism and prolonged intubation.


A total of 25 patients met inclusion criteria. Four patients experienced an infection—two patients had cheek implant infections delayed by months, one had a facelift hematoma that became infected, and one had an intraoral incision infection. One patient suffered from pulmonary embolism 2 months after surgery in the setting of hormone replacement therapy. All patients were extubated at the end of the case and none required reintubation. All patients had good cosmetic results.


Despite elevating multiple planes of the face at the same time, there were no complications related to vascular supply in any of the patients. Complications were limited to those known to occur with the individual procedures. This study demonstrates that concurrent procedures that elevate multiple planes in the face in a single setting may be performed safely and with good cosmetic outcomes.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors


Combined procedures Facial plastic surgery Multiple facial procedures Face lift Transgender Concurrent procedures Facial feminization 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Boston Medical Center.


For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck SurgeryUniversity of KentuckyLexingtonUSA
  2. 2.Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck SurgeryBoston University School of MedicineBostonUSA

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