According to the Williams Institute, 1.4 million adults identify as transgender in the United States. In New York specifically, the transgender population is around 78,600; representing 0.41% of the population in New York State. Currently there are 22 states along with DC that prohibit discrimination based on sexual orientation and gender identity, which means there are 28 states that don't. Luckily for transgender people, New York is one of the states that does prohibit discrimination.
This also means that in New York, transgender people have access to healthcare and gender-affirming procedures. Not every transgender person will want medical or surgical treatment or transformative procedures. Regardless, our goal is to create a welcoming, supportive, and non-judgmental environment, not just for transgender patients, but for all patients. Gender affirming treatments and procedures have been deemed medically necessary by the World Professional Association for Transgender Health. Denial of access to gender affirming care is associated with high-risk behaviors, including suicide. In fact in 2016, Dr. Jeffrey Spiegal, one of the pioneers in facial gender affirming surgery, published a study demonstrating a statistically significant improvement in quality of life among 247 transgender females who had undergone facial gender-affirming surg(Knott & Seth, 2022).
What can we, as an oculoplastic surgery practice, do to support our transgender community? We can assist with gender-affirming procedures of the face. The majority of interventions will occur in patients transitioning from male to female, i.e., transgender women. The reason is that in female-to-male transitions, testosterone therapy typically produces enough changes in secondary characteristics of the face (growth of facial hair, thickening of the skin, increase in frontal bossing, lowering of the voice, etc.) that surgery is not necessary nor often sought out. However, in some cases, placement of implants, fat transfer, or even filler can increase volume in the lower third of the face to contribute to masculinization. A more masculine jaw can be created using filler as well. Obviously, many males seek out Botox or other cosmetic procedures to keep them looking youthful, regardless of transition.
Critical components of facial gender affirmation include self-resemblance, youthfulness, symmetry, and sexual dimorphism (systemic differences in in the sexes of a species). Still, the majority of transgender people seeking surgery, or gender affirming procedures are male-to-female transitioning, typically focusing on the upper third of the face (Teixeira & Hohman). Here at New York Eye and Face we can assist with gender-affirming procedures by utilizing Botox, filler, and surgery. We can perform an upper lip lift using Botox, lip filler for fuller and more feminine lips, feminization of the eyes via lateral canthoplasty (reshapes the outer corner of the eyes), brow lifts, cheek lifts, and other rejuvenating procedures.
The field of gender-affirming surgical care and non-surgical care is growing as access and interest increase. Though controversy regarding insurance coverage, government support, and societal acceptance continues, understanding of the transgender community will continue to improve. As research persists and interest increases, training for physicians in this field will continue to improve as well. In fact, both of our surgeons recently attended a symposium where a physician spoke specifically about nonsurgical procedures for the transgender population. They learned a lot and can't wait to share it! We would love to welcome you to New York Eye and Face Oculoplastic Surgery, where we provide an accessible, friendly, supportive, and non-judgemental environment for all.
For more information, check out the resources below:
Deutsch, D. M. B. (2016, June 17). Overview of gender-affirming treatments and procedures. Overview of gender-affirming treatments and procedures | Gender Affirming Health Program. Retrieved June 10, 2022, from https://transcare.ucsf.edu/guidelines/overview
Flores, A. R., Herman, J. L., Gates, G. J., & Brown, T. N. T. (n.d.). What percentage of the population is transgender in 2022? World Population Review. Retrieved June 10, 2022, from https://worldpopulationreview.com/state-rankings/transgender-population-by-state
Knott, D. P. D., & Seth, D. R. (2022, February 11). Transgender Care: Otolaryngologists can help fill an unmet need for this patient population. ENTtoday. Retrieved June 10, 2022, from https://www.enttoday.org/article/transgender-care-otolaryngologists-can-help-fill-an-unmet-need-for-this-patient-population/
State Maps - Laws & Legislation. Human Rights Campaign. (2022, January 19). Retrieved June 10, 2022, from https://www.hrc.org/resources/state-maps
Teixeira, J., & Hohman, M. H. (n.d.). Transgender Surgery of the Head and Neck. National Center for Biotechnology Information. Retrieved June 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/33760488/
