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Revision & Salvage GAS

Revision and salvage surgery in gender-affirming care is a critical and growing subspecialty, driven by the high baseline complication rates of primary procedures — particularly genital reconstruction — and the increasing volume of patients presenting with functional and aesthetic concerns requiring secondary intervention. This page is organized by primary procedure. For primary techniques, see Feminizing and Masculinizing procedures.

Revision After Vaginoplasty (Transfeminine)​

Up to one-third of patients require secondary surgical revision after penile inversion vaginoplasty (PIV), addressing both functional and aesthetic concerns.1 A 240-patient institutional series reported 7.9% reoperation/revision, principally for cosmesis (3.8%) and stenosis (2.1%), but median follow-up was only 87 days. This short-term estimate is not directly comparable with longer-term revision rates.2

External genital (vulvar) revisions are the most frequently performed secondary procedures. In a series of 35 patients undergoing vulvar revision, the majority required concurrent corrections in multiple categories:3

  • Labial concerns (77.1%) — excess tissue, asymmetry, or insufficient labia minora / majora.
  • Clitoral concerns (57.1%) — buried clitoris, excess hooding, or inadequate sensation.
  • Urologic concerns (48.6%) — meatal stenosis, spraying urine stream, or urethral redundancy.
  • Introital concerns (34.3%) — posterior introital webbing limiting penetration, or canal stenosis.

Common revision techniques include posterior introital web release, revision labiaplasty, clitoral unhooding / repositioning, and meatoplasty.13 Patients who developed minor postoperative complications after primary PIV (granulation tissue, intravaginal scarring) were significantly more likely to require revision. After revision, 82.4% reported satisfaction and 76.5% reported resolution of genital dysphoria.4

Salvage for Neovaginal Stenosis​

Neovaginal stenosis is an important long-term complication. Published rates vary with technique, follow-up and definition; reports as high as 30% should not be treated as the expected rate for every procedure. Assess scar, pain, tissue healing and pelvic-floor or access difficulties as well as dilation; avoid assuming every narrowing is caused by inadequate adherence.5 Salvage options include:

  • Robotic peritoneal flap revision — in 24 patients with stenotic or absent canals after PIV, robotic peritoneal flap mobilization achieved a mean vaginal depth of 13.6 cm and width 3.6 cm at mean follow-up of 410 days, with no rectal injuries; one patient required reoperation for postoperative bleeding. This uncontrolled cohort does not establish comparative safety.6
  • Robot-assisted sigmoid vaginoplasty (RSV) — a 36-patient cohort included 11 primary and 25 revision operations. The revision subgroup had a mean preoperative depth of 3.4 cm; final mean depth of 17.6 cm was reported for the whole cohort, so these are not a paired subgroup comparison. No fistulas were reported; two sigmoid-skin anastomotic strictures required intervention.7
  • Laparoscopic intestinal vaginoplasty — in a comparison of 21 intestinal vs 32 full-thickness skin graft (FTSG) revision vaginoplasties, intestinal vaginoplasty achieved significantly greater depth (15.9 cm vs 12.5 cm, p < 0.01). This retrospective comparison cannot establish overall superiority.8
  • Right colon vaginoplasty — a 22-patient salvage cohort reported high satisfaction, but six patients experienced 14 long-term complications, including five prolapses, four stenoses (two introital and two from extrinsic rectovaginal compression) and three episodes of diversion neovaginitis. Bowel-specific morbidity must remain part of counseling.9

Rectoneovaginal Fistula​

In a retrospective series of 1,082 patients, rectoneovaginal fistula occurred after 0.8% of primary and 6.3% of revision vaginoplasties (OR 8.6). There were 25 neovaginal fistulas in total: 13 rectoneovaginal, 11 urethroneovaginal and one pouch-neovaginal fistula. Management approaches include:101112

  • Intraoperative rectal injury — prompt assessment and repair, with colorectal input when needed. One institutional series described two- or three-layer repairs in 10 injuries among 146 procedures. A separate series used rectoprostatic-fascia reinforcement for 14 rectal injuries and five fistulas, with no recurrence at one year; these small series do not establish a universally required repair configuration or guaranteed success.1112
  • Delayed rectoneovaginal fistula — individualize timing, local repair and tissue interposition according to defect, infection and tissue quality. Fecal diversion is selective rather than mandatory for every fistula; four patients in the 25-fistula cohort underwent diversion. In most patients, surgical repair was successful without impairment of neovaginal function.10
  • Urethroneovaginal fistula — often arises secondary to meatal stenosis; managed with fistulectomy and temporary suprapubic cystostomy when needed.10

Revision After Phalloplasty (Transmasculine)​

Urethral lengthening can entail substantial revision burden. In a 63-patient cohort combining 55 phalloplasties and eight metoidioplasties, 46 patients (73%) required urethral revision; this is not a phalloplasty-only population estimate.13 A separate online survey of 129 patients after penile reconstruction reported 281 complications and 142 revisions, with the limitations of self-selected respondents.14

Urethral Complications — The Dominant Driver of Revision​

  • Urethrocutaneous fistula — reported in 27–54% of phalloplasty patients. Notably, 19–54% of fistulae resolve spontaneously without surgical intervention. For persistent fistulae, repair options include fistulectomy with primary closure, local flap coverage, or buccal mucosa graft urethroplasty.151617
  • Urethral stricture — risk varies with reconstruction, urethral segments and follow-up. Define the location and length before selecting endoscopic treatment, local repair or staged urethroplasty. A frequently quoted comparison of 82% versus 43% three-year recurrence-free outcomes for open versus endoscopic treatment comes from a 96-patient metoidioplasty cohort, not a phalloplasty trial; small technique-specific subgroups do not establish 100% success rates.51317
  • Colpectomy (vaginectomy) — a retrospective 294-patient study found fistula in 111/232 without primary colpectomy versus 13/62 with it (48% versus 21%). This association is not proof of a causal benefit or a requirement to remove a vagina the patient wishes to preserve; discuss how the urethral and vaginal goals affect planning.18
  • Persistent vaginal remnant — a symptomatic remnant may contribute to pooling, infection or fistula and require treatment. An incidental remnant does not automatically require excision.16

In the 63-patient mixed reconstruction cohort, 44 patients (70%) ultimately voided from the phallic tip. Measured symptom scores and flow did not differ meaningfully from preoperative values, but this does not establish normal function or equivalent outcomes for every reconstruction.13

Flap Failure and Redo Phalloplasty​

Flap failure represents the most challenging salvage scenario. In a Dutch series of 18 patients who underwent secondary reconstruction after primary flap failure:19

  • Reconstruction involved a new shaft flap (n = 7), new urethral flap (n = 4), or both (n = 7).
  • Zero redo flap failures occurred.
  • 13 of 16 patients with urethral lengthening (81%) achieved standing micturition.
  • Among 11 questionnaire respondents, 72% were satisfied or very satisfied with penile appearance and all would undergo surgery again. Response and selection limits matter when counseling other patients.

An algorithmic framework from two high-volume centers (Johns Hopkins / Harvard and GU Recon / Buncke Clinic) guides the critical decision between salvaging the existing neophallus vs complete redo phalloplasty:20

  • Preserve the original flap when feasible — partial tissue loss can often be addressed with local flaps or skin grafts.
  • Additional free flaps may be required for significant tissue deficiency.
  • Complete redo phalloplasty is reserved for severe cases (total flap loss, multiple concomitant complications).
  • Multidisciplinary collaboration (plastic surgery, urology, microsurgery) is essential.

Common non-urethral complications requiring revision include excess bulk / lymphedema, phalloplasty malposition, hypertrophic / keloidal scarring, and donor-site issues.2021

Penile Prosthesis Revision (Transmasculine)​

Penile prosthesis implantation after phalloplasty carries exceptionally high revision rates compared with cisgender populations, reflecting the challenges of placement without native corporal bodies. Flap sensation depends on reconstruction and nerve coaptation; a neophallus is not necessarily denervated or insensate.

  • In a Dutch cohort of ZSI implants (50 patients, 85 implantation procedures including 35 secondary implantations), the 3-year explantation-free survival was only 39% for hydraulic and 31% for malleable prostheses.22
  • Secondary (redo) implantations were associated with higher complication odds in that cohort (OR 3.5, p = 0.03); urethral lengthening was associated with late complications (HR 2.6, p = 0.01). These are observational estimates, and an odds ratio is not a risk ratio.22
  • In an infrapubic series, 40 patients received implants and 30 had maintained follow-up; 12/30 required surgical revision at a mean of 35 months. The most common complications were device detachment (7/30), malposition (3/30), and infection (1/30). No neophallus erosions or flap losses occurred.23
  • Another retrospective series reported 21 prostheses removed or replaced, illustrating the need to discuss repeat operations and device-specific follow-up.24
  • A 2026 Delphi project recruited 21 experts; 17 completed round one and 16 round two, producing 53 consensus items for implant care. This is a practice-consensus protocol, not evidence that adopting it has already reduced complications.25
  • An 80-patient implant cohort found infection probability decreased with case number. This supports a possible learning effect, but the observational association does not establish causality or a validated minimum center volume.26

Revision After Chest Surgery​

Masculinizing Top Surgery​

Reported revision estimates depend on technique, follow-up and whether minor contour touch-ups are counted:

  • Revision rates range from 5.4–25.6% across series, with the periareolar technique having higher revision rates than double incision with free nipple grafting.272829
  • Most common indications — residual breast tissue, nipple-areola complex malposition, contour irregularity, and dog-ear deformity.2830
  • Concomitant liposuction was associated with fewer revisions in one cohort (p = 0.026); this was not a randomized comparison.27
  • In a 560-patient series, touch-up procedures were performed in 9% of patients.30
  • Some cohorts reported hematoma rates of 10.8–14% and an association with testosterone use.2930 These findings do not show that holding testosterone prevents bleeding: a separate 490-patient cohort found hematoma rates of 2.9%, 2.8% and 2.9% when testosterone was held, continued or never used, respectively.31

Transfeminine Breast Augmentation Revision​

  • Reoperation rate due to complications is approximately 5%, with capsular contracture being the most common indication.32
  • In a 30-year Amsterdam cohort of 527 patients (median follow-up 11.2 years), long-term reoperations included implant rupture (5.7%), capsular contracture (4.9%), and aesthetic concerns (3.8%).33
  • Capsular contracture (Baker III–IV) occurs in 3–5.6% of transfeminine patients, comparable to cisgender women.3334
  • Management follows standard principles — capsulectomy, implant exchange, and / or plane change. Acellular dermal matrix may reduce recurrence, though long-term data are limited.35
  • Transfeminine patients have higher rates of implant malposition (3.89%) and hematoma / seroma (0.63%) compared with cisgender women, likely related to wider chest dimensions and larger implant sizes.3436

Revision Facial Feminization Surgery​

Secondary FFS is increasingly common as primary FFS volume grows. In a series of 161 FFS patients, 25.5% underwent secondary surgery, consisting of additional procedures on previously unoperated areas (n = 32) and / or revision of previously operated areas (n = 30).37

  • Most commonly revised areas — nose (36.6%), forehead / brow (26.8%), cheeks (17.1%), chin (17.1%), lips (12.5%).37
  • Dominant indication — undercorrection to feminine ideals across all facial units.3738
  • Feminizing rhinoplasty revision rate — 16.7% in a 102-patient series, most commonly for persistent dorsal hump (36.4%) and tip concerns (36.4%). No patient characteristics were significantly associated with revision need.39
  • Revision rates for gender-affirming rhinoplasty are comparable to those reported for cosmetic rhinoplasty in the general population.40
  • Causes of poor outcomes after FFS include inadequate bone reduction, asymmetric contouring, visible hardware, and soft-tissue complications (alopecia at coronal incision, temporal hollowing).38

Overarching Principles for Revision & Salvage GAS​

Several cross-cutting themes emerge:

  1. Multidisciplinary teams are essential — revision cases often involve concurrent urologic, plastic surgical, and colorectal issues that require coordinated planning.1620
  2. Experienced multidisciplinary services can coordinate complex salvage and repeated follow-up. Existing small cohorts and learning-curve associations do not guarantee superior outcomes for every center or establish a volume threshold.1926
  3. Patient counseling is paramount — patients should be informed preoperatively that revision is common (not a failure) and that satisfaction remains high even after multiple procedures. Some cohorts report high satisfaction despite complications, but respondent selection and incomplete follow-up limit generalization.419
  4. Pelvic floor symptoms merit assessment and individualized rehabilitation. The often quoted 94.1% dysfunction estimate came from a 68-person testosterone-treated online sample that excluded previous urogynecologic surgery; it is not a postoperative incidence estimate.41 Consider pelvic floor physical therapy for appropriate symptoms, while recognizing the limited procedure-specific treatment evidence.5
  5. Standardized outcome reporting is improving: the 2025 GenderCOS core set for feminizing genital surgery and the 2026 implant consensus provide useful starting points. Core outcomes and expert consensus do not replace validated measures and comparative follow-up for each reconstruction.2542

Footnotes​

  1. Morris MP, Wang CW, Lane M, Morrison SD, Kuzon WM. "Common Revisions After Penile Inversion Vaginoplasty: Techniques and Clinical Outcomes." Plast Reconstr Surg. 2022;149(6):1198e–1201e. doi:10.1097/PRS.0000000000009159 ↩ ↩2

  2. Levy JA, Edwards DC, Cutruzzula-Dreher P, et al. "Male-to-Female Gender Reassignment Surgery: An Institutional Analysis of Outcomes, Short-Term Complications, and Risk Factors for 240 Patients Undergoing Penile-Inversion Vaginoplasty." Urology. 2019;131:228–233. doi:10.1016/j.urology.2019.03.043 ↩

  3. Dy GW, Salibian AA, Blasdel G, Zhao LC, Bluebond-Langner R. "External Genital Revisions After Gender-Affirming Penile Inversion Vaginoplasty: Surgical Assessment, Techniques, and Outcomes." Plast Reconstr Surg. 2022;149(6):1429–1438. doi:10.1097/PRS.0000000000009165 ↩ ↩2

  4. Boas SR, Ascha M, Morrison SD, et al. "Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty After Gender-Affirming Genital Surgery." Plast Reconstr Surg. 2019;144(6):1451–1461. doi:10.1097/PRS.0000000000006282 ↩ ↩2

  5. Motiwala ZY, Misra S, Desai A, et al. "Postoperative Urogynecologic Complications After Gender-Affirming Surgery: A Narrative Review." Int Urogynecol J. 2026;37(4):805–822. doi:10.1007/s00192-025-06405-6 ↩ ↩2 ↩3

  6. Dy GW, Blasdel G, Shakir NA, Bluebond-Langner R, Zhao LC. "Robotic Peritoneal Flap Revision of Gender Affirming Vaginoplasty: A Novel Technique for Treating Neovaginal Stenosis." Urology. 2021;154:308–314. doi:10.1016/j.urology.2021.03.024 ↩

  7. Sljivich M, Torres C, Chen D, et al. "Feasibility and Outcomes After Robot-Assisted Sigmoid Vaginoplasty for Gender Dysphoria." Urology. 2025. doi:10.1016/j.urology.2025.06.003 ↩

  8. Van der Sluis WB, Bouman MB, Buncamper ME, Mullender MG, Meijerink WJ. "Revision Vaginoplasty: A Comparison of Surgical Outcomes of Laparoscopic Intestinal Versus Perineal Full-Thickness Skin Graft Vaginoplasty." Plast Reconstr Surg. 2016;138(4):793–800. doi:10.1097/PRS.0000000000002598 ↩

  9. Garcia MM, Shen W, Zhu R, et al. "Use of Right Colon Vaginoplasty in Gender Affirming Surgery: Proposed Advantages, Review of Technique, and Outcomes." Surg Endosc. 2021;35(10):5643–5654. doi:10.1007/s00464-020-08078-2 ↩

  10. van der Sluis WB, Bouman MB, Buncamper ME, et al. "Clinical Characteristics and Management of Neovaginal Fistulas After Vaginoplasty in Transgender Women." Obstet Gynecol. 2016;127(6):1118–1126. doi:10.1097/AOG.0000000000001421 ↩ ↩2 ↩3

  11. Pansritum K, Thomrongdullaphak S, Suwajo P. "A Rectoprostatic Fascia Reinforcement Flap for Rectal Injury and Rectoneovaginal Fistula in Gender-Affirmation Surgery." Plast Reconstr Surg. 2022;150(4):909–913. doi:10.1097/PRS.0000000000009575 ↩ ↩2

  12. Morris MP, Wang CW, Holan C, et al. "Rectal Injury During Penile Inversion Vaginoplasty: An Algorithmic Approach to Prevention and Management." Plast Reconstr Surg. 2023;152(2):326e–337e. doi:10.1097/PRS.0000000000010246 ↩ ↩2

  13. Veerman H, de Rooij FPW, Al-Tamimi M, et al. "Functional Outcomes and Urological Complications After Genital Gender Affirming Surgery With Urethral Lengthening in Transgender Men." J Urol. 2020;204(1):104–109. doi:10.1097/JU.0000000000000795 ↩ ↩2 ↩3

  14. Robinson IS, Blasdel G, Cohen O, Zhao LC, Bluebond-Langner R. "Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients." J Sex Med. 2021;18(4):800–811. doi:10.1016/j.jsxm.2021.01.183 ↩

  15. Nassiri N, Maas M, Basin M, Cacciamani GE, Doumanian LR. "Urethral Complications After Gender Reassignment Surgery: A Systematic Review." Int J Impot Res. 2020;33(8):793–800. doi:10.1038/s41443-020-0304-y ↩

  16. Elyaguov J, Isakov R, Nikolavsky D. "Evaluation and Management of Urologic Complications Following Transmasculine Genital Reconstructive Surgery." Neurourol Urodyn. 2023;42(5):979–989. doi:10.1002/nau.25100 ↩ ↩2 ↩3

  17. de Rooij FPW, Falcone M, Waterschoot M, et al. "Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men." J Sex Med. 2022;19(2):377–384. doi:10.1016/j.jsxm.2021.12.006 ↩ ↩2

  18. Al-Tamimi M, Pigot GL, van der Sluis WB, et al. "Colpectomy Significantly Reduces the Risk of Urethral Fistula Formation After Urethral Lengthening in Transgender Men Undergoing Genital Gender Affirming Surgery." J Urol. 2018;200(6):1315–1322. doi:10.1016/j.juro.2018.07.037 ↩

  19. van der Sluis WB, Al-Tamimi M, Pigot GLS, et al. "Redo Phalloplasty and / or Urethraplasty After Previous Flap Failure in Phalloplasty in Transgender Men: Surgical Considerations and Outcomes." J Sex Med. 2024;21(11):1085–1093. doi:10.1093/jsxmed/qdae119 ↩ ↩2 ↩3

  20. Keller PR, Chen ML, Ovadia SA, et al. "Revision Phalloplasty: Evaluation, Algorithms, and Techniques for Salvage After Major Complications." Plast Reconstr Surg. 2024;154(2):362e–373e. doi:10.1097/PRS.0000000000010960 ↩ ↩2 ↩3

  21. Loughran A, Coon D. "Advanced Phalloplasty: Management of Complications and Techniques for Revision." Clin Plast Surg. 2025;52(4):507–514. doi:10.1016/j.cps.2025.06.007 ↩

  22. Levy M, van der Sluis WB, van Abbema EL, et al. "Hydraulic and Malleable Female-to-Male Penile Implants After Phalloplasty in Transgender Individuals: A Retrospective Cohort Analysis." BJU Int. 2025. doi:10.1111/bju.16911 ↩ ↩2

  23. Sun HH, Isali I, Mishra K, et al. "Surgical Outcomes at a Single Institution of Infrapubic Insertion of Malleable Penile Prosthesis in Transmen." Urology. 2023;173:209–214. doi:10.1016/j.urology.2023.01.001 ↩

  24. van der Sluis WB, Pigot GLS, Al-Tamimi M, et al. "A Retrospective Cohort Study on Surgical Outcomes of Penile Prosthesis Implantation Surgery in Transgender Men After Phalloplasty." Urology. 2019;132:195–201. doi:10.1016/j.urology.2019.06.010 ↩

  25. Levy M, Falcone M, Bohr J, et al. "Penile Implants After Phalloplasty in Transgender Individuals: A Consensus-Based Surgical Clinical Protocol Concerning Pre-, Peri-, and Postoperative Care." J Sex Med. 2026;23(2):qdaf365. doi:10.1093/jsxmed/qdaf365 ↩ ↩2

  26. Briles BL, Middleton RY, Celtik KE, et al. "Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications." J Sex Med. 2022;19:641–649. doi:10.1016/j.jsxm.2022.01.518 ↩ ↩2

  27. Kuruoglu D, Alsayed AS, Melson VA, et al. "Masculinizing Chest Wall Gender-Affirming Surgery: Clinical Outcomes of 73 Subcutaneous Mastectomies Using the Double-Incision and Semicircular Incision Techniques." J Plast Reconstr Aesthet Surg. 2023;85:515–522. doi:10.1016/j.bjps.2023.02.020 ↩ ↩2

  28. Donato DP, Walzer NK, Rivera A, Wright L, Agarwal CA. "Female-to-Male Chest Reconstruction: A Review of Technique and Outcomes." Ann Plast Surg. 2017;79(3):259–263. doi:10.1097/SAP.0000000000001099 ↩ ↩2

  29. Huber PD, Bittencourt RC, Jeziorowski A. "Masculinizing Mammoplasty for Female-to-Male Transgenders: 10 Years' Experience." Aesthetic Plast Surg. 2024;48(19):3825–3835. doi:10.1007/s00266-024-03931-4 ↩ ↩2

  30. Lo Russo G, Scortecci L, Ruccia F, Khajuria A, Gada L. "A New Algorithm for Masculine Chest-Wall Contouring in 560 Trans-Afab Patients: Clinical Outcomes and Patient-Reported Satisfaction Using the TRANS-Q Questionnaire." Aesthetic Plast Surg. 2025. doi:10.1007/s00266-025-04942-5 ↩ ↩2 ↩3

  31. Robinson IS, Rifkin WJ, Kloer C, et al. "Perioperative Hormone Management in Gender-Affirming Mastectomy: Is Stopping Testosterone before Top Surgery Really Necessary?" Plast Reconstr Surg. 2023. doi:10.1097/PRS.0000000000009858 ↩

  32. Schoffer AK, Bittner AK, Hess J, Kimmig R, Hoffmann O. "Complications and Satisfaction in Transwomen Receiving Breast Augmentation: Short- and Long-Term Outcomes." Arch Gynecol Obstet. 2022;305(6):1517–1524. doi:10.1007/s00404-022-06603-3 ↩

  33. Sijben I, Timmermans FW, Lapid O, Bouman MB, van der Sluis WB. "Long-Term Follow-Up and Trends in Breast Augmentation in 527 Transgender Women and Nonbinary Individuals: A 30-Year Experience in Amsterdam." J Plast Reconstr Aesthet Surg. 2021;74(11):3158–3167. doi:10.1016/j.bjps.2021.03.107 ↩ ↩2

  34. Liu C, Shahid M, Yu Q, et al. "Complications Following Breast Augmentation in Transfeminine Individuals: A Systematic Review and Meta-Analysis." Plast Reconstr Surg. 2024;153(6):1240–1251. doi:10.1097/PRS.0000000000010691 ↩ ↩2

  35. Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. "Systematic Review of Capsular Contracture Management Following Breast Augmentation: An Update." Plast Reconstr Surg. 2024;153(2):303e–321e. doi:10.1097/PRS.0000000000010358 ↩

  36. Torres Perez-Iglesias CA, Heyman A, Koh DJ, et al. "Technical and Clinical Differences Between Transgender and Cisgender Females Undergoing Breast Augmentation." Ann Plast Surg. 2023;91(5):534–539. doi:10.1097/SAP.0000000000003706 ↩

  37. Rochlin DH, Chaya BF, Rodriguez Colon R, et al. "Secondary Surgery in Facial Feminization: Reasons and Recommendations." Ann Plast Surg. 2022;89(6):652–655. doi:10.1097/SAP.0000000000003308 ↩ ↩2 ↩3

  38. Simon D, Capitán L, Coon D, et al. "Secondary Facial Gender Surgery: Causes of Poor Outcomes and Strategies for Avoidance and Correction." Plast Reconstr Surg. 2023;152(2):347e–357e. doi:10.1097/PRS.0000000000010324 ↩ ↩2

  39. Rothberg SE, Bao E, Bastidas N. "Feminizing Rhinoplasty in Transfeminine Patients: Complications and Outcomes in 102 Patients." J Craniofac Surg. 2025. doi:10.1097/SCS.0000000000011515 ↩

  40. Lehmann RJ, Kruglik CP, Nuara MJ, Cole AM. "Gender-Affirming Rhinoplasty: A Scoping Review." Laryngoscope. 2025. doi:10.1002/lary.32339 ↩

  41. da Silva LMB, Freire SND, Moretti E, Barbosa L. "Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study." Int Urogynecol J. 2024. doi:10.1007/s00192-024-05779-3 ↩

  42. Vallinga MS, Roijer PJ, Pidgeon TE, et al. "The Core Outcome Set for Studies on Feminizing Genital Gender-Affirming Surgery: Findings From the GenderCOS Project." EClinicalMedicine. 2025;85:103323. doi:10.1016/j.eclinm.2025.103323 ↩