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Facial gender-affirming surgery (FGAS) plays a central role in the multidisciplinary care of transgender and gender-diverse individuals. While these procedures are increasingly performed in outpatient settings, high-quality data on safety and perioperative risk in ambulatory practice remain limited. This retrospective study evaluates clinical outcomes and safety parameters in a large consecutive patient cohort treated in a specialized private practice.

We conducted a retrospective chart review of 209 consecutive patients who underwent facial gender-affirming procedures in an ambulatory surgical center between January 2021 and December 2025. Procedures included combinations of forehead contouring, brow lift, rhinoplasty, genioplasty, mandibular shaving (V-Line), and tracheal shave. Primary endpoints were perioperative safety outcomes, including intra- and postoperative complications, as well as patient satisfaction. Descriptive statistics were used to summarize outcomes.

All 209 patients completed their procedures in an ambulatory setting without major intraoperative adverse events. Surgical duration ranged from 45 minutes to 8 hours. One major complication (pneumocephaly) occurred, requiring hospital admission and conservative management. Minor complications were infrequent and were managed conservatively without long-term sequelae. Overall, patients reported high satisfaction with their surgical outcomes.

This 5-year single-surgeon retrospective study demonstrates that comprehensive FGAS can be performed safely in an accredited outpatient setting. Even complex procedures involving multiple interventions and prolonged operative times were completed safely. These findings support the feasibility and safety of ambulatory FGAS when strict patient selection, standardized perioperative protocols, and an experienced multidisciplinary team are employed. Operative time was limited to a maximum of 8 hours.

As demand for gender-affirming surgery (GAS) rises globally, future surgeons require core competencies in transgender and gender-diverse (TGD) care. However, undergraduate exposure remains poorly defined. This study evaluated international medical student exposure, confidence, and educational needs, and assessed the impact of a targeted educational intervention.

A cross-sectional survey of clinical-year medical students across 38 medical schools in 11 countries assessed GAS teaching exposure, clinical experience, confidence, and preferences. Subgroup analyses were performed by intended specialty, and thematic analysis identified barriers. Findings informed the design of a pilot intervention incorporating a pre-learning module, simulation-based scenarios, and an interdisciplinary workshop. Pre- and post-intervention assessments measured knowledge and confidence.

A total of 1,084 students responded. Only 17% reported formal GAS teaching, and 9% had observed or assisted in a GAS case. Confidence in peri-operative TGD care was low (19%), despite 68% supporting mandatory curriculum inclusion. Major barriers included lack of trained faculty (56%), limited curricular time (43%), and restricted clinical exposure (41%). Preferred modalities were clinical experience (74%), simulation (58%), and interdisciplinary teaching (45%). Students pursuing plastic surgery reported greater exposure (41% vs. 17%, p<0.001) and higher confidence (32% vs. 13%, p<0.001).
In the pilot intervention (n=48), mean knowledge scores improved from 52%±14 to 81%±10 (p<0.001), with a large effect size. Confidence in peri-operative TGD care increased from 21% to 67% (p<0.001). Ninety-two percent of participants rated the intervention as highly relevant and supported integration into the core curriculum.

Medical students demonstrate limited exposure to and low confidence in GAS despite recognising its importance. A targeted, simulation-based and interdisciplinary intervention produced large, significant improvements in knowledge and confidence, supporting a feasible and scalable model for integrating competency-based GAS education into undergraduate training.