Non-surgical facial harmonization for gender affirmation and psychosocial well-being in transmasculine persons: an exploratory mixed-methods study
Keywords:
Transmasculine persons, Gender-affirming care, Facial recognition, Hyaluronic acid, Health promotion, Facial masculinization, Gender congruence, Non-surgical gender affirmation, Transgender health, Body image satisfaction, Psychosocial outcomesAbstract
BACKGROUND: Facial appearance plays a central role in gender recognition and identity congruence, particularly among transmasculine individuals. Although the demand for gender-affirming care has increased, evidence regarding the psychosocial implications of nonsurgical facial masculinization using hyaluronic acid remains limited, especially within public health systems.
OBJECTIVES: To describe the subjective and psychosocial experiences related to nonsurgical facial harmonization with hyaluronic acid among transmasculine individuals receiving care in public health settings.
DESIGN AND SETTING: A mixed-methods exploratory study with a qualitative core component was conducted in a public, gender-affirming outpatient clinic in Salvador.
METHODS: Six transmasculine patients participated in semi-structured interviews. The FACE-Q Satisfaction with Facial Appearance Overall Scale (SFAOS) and Beck Anxiety Inventory (BAI) were administered before and 30 days after the procedure as complementary quantitative measures. Qualitative data were analyzed using thematic content analysis based on Bardin’s framework, with sampling guided by theoretical saturation.
RESULTS: Participants reported perceived reductions in facial dysphoria, improvements in self-perception, and greater social confidence after the procedure. Complementary quantitative measures indicated consistent short-term increases in facial satisfaction scores and a trend toward reduced anxiety.
CONCLUSIONS: In this exploratory study, nonsurgical facial harmonization with hyaluronic acid was associated with short-term improvements in self-perceived facial satisfaction and psychosocial comfort among transmasculine participants. Given the small sample size and short follow-up period, these findings should be interpreted as preliminary. Larger studies with longer follow-up periods and comparative designs are warranted to evaluate the durability and generalizability of our findings.
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