Assessment of Malar Feminization: A Prospective Comparative Pilot Study

Background: Malar region treatment is crucial for facial feminization in individuals assigned male at birth (AMAB). The main therapeutic options are malar implants and lipofilling, sometimes combined with injectable fillers. However, no consensus exists in the literature on the superiority of one technique over the other. This is the first report to compare and evaluate the effectiveness of malar implants and lipofilling for feminizing the midface in AMAB patients, and to assess patient satisfaction. Methods: Between November of 2018 and November of 2022, the authors conducted a prospective comparative bicentric study on 40 patients who voluntarily underwent midface feminization using either fat grafting or malar implants. Patient satisfaction and the efficacy of each technique for cheek feminization were evaluated using the FACE-Q scales, the Satisfaction With Life Scale, the Subjective Happiness Scale, and the Face and Neck Lift Objective Photo-Numerical Assessment Scale, administered preoperatively and 1 year after surgery. Results: A significant improvement ( P < 0.05) was observed in both groups between preoperative and postoperative scores, indicating high satisfaction and efficacy, independent of the chosen method. Neither technique proved to be superior to the other in terms of patient satisfaction. Conclusions: Malar enhancement using implants or lipofilling is effective for malar feminization in AMAB patients. Malar remodeling techniques should be tailored to each patient’s expectations and preoperative clinical evaluation. Further studies with a longer follow-up period and a larger patient cohort are needed to determine whether one technique may prove superior to the other.