Are facial-changing surgeries for transgender patients cosmetic procedures or medically necessary operations that should be covered by health insurance? 

That question is one that appears to be at the next front of the transgender healthcare debate, as some plastic surgeons push for more insurance coverage for surgeries that alter transgender patients’ faces to look more or less feminine or masculine. 

“We continue to advocate that treating these procedures differently than other gender-affirming operations is arbitrary and irrational,” a Harvard University professor and plastic surgeon, Devin Coon, and a Harvard researcher, Manraj Kuar, write in a recent article in a leading plastic surgery journal, Plastic and Reconstructive Surgery. 

The American Society of Plastic Surgeons, which didn’t respond to a request for comment, describes on its website a variety of available “gender confirmation” or “affirmation” surgeries to “give transgender individuals the physical appearance and functional abilities of the gender they know themselves to be.” 

Facial feminization surgery, for instance, aims to transform masculine features to a “more feminine or nonbinary appearance” and can include chin and forehead reductions, advancing the hairline, and reducing the jaw and Adam’s apple. Facial masculinization surgery increases the length of the chin and forehead and can include an “Adam’s apple enhancement.” 

“I don’t find it at all surprising that plastic surgeons are trying to get on the insurance grift over so-called gender affirming care,” a senior research fellow at the Heritage Foundation, Jay Richards, tells the Sun. “If insurance can cover a procedure that, say, removes the sexual organs from minors, then it’s a pretty sure step to facial sex trait modifications, because of course males and females do look differently, at least on average, in their facial structure.” 

The plastic surgery article cites an analysis of more than 300 insurance policies finding “limited coverage” among insurers for “facial operations as compared with feminizing and masculinizing genital and top operations.”

The eighth version of the World Professional Association for Transgender Health’s Standards of Care marked a “shift in perspective regarding the ‘medical necessity’ of several gender-affirming procedures,” the analysis notes. “Noteworthy is the reclassification of facial surgery, previously considered primarily cosmetic, as medically essential.” 

After Starbucks in 2018 announced coverage for facial surgery, Dr. Coon and Ms. Kuar note, there was hope more companies would follow suit, but that hasn’t materialized.

Compared to genital procedures over the past five years, feminizing top surgery and facial surgery “have progressed far more slowly and continue to be frequently treated as second-tier ‘cosmetic’ procedures, overlooking social aspects of transition and the physical safety concerns of people seeking gender-affirming surgery,” the article notes. 

“It seems like madness and it is,” Mr. Richards says. Very few people, he adds, “genuinely believe that, say, shaving part of the bone off of your cheek or your brow, or modifying the shape of your nose, is medically necessary in the same way that, say, open-heart surgery or something is.” 

American doctors are charging ahead with gender transition procedures despite the tide turning against them in several European countries, including the U.K., especially when it comes to youth. One psychologist and sex researcher recently told the Sun that “U.S. practitioners are on a sinking ship of medical transition.” 

There isn’t yet long-term data on sex-trait modification procedures, Mr. Richards says, nor is there much data on regret rates for children who undergo the procedures. 

“The real question is going to be what the regret rates are in, say, eight to 10 years, which we think is the relevant timescale for determining these questions,” he says.

Because the procedures haven’t been conducted for very long for this purpose, he says they are “essentially uncontrolled experiments.” 

“The plastic surgeon lobby is doing their best to get the procedures covered,” he says, “despite their obviously draconian and experimental nature.”