Postoperative nausea and vomiting (PONV) is a well known immediate postoperative risk of surgery, almost always related to the use of anesthetic agents. There are many known risk factors for it and it is hard to pin down one specific cause in many cases. In women higher PONV is reported to occur due to higher estrogen levels during their periovulatory phase.
In the December 2023 issue of the Global Open section of the journal Plastic and Reconstructive Surgery an article was published on this topic entitled ‘ High Incidence of Postoperative Nausea and Vomiting in Transgender Women Undergoing facial Feminization Procedures’. Chart reviews of transgender women aged older than 18 undergoing facial feminization surgery over a five year period served as the study data.. Data collected included hormone use and PONV history from prior surgeries.. PONV was defined as any nausea and vomiting during the immediate perioperative period. Males and cis-gender patients undergoing rhinoplasty surgery served as the controls.
Of nearly 300 (282) patients undergoing FFS surgery, 104 of them had PONV for an almost 40% incidence. (37%) This contrasted sharply with the control rhinoplasty group which had just over 10% PONV incidence. (11%)
This study is interesting in that a significant increase in PONV in transfemale facial surgeries was seen. This is not been why experience in transfemale face or body surgeries where our incidence is 10% or less, significantly lower than the 20% to 30% occurrence for all surgical procedures. This is undoubtedly not a reflection of the procedure being performed or the level of hormones that these patients may be on. Rather it is our preoperative protocol which specifically focuses on PONV prevention learned in over 30 years in a private surgery center. The preoperative administration of oral phenergan, scopolamine patch and IV steroids combined with the use of Emend in patients with a known history of PONV goes a long way in keeping this unsavory postoperative sequelae to a low incidence in FFS as well as in all elective aesthetic surgery patients.
Dr. Barry Eppley
World-Renowned Plastic Surgeon