Key Points The impact of hyperlactatemia following facial gender affirmation surgery (FGAS) remains unclear The present study sought to examine implications of intraoperative hyperlactatemia during FGAS This retrospective cohort study included patients undergoing FGAS between 2015 and 2023 with at least two intraoperative lactate levels Included 17 patients with peak lactate levels ranging from 1.2-10.9 mmol/L, all of which normalized by the end of surgery or on the first postoperative day This study highlights the reassuring lactate normalization within one day of surgery, cautiously concluding that intraoperative lactatemia may be managed expectantly