Purpose of Review <p>The goal of this paper is to review the philosophy, techniques and evidence supporting the utilization of virtual surgical planning (VSP) in facial gender affirming surgery (FGAS).</p> Recent Findings <p>Evidence supporting utilization of VSP in FGAS describes potential benefits protecting key anatomy (including the base of the skull and the inferior alveolar nerve). Postoperative imaging of patients who underwent surgery with VSP have shown high degrees of accuracy in bone approximation and high degrees of patient satisfaction. Available evidence also suggests possible reductions in operative time and decreased intraoperative decision-making fatigue.</p> Summary <p>Building on the evidence in craniofacial and head and neck reconstructive surgery, VSP can improve surgical accuracy, decrease operative times, and reduce surgical decision-making fatigue when used in FGAS</p>