Facial Feminization Surgery

The upper third of the face, comprising the hairline, brows, and upper eyelids, and the forehead and underlying frontal bone, shows the most gender differences. As such, addressing this area is essential for feminization of the face.

Masculine features include excess prominence of the frontal bone and upper aspect of the orbit (eye socket). This prominence acts as an awning over the eyes, keeping them more recessed and in shadow.
During surgery, this bony prominence is removed, and the orbits are reshaped to create a feminine shape. These techniques may involve controlled bone cuts, known as osteotomies, to safely and accurately reshape the frontal bone.

Forehead contouring is usually done with a frontal sinus setback or a type 3 cranioplasty procedure, along with bone shaving. During the setback, the frontal sinus wall is removed, reshaped, and repositioned posteriorly to create a smooth, feminine forehead contour.

The masculine hairline tends to have an “M” shape, with recession near the temples. The feminine hairline is typically rounded or assumes an upside-down “U” shape.

Scalp advancement, also known as hairline lowering, is used to change the hairline into a more feminine shape and to lower it. In some cases, hair transplantation may also be used to refine density and contour around the temples.

Masculine brows tend to sit lower and closer to the eyes, with a more horizontal shape. In contrast, feminine brows sit higher above the eyes and peak laterally. Lifting the brows and changing their orientation helps to feminize the face.

When combined with forehead contouring, the eyes can take center stage, as they are no longer sitting in shadow and appear more open. An eyelid lift or blepharoplasty can further make the eyes appear more youthful and feminine.

Nasal surgery for facial feminization primarily consists of a rhinoplasty. During this procedure, the nose is typically reduced in size, and the tip is slightly upturned to give a more feminine appearance. At the same time, anatomic issues that may affect breathing are usually corrected, including straightening a deviated septum and reducing enlarged turbinates.

These surgeries are performed on the inside of the nose and do not affect the external appearance. However, when combined with a rhinoplasty, the nose looks and functions its best.

Like the forehead or frontal bone, the masculine jaw, or mandible, has excess jawbone that makes it appear wider and more square than the feminine jaw. Feminine jaws tend to have more of a heart-shaped appearance. The goal of jaw and chin contouring is to remove excess bone to create a more tapered, narrower jaw.

Genioplasty is another word for reshaping the chin. Many different techniques can be used, from just shaving the bone to adding a chin implant to making cuts in the bone to allow the excess bone to be removed. These procedures are all done inside the mouth, so there are no external scars.

After Jaw Or Chin Contouring For Facial Feminization

This area tends to have the most significant swelling and takes the longest to resolve, as it is gravity-dependent, and is where all swelling will pool. After surgery, a special dressing will be applied to help minimize swelling around the jaw. Patients are advised to utilize compression garments consistently, especially for the first month after surgery.

It typically takes three to six months before changes from surgery become apparent, and it will take at least a year to see the full results. Right after surgery, you will be able to eat as nothing is done to the teeth, but it may be uncomfortable for the first few days. Most patients start with liquids and soft foods, then resume solid foods within a few days.

Also called a tracheal chondroplasty or chondrolaryngoplasty, a tracheal shave reduces the size and prominence of the Adam’s apple (thyroid cartilage). In more masculine neck structures, this cartilage tends to protrude prominently, creating a noticeable bulge along the neckline.

The surgery addresses this issue by minimizing the protrusion, ultimately achieving a smoother, more feminine neckline.

What Happens During Tracheal Shave

During surgery, an incision is made in a neck crease to make it less visible. The thyroid cartilage or Adam’s apple is exposed, and the prominence is removed to create a smooth neck contour.

Risks And Complications Of Tracheal Shave

It is important to know that the thyroid cartilage houses the larynx or voice box. The voice box plays an important role in both talking and swallowing. Working in this area to remove excess cartilage can theoretically affect your voice, leading to hoarseness or other changes, as well as swallowing difficulty.

Fortunately, these are usually temporary and resolve as swelling improves. It is important to choose a surgeon who understands the anatomy in this area and has experience operating around the larynx to minimize the risk of any complications.

Recovering From A Tracheal Shave Procedure

The recovery period following a tracheal shave is generally straightforward and minimal. Patients may experience mild pain and discomfort after the procedure, though these symptoms typically subside within a few days.

Some patients may find their voices hoarse and experience difficulty swallowing solid foods initially, but this tends to resolve quickly. You can start with liquids or soft foods.

Fat transfer, also known as fat grafting, involves harvesting fat from one area of the body and using it to add volume to another. Typically, fat is harvested from the abdomen, thighs, or flanks. Common areas of the face for fat transfer include the lower eyelids, cheeks, temples, and the area around the mouth.

The goal of this procedure is to achieve a more feminine shape. The transferred fat will be permanent. However, it will gradually decrease with age.

FFS usually aims to reduce the size and shape of most areas of the face to remove masculine features. However, the cheek tends to be more prominent in feminine faces. Therefore, the goal of feminizing the cheek is to augment it, which can be accomplished via a fat transfer or with implants.

The male nose is typically larger in all dimensions compared to a female nose, including the width of the nasal bones and the size of the tip. The feminine nasal tip is also more turned up (rotated). During feminizing rhinoplasty, the goal is to reduce the overall size and dimensions of the nose, narrow and rotate the tip, and create a nose that matches the rest of the face.

It is important to know that over-reducing the nose can lead to breathing difficulties. For this reason, it is highly recommended that you find a surgeon who understands the functional ramifications of surgery to ensure you get the best aesthetic result without compromising breathing.

Through an incision hidden at the base of the nose, an upper lip lift removes a portion of the skin beneath the nose, shortening the distance between the nose and the upper lip. With this procedure, the upper lip appears fuller, and increased tooth show leads to a brighter smile.

The feminine face is typically more tapered and heart-shaped in the lower third. Meanwhile, the masculine face is more square. With aging, as the cheek tissues descend, more tissue accumulates around the jaw and neck, further widening the lower face.

Due to prolonged swelling after jaw and chin contouring, the soft tissue around the jaw and neck can also become more stretched and redundant. Facelift and neck lift can address all these issues and recreate the heart-shaped contours of a feminine face.

Injectable fillers can be used for cheek and lip augmentation, hollowing of the lower eyelids, or to address volume loss and wrinkles in other areas of the face. Unlike fat, which tends to be permanent, fillers typically last one to two years. They also do not require surgery or anesthesia.

Neuromodulators such as Botox are useful for treating and preventing wrinkles and can help maintain the results of a brow lift. Other procedures include hair removal and skin resurfacing.