Facial Feminization Surgery

Facial feminization surgery for MtF patients attempts to shift the male facial patterns to more feminine patterns.   The surgery involves many kinds of procedures, which will vary with each individual.

The differences between male and female facial features vary with age, nationality and how early hormonal therapy begins.  The pure female or pure male face is a matter of ideal, and most individuals will have a mixture to varying degree of each type.  If you desire a more feminine face, you should consider your own wishes, as well as the viewpoints of others who know your facial features and expressions well enough to give honest critique.  It is essential, moreover, that you have realistic expectations and realize that results may vary amongst individuals who may have similar procedures.

Figure 1 Female and Male Facial Profile

Major differences between the male and female faces:

Hairline pattern:
The hairline of a male is typically higher on the forehead; there may be now or in the future a recession of the hairline due to male pattern baldness, family history and/or other causes; and generally the appearance of the male hairline it is squarish and identifiable as male, especially in older persons.  Conversely, the female hair pattern is oval shaped, more smooth and full around the facial edge.

Forehead:
The male has more bone-bossing (the ridge above the eyes) as well as a flat mid-central forehead, and often a forehead that angles more steeply away from the brow bone.  The female forehead is typically rounder in all dimensions and almost never has a prominent brow bone.

Nose:
A male will typically have a different angle between his nose and forehead, and also a broader nasal bone, often a nasal hump, and the nose will generally appear longer.  The female nose is tilted at a more obtuse angle to the face and there will usually be more downward curve of the nasal ridge. There will be less nasal hump and a more upward nasal tip. 

Note please that these are generalizations of the pure male and female faces typical of most racial or nationality groups.  An individual may have more or less of these features.  The objective of the surgery is to do the most aesthetically effective procedure to maximize the feminine appearance of the face.  Transgender persons may retain some features of their former gender simply because surgery cannot correct every problem.  What surgery can do is improve the situation.

Lips:
Male upper lip is longer and thinner than female’s. Female lips have fullness and opened to show the front teeth.

Chin:
Male chin is broad, protrude, and masculine. Female chin is pointy and less prominent.

Jaws:
Male lower jaw is broad, masculine, and more muscle-salivary glands covering.

Skin:
Adult male complexion is coarse and thick, even after hair removal therapy.

The Procedures for Facial Feminization:

Forehead Hairline Correction
The procedure for forehead hairline correction involves hairline lowering procedure and hair transplantation.

Forehead Contouring

There are 3 categories for forehead contouring:

1. Procedure 1
   Forehead contouring is an implantation at the mid forehead area to improve the curve of forehead profile. There are options for implanted material: Injectable material, fat graft, or permanent implants
   
   
2. Procedure 2
   Forehead contouring is a bone shaving procedure at above the eye area. The bone can be reduced approximately 5-6 mm.  The incision is on the scalp behind the hairline.
   
   
3. Procedure 3
   Forehead bone contouring is a bone depression at the outer table of frontal bone in front of frontal air sinus. The procedure is preserved for who has prominent forehead bone and deep eye set.

Rhinoplasty

The Rhinoplasty is performed in two types:

1. Typical rhinoplasty involves the correction of over-sized nose, hump on the bridge, and undesirable shape of the tip or wide nostrils by methods of bones and cartilages modification (Caucasian nose). The surgery is performed under general anesthesia.
2. Augmentation rhinoplasty with synthetic material (silicone, GORTEX), or soft bone (cartilage) for most Asian nose.

Mentoplasty (Chin Correction)

The patient with either a jutting or a square chin may benefit from sculpting the prominence. It is done through an oral approach. Chin augmentation may benefit for those with recessive chin.

Ancillary Procedures:

Malar-Cheek Bone Contouring / Enhancement

Cheek bone enhancement is performed by synthetic material or bone graft.
Cheek bone contouring is performed by sculpting with the rotary power equipment. The surgery is performed under general anesthesia. 

Reduction Thyroid Chondroplasty (Adam's Apple Shaving)
The prominent part of the Adam's apple is shaved. A short horizontal neck incision is made in an inconspicuous natural crease. The surgery is performed under local anesthesia.