COSMETIC TOWN JOURNAL

Facial Feminization

Toby Mayer, MD

January 31, 2017



The issue of gender identity is a complicated one that is not completely understood by the general public.  For example, there are many men who identify themselves as female even though they were born male.  The most recent, and prominent example of this is Bruce Jenner’s public change into Caitlyn Jenner.  One of the procedures men undergo to become more feminine is known as facial feminization.

 

DEFINITION

Facial feminization surgery involves a series of procedures for making a male look like a female. There are certain physical characteristics that distinguish males from females. The procedure takes the male face and makes alterations to make it look more feminine. The extent of facial feminization depends on whether or not the patient is adding anything besides feminization procedures. An example includes a facelift to combat aging or fat bags in the lower eyelids. That’s not a gender specific procedure but there are certain procedures that are designed to create feminization in a male.

 

HAIRLINE PROCEDURES

If there is hair loss, like temporal recessions or baldness with no more hair at the front, the hair loss will stop once patients start taking estrogen.  If they start hormones in their teens, they won’t have any baldness. They may have recessions, which can be filled in with micrografts. Often patients have frontal hair loss so they need the Fleming-Mayer Flap procedure.  This procedure involves moving an entire piece of the scalp, including hair, from the side of the head to the front while leaving the scalp and hair attached.  The area where it was removed from is stretched and closed.

Assuming the hairline is relatively normal, there is also a procedure called the irregular trichophytic hairline incision. That incision trims the hair so it can grow both through and in front of the hairline without a visible scar.

If a patient has a hairline, usually male to female, the hairline is advanced with or without micrografts and some recessions at the same time.  The bone of the brow is shaved down because that’s the secondary male sex characteristic. The shaving removes two big bumps where the eyebrows are located.  A forehead lift is performed at the same time because male brows are very low. Female brows have good height so it is a very feminizing procedure.

 

NOSE

Most males have a big nose. Often the tip is bulbous so the nose needs to be elevated in facial feminization without creating an artificial result. If the nose is made small and is upturned too much, it doesn’t look natural. The procedure often entails narrowing the bridge, removing a hump, refining the tip and possibly narrowing the base.

 

LIPS

In facial feminization, a lip lift is done to shorten the white part of the upper lip with or without fat grafting of the upper and lower lip, since many men have thin lips. The fat grafting makes the red part of the lips larger. The lip lift makes the white part of the upper lip smaller.

 

ADAM’S APPLE

A procedure that is very common with transgender patients is shaving the Adam’s apple. The Adam’s apple is never removed because it is part of the windpipe. There is a part of the windpipe that bulges forward (like the prow of a ship) that is removed because a person is still able to breathe without that part. At the same time, the pitch of the voice is raised so that it’s in the female range.

 

VOICE FEMINIZATION

The sole purpose for this procedure is to change the pitch of a male's voice into the female range.  It will not help someone sing better, or strengthen his or her voice. It allows the transsexual patient better to conform to a female if their voice sounds female.  A tiny incision is made in the natural crease of the neck and the vocal chords are adjusted bringing the voice into the female range.

 

CHIN REDUCTION

In facial feminization, the chin is reduced in a lot of patients so it’s closer to the face. If it’s too long, the vertical length of the chin can be reduced.  Most males have squareness to their chin and it can be rounded at the same time.  Some patients are receded and they need a chin implant placed. It’s a different kind of implant because patients don’t want a broad implant. Chin implants can fill in the depressions people get at the sides of the chin as they age. The jowl forms behind it. The jowl is positioned as part of a facelift, excess skin is removed, the chords in the neck are removed and the appearance is tightened. The skin is not pulled too tight because it creates a windswept appearance.

 

COST

The cost of facial feminization depends on how much work is being done on the patient. Are they just doing the nose or are they going to do everything? Once a person decides to do multiple procedures, it gets into the $30,000 -$50,000 range. Without the anti-aging procedures, it costs about $15,000-$20,000.

 

RISKS/LIMITATIONS

The only real risk of facial feminization is infection following a facial implant. That’s about a 1 in 1000 chance. Simply taking the implant out and putting it back in a few months later solves this issue.

There is some swelling and bruising for a week or two with some of the procedures.  With a hairline incision, there is numbness on the top of the head for about 6-12 months.  The feeling comes back over a period of time.

 

MULTIPLE PROCEDURES

Some patients have all of their facial feminizations procedures done in one surgery while others spread it out over multiple sessions.  If a patient wishes to combine multiple procedures into one session, the cheeks, chin, nose, forehead, Adam’s apple, voice and facelift can all be done at once. 

 

RECOVERY

The patient’s recovery time from facial feminization is normally two weeks. Depending on the amount of procedures, some people are back at work in a week to ten days. Bruising is what prevents patients from going back to work. Patients should keep in mind that the chin and cheeks do not bruise and the bruising on the forehead is very minimal. The areas with the most bruising are the nose and lower eyelids.

 

FINAL THOUGHTS

Facial feminization is a procedure that can be performed in one visit to the doctor or it can be spread out over multiple visits.  The procedure takes typical male facial features and alters them to be closer in shape and size to a typical female’s features. It’s a procedure that should be performed by a skilled and experienced surgeon.  Before making the final choice of a doctor to perform the procedure, the potential patient should quiz the doctor about his or her background and experience and the doctor should possess a great deal of experience in facial feminization.  Ask to meet with patients who have had facial feminization – those doctor’s who have performed numerous facial feminization surgeries have patients returning daily for follow-up appointments so it will be convenient for them to see actual patients.  Only when a patient feels completely comfortable with the doctor should he proceed with a facial feminization procedure.

 

Written by Cosmetic Town Editorial Team – MA

Based on an exclusive interview by Dr. Toby Mayer in Beverly Hills, CA

Article Last Updated on January 31, 2017

Toby Mayer, MD

January 31, 2017

Before After
Before After
Facial Feminization
This patient has had a facial feminization procedure performed by Dr. Mayer.
Before After
Facial Feminization
This patient has had a facial feminization procedure performed by Dr. Mayer.
Before After
Facial Feminization
This patient has had a facial feminization procedure performed by Dr. Mayer.