Facial feminization surgery (FFS) encompasses a broad range of procedures to alter typically masculine facial features to bring them closer in shape, size, and aesthetics to typically feminine facial features. However, this can be for both biological women and trans women.
Forehead and Eyes
The upper face and forehead are a tell-tale sign of masculinity and femininity. Males tend to have a higher hairline that is more rectangular shaped. They can also have a more prominent brow bone and a more sunken appearance of the eyes. Their eyebrows sit more horizontally on the brow bone. Whereas women, have a shorter hairline that is more oval shaped and minimal prominence of the brow bone. Their eyebrows have a more arched shape and sit slightly above the brow bone. There are another of options to address these issues.
For hairline lowering, this can be performed on women or men that have “five finger forehead” and desire to have a lower hairline. If we are augmenting the shape of the hairline, the incision can be tailored depending on the patients desires. Sometimes, a small amount of hair transplanting has to be done in the temple regions in a second stage to fully change the shape.
To address the brow bone prominence, the bone has to be shaved down. Sometimes, this procedure is done with hairline lowering and brow lift simultaneously. If the hairline is not shortened, then the incision is hidden behind the hairline. This decision is completely customized to the patient and their desires.
Midface
FFS for the midface often focuses on the cheek bones, nose, and lips. Women tend to have a more heart shaped face, therefore, the cheek bones can be augmented with either filler or a more permanent solution with customized implants. Additionally, to create a more balanced face, rhinoplasty and/or lip lift are often performed simultaneously for full facial feminization in order to make the face more proportional with softer features.
Rhinoplasty allows for a more feminine nasal profile and tip. A subnasal lip lift creates fuller upper lip and subtle tooth show to give a more feminine pout.
Jawline or V-line Surgery
One of the most common reasons for FFS is to augment the jawline. Males tend to have a more rectangular and prominent jawline. Whereas females have a more rounded or oval shape.
This change can be done with a variety of procedures all done from incisions INSIDE the mouth. A genioplasty allows the surgeon to make bony cuts to change the shape of the chin, advance, or set the chin back. If the chin shape changes, then the jawline is contoured laterally and at the angle in order to make the jaw more “V-line”.
In order to make a customized plan for the patient, you will have to get a CT scan before surgery in order to determine how much bone can be removed and the desired final shape. Decreasing the size of the jaw can cause loose soft tissue which may have to be addressed in a second stage with liposuction or a modified neck lift after swelling resolves.
Chondrolaryngoplasty (Tracheal cartilage shave)
Chondrolaryngoplasty or “trach shave” is a procedure to decrease the visualization of the Adam’s apple which is a distinctly male feature. Dr. Nagy is trained in both airway surgery and aesthetics, therefore, is uniquely qualified for this procedure. This procedure is done through either a well-hidden skin incision or through an incision in the mouth. This allows contouring of the tracheal cartilage without affecting the vocal cords. However, the voice can change temporarily due to swelling. These concerns are addressed during the consultation.
Celeste Nagy MD
