When undertaking any form of plastic or cosmetic surgery, it is critical to take into consideration each patient’s ethnicity. Different ethnic groups have different facial proportions and different cultural concepts of what constitutes ‘beauty’. A skilled plastic and craniofacial surgeon will take these into account and adapt surgical procedures accordingly. Often, patients of Asian ethnicity — such as Korean, Japanese, Chinese, and other Asian countries and regions — may seek out a jaw and chin narrowing procedure known as Asian V-Line surgery. Depending on their existing facial proportions, the patient may also need to reduce the size of their masseter muscle to reduce a prominent mandibular angle and jaw width to produce a narrower, slender and more feminine facial profile.
The masseter muscle runs down the cheekbone to the lower jaw on each side of the face. It is known as one of the “muscles of mastication” because it helps us to chew food and move our jaw up and down while speaking. The masseter is typically larger in people of Asian ethnicity due to natural genetic differences creating a wider face proportion. Typically Asian women, or Asian transgender individuals seeking facial feminization, want a softer, smoother appearance to the jawline, and therefore seek to reduce the size of the masseter muscle at the same time.
Reduction of the masseter muscle for those of Asian ethnicity may be performed by either non-surgical or surgical method…
The masseter muscle can be reduced significantly using non-surgical injectable treatments such as botulinum toxin — more commonly known as Botox® or Dysport®. The procedure is non-invasive because it involves a series injections placed directly into the masseter muscle. The treatment is performed over several sessions with small doses of botulinum toxin until the masseter muscle has reduced down by degrees to the desired appearance. The number of sessions will depend on the individual’s reaction to the treatment. Some people may only need 1-2 sessions, others may need 3-4 sessions to achieve the desired results. In most patients, the masseter muscle will stay reduced in size permanently – even without further injections.
For some Asian patients, non-surgical masseter muscle reduction will not have the desired effect, making a surgical reduction of the muscle their best option. The surgery is performed on the inside of the mouth between the gum and cheek via small incisions that leave no visible scarring. The jaw bone and masseter muscle are surgically reduced and reshaped to achieve a rounder, smoother, and more slender contour. When the correct amount of muscle and bone has been removed, the incision is closed with self-dissolving sutures.
Ultimately, an in-person consultation with your plastic surgeon will help you decide if a surgical or non-surgical option is the best course of action for you.Read more
Typically, the male jaw is wider and taller than the female jaw. Men tend to have wider, heavier-set jawlines with a flatter base and a sharper angle between the chin and jaw. This gives the male jawline a prominent “square” look. Women’s jawlines typically have rounded edges, are more tapered and pointed.
Many of our patients who are considering undertaking facial confirmation surgery to feminize the face, often mistakenly think that they need “Asian” V-Line surgery for the jaw when what is actually needed is feminizing jaw surgery — otherwise known as FFS-specific jaw contouring or jaw tapering.
V-Line jaw surgery typically works to narrow the jawline and bring it forward. This procedure is typically ideal for women who have an overly-square jawline and want a more feminine, streamlined appearance to the jaw and the chin. This tactic, however, doesn’t work to feminize a male’s face because typically a male face is taller or longer, so a V-Line procedure would only make the face appear more elongated. In the case of a male transitioning into a female, what is really needed is jaw contouring surgery to shape the jaw into a more feminine aspect as well as a vertical reduction genioplasty (shortening the height of the chin). In comparison, a V-Line procedure commonly should not reduce the vertical height of the chin as that would run counter to the intended appearance.
If the face to be feminized is overly long, a condition that is known as vertical maxillary excess or “long face syndrome”, we may also recommend surgical correction via a jaw surgery procedure known as the Le Fort Osteotomy I. Read more about Long Face Syndrome and Facial Feminization here.Read more
When a transgender person is seeking to undertake facial feminization surgery there are several relevant FFS procedures that may be recommended depending on existing facial structure and aesthetic goals. Some FFS procedures fall under the category of plastic surgery (soft tissues), others under craniofacial surgery (the underlying facial skeleton), and others yet under orthognathic surgery (surgery of upper and lower jaws).
One of the lesser utilized FFS procedures is the surgical correction of long face syndrome or vertical maxillary excess. This condition is a facial deformity caused by a disproportionately grown upper or lower jaw making the face appear overly long. Depending on the individual, the vertical maxillary excess may result in a very “gummy” smile and a thin, over-elongated face.
Vertical maxillary excess is easily correctable with orthognathic (jaw) surgery and is ideal for transgender individuals who are transitioning into females and have an excessively long face relative to their gender-adjusted soft tissue envelope (the skin, subcutaneous tissue, and deep fascia). The surgery is often used in the setting of a staged procedure. For instance, depending on the individual’s existing features, we usually prefer to complete the maxillary impaction prior to doing a rhinoplasty, unless there is to be a long course of orthodontic treatment involved. This procedure should also be done before an upper lip lift is performed because the lip lift is a finishing touch based on balanced proportions of the facial skeleton. Otherwise, the rest of the surgical procedures follow the same long format surgical session within the cluster of procedures that make up FFS.
Reducing the height of the face significantly adds to the outcome of facial feminization because shortening the face creates a more feminine appearance. Typically men’s faces are longer or taller, more angular, with higher foreheads and hairlines than women. And women’s faces are typically rounder, shorter in height, and less angular particularly around the chin and jaw area — amongst other differences.
Other related procedures that may be recommended regarding the lower half of the face to enhance feminization may include upper lip lift surgery, chin recontouring, “Asian” V-Line surgery, or chin reduction surgery.
The mechanics of surgically reducing the length of the face are essentially identical as those used in the Le Fort Osteotomy – an orthognathic (jaw surgery) procedure. Known as the “workhorse” of jaw surgery, this procedure is typically used in non-FFS patients for the treatment of upper jaw malocclusion and cleft palate.
In FFS patients, the Le Fort Osteotomy I maxillary intrusion involves the cutting of the jaw in the area between the nose and teeth to shorten the maxillary bone. Then reattaching the bone to bring the upper half of the face more harmoniously in balance with the bottom half in order to shorten the length of the face to a more feminine aspect.Read more