Male-to-female body contouring is also known as feminizing body contouring or body feminization surgery. The goal of this surgery is to reshape the body for people who were assigned male at birth and desire a more feminine form. People seeking this may identify as transgender women, feminine-leaning, or be elsewhere on the spectrum of gender identity, but in all cases, they feel dysphoria regarding their bodies.
Many techniques are available to feminize the body and a surgeon who is well trained in the nuances of gender confirmation for trans women is best suited to achieve aesthetic results that will match the individual’s vision for their body.
Feminizing body contouring can improve self-esteem and confidence and help with the fit of feminine clothes, which are typically narrower at the waist and wider at the hips.
The anatomy of trans women is different from that of cis women. This makes it critical that you work with a surgeon with the appropriate knowledge base and the skill set required to give you the best possible results.
Dr. Ginger Xu is a Board-certified plastic surgeon who has helped many trans women achieve greater self-confidence through feminizing surgery. Dr. Xu received specialty training in aesthetic plastic surgery at Harvard where she also gained particular proficiency in surgery for transgender patients. She is now based in the San Francisco Bay area.
Dr. Xu embraces the responsibility of transforming her patient’s appearance to reflect their inner values and sense of self. She seeks to create natural results that give her patients the emotional relief and comfort of having physical features ultimately aligning with their unique identity.
MTF body contouring for gender affirmation is reshaping the body into a more feminine form to relieve gender dysphoria. In addition to facial feminization surgery and feminizing top surgery or mammaplasty, the areas of the body that typically can be transformed and feminized with body contouring include:
- Waist and hips – using liposuction and fat transfer (also known as fat grafting) to achieve a feminine hip-to-waist ratio
- Abdomen – using abdominoplasty or “tummy tuck” procedures
- Buttocks – using butt augmentation procedures
Compared with cis women, these areas are shaped differently in people assigned male at birth who pass through puberty. The influence of male hormones affects both bone structure and the location of fat deposits.
Although hormonal treatment and lifestyle changes can help to feminize the body, it may not be sufficient for some who feel they need more substantial feminization through surgery.
Feminizing body-contouring surgery uses standard plastic surgery techniques such as liposuction and fat grafting to redistribute fat on the body and create more feminine contours along the waist, abdomen, hips, and buttocks.
People who are good candidates for feminizing body contouring:
- Are in good physical health
- Are in good emotional health
- Have usually been on hormone therapy for at least one year
- Are close to healthy body weight – but have some excess fat deposits that can be harvested for transfer to other sites on the body
- Have stable body weight – changes in body weight after surgery can affect the results
- Are non-smokers or have quit smoking at least six weeks before surgery
- Have a clear and realistic vision and goal for their body
The feminine body shape varies widely, with descriptions ranging from pear-shaped to hourglass-shaped. There are also cultural and generational variations in perceived ideals. But there are certain characteristics of the female form that are relatively standard and can be manipulated for people assigned male at birth who would like more feminine body proportions.
Compared with men, the differences in body shape (read about differences in face shape here) of women tend to have:
- Higher body-fat percentage
- A narrow waist
- A wide pelvis
- More fat on the buttocks and hips
- Rounder buttocks that are fuller and project to create an S-shaped profile
- Waist-to-hip ratio ranging between 0.65 to 0.8
Some of these characteristics can be accentuated in people assigned male at birth by:
- Hormone therapy – this can help to move fat deposits to more feminine locations and increase the amount of breast tissue
- Lifestyle changes – exercise may increase the size and roundness of the buttocks
- Feminizing top surgery
- Body contouring
For feminizing body contouring, surgeons use a combination of techniques to:
- Decrease fat in typical masculine locations – lower torso, abdomen
- Increase the fat in typical feminine locations – buttocks, hips
- Create a feminine waist-to-hip ratio of around 0.7, if possible
- Contour the shape of the buttocks
A range of procedures is available to help you reach your goal of having a more feminine body. In general, feminizing body contouring (read about feminizing chest surgery here) involves the customized use of standard techniques:
- Fat Transfer
- Butt Augmentation – typically using fat transfer, which is also known as a Brazilian Butt Lift
- Tummy Tuck (Abdominoplasty) – for trans women with excess skin or sagging skin on the abdomen
These techniques are flexible and can be combined for sculpting and fine-tuning the contours of the body. For this reason, choosing a surgeon with a sense of artistry and specialized training in aesthetic plastic surgery for gender confirmation is essential. The best way to learn about which customized approach can help you achieve your goals is to make an appointment with Dr. Xu. During the consultation, Dr. Xu will listen to your goals, examine your body and recommend an approach that best suits your needs.
The aim of liposuction is to remove fat deposits from unwanted areas and/or change the overall body shape through contouring. For feminizing body contouring, liposuction removes fat found in typical areas for men. These include the abdomen, lower torso (love handles), lower back and the area below the buttocks. Your surgeon will also use liposuction to sculpt a more feminine waistline and begin the process of making the buttocks more shapely by removing typically male fat deposits around the buttocks.
The fat harvested during liposuction is then prepared for fat transfer (also known as fat grafting). Live fat cells are purified and unwanted blood and other tissues are removed. The fat cells can then be injected at multiple sites on the hips and buttocks to increase the size and feminize the contours of these areas. Fat transfer to the buttocks tends to result in more natural-looking results than buttock implants. The fat transfer will help to create buttocks and hips with more fullness and projection and, overall, a more feminine silhouette.
You and your surgeon must communicate and work together so you have a good understanding of the process that will give you the results you desire. The goal of a good surgeon should be to arm you with the knowledge you need to make the best decisions about your feminizing body contouring. Dr. Xu can help you understand how different procedures will affect the final look you will achieve.
It is important you have a realistic understanding of:
- How your body will look after surgery
- Limitations of the procedures
- Any short- and long-term effects – such as the potential need for more surgery
- Any possible complications
The choice of surgical techniques will depend on a number of factors including:
- The condition of your skin
- Your body type before surgery
- The location of fat deposits on your body
- How hormonal therapy, diet, and exercise have affected your body
Dr. Xu encourages open and honest communication about your body, your lifestyle and what you want for the future. Photos of your desired look can help her understand your needs. Your medical history is also important, including any information about medical conditions.
Things to discuss with Dr. Xu include:
- Why you want the surgery
- Your future lifestyle goals
- What appearance you hope to achieve
- What sort of body shape or form you would like
Dr. Xu understands the responsibility of transforming a person’s appearance to better reflect their gender identity and build self-esteem. Her top priority is understanding your vision and desires. During a consultation, Dr. Xu will explain:
- The different types of body contouring procedures
- Special considerations for trans women
- The need for further operations
- How facial feminization or feminizing top surgery can be combined with body contouring to enhance your femininity if you are interested in these procedures
- Potential complications
Once Dr. Xu has examined you, she will use her artistic sense to recommend an approach to your surgery that will suit your identity and vision for your body.
Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least six weeks prior to surgery.
You may need to get a blood test or undergo additional tests depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare include:
- Making sure you get enough sleep and rest
- Eating a healthy diet with adequate protein and nutrition
- Exercising or engaging in physical activity to strengthen your body
- Maintaining a positive state of mind
- Prioritizing your well-being and reducing stress levels
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.
Recovery will depend on which procedures you choose to have done. Initially, you should avoid any heavy lifting. After both liposuction and buttock fat grafting procedures, you must wear a compression garment to help shape the treated areas as they heal. For the first two weeks after buttock fat transfer, you should not sit on your buttocks to help the fat cells survive. You should continue to wear the compression garment and avoid strenuous exercise for up to six weeks.
After your surgery, you will feel moderate discomfort. The amount of pain you feel depends on a number of factors such as:
- Which body contouring procedures you had
- Whether you had other feminizing procedures at the same time (eg. feminizing top surgery)
- Your age
- Your health before the surgery
Prescription pain medications might be needed during the initial recovery period. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
If you have had a combination of surgeries, Dr. Xu can advise you of any additional recovery needs.
During the early stages of recovery, follow these tips to improve your results:
- Wear your compression garments as instructed – to decrease swelling and help shape the treated areas as they heal
- Take pain-relieving medication as instructed
- Use ice packs – to decrease swelling, bruising and pain
- Do not shower or get your incisions wet – use baby wipes until the dressings are removed and you get the go-ahead from your doctor to enter water
- Only carry or lift very light weights – especially in the early weeks after surgery
- Do not put pressure on your buttocks for at least two weeks, if you had fat transfer to the buttocks – to improve survival of the transferred fat cells
- Avoid strenuous exercise – ask your doctor when you can return to full activity
- Do not smoke or drink alcohol – both affect wound healing
- Do not expose and scars to the sun for at least six months – the sun can cause scars to become permanently darker and more noticeable
- Use scar treatments – ask Dr. Xu about skincare and scar treatments to use once your dressings have been removed
Usually, it is recommended you stop estrogen-based hormone therapy two weeks before surgery. This is to reduce the risk of potentially dangerous blood clots developing in your legs and lungs. But this is a personal choice that depends on how you weigh the potential risks against how you will be affected if you stop taking hormones. This recommendation is also based on the risk profile of cis women, which may not be the same for trans women.
Dr. Xu can further discuss with you the options and implications of remaining on hormone therapy during body contouring.
Yes, the results of feminizing body contouring are long-lasting. But to maintain the aesthetics of your feminine body contours as designed by your surgeon, you should maintain your body weight as your overall appearance will change with weight gain.
You should keep in mind that the appearance of your contoured body areas immediately after the procedure does not represent your final size or shape. Any areas where fat was injected will appear larger because of the combined effect of post-operative swelling and the volume of the new fat. Areas where fat was removed may also still be swollen from fluid left behind during the procedure. Once all the swelling has settled down (after six weeks), you will be able to see the final result. If you think you would like additional changes in some areas, there is the possibility of repeat procedures to give you the contours you desire.
Your risk for complications will depend on the specific technique used. Dr. Xu will make you aware of these before you have surgery. Each person must consider the risks associated with body contouring and accept the risks before surgery can commence.
Choosing a skilled aesthetic plastic surgeon is important because issues with body contouring can include:
- Irregular contours of the body part being treated
- Skin indentations – more likely if the liposuction cannula moves too close to the skin, especially in very thin people
- Skin burn – from overheating during ultrasound-assisted liposuction techniques
- Loose skin once liposuction has removed underlying fat
- The potential need for additional revision surgery to obtain your desired result
- Chronic pain
- Minor asymmetry
- Fat embolism during surgery – this is a very rare condition where droplets of fat escape into the bloodstream and have the potential to block blood vessels
- Fat reabsorption
- Fat necrosis
- An unevenness of the deposited fat in the buttocks
- The potential need for additional fat transfer to obtain your desired result
If you are planning liposuction or fat transfer combined with other surgical techniques (e.g. tummy tuck), Dr. Xu can advise you of any additional potential complications. The risk of some common complications from surgery can be decreased by following your doctor’s post-surgery instructions.
Combination surgeries are more complex and will cost more. The best way to understand the costs of surgery is to schedule a consultation with Dr. Xu. Dr. Xu is a Board-certified plastic surgeon with a high level of technical expertise and the vast experience in gender-affirming surgery necessary to help people achieve their aesthetic goals.
Many people are unaware of the range of techniques available to help them achieve their goals for a feminine body. Dr. Xu will listen to your vision for your body and discuss the surgical options that can best create the results you want, and that ultimately reflect your true inner self.