Most of the conversation around facial gender confirmation surgery does not take into account one critically important factor in facial features: the transgender patient’s racial or ethnic background. All too often it is simply assumed that the patient is Caucasian or “white”.
Dr. Deschamps-Braly has had extensive experience in facial feminization for people of all major ethnicities. In his work, he has discerned marked differences in facial feature proportions that need to be taken into consideration when undertaking any type of facial gender confirmation surgery.
1. Feminizing the Asian Face
Performing facial feminization surgery on a person of Asian ethnicity is very different than if the patient is Caucasian or African American. If you are of either Korean, Japanese or Chinese background, it’s critical to understand that what constitutes a typically “female” Asian face may be vastly different — aesthetically and structurally — than a typical European, African American, or even Polynesian face.
For this reason, it’s very important to ensure that your plastic and craniofacial surgeon understands these sometimes very subtle, and sometimes very dramatic ethnic differences and that they have had extensive experience in performing facial gender confirmation surgery on Asian faces.
First and foremost, the shape and size of the forehead and the brow should be the main focus of feminization for those of Asian background. Forehead feminization typically includes reduction and contouring to create a smoother, rounder, more feminine forehead.
Also, a feminizing brow lift and/or brow shaping procedure works to reduce the distinctly ‘heavy’ Asian male brow bossing and “opens up” the eyes to create a more feminine and rejuvenated appearance.
There are several key differences that we take into consideration when we feminize an Asian forehead. For example, a Chinese female forehead will typically project significantly less than a caucasian female. However, a Japanese forehead is even positioned ‘behind’ the eyeball, with no overhang above the eye.
The hairline position on the forehead will also be a little different depending on which Asian background you come from. When undertaking feminizing hairline lowering on Chinese and Koreans we make allowance for the fact that they have slightly higher hairlines to begin with, so we may not lower the hairline as significantly as we might for a person of European background.
When it comes to feminizing the lower face the most common procedure we recommend for those of Asian background is “Asian V-line” jaw reduction surgery. This is because Korean, Japanese, and Chinese males (and females) will typically have much heavier and wider-set jaws. Asian V-line surgery is very popular all throughout Asia for both men and women.
Feminization of the nose is also quite different for those of Asian ethnicity. In our experience, most Asian FFS patients will seek to in fact augment their nose to make it larger. This may seem counterintuitive in terms of feminization because typically we make the male nose smaller to feminize it. However, in some cases a feminizing rhinoplasty will include augmentation to ensure it the nose maintains a natural aesthetic balance with other newly feminized facial features.
2. Feminizing the African American Face.
The shape and size of the forehead and the brow should be the main focus of facial gender confirmation for those of African American heritage. Typically the forehead will project a little further outwards than that of a person of Asian descent, but not as far as that of a person of European descent.
Forehead feminization for African Americans typically includes forehead reduction and contouring to create a smoother, rounder, and more feminine shape. Also, a feminizing brow lift and/or brow shaping procedure is recommended to reduce the distinctly ‘heavy’ African American male brow bossing and to “open up” the eyes to create a more feminine appearance.
The hairline position on the forehead will also be different because African American women tend to have naturally higher hairlines than European women. Therefore, when we perform feminizing hairline lowering we make allowance for the fact that African American women have slightly higher hairlines to begin with, so we may not lower the hairline as significantly as we might in others. Ultimately, it all depends on your newly feminized facial features to ensure aesthetic balance and a natural looking result.
Typically, gender confirmation of the nose via feminizing rhinoplasty is recommended for most FFS patients. Often our African American transgender patients are seeking a narrower, more streamlined female nose. However, we also want to make sure that your nose will maintain a size and shape that is in harmony with your natural African American facial features, so that you still look like you.
Feminizing jaw surgery is also recommended because often the male African American jawline is quite broad and angular – often wider and squarer than what we see in other ethnicities. The jaw will often need to be narrowed and softened via feminizing jaw contouring or reshaping.