Every Colour Please

Elegance isn’t solely defined by what you wear. It’s how you carry yourself, how you speak, what you read. We have got to change our ethics and our personal financial system and our whole way of understanding the world. It has to be a world in which people live rather than die a sustainable world.

I didn’t want to be a fashion designer, and for a good half of my career I didn’t like it. I always wanted to do other things. It’s the attitude you bring to clothes that make the difference. Everything I do is a matter of heart, body and soul.

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Our New Office Space

We are excited to announce the opening of our new office space along with a simultaneous feature in the online and print editions of Wallpaper* magazine.

Located in the Tiffany Building overlooking Union Square in San Francisco’s downtown district, this modernist space was designed by Delugan Meissl Associated Architects, Vienna — designers of the Porsche Museum Stuttgart, Germany.

“The extraordinary precision, subdued beauty, and intimate ambiance reflect the approach of both architect and doctor: ‘We very consciously sought to avoid associations with a sterile clinical space,’ explains Delugan.”

– read more in Wallpaper* magazine 

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The Persian “Nose Job”

Rhinoplasty for Persian (Iranian) Noses

Rhinoplasty (“nose job” or nasal surgery) is very popular with Iranians, or Persians, with Iran having one of the highest rates of nasal surgery in the world. As a consequence, people with a Persian or Iranian background are very knowledgeable and savvy about the look they want to achieve with rhinoplasty. There are large Persian communities in the United States, including in Los Angeles, who actively seek to change the shape and size of their noses for various reasons.

Even though one of the most common plastic surgeries, a typical nose job is one of the most difficult of all plastic surgery procedures. Surgeons need technical excellence and a sense of artistry to understand how to design a new nose that will suit you and take into consideration your cultural background.

Dr. Deschamps-Braly has extensive experience in plastic surgery and rhinoplasty for people of all major ethnicities and has the flexibility to adapt his work to suit a range of needs for people with a Persian or Iranian background.

His training in three surgical disciplines enables him to combine surgical experience and artistry with an understanding of the differences in the proportions of facial features to provide a result that best suits his clients’ needs.

Reasons People with Persian Backgrounds may seek a Nose Job

For many years, plastic surgeons created the same shape nose for every client and often that nose was based on a Caucasian or “white” standard. However, a good surgeon should listen and understand your needs and design a nose in harmony with the rest of your face and, if you prefer, with aesthetics that suit your ethnic or cultural background.

People consider a “nose job” for a range of reasons such as:

  • Changing the size and shape of the nose to improve the appearance of the face
  • Correcting structural changes caused by accidents or injuries

Many people of Persian or Iranian background prefer their new nose to look totally natural–as if they haven’t even had a nose job procedure. They also have major concerns about the possibility of complications or the need for additional work or revision after rhinoplasty.

To ensure the best possible result, choose a surgeon with diverse experience who listens to your needs and has the flexibility to design a surgical approach to suit you and your face.

A Personalized Approach to Rhinoplasty for People with a Persian Background

Of course, everyone’s nose and face are different, but people with a Persian background who want rhinoplasty may have nasal features including:

  • a crooked nose
  • a drooping tip
  • a bulbous tip
  • a bump on the bridge of the nose (dorsal hump)
  • a nose that is too large, long or wide

No matter the size and shape of your nose, Dr. Deschamps-Braly will listen to your concerns and conduct a thorough physical examination of your nose and photograph you from several angles, including your profile and other features.

If your nose job is successful, your new nose should always be in harmony with the rest of your face. Some people with a Persian or Iranian background prefer their new noses to be in keeping with their cultural identity, while others do not. Once Dr. Deschamps-Braly understands the changes that you would like, he will use his vast experience and artistry to design a nose that he believes will give you the best possible result.

Want to know more about nasal surgery?

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Jaw Reduction Surgery, FFS, and Asymmetrical Jaws

Jaw Reduction Surgery, FFS, and Asymmetrical Jaws

Nothing in nature is truly symmetrical and all faces have a degree of asymmetry. But if your face has a more pronounced form of asymmetry, a range of approaches used during facial feminization surgery (FFS) can be helpful.

Many areas of the face can appear asymmetrical – from the hairline and forehead down to the chin and jaw. Asymmetry of the jaw and chin can especially impact the aesthetics of your face.

Depending on the nature of the asymmetries of your face, FFS can help to create a more harmonized and symmetrical look while also creating a natural, feminine face that reflects the inner you.

Dr. Deschamps-Braly has trained in three surgical specialties and has proven expertise in the artistry of facial feminization. He can advise an integrated approach and optimal timing for any surgeries needed to enhance the symmetry of your face while creating a naturally feminine look.

Options for correcting jaw asymmetry

Asymmetry of the jaw can affect both the aesthetics of your face and functions such as chewing. Physical asymmetries have a range of causes such as:

  • Genetics – the jaw shape you were born with
  • Developmental changes
  • Injuries and/or illness
  • Dental work

Depending on the nature of your facial structure, surgical options for jaw reshaping can include:

If jaw correction (orthognathic surgery) is needed, we suggest you have this surgery first and ensure your bone is healed before you begin FFS. In that way, jaw reduction and chin surgery can be used to complete the feminine look of your lower face. Also, a word of caution, if jaw reduction is done before orthognathic surgery, it may no longer be possible to make the precise cuts needed for your orthognathic or FFS procedure.

Jaw reduction during FFS can improve jawline asymmetries

Feminizing the jaw with jaw reduction typically involves removing bone to contour and shape the jaw so it is narrower and less square. The procedure refines jawline angles and improves the proportions of the face, including asymmetries.

Whether or not corrective jaw surgery is needed, jaw reduction will be able to improve your jawline to give you the best possible result.

Jaw reduction and contouring procedures include:

  • Reshaping of the back corner of the lower jaw bone so it appears rounder and less square
  • Shaving bone off the lower edge of the jaw to make the jawline narrower and more feminine
  • Shaving layers of bone off the sides of the jaw – the jaw bone (mandible) is structured like an oreo cookie, with a hard outer layer and a spongy middle layer followed by a hard inner layer. The entire cortical outer layer can be removed without damaging the structural integrity of the jaw
  • Reduction of chewing muscles to give a narrower appearance (Masseter muscle reduction – can be either a surgical or non-surgical procedure).

Any asymmetry of the chin will also contribute to the overall look of your lower face. As the chin and jaw are often treated together in FFS, surgery to feminize the chin (genioplasty/mentoplasty) can help to correct any chin asymmetry at the same time.

Want to know more?

References – for those who like to dig deeper

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The Art of the Indian Nose Job (Rhinoplasty)

Is a “Nose Job” really that different for people of Indian and Pakistani backgrounds?

Of the plastic surgery disciplines, rhinoplasty (“nose job” or nasal surgery) is one of the most difficult. To get the most pleasing result, your surgeon needs a sense of artistry to design a new nose that suits you and your cultural or ethnic background.

For many years, plastic surgeons have created the same shape nose for every client and often that nose was based on a Caucasian or “white” standard. But a good surgeon listens and understand the needs of their client and designs a nose in harmony with the face and, if requested, cultural background.

Dr. Deschamps-Braly has extensive experience in plastic surgery and rhinoplasty for people of all major ethnicities. His training in three surgical disciplines enables him to combine surgical experience and artistry with an understanding of the differences in the proportions of facial features to provide a result that best suits his clients’ needs.

This diversity of experience means Dr. Deschamps-Braly has the flexibility to adapt his work to suit a range of needs for people of Indian or Pakistani backgrounds.

Rhinoplasty and People of Indian and Pakistani backgrounds

In South-Asian countries (including India and Pakistan), rhinoplasty has become increasingly popular, so now we have a much better understanding of the shape of noses of people from different regions.

It is not surprising that such a large land area contains people from many different cultures. If you are originally from South Asia or your family’s background is from that part of the world, your surgeon must be aware of the potential differences in your facial proportions and listen to your needs as you consider rhinoplasty.

People consider “nose jobs” for a range of reasons including:

  • Correcting structural changes caused by accidents or injuries
  • Changing the size and shape of the nose to improve the appearance of the face

No matter the reason, many people with Indian or Pakistani backgrounds want to have a nose job that results in a nose that sits in harmony with the rest of their face, while also maintaining their cultural identity.

A personalized approach to rhinoplasty for people of Indian and Pakistani backgrounds

The shape of South Asian noses is an active research area in the medical literature. Research shows there is not one single typical South Asian nose, per se, although there are some regional characteristics that may affect the outcome of your nose job.

The noses of people with North Indian and Pakistani backgrounds are more likely to have features in common with people with Persian or Middle Eastern backgrounds including:

  • A drooping tip that can make the nose appear longer
  • A bump on the bridge of the nose (dorsal hump)
  • Wide bones in the upper nose

The noses of people from South India are more likely to have features including:

  • A less defined tip of the nose
  • A short nose bridge
  • A wide base of the nose
  • Thicker skin over the nose

No matter the physical characteristics of your nose and face, Dr. Deschamps-Braly will listen to your concerns and conduct a thorough physical examination of your nose and photograph you from several angles, including your profile and other features. Thicker skin can tend to mask the underlying surgical changes of rhinoplasty and, in this case, he can advise you if a different approach to your procedure is needed.

Once Dr. Deschamps-Braly fully understands both your facial features and the changes you would like, he will use his vast experience and artistry to design a nose that he believes will give you the best possible result.

Want to know more about nose job surgery?

References – for those who like to dig deeper

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Facial Feminization and Jaw Surgery: Which Comes First?

Facial Feminization and Jaw Surgery: Which Comes First?

Many people – including those considering facial feminization – need orthognathic surgery (corrective jaw surgery) to correct functional and aesthetic issues with their teeth, chewing and/or jaw structure. These include:

  • Underbite – the lower teeth overlap the upper teeth and the chin appears large because the lower jaw protrudes
  • Overbite – the upper teeth overlap the lower teeth forcing the lower jaw backward towards the ears causing small or “invisible” chin
  • Crossbite – mismatched jaw sizes or crooked jaw and alignment of the teeth
  • Open bite – jaws cause the teeth to protrude and cause an open space between upper and lower jaw even when the mouth is closed
  • Long face syndrome – or vertical maxillary excess, can result in an excessively elongated face and a “gummy smile” (Read more about long face syndrome and FFS here.)
  • Disproportion in the position of the upper jaw (maxilla) and teeth in relation to the upper lip – or labio-dental disproportion, is another type of vertical maxillary position problem

Regardless of the length of your face, labio-dental disproportion is the main feature used to determine the position of the upper jaw during orthognathic surgery. In the context of facial feminization surgery (FFS), the maxilla must be positioned in anticipation of any future lip shortening and must be integrated into the entire plan. A consultation for FFS should precede orthognathic surgery and, to ensure a harmonious result, it is preferable if the same surgeon performs both procedures.

Any jaw surgery will impact the overall aesthetics of your face. The diversity of surgical procedures needed for combined corrective jaw surgery and FFS requires an element of artistry and timing combined with the techniques of plastic surgery (soft tissues), craniofacial surgery (the underlying facial skeleton), and orthognathic surgery.

Consulting with a surgeon trained in all three specialties, such as Dr. Deschamps-Braly, has the advantage of facilitating an integrated approach and optimal timing for any surgeries needed and is more likely to give you the best possible aesthetic and functional result.

Phasing of Corrective Jaw Surgery with Facial Feminization

One of the most frequently asked questions we receive from people needing corrective jaw surgery and considering FFS is: Which comes first, facial feminization or corrective jaw surgery for my bite?

In general, we suggest FFS procedures are performed at least six months after corrective jaw procedures.

Depending on the corrective surgery needed, it might not be physically possible to perform FFS at the same time as corrective jaw surgery. For example:

An additional consideration is that feminizing procedures such as lip lifts and jaw contouring are better used to improve your feminine appearance after your bite or other lower face anatomical characteristics have been corrected.

Phasing of Facial Feminization surgery

Once your corrective jaw surgery is completed, we typically recommend FFS be considered as a cluster of procedures that can be completed as:

  • A single long-format session to feminize the entire face
  • Two phases of surgery on related parts – such as the upper face (forehead and nose) and lower face (jaw and chin) – can be performed days or even years apart

In either case, we typically phase our FFS procedures in a “top-down” approach because in many people the forehead and nose are the most prominent features of the face.

Forehead and Nose

Successful FFS creates a nose with feminine size and shape and an appropriate transition between the forehead and nose.

Simultaneous surgery on the forehead and nose enables the surgeon to have better control over the angle between the forehead and nose. Depending on your facial characteristics, age and ethnicity, the procedures involved can include:

Jaw and Chin

While corrective jaw surgery will enhance the general function and aesthetics of your jaw and bite, in some cases it might also begin to contribute to a more feminine appearance. This is because the chin and jaw represent most of the area of the lower face and contribute strongly to a more masculine appearance.

In general, we recommend FFS for the jaw and chin are performed together so the contour of the jaw after surgery matches the chin.

Depending on the structure of your face after your corrective jaw surgery, feminizing the lower part of your face might require feminizing jaw surgery to create:

  • a smaller, narrower and less square jaw
  • a thinner, lower jawbone (mandible)
  • a shorter and less angular chin

Feminizing the jaw (called jaw contouring, jaw shaping or jaw reduction) typically involves removing bone to contour and shape the jaw so it is narrower and less square. As mentioned above, if performed after your corrective jaw surgery, jaw contouring will be able to improve your jawline to give you the best possible feminine appearance.

Jaw contouring procedures include:

reshaping of the back corner of the lower jaw bone so it appears rounder and less square
shaving bone off the lower edge of the jaw to make the jawline narrower and more feminine
reduction of chewing muscles to give a narrower appearance (Masseter muscle reduction – can be either a surgical or non-surgical procedure).

To decrease the risk of complications, corrective lower jaw surgeries and/or removal of wisdom teeth should be completed six months before jaw contouring.

Surgery to feminize the chin (genioplasty/mentoplasty) usually involves removing bone to decrease the height and width of the masculine chin. The shape of your chin might have changed after any corrective jaw surgery, but if you have a receding chin, the bone is repositioned forwards so as to correct the profile of the face.

Want to know more?

References – for those who like to dig deeper

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Jaw Contouring for FFS and Wisdom Teeth

JAW CONTOURING FOR FACIAL FEMINIZATION SURGERY AND EXTRACTION OF WISDOM TEETH

If you are considering facial feminization surgery (FFS) and you haven’t had your wisdom teeth removed, we recommend an analysis of the state of your teeth and an integrated approach to any surgeries required.

Removing your wisdom teeth – or any other corrective surgery to your jaw – can impact the overall aesthetics of your face and is best considered in the context of any future FFS.

Consulting with plastic surgeons trained in multiple surgical specialties and with proven expertise in the artistry of facial feminization, such as Dr. Deschamps-Braly, has the advantage of facilitating an integrated approach and optimal timing for any surgeries needed for your oral health and aesthetic surgery and is more likely to give you the best possible result.

THE CASE FOR REMOVING WISDOM TEETH BEFORE FFS

Most people have 32 permanent adult teeth, with four wisdom teeth emerging between 17 years of age and the early 20s. Typically, one wisdom tooth is located at the very back of each row of teeth on each side of the upper and lower jaw.

In many people, the wisdom teeth become impacted – meaning they will emerge and collide with the other molars. There are different degrees of impaction, but in general it can create problems including:

  • Difficulty in cleaning
  • Infection & cysts
  • Crowding of the teeth that force the positioning of other teeth to become irregular, especially at the front
  • Damage and pressure on neighboring teeth
  • Wisdom teeth that cannot emerge and remain embedded in the jaw bone

Some people don’t have their wisdom teeth removed as young adults because the teeth wouldn’t cause problems. But as you age, the roots of wisdom teeth become longer and the jaw bone becomes denser which means problems become more likely.

Problems with wisdom teeth can occur at any time but are more likely to occur in your 30s. In addition, the removal of wisdom teeth is more likely to cause complications when you are older, as the roots have grown further into the bone.

For all these reasons, if you are considering FFS, we recommend thinking about removing your wisdom teeth before undergoing a jaw reduction surgery. If problems with the teeth emerge after FFS, extracting the wisdom teeth may affect any previous jaw surgery and affect the overall aesthetics of the feminine face you worked so hard to achieve.

ADVANTAGES OF HAVING FFS AFTER EXTRACTION OF WISDOM TEETH

In terms of the aesthetics of the face, some people find removing their wisdom teeth makes their jaw appear narrower and their facial features have a more feminine appearance. While some might consider this a benefit, especially in their youth, others have reported their face appeared gaunt and looked older.

Your FFS surgery is best designed to correct and perfect your look after you have had any other structural surgeries to your jaw such as extraction of wisdom teeth or corrective jaw surgery (orthognathic surgery).

EXTRACTION OF WISDOM TEETH BEFORE FFS CAN HAVE THE FOLLOWING BENEFITS:

  • If you are unhappy with the way your face looks once wisdom teeth have been removed (gaunt cheeks, aging, etc.), you can discuss the potential for improving the aesthetics of your face during FFS.
  • Without wisdom teeth, the surgeon can more easily design any jaw bone cuts required to give you the best result with FFS – the presence of wisdom teeth can affect Dr. Deschamps-Braly ability to cut your jaw bone.
  • Any previous jaw contouring for FFS might affect the outcomes of wisdom tooth extraction, especially if you are older than your early 20s and the roots of your wisdom teeth have grown further into your bone.
  • If you have more serious complications after tooth extraction, you might need further surgeries that might affect the aesthetics of your face.
  • Any asymmetries in your jawline after wisdom teeth have been removed can potentially be corrected by FFS.

DISADVANTAGES OF REMOVING WISDOM TEETH AFTER FFS

Like any medical procedure, removing wisdom teeth can have complications, especially if you have a severe impaction requiring a more complex surgical procedure.

Depending on the position of your wisdom teeth and your age, extraction can affect your jawbones and cheeks, especially if you are older than your early 20s. Anything that affects your upper jaw, lower jaw or cheeks could impact the aesthetics of the look you have achieved with previous facial reconstructive surgery.

Even if there are no complications, some people just don’t like the way their face looks after their wisdom teeth have been removed. Correcting this might require more surgical procedures.

POTENTIAL CONSEQUENCES OF WISDOM TOOTH REMOVAL ON FFS SURGERY

Extraction of wisdom teeth can cause short-term complications that are less likely to affect previous FFS, including:

  • Temporary swelling of the cheeks and jaw in the days after the procedure
  • Infection – can be treated with medication or draining and cleaning of the area
  • Dry sockets – caused by the loss of the blood clot in the empty tooth socket

Other complications that could impact the aesthetics achieved with previous FFS surgery include:

  • Damage to nearby teeth
  • Damage to the sensory nerve in the lower jaw – usually temporary tingling or numbness in the lower lip, chin, or tongue
  • Lower jaw bone breaks
  • Sinus communication – removal of upper teeth can create an opening between your mouth and sinuses

Want to know more?

References – for those who like to dig deeper

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Rhinoplasty and Facial Feminization: Which Comes First?

Like many people, transfeminine individuals often focus on their nose and might wonder if nose surgery (rhinoplasty) alone might be enough to give them the feminine appearance they are seeking.

It’s natural to want fast results so you can present your feminine self to the world as soon as possible. The masculine nose tends to be larger than that of a cisgender woman of similar size, so you might be tempted to rush into only having rhinoplasty or having rhinoplasty before facial feminization surgery (FFS). But a smaller feminine nose on a face that remains mostly masculine in appearance may not give you the natural feminine effect you were hoping for.

If you are considering rhinoplasty and FFS (facial feminization surgery) you will usually want to have both done at the same time

To give you the most natural result, your nose should be in harmony with your whole face. The question is: which face?

  • Do you want your nose to look more feminine in the masculine face you have before FFS?
  • Or, do you want your nose to be in harmony with the feminine face you will achieve after FFS?

Creating a feminine nose before FFS might make it difficult for your surgeon to create both a feminine nose and an appropriate transition between your forehead and nose. If you think you might have FFS in the future, having rhinoplasty first might also mean you will need a second rhinoplasty to ensure your nose harmonizes with your new feminine face.

To give the best results, we recommend you consider an integrated FFS plan before having rhinoplasty. That way, your new nose can be designed to harmonize with the aesthetics of your future feminine face.

We recommend rhinoplasty and FFS as either:

  • A single long-format session to feminize the entire face, or,
  • Two phases of surgery to harmonize related areas such as the upper face (forehead and nose) and lower face (chin and jaw) – these can be performed days, weeks, or even years apart.

Benefits of rhinoplasty performed at the same time as FFS

An essential element of the success of FFS is a nose that has a feminine size and shape and is in harmony with your final feminine face, with an appropriate aesthetic transition between the forehead and nose.

Simultaneous surgery on the forehead and nose enables the surgeon to have better control over the angle between the forehead and nose. Lip-lift techniques can also be performed at the same time to normalize the ratio of the length of your upper lip and the amount of tooth show we expect in a feminine profile.

The results of simultaneous upper face FFS speak for themselves. In a study of 200 people who had rhinoplasty in combination with forehead reconstruction and/or lip-lifting, the surgeon was able to achieve a good transition between forehead and nose and most clients were highly satisfied with the femininity of their nose after the surgery.

Disadvantages of rhinoplasty on its own, or before forehead feminization

Of course, FFS needs to take into consideration your individual situation and the features of your face.

The timing of the FFS procedures will impact your results. While up-front rhinoplasty might seem like a quick fix, there are some disadvantages:

  • Your brow might look more prominent if you have rhinoplasty alone or before FFS.
  • You might need additional rhinoplasty during a future forehead feminization procedure.
  • Your first rhinoplasty will not be performed in the context of a full FFS design – it may not give the best result for your future face.

We recommend a consultation to fully understand all your options and to consider an overall FFS plan that will give you the best and most natural results.

Want to know more?

References – for those who like to dig deeper

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5 Features That Can Make Your Face Look Masculine

Have you ever thought: “How can I make my face look more feminine?”

It is quite common for women to feel that specific facial features may make their face appear too masculine. But when you consider the options for making your face look more feminine, it is important to consider all of your facial features and how they relate to each other.

There is no one-size-fits-all approach to facial feminization. Your surgeon should consider you as a person – not just one feature of your face. The proportions of your whole face, your height, and even your ethnic background can all affect the options available to give you the most natural result. Your surgeon’s skill lies in understanding this and working to give you a natural feminine beauty so your real, feminine self can shine.

1. The masculine hairline, forehead, and brow

The forehead makes up 35% to 40% of the surface area of your face so it can dominate how masculine your face looks. Given the forehead is framed by your hairline and brow, it’s easy to understand why the top half of your face contributes strongly to a more masculine or feminine appearance.

Typical masculine characteristics of the top half of the face:

  • The hairline sits further back on the skull and makes the forehead appear higher– a receding hairline further enhances this effect.
  • The forehead frontal bones protrude more and create a sense of deeper set eyes – female foreheads are more rounded or convex.
  • The brow appears lower, heavier and more prominent.

Surgical treatment options:

A skilled surgeon will understand that it’s important to match the feminine appearance of your hairline, forehead, and brow with people of your ethnic background while also keeping this area of your face looking natural and in proportion with your whole face. The height and the size of the midface also impact the ideal size of the forehead to give a more feminine look.

Treatment options to make your hairline, forehead, and brow more feminine include:

2. The masculine nose

The shape and size of the nose is highly variable. The characteristics of the nose can seem subtle but are important to giving either a more masculine or feminine appearance. This makes the surgery required to change the nose (rhinoplasty) an artistic and delicate endeavor. It is important to maintain balance and harmony between the forehead and nose, and the nose may sometimes be made more masculine looking if the forehead is treated in isolation.

Noses with more masculine characteristics tend to have:

  • a larger size
  • more angular dimensions
  • a bridge that is wider and straighter
  • a nasal tip that does not tend to point upwards

Surgical treatment options:

Surgically changing the size and shape of the nose to appear more feminine is best performed while considering changes to the hairline, forehead, and brow. This will ensure the face is aesthetically balanced and for a more natural result.
Read more about the delicate process of feminizing rhinoplasty (nasal reduction and reshaping).

3. Masculine cheeks and lips

The shape and size of the lips and cheeks tend to be different in women and men. As with other facial features, the whole face needs to be taken into account when planning the best result for facial femininization surgery.

Men’s lips tend to be:

  • thinner or narrower
  • flatter or less plump
  • further from the base of the nose

Men’s cheeks tend to be less full or plump and the cheekbones tend to be lower on the face and less prominent.

Surgical treatment options:

The treatment options for lips and cheeks are varied and depend on your age, facial features, and your desired outcome. The options might include augmentation or reduction or a combination of both:

4. The masculine chin and jaw

The chin and jaw represent most of the area of the lower face and contribute strongly to a more masculine appearance. In men, both these structures are generally larger in size, with typical characteristics including:

  • a taller, angular and squarer chin
  • a larger and wider jaw
  • a thicker lower jawbone (mandible)

Surgical treatment options:

In general, the jaw and chin are best treated together so the contour of the jaw after surgery matches the chin.

Surgery to feminize the chin (genioplasty/mentoplasty) usually involves removing bone to decrease the height and width. In contrast, for people with receding chins (2% of individuals), the bone is repositioned downwards to leave room for new bone growth that will lengthen the chin.

Like the chin, the feminization of the jaw typically involves removing bone to contour and shape the jaw so it is narrower and less square.

5. Adam’s apple

In most men and some women, the thyroid cartilage on the throat is larger and projects forward to form the small bump known as the Adam’s apple. The thyroid cartilage is not usually noticeable in women and this makes the Adam’s apple one of the most prominent features creating a masculine appearance.

Surgical treatment options:

The choice of surgical treatment to reduce the size of the Adam’s apple can have a marked effect on the final result. Dr. Deschamps-Braly uses advanced techniques that reduce the risk of the thyroid cartilage growing back. His techniques also avoid creating any noticeable scar on top of the voice box in the middle of the throat. Other techniques can leave a noticeable scar on top of the voice box on the front of the neck. As an added complication, if the scar over the voice box adheres to the underlying cartilage as it heals, it can move during speech and become even more noticeable.

Many women who have masculine facial features have problems with sexual arousal and fertility, and you can buy flibanserin to solve these problems.

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References – for those who like to dig deeper:

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Shock Hair Loss After Scalp Surgery

What is Shock Hair Loss? Is it Permanent?

By Dr. Sara Wasserbauer, Surgical Hair Restoration Specialist

Hair loss after surgery often termed “shock loss”, is the loss of hair after surgery. Procedures such as follicular unit hair restoration, hairline lowering (AKA scalp advancement), or indeed any significant scalp surgery (especially those requiring general anesthesia) can cause this temporary shedding of hair. This condition occurs in about 10-15% of patients, typically within 2 to 6 weeks of surgery and significantly resolves 3-6 months after the surgery (although full regrowth can take up to a year).

The areas potentially affected by shock hair loss can be in the area of the incision – or in the case of direct hair restoration – in the area where the new hair grafts are placed. Shedding around the incision is usually limited to a band approximately an inch or less wide, on either side. Shedding in the area of restorated grafts is more diffuse and typically not all the hairs are shed.

Generalized “whole head” shedding is more commonly associated with significant surgeries requiring general anesthesia, and is less common with scalp surgery by itself. Any of these “sheds” are likely caused by a combination of temporary blood supply disruption during surgery, local tissue inflammation, and the intrinsic “shed-rest-regrowth” cycle of the hair itself.

It is usually difficult to tease out which factor causes the most shedding in each individual patient’s situation, but not all patients experience this “shock loss,” so no definitive prevention or treatment exists, although many helpful options are available.

Is shock hair loss permanent?

Shock loss is a temporary condition, but it can cause a significant amount of psychological stress. Patients commonly relate their frustration with the paradox that they are attempting to add hair rather than lose hair. Usually, scalp surgery patients are trying to remedy hair loss associated with aging, pattern hair loss conditions (aka androgenetic alopecia), or they may be undergoing the cluster of procedures that comprise facial feminization surgery. Thankfully, shock hair loss is almost always temporary and the hair eventually grows back, although regrowth may take from several months to a year after surgery.

A good basic understanding of shock hair loss can help to calm any stress or fear around this condition when considering hairline lowering–or other types of scalp surgery. Shock hair loss should not be confused with alopecia areata, which is an unrelated autoimmune disease that also results in hair loss and is medically treatable.

Why does shock hair loss happen with scalp surgery or FFS?

The exact reason why shock hair loss happens is not scientifically known but it is safe to deduce that it is a result of a combination of factors. With FFS surgery, the surgical trauma to the scalp, stress from the surgical incision, along with the pulling on the scalp and the injections that go along with surgery, are sufficient to trigger the hair’s natural shedding and regrowth cycle. Regardless of the cause, it is a reasonable precaution to choose a surgeon who has significant experience with scalp surgery and is adept at suturing the scalp in such a way as to reduce trauma.

How long will it take for my hair to grow back?

In nearly all cases of shock hair loss, the loss is temporary and will eventually start to grow back. Most patients report initial regrowth at between 3-6 months. There is always a lag as the hair re-enters the growth phase so regrowth may appear patchy at first (because the hair follicles often grow back at varying rates). It may take 12-18 months to mature into the previously normal hair thickness and texture, particularly if a patient is choosing to wear their hair long. Patience with the healing process is the key.

How can shock hair loss be prevented?

The mechanism of shock hair loss is not well understood and therefore it is difficult to predict and prevent. There is some data that both Rogaine (Minoxidil) and Finasteride started one month before surgery and continued for a year afterward can decrease shedding from shock loss as well as speed recovery and hair regrowth. Low-Level Laser Therapy (LLLT), also known as Photobiomodulation, has benefits for healing and regrowth as well.

Patients should ensure that your surgeon has plenty of skill and experience with scalp surgery to reduce the other factors that may contribute to shock hair loss. Before your surgery, ask your surgeon to show you case studies of surgeries they have performed. Be sure that the results obtained include data from within the 2 to 6-week postoperative window.

And most importantly, make sure that all candidate surgeons are board-certified.

Want to know more about hairline surgery? Read our popular article on hairlines and scalp surgery: Demystifying 3 Common Myths About Feminine Hairlines also by Dr. Sara Wasserbauer, a Surgical Hair Restoration Specialist.

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