Key Elements of Facial Feminization for Women with Masculine-Looking Faces

Facial feminization surgery is typically associated with gender confirmation surgery for transgender individuals. However, the same procedures may also help non-transgender women who feel they have masculine faces and want to appear more feminine.

If you are a cisgender female, you may be an ideal candidate for facial feminization surgery if you feel that your face is too masculine-looking in some way. The most common complaints that we hear from women who are ideal candidates for this surgery are their…

• Forehead is too high or too “bold”
• Eyes seem “dark” or too “deeply set”
• Brow is too prominent or “heavy”
• Jaw is too wide and chin is angular or too sharp

You may need just the one procedure, but most often we will use a combination of procedures depending on the area of the face, your desired results, and expectation of outcomes.

For example, if you have an overly heavy brow and excessively prominent forehead, you may also need a rhinoplasty (nasal surgery) because the forehead and the nose are physically and aesthetically linked. If you change one, the other will usually need to be changed to ensure aesthetic harmony and facial feature balance.

Which surgical procedures are typically included in facial feminization for non-transgender women?

The ultimate answer to which procedures will be right for you will be revealed during your first surgical consultation. Ultimately, it depends on your facial structure and the areas that you consider as too masculine. Your surgeon will likely recommend a combination of plastic and craniofacial surgical procedures. Common feminization procedures include:
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• Forehead reduction and contouring
• Scalp advancement
• Brow lift (browplasty)
• Rhinoplasty (nose surgery)
• Lip reshaping (upper lip lift, lip filling, corners-of-mouth lift)
• Cheek enhancement
• Chin recontouring (genioplasty)
• Jaw contouring and tapering
• Masseter muscle reduction
• Adam’s apple reduction
• Earlobe reduction

Forehead Reduction and Contouring

Forehead contouring and reduction is one of the most common feminization surgeries that are requested by non-transgender women. The procedure results in a significant feminization of the face while keeping the features looking natural and in proportion.
Read more about feminizing forehead reduction.

Brow Lift (Browplasty)

If you have a low-set brow, a brow lift may be recommended to accompany forehead reduction surgery. The brow lift raises the eyebrows into a higher, more feminine position on the face and also works to eliminate common signs of aging such as forehead wrinkles, crow’s feet, and horizontal or vertical lines such as frown lines and furrows between the eyebrows and around the eye.
Read more about brow lifts here.

Rhinoplasty (Nose Surgery)

If you are reshaping your forehead and brow to appear more feminine, a rhinoplasty (nose surgery) may also be recommended to achieve an overall aesthetically beautiful result. More an art than a science, a rhinoplasty is best left to board-certified surgeons with extensive experience in plastic surgery and preferably members of The Rhinoplasty Society, whom have been vetted by the society and have exceptional experience in rhinoplasty. Along with keen surgical skills, your surgeon must also possess an artistic eye to visualize how your reshaped nose will appear in harmony with your other facial features.
Read more about rhinoplasty for feminization here.

Lip Reshaping

The lips are one of the main features of a feminine face. Depending on your existing features and age, you may consider either a lip lift (upper lip reduction), lip augmentation (lip filling), or a corner-mouth lift:

• An upper lip lift shortens the vertical length of the upper lip and improves the visibility of upper teeth, creating a more feminine and youthful appearance.
• Lip augmentation fills or plumps the lips so that they appear fuller, younger and more feminine.
• A corner-mouth lift lifts the corners of your mouth but does not affect lip movement.
  Read more about lip enhancement procedures here.

Cheek Enhancement via Augmentation

The cheeks are a significant aspect of the feminine face. Cheek enhancement via augmentation works to give the cheeks a rounder and smoother feminine appearance.

Cheek augmentation includes the use of fat transfer or fat grafts to create a fuller more feminine cheek shape (with fat taken from another part of your body).
Read more about cheek augmentation surgery here.

Chin Recontouring (Genioplasty / Mentoplasty)

One more of the most requested facial feminization surgeries for cisgender women is chin re-contouring (genioplasty) to alter the shape of the chin by reducing, reshaping, or augmenting (if necessary). Chin surgery may also involve the elimination of asymmetries (lop-sided features) to ensure a more symmetrical appearance. No chin implants are used in chin recontouring other than small screws to hold the bones in their proper position.
Read more about feminizing chin surgery here.

Jaw Contouring (Reshaping and Tapering)

Some cisgender women possess an unusually wide or angular jaw that makes them appear masculine. Jaw contouring works to make the jaw appear rounder and smoother resulting in a more feminine profile. The bone of the jaw is shaved along its lower edge, and chewing muscles may also be reduced to make the jaw more slender. Jaw contouring is also ideal for women who may have an unbalanced face and wish to have their features appear more symmetrical.
Read more about feminizing jaw contouring here.

Masseter Muscle Reduction

The Masseter muscle is located in the rear part of the cheek, it runs from the cheekbone down into the lower jaw on each side of the face. The Masseter connects the lower jawbone to the cheekbone and is one of the “muscles of mastication” because it works to raise and close the jaw while chewing.

In some people, this muscle becomes enlarged due to clenching or grinding of the teeth (bruxism), or from excessive chewing of gum causing jaw pains and headaches. Enlargement of the Masseter can also cause increased muscle bulk creating an overly-square jawline that can make a female face appear masculine.

Depending on your facial features and expected outcomes, your surgeon will recommend either a surgical or non-surgical treatment:
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• Non-Surgical Reduction Of The Masseter: Injectable muscle relaxing agents such as Botox® or Dysport® work extremely well to reduce the Masseter muscle and also decrease habitual jaw clenching or teeth grinding (Bruxism).
  Read more about reducing the Masseter muscle via Botox® or Dysport® injections.
• Surgical Reduction Of The Masseter Muscle: Surgery to access the Masseter is performed through incisions on the inside of the mouth, between the gum and cheek, leaving no visible scarring. Your surgeon will then shape and reduce the bone and Masseter muscle to achieve a well-rounded, smoother and more streamlined jawline contour.
  Read more about the surgical reduction of the Masseter muscle here.

Adam’s apple reduction

Some women are born with a naturally prominent Adam’s apple. Reducing the size of an Adam’s apple with a tracheal shave (AKA Laryngochondroplasty) is often one of the most straightforward feminization procedures. Shaving the thyroid cartilage reduces the outward prominence of the Adam’s apple and gives the throat a smoother more feminine appearance.

It is critical that the surgery is performed correctly because otherwise the cartilage may grow back and the procedure will need to be repeated. Furthermore, a high level of surgical skill is necessary during the procedure as the voice may be injured if your surgeon is not skilled at identifying the positioning of the vocal cords and protecting them during surgery.
Read more about Adam’s apple reduction (tracheal shave) here.

Earlobe Reduction Surgery

The ears are a significant facial feature that contributes to gender expression and age. Older patients are typical candidates for earlobe reduction surgery because the cartilage of the ears continues to grow throughout as we age. Gravity also causes the earlobes to sag, stretch, and enlarge, creating pendulous earlobes — which may not look aesthetically pleasing or feminine.

Feminizing the earlobes can be achieved by reshaping and reducing a larger or longer ear. The earlobe is trimmed and reshaped as desired for a more feminine look.

Ultimately, the single most crucial step in feminizing an ear is crafting a smooth and natural inferior lobe border. Dr. Deschamps-Braly is known for his aesthetic finesse and expertise in achieving consistent and aesthetically beautiful outcomes.
Read more about earlobe reduction surgery here.

Forehead reduction surgery (AKA forehead reshaping and contouring) is a craniofacial surgical procedure typically performed for aesthetic purposes and as a part of facial feminization surgery. The procedure requires the highly advanced surgical skill set of a cross-trained surgeon who is skilled in both general plastic surgery AND craniofacial surgery. A high level of skill is needed because the surgeon will not only be altering the soft tissues of the face (plastic surgery) but also the skeletal (bony) structure of the skull.

How Does Forehead Reduction or Contouring Enhance Your Appearance?

The forehead makes up almost 35-40% of the entire facial surface. It dominates and aesthetically affects all other facial features so if it is out of balance in some way it will affect your whole facial shape. For example, you may feel that your forehead and brow area are too broad or too prominent creating an ‘overhanging’ effect over the eyes. Your forehead may also be asymmetrical in shape, or appear too masculine or too feminine for your specific gender expression, or out of balance with your other facial features in some way.

For trans and cisgender women, forehead reduction improves the facial profile by creating a more feminine and harmonious interplay of how the forehead aesthetically relates to other facial features. The procedure shapes the forehead–and also the delicate bones around the eye socket–to minimize the bony ridge of an overly-prominent forehead. Reduction and reshaping of the brow also work to “open up” the eyes, helping to transform and feminize the upper facial area.

For trans and cisgender men, the challenge may be that the forehead is not masculine enough in appearance. In such cases, depending on your existing facial features and the desired result, we may instead recommend forehead lengthening and augmentation.

Are You An Ideal Candidate For Forehead Reduction?

You are an ideal candidate for forehead reduction or reshaping if you are a relatively healthy adult who feels that your forehead and brow is in some way detracting from your appearance.

Our most common forehead reduction patients are trans women as a part of their facial feminization surgery or cisgender women who feel that their brow and forehead is too prominent or ‘masculine-looking.’ However, we may also perform forehead reshaping and contouring on trans or cisgender men who feel that their forehead is too ‘feminine’ or oddly-shaped in some way.

How Is Forehead Contouring Surgery Performed?

As with most craniofacial procedures, forehead reduction is performed under a general anesthetic. Your surgeon will begin by accessing the forehead by making an incision right on, or right inside, the hairline–depending on if your hairline position also needs to be lowered (see: Feminizing Hairline Lowering AKA Scalp Advancement).

The exact procedure will vary slightly from patient to patient but most often the brow bone is osteotomized (the bone is cut to shorten or lengthen it or to change its alignment), and then reconstructed to reduce the size of the forehead. The orbital bones (around the eyes) are also shaped to modify brow shape.

The frontal bone (between the eyebrows) is then removed, shaped and contoured, and reattached in such a way that it does not interfere with the underlying sinus cavity structures.

Forehead contouring is often undertaken in conjunction with a brow lift or hairline lowering because of the location of the surgery and to ensure a harmonious and aesthetically-pleasing result.

Are Steel or Titanium Wires Used for Forehead Reshaping?

In the past, we have used titanium plates and screws for many different applications in craniomaxillofacial surgery. In fact, our surgical practice had used them since the 1980’s when they were first introduced and became commercially available. However, we don’t find them ideal for forehead surgery. Today, we prefer to use a non-magnetic stainless steel wire for securing the bones during forehead contouring. We use them because they are lower profile than are titanium plates, and we achieve a more secure fixation based on being able to put compression on the healing bone. These wires do not create unwanted delays in airport security or issues during MRI imaging.

If your forehead needs augmenting or filling out of a concavity, the doctor will use a biologically inert synthetic material to create a more rounded feminine shape.

Will There Be Visible Scars?

As with any surgery, scars may occur, however, because the primary incision is made at (or inside) the hairline, any scarring is minimal and barely visible. When creating an incision, we are very careful with placement to minimize scarring. And when forehead reduction is performed in conjunction with hairline lowering the scars are virtually invisible.

What Is The Price for Forehead Reduction Surgery?

The price of forehead reduction surgery will vary depending on your circumstances and the degree of change required for a satisfactory result. In fact, it is almost impossible to forecast the financial commitment that is needed until your surgical consultation.

However, when considering the price of your surgery, there are a few factors to take into consideration:

• Your existing features: the degree of forehead reduction, contouring, and/or reshaping you may require
• If any additional procedures are necessary, for example, a brow lift and/or hairline lowering
• Any pre-existing health conditions that may affect your surgery
  Hospital-specific fees

How Long Does It Take To Recover From Forehead Reshaping Surgery?

Typically, you will stay overnight in the hospital for the first night after surgery. Your surgeon will perform a post-op examination before allowing you to go home or back to your hotel.

We take steps before surgery to ensure that your bruising and swelling is kept to a minimum. However, you may still have some swelling for at least a week or two. Also, it is common to have some minor swelling that may last up to two months.

You may also experience some temporary loss of sensation in the forehead area, this is normal and resolves on its own within two-to-four months. In some patients, it may take up to 10 months for their feeling to return to normal and although this may feel uncomfortable, it is not long-term and part of the healing process.

Why Choose a Surgeon with Cranio-Maxillofacial Training for your Surgery?

Because forehead contouring and reshaping surgery involve altering your actual facial skeleton (the bones), it is critical that your surgeon is a board-certified plastic surgeon with craniofacial and maxillofacial surgical training and qualifications. Only highly-skilled surgeons who are cross-trained in general plastic surgery AND craniofacial surgery possess the advanced skill set to ensure a successful result.

The Story of Our Patient’s Facial Feminization Was Featured in The New Yorker Magazine

“Abby Stewart sometimes thought that she was born to be a teacher. At the small college in Colorado where she was an instructor in the biology department, she enjoyed preparing lectures for business or history majors who were simply fulfilling a requirement by taking her course in anatomy and physiology. She worked hard to prove to these students that they should still care about biology, and one way she captured their attention was by describing natural phenomena that, at first glance, might seem peculiar. She revealed that clown fish—like Nemo, in the Pixar movie—are hermaphrodites, starting out as male but sometimes becoming female as they mature…” Continue reading on The New Yorker’s website. 

To learn more, contact our office.

Reduction of the Masseter Muscle for Asian Patients (Surgical & Non-Surgical)

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.

What is the Masseter Muscle? Why is it larger in those of Asian background?

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…

1. Non-Surgical Reduction of the Masseter Muscle using Botox® or Dysport®

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.

2. Surgical Reduction of the Masseter Muscle:

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.

Which form of masseter muscle reduction is right for you?

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 about masseter muscle reduction here.

Understanding the Differences Between V-Line Surgery and Feminizing Jaw Surgery is Critical.

The Gender-Specific Differences of Male and Female Jaws

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.

“Asian” V-Line Jaw Surgery vs. Feminizing Jaw Surgery

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.

What is the difference between “Asian” V-Line Jaw Surgery and 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.

What is Vertical Maxillary Excess? How can it be Corrected within the Context of Facial Feminization?

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.

Surgical Correction of Vertical Maxillary Excess within the Context of FFS

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.

How is the Surgery Performed?

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 about the Le Fort Osteotomy I here.

Chin implants may be a popular choice for chin surgery but removing them is also one of the most popular revision surgeries that we perform.

Chin implants are typically used in chin surgery (genioplasty) to improve a “weak” or nonexistent chin, or within the context of Asian V-Line surgery. The popularity of chin implants has grown over the last few years and has become one of the fastest growing procedures in plastic surgery. Unfortunately, chin revision surgery (revision genioplasty) is also one of the most popular revision surgeries we perform due to the often unsatisfactory results or resultant medical complications of using chin implants.

Chin implants are problematic and often cause complications.

Although chin implants are an option in some cases, and occasionally used, we believe that placing a foreign object (an implant) into your own body is counterintuitive and often problematic when there are much better ways to reshape and augment the chin.

Often chin implants are placed by inexperienced or unskilled surgeons and sold to the patient as an “inexpensive” or simple solution. This, of course, is so often untrue, due to the frequency of need for chin surgery revision procedures! Instead of one operation, the patient needs another one — often at an increased cost because a secondary procedure is always more complex than a primary one — not to mention the suffering, stress and mental anguish over the first, failed procedure.

Chin implants often cause complications, with the most common being:

• The implant shifting from its original location,
• The implant eroding into the roots of the anterior teeth,
• And, most commonly a squaring of the chin which in females, in particular, can have an undesired masculinizing effect that is altogether unsatisfactory.

It is our belief, that a far better option in our experience, is to reshape the underlying skeleton or foundation of the chin by altering or repositioning the bone. In fact, there are several non-implant options for genioplasty surgery: the chin may be moved forward, down, centered, widened, or narrowed — depending on the desired outcome. In these cases, outcomes are improved because there are more “degrees of freedom” for the surgeon to reshape the chin into an aesthetically pleasing shape that is in harmony with other facial features.

The risks, complications and side effects of chin implants.

Apart from the obvious risk of choosing an unskilled or inexperienced surgeon to insert a chin implant – that the aesthetic result will not be a satisfactory one – there are several other serious medical complications and side effects to be aware of:

• Damage to the marginal mandibular nerve — leading to permanent loss of movement in the lower lip
• Damage to the mental nerve (a sensory nerve which provides sensation to the front of the chin and lower lip as well as the buccal gingivae of the mandibular anterior teeth and the premolars)
• Implant is placed in the superficial tissues — not under the periosteum (the dense layer of vascular connective tissue enveloping the bones) leading to implant movement under the skin
• The wrong sized chin implant is used resulting in a chin looks out of sync or inharmonious with other facial features
• Injury or damage to the teeth, gums, or surrounding nerves
• Permanent loss of sensation, and/or scarring.
• Slow healing, infection, or internal bleeding leading to removal of implant
• Inadvertent masculinization of the female chin
• Unsightly deepening of the labiomental crease (the deep groove underneath the lower lip)

It is critical that when you choose a surgeon for your chin surgery, that you choose a U.S. Board Certified surgeon. The risks of choosing an uncertified, unskilled or inexperienced surgeon are too great and must be avoided at all costs.

Feminizing the African American Face

If you are of African American heritage and seeking to have facial feminization surgery (FFS) it’s critical to understand that what constitutes a typically female African American face may be vastly different — aesthetically and structurally — than a typical European, Asian, or even Hawaiian (Polynesian) face.

So before you select a plastic and craniofacial surgeon for your facial feminization surgery, it’s imperative to ensure that they have an in-depth understanding of the differences between the facial structures of people of different ethnic backgrounds, and most importantly proven experience with performing FFS on African Americans.

The forehead is the critical to feminizing the African American face.

The shape and size of the forehead and the brow should be the main focus of facial feminization 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 typically includes forehead reduction and contouring to create a smoother, rounder, and more feminine forehead. 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 and rejuvenated 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.

Feminizing the lower half of the African American face.

Typically, feminization of the nose via feminizing rhinoplasty is recommended for those of African American heritage. Often gender transition 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.

Read more about the cluster of surgical and non-surgical procedures that comprise facial feminization.

Facial Feminization Surgery for Women

Often when we talk about facial feminization we are referring to the surgery within the context of transgender individuals. However, there is another set of circumstances wherein facial feminization surgical procedures may be incredibly useful: for cisgendered women (female assigned female at birth) who are born with “masculine”-looking features and who are want to appear more feminine.

What features make a woman’s face appear “masculine”?

The most common complaint we hear from our female patients who are seeking facial feminization is either the forehead and brow and/or the jawline and chin is too prominent or too “bold”. These two features — more than any others — contribute to a masculine-looking appearance in cisgendered women.

The good news is that a plastic surgeon, such as Dr. Deschamps-Braly, who also has extensive craniofacial and jaw surgery expertise can help to feminize these features while still ensuring that you still look like you. And herein lies the true skill of any form of gender-related facial surgery: along with excellent surgical skills, your surgeon must also possess a deep understanding of gender-related aesthetic differences in terms of male/female facial proportions, and an appreciation for what constitutes “beauty” in the feminine face to ensure an optimum outcome.

Read more about the differences between “beautiful” vs. “feminine” here.

Recommended surgical procedures to create a more feminine appearance:

There are many ways you can make your face appear more feminine. After an in-depth consultation, your surgeon may recommend one or more of the following procedures, depending on your circumstances and desired results:

• Feminizing Forehead Reduction and Contouring: to create a more feminine, softer appearance of the forehead, and reduce the heavy appearance of the male brow.
• Feminizing Brow lift (Browplasty) – raises the eyebrows into a higher, more feminine position on the face. Also helps to reduce common telltale signs of aging such as forehead wrinkles, crow’s feet, horizontal or vertical lines such as frown lines and furrows between the eyebrows.
• Feminizing Rhinoplasty (nasal surgery) – some women may have a very prominent or ‘masculine’ looking nose. In such cases, feminizing rhinoplasty may help.
• Feminizing Cheek Enhancement – gives the cheeks a rounder and smoother feminine appearance. Depending on your existing features and the desired effect, the procedure includes either cheek augmentation or cheek reduction.
• Feminizing Chin Recontouring (Genioplasty) – alters the shape of the male chin by reducing, reshaping, or augmenting (making the chin larger). Most often the male chin is reduced in size and reshaped to be less angular, creating a smoother and more feminine aesthetic.
• “Asian” V-Line surgery – suitable for all ethnicities: this surgery works to contour and slim the lower jaw, creating a more slender jawline while at the same time reducing jaw width and a producing a sharper, better-defined chin profile.
• Jaw Contouring – The male jaw is usually wider and more angular than the female jaw. Men tend also to have a sharp back “corner” to the jaw, which can be made to appear rounder and smoother through jaw contouring resulting in a more feminine look. The bone of the jaw can also be shaved along its lower edge and chewing muscles reduced to make the jaw more slender.

Ultimately, the decision with regards to which surgical procedures will suit your circumstances is one that will be made in consultation with you and your surgeon.

Read our next article on the Key Elements of Facial Feminization for Women with Masculine-Looking Faces.

Feminizing the Asian Face

We often often tell our patients that performing facial feminization surgery on a person of Asian ethnicity is very different than other types of FFS.

If you are of Asian background, either Korean, Japanese or Chinese, and you’re seeking facial feminization surgery (FFS) 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 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 differences, and that they have had extensive experience in feminizing Asian faces.

The forehead is the key to feminizing an Asian face.

First and foremost, the shape and size of the forehead and the brow should be the main focus of facial 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 may even be different than a Chinese one, wherein sometimes the 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.

Feminizing the Asian nose and jawline.

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.

Read more about the cluster of surgical and non-surgical procedures that comprise facial feminization.