Softening Your Facial Features: Creating Aesthetic & Emotional Harmony for Those With Gender Dysphoria

August 11, 2022 | Facial Feminization, MTF Surgery

2 Minute Read:

Trans women have a lot to think about when considering gender-affirming surgery and which cosmetic procedures they want to undergo.

If you are beginning this portion of your transition, you may choose top surgery or MTF breast augmentation first. This is understandable since breasts have always been the hallmark of the female form.

However, breast enhancement isn’t the only plastic surgery procedure that can provide dramatic results and help you on your journey.

Facial feminization procedures can refine your facial features to minimize masculine attributes, allowing your external features to better match who you really are. Following these techniques, many trans women are ecstatic about their more delicate and feminine-looking appearance.

Facial Feminization Procedures

Many trans women seek facial feminization surgery (FFS) because they are unhappy with the masculine aspects of their face and neck and want to soften these features.

Some FFS procedures include (but are not limited to):

Hairline lowering, which is also referred to as forehead shortening
Brow bone reduction, also known as brow bossing or forehead bone reduction
Brow lift or eyelid surgery
Cheek augmentation and buccal fat pad reduction
Rhinoplasty (nose job)
Jawbone or chin contouring
Thyroid cartilage reduction, also called an Adam’s apple reduction or tracheal shave
Fat grafting

You are unlikely to need all these procedures, and a consultation with a plastic surgeon who is skilled and experienced in gender-affirming surgery can help you decide which surgery or combination of procedures will serve you best.

Before and after image of a patient who underwent facial feminization in Austin. TX. — *Actual Patient

Your Feminization Surgery Consultation

First and foremost, you want to choose a reputable, board-certified plastic surgeon who regularly performs gender-affirming and facial feminization procedures.

Make a list of all your questions and goals, and be sure to make these concerns known to the doctor. The surgeon should listen carefully and address each issue clearly and informatively.

A qualified plastic surgeon will be able to explain which procedures are best to achieve your goals and how they work together to provide natural and pleasing results.

Upper, Middle, and Lower FFS

Upper FFS

Patient undergoing forehead ridge surgery. — Endoscopic forehead boney ridge reduction. Combined with fat grafting to the temple and brow lift for less invasive upper third facia feminization. *Actual Patient*

The forehead ridge is a common concern among trans women. This area is often the first step in female feminization surgery. In many cases, the position and shape of the eyebrows and appearance of the hairline are addressed. Fat grafting is also frequently used to soften the bony appearance around the eyes and decrease the hollow region in the temples.

This procedure can be done as an open Type 3 Cranioplasty.

With this open approach shape of the orbit, also known as the eye socket, can be changed and the hairline can be advanced to reduce the length of the forehead.

Patients who do not need reshaping of the eyes, do not need their hairline advanced, and do not have too large of a forehead ridge can still have the excess bone addressed in a less invasive manner. Dr. Weinfeld has developed an endoscopic approach where the excess bone is reduced with a long guarded burr through small incisions hidden in the hair.

The softening is complemented with precise fat grafting to further feminize the entire upper third of the face

Middle FFS

The common areas to address in the middle third FFS are the nose and the cheeks.

Rhinoplasties transform a larger, wider, less defined nose to a smaller, narrower, better defined nose that is perceived as more feminine. The upper outer boney region of the cheek can be enlarged with implants and/or fat grafting to make them fuller and more feminine. The center, fleshy part of the cheek can be made more slender, debulking the lower face (a more masculine volume distribution) with a buccal fat pad reduction.

This gives a subtle pucker appearance, which also is feminizing, and creates the appearance of some weight loss in heavier faces. Buccal fat pad reduction has the added benefit of enhancing the contour of the jaw in the lower third of the face.

Lower FFS

Some trans women benefit from an upper lip lift or shortening. Most trans women also benefit from fat grafting to the lips. Jaw reduction, chin recontouring (feminization mentoplasty), and thyroid cartilage reduction or Adam’s apple reduction are all part of lower female feminization surgery.

Depending on your specific case, the surgeon may be able to perform an upper FFS and a lower FFS at the same time or will recommend splitting these surgical procedures in two phases.

Facial Feminization (FFS) in Austin, TX

Dr. Adam Bryce Weinfeld treats trans women with gender dysphoria who wish to undergo facial feminization or FFS in Austin, Texas. Call Dr. Bryce’s office at the number above, or scroll down to contact us online.