Gender affirmation for The Face

Is facial feminization something you want to learn more about?

Complex surgeries can be done to feminize the face, and we describe the many aspects of facial feminization surgery below. Not all procedures are going to be useful to you, but we thought a quick overview may be helpful.

To look further into gender affirmation for the face, book a consultation with Dr. Gill.

Gender affirmation is a sensitive topic and terminology changes so please excuse us for any errors. At Pulsar Health, we respect everyone's choices. To keep things simple, we will not discuss non-binary or other designations, and just talk about a more feminine appearance as trans-women and a more masculine appearance as trans-men. Please pardon any errors we may make in terminology and descriptions regarding gender.

We will not be going into any detail on hormone therapies or psychological readiness for surgery, which are both absolutely essential prior to undergoing gender affirmation surgeries. We only operate on adults who are in a healthy environment with support, and somewhat stable at this stage in their life. Healing from surgery involves many factors beyond the procedure itself, and we want to make sure you are set up for success. 

Most facial gender affirmation procedures are "male-to-female" facial feminization, as testosterone therapy is usually sufficient for most trans-men to attain the look they want. Some trans-men do want to masculinize further, such as using jawline implants or fillers. Please refer to the sections in Facial Features that may be relevant, such as the Snatched Jawline section or Facial Balance: Tox, Fillers & Threads.

Dr. Gill is a craniofacial surgeon, and has performed facial surgeries for trans-women. She was hired to head the gender affirmation program at Kaiser Permanente in Sacramento, California. The entire procedure of facial feminization is quite extensive. The following areas are addressed:

1. Adam's apple - the front portion of the cartilage is shaved down ("laryngeal chondroplasty" or "tracheal shave") while watching from the inside with the aid of a bronchoscope to make sure we do not affect the vocal cords or enter into the trachea.

2. Forehead correction - this is usually done through a hairline incision so that we can reduce the height of the forehead at the same time as accessing the lower brow to reduce "bossing" or protrusion of the lower forehead. The sinus cavities lie just deep to this area, so the degree of reduction can be planned beforehand with the use of CT imaging. Sometimes thinning of the bone is enough whilst at other times, the front wall of the sinus has to be removed and placed further back, securing it with plates and screws.

3. If the eye socket is to be opened up for a more rounded upper eye socket, care must be taken to release the nerves in that area gently. Additionally, the outer parts of the eyes may be lifted in a "lateral canthoplasty / canthopexy".

4. The eyebrows are usually positioned higher than their original position as the forehead height is set and the hairline incision closed. Of note, feminine hairlines are more rounded than the M shape of masculine ones.

5. A rhinoplasty - reshaping the nose into a more feminine delicate shape and size - can then be performed or deferred for a different day as it is quite long in and of itself. If there is a great deal of size reduction, there is a risk of "open sky deformity" which needs to be corrected so that the front "dorsum" (bridge area and below) of the nose is solid. The nasal tip usually requires quite a lot of reduction and to change the angles to more feminine ones. The nasal cartilages may need to be trimmed and the tip "sharpened" for more refinement. The skin does tend to shrink fairly well by itself, but will need to be taped initially to help it go down. More complex fixation may be required. If osteotomies are needed (bony repositioning), use of an external splint is important to protect the new position as well as internal splinting. (You can check out the Shapely Nose section if you want more information on recovery and other considerations.)

6. Jaw surgery - usually this simply entails shaving down the outer edges of the mandible ("mandibular angle reduction") and making the chin more pointed ("genioplasty"), but it can be more complex and require movement of the jaws themselves ("orthognathic surgery").

7. Fat grafting or facial implants - cheek or chin implants may be desired but insurance does not always cover these procedures whilst it may cover the deeper, more bony work listed above. These implants can also be done at a later date, like the rhinoplasty.

Other procedures may be helpful, such as shortening the distance between the nose and red lip, called a lip lift. This is a relatively simple procedure that has a nice impact on facial appearance. Lip filler can also enhance a feminine appearance.

Laser hair reduction may be helpful. At Pulsar Health, we have the Alexandrite laser for clients with lighter skin tones, and the Nd-Yag laser for hair reduction in clients with darker skin tones. Laser hair reduction requires dark hair color to be effective.

We do not offer hair transplantation, but if the degree of hair replenishment required is less, there are some choices that you can check out in the Hair restoration section under "Smooth Skin and Happy Hair Days".

In addition, we do recommend regular facials to minimize pores and foster smooth skin, as well as possibly more intense treatments such as the carbon dioxide laser to improve skin texture.

We take many insurance plans as well as do cosmetic cash-based procedures at Pulsar Health, so please book a consultation if you are interested in meeting us and learning more.