Facial Feminization Surgery - An Overview

Introduction

The face plays an important role in identifying a person’s gender. Facial features vary from person to person, but a few unique biological features help distinguish male faces from female faces. Regardless of gender, males, and females can have similar features, but their relation to each other and position can make a difference in the face’s overall appearance. The development of facial features depends not only on the gender of a person but also genetics.

What Is Facial Feminization Surgery?

Facial feminization essentially means altering facial features to make a face look more feminine, which is achieved by undergoing a series of procedures to change an individual’s facial features that would result in an overall feminine appearance. Facial feminization surgery involves making structural changes to facial features. The facial features of men and women differ; this difference is what the brain catches to identify a person’s gender. Some features are unique to males and females. A few such features are:

• Forehead: A stronger and more prominent forehead is commonly associated with a male face. The reason for this is the shape of the male’s forehead frontal bone. In addition, a receding hairline is also suggestive of a masculine face, which results in a further elongated look on the forehead. On the other hand, females have smaller foreheads, which helps distinguish male and female facial patterns.

• Eyebrows: Men have a unique feature called brow ridge, which is absent in women and makes their eyebrows look protruded. This feature is absent in women, which gives their eyebrows a softer, more rounded appearance. The eyebrows in men are bushier and placed closer to the upper eyelid, which makes the eye look smaller. Women’s eyebrows are usually placed higher up and are arched, making the eye look larger and feminine. Changes in the shape of eyebrows and the distance between them can significantly impact the overall appearance.

• Eyes: Men tend to have smaller eyes that are deep-set and placed closer to each other. Conversely, women have larger eyes that are set apart.

• Nose: The male nose is usually larger and wider at the base than the women’s. A dorsal hump is also considered a masculine facial feature. Female noses are smaller and narrower at the base. In addition, they have curved bridges, and there tends to be a slight upward tilt at the tip of the nose.

• Cheeks and Cheekbones: Male cheeks are not prominent, and they appear flatter. Women have fuller prominent cheeks.

• Chin and Jawline: Men’s jawlines and chins appear larger and more chiseled. Women, on the other hand, have rounder and less defined jawlines and smaller chins.

• Lips: Men have shorter upper lips, which are usually flat because they are placed away from the nose. Women have fuller lips which are positioned closer to the nose.

All these factors are considered while changing facial features to look more feminine, which is especially valid in transgender women who desire to achieve a more feminine face.

What Are the Indications of Facial Feminization Surgery?

Facial feminization can be beneficial to different categories of people. The main beneficiaries of this surgery are:

• Transgender Women: A transgender person is a person whose gender identity does not match the sex registered for them at birth. Transgender people transitioning from male to female can benefit from facial feminization surgery to deal with the stigma surrounding transgender people and to achieve the desired outcome. Transgender women usually have masculine facial features, which can be made more feminine using facial feminization surgery.

• Cisgender Women: A cisgender person's gender identity corresponds to the sex assigned at birth. Cisgender women also opt for facial feminization surgery to correct certain features that are masculine in appearance. For example, even though facial patterns are unique in men and women, certain women can develop masculine facial features. Women who desire to change this can benefit from facial feminization surgery.

• Gender Dysphoria: Gender dysphoria is a feeling of unease or distress in individuals whose gender identity does not match their biological sex registered at birth, which can even lead to depression and anxiety if not identified and treated. Individuals with gender dysphoria can opt for facial feminization surgery for reassurance and achieve the desired facial features.

What Are the Different Facial Feminization Surgical Procedures?

Subtle differences in facial features make a face masculine or feminine. These changes can be in any part of the face, like eyebrows, lips, nose, forehead, or even hairline. Knowledge about these parameters can help in achieving the desired results. Different areas of the face are addressed in many procedures, depending on the alterations to be made.

• Forehead Procedures: The forehead can be contoured by shaving off brow bone prominence to give a flat brow space. However, extensive shaving of the brow bone can expose the sinus cavity. Hence, care should be taken while performing the procedure.

• Hairline Alterations: Hairline alteration procedures often accompany forehead procedures to address receding hairline and male pattern hair growth. Some cases may even require hair transplants to achieve the desired outcomes.

• Nose Procedures: Rhinoplasty is a commonly done procedure to change the appearance of the nose. For example, feminine noses are smaller, with a distinct upturn at the tip, which can be achieved through rhinoplasty.

• Cheek Augmentation: This procedure involves placing cheek implants to give a fuller appearance to the cheeks, which is an uncommon procedure because the result can be achieved without surgery through hormone therapy.

• Lip Lift: Female lips tend to have a shorter space between the upper lip and the base of the nose. A lip lift can achieve this.

• Genioplasty: Changes in chin shape and size can be achieved by genioplasty. However, some cases require chin reduction, and some require chin augmentation.

• Jaw Surgery: Changing the shape of the jaw can be done to achieve a more feminine appearance. However, extensive shaving of the jaw bone exposes a major nerve that runs through the jaw. Hence, it is a fairly risky procedure.

• Tracheal Shave: This procedure is done to reduce the protrusion of the adam’s apple, which is prominent in males.

What Are the Risks and Complications Associated With Facial Feminization Surgery?

Facial feminization surgery often yields great results and helps people achieve their desired facial appearance. But like any other surgical procedure, facial feminization also comes with risks and complications that should be considered while opting for the procedure.

Some of the common complications are:

• Changes in Skin Sensation: Skin sensation can be altered in most patients undergoing skin feminization surgery. Some experience loss of sensation or numbness temporarily, which usually resolves on its own.

• Frontal Sinus Problems: Surgeries involving frontal bone repair or repositioning can have complications like infection, pain, fluid collection, etc., which might require additional surgery to resolve.

• Nerve Injury: Motor and sensory nerves are at risk of injury during facial feminization surgery. Temporary weakness or paralysis of the face may occur after surgery. The chances of these complications becoming permanent is extremely rare.

• Nasal Airway Changes: Alterations in the airway can occur after rhinoplasty or septoplasty procedures. These complications require additional surgery to be corrected.

• Perforation of the Nasal Septum: There is a risk of the nasal septum being perforated during rhinoplasty, which also requires additional surgical correction.

• Asymmetry: The human face typically has slight asymmetry. Any visible asymmetry following surgery can be considered a complication and needs additional revision.

• Delayed Healing: Delay in healing is a common complication in most surgical procedures, especially if the patient has co-morbidities, which can be addressed by changing the wound dressing or additional surgery to remove non-healed tissue.

• Damage to Deeper Structures: Certain facial feminization surgeries have a potential risk of damaging deeper structures like the brain, blood vessels, muscles, etc. The intensity of risk depends on the site and type of procedure.

• Allergic Reaction: Local allergies to tapes and sutures are common. However, more severe allergies to drugs during or after surgery needs additional treatment.

• Eyelid Disorders and Eye Irritation: Surgery around the eyes can cause swelling, bleeding, and pain in the eyelids and surrounding structures. Eye irritation is also commonly seen in such cases.

• Hair Loss: Hair loss is commonly seen in surgeries that involve placing incisions in the scalp. Hair loss is usually temporary and resolves after a few months.

• Pain: Normally, pain from the surgery can last for 3-6 months. Any pain that lasts more than this period is abnormal.

• Discomfort Due to Implants: Specific facial feminization procedures require placing plates, pins, or screws to help stabilize bones or other structures. Improper placement of these can cause pain and discomfort, which requires additional surgery.

Conclusion

Facial feminization surgery is a great way to boost one’s confidence and fight away insecurities. But it comes with a broad range of complications, which the patient should be aware of. However, if the benefits overweigh the risks, the patient can benefit from this procedure without fear. Experienced surgeons can help minimize the potential for risks and ensure success.