Facial Gender Affirming Surgery
Facial feminization surgery (FFS) is a combination of procedures that can provide a more feminine appearance. Specific features, such as the hairline, jawline, or neck, can be softened to affirm your feminine identity.
Who Can Benefit From Facial Feminization
Facial feminization procedures can be performed on anyone who desires a more feminine appearance. Surgery, particularly on the midface, should be delayed until facial growth has plateaued. For transgender women, hormone therapy and puberty blockers change the growth patterns of the face. So, the use of puberty blockers, length of time you have been on hormones, and your age are taken into consideration to determine the optimal timing for surgery. The procedures that would be specifically beneficial for you will be part of the equation since different parts of the face are affected at different time points with hormones.
There is no upper age limit unless the patient has poor health or a certain medical condition that would make a particular procedure a significant risk. The best candidates for any of the facial feminization procedures do not smoke and are in good physical health. Candidacy can best be determined during a consultation with Dr. Sturm.
Hairline and Brow Feminization
The relationship between the hairline, brows, and eyes conveys a lot of information about who we are. The eyebrows frame the eyes, where most people look first on the face. Shaping the brow bone to be smooth with the forehead is a powerful way to feminize the face. Also, the brows can be elevated to lie above the orbital rim (brow bone) and given a delicately arched shape.
The hairline frames the face. Masculine hairlines tend to be lower in the middle and higher on the sides because of the effect of testosterone. To feminize the hairline, the sides and sometimes the middle are brought forward for a softer, more round shape, making the forehead smaller. This can be done with scalp advancement, hair transplantation, or a combination of the two.
We talk about the hairline and the brows at the same time because we can use techniques to raise the brows, lower the hairline, or do both with the same procedure. Each face is different, so Dr. Sturm will tailor the techniques for each patient.
Dr. Sturm corrects a prominent forehead by setting back the anterior wall of the frontal sinus while maintaining the functionality and integrity of the sinus. The frontal bone on the top and sides of the eyes can be contoured to give a more open appearance. Dr. Sturm can lift the brows endoscopically or with an incision at the hairline that can shorten the forehead at the same time. The brows are elevated and fixated with permanent sutures. The hairline can be moved forward, removing the excess skin in scalp advancement. Hair transplantation takes hair from the back of the scalp and moves it to the temples to create a rounder hairline.
For about 10 days after surgery, you will have swelling and some bruising. Between seven and 14 days following surgery, your sutures will be removed in our office. You should also be able to return to work and daily activities in seven to 14 days following surgery. However, you should avoid vigorous exercise for four weeks.
The brow lift can be performed endoscopically with several small incisions in the scalp. The scalp advancement can be done by making an incision at the hairline that is specifically placed so that the hair will grow back through the scar to make it even less visible. Forehead shaping can be performed through the same incision as a scalp advancement or an incision placed further back in the hair. Hair transplantation can be performed without incisions or with a small incision in the posterior scalp.
Most people experience some discomfort with forehead contouring and brow lifting that can be controlled with oral pain medications. Scalp advancement and hair transplant procedures result in minimal pain.
Eyelid and Midface Feminization
The midface describes the area from the eyes to the bottom of the nose. Generally, feminine faces have larger, rounder eyes, fuller cheeks, fuller lips, and smaller, more elegant noses.
For the eyes, extra skin can be removed from the upper lid to create a more open, round appearance. Cheek implants are placed through an incision inside your mouth, between the upper gums and cheek. Dr. Sturm creates a pocket over the cheekbone. Then, she slides the implant through the incision and stitches it in place. The implant is made of medical-grade plastic in a roughly triangular shape and is very safe. There are both surgical and non-surgical lip augmentation approaches to obtain a more feminine look. The surgical lip lift shortens the “white lip” (between the bottom of the nose and the cupid’s bow), elongates the “red lip” (where you place lipstick), and gives more of a pout to the shape of the upper lip. The lips can be volumized with a semi-permanent biological scaffolding (acellular dermis) that lasts five years or longer or injectable fillers that last about six to nine months.
Many people experience swelling and bruising that resolves approximately one week after eyelid surgery. With cheek implants, you may feel some tightness or numbness around your cheeks for a few weeks, and you will have some swelling. Swelling subsides gradually, and your new look continues to reveal itself over a couple of months. You can have swelling of the lips after augmentation for about one week.
The incisions for eyelid surgery heal very well in the crease of the upper lid. The incisions for cheek augmentation are all in the mouth and, therefore, result in no visible scars. The lip lift incision is hidden in the junction between the nose and the upper lip. Injectible or semi-permanent fillers produce no visible scars.
Pain is minimal, and most patients do not end up needing the pain medications they are given. However, every person is different.
Changing the appearance of your nose can have a significant impact on achieving a more feminine look. Rhinoplasty, commonly known as a nose job, is one of the most popular cosmetic surgery operations, yet it is one of the most challenging. Male noses tend to be larger and fuller; facial feminization requires changing the nasal contour to make it smaller and more refined. This is a difficult and complex surgical procedure, so it is extremely important that you select a facial plastic surgeon with experience and specific training in rhinoplasty, like Dr. Sturm, to give you confidence in a successful outcome.
Rhinoplasty is a very individualized surgery because no two noses are the same. The surgical technique selected will be based on the anatomy of your current nose and your individual surgical goal.
A splint is placed over the nose for five to seven days to protect it in the early phase of healing. After this comes off, tape is placed over your nose to reduce swelling until the 10th day. Some patients experience swelling and/or bruising around their eyes depending on how easily they bruise. The nose will be swollen in a manner that you and I will know but that other people generally won’t notice. Approximately 90 percent of swelling goes down in three months, and the rest resolves over one year.
The rhinoplasty procedure can be performed using a “closed” technique with no external incisions or an “open” technique with a small incision under the tip of the nose just above where it meets the upper lip. This incision heals very well and is nearly imperceptible in most people.
Pain is minimal in most people and can be controlled with pain medications.
Jaw and Chin Feminization
Masculine features of the jaw vary from person to person. There are many beautiful women with a face that is square rather than oval or heart-shaped. However, a prominent and wide lower jaw that flares outwards can give the face a more masculine look, whereas a feminine face often has a narrower jawbone. The jawline can be softened with jaw or chin contouring.
During surgery, incisions are made between the gum and cheek to expose the jaw, also known as the mandible. A predetermined section of the jaw bone is cut and/or shaved to achieve a well-rounded jawline contour, curving down from back to front. The chin can be advanced or moved back. In addition, implants can be used to achieve the desired look. Patients over 40 may experience loose skin around the jaw or chin after a jaw shave. This can be tightened after the original jaw shave procedure with a lower facelift.
After surgery, you will experience swelling. The amount of swelling varies from patient to patient. In some instances, there may be visible bruising. Your mouth will need to be cleaned a few times a day with mouthwash. It may take four to six weeks before the cosmetic improvement will be obvious due to swelling.
The incisions are all within the mouth; you will not have external scars.
Most people experience some discomfort that can be controlled with oral pain medication.
An “Adam’s apple” is a prominent notch in the thyroid cartilage. This notch is visible in some women but can be very prominent in men. Therefore, it is considered by many to be a masculine characteristic. Shaving the notch, also known as a tracheal shave, can provide a softer, more feminine contour to the neck.
The thyroid cartilage is reduced by shaving the most prominent area along with the rim of the upper border of the trachea while protecting the vocal chords.
Postoperatively, you will experience some swelling during the first 24 to 48 hours. An ice pack should be applied to the area to relieve swelling and discomfort. Mild voice weakness can also occur in the first few days following surgery.
With tracheal shave surgery, a tiny incision is placed in the crease of the neck below the chin. This allows the scar from the incision to be minimally visible.
Discomfort is usually mild but can be alleviated with ice and oral pain medication.