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Facial Feminization in a
Male to Female Transsexual

The process of facial feminization involves an understanding of what characterizes the male versus the female physiognomy or facial structure. Unlike the transformation seen in facial masculinization, which occurs when male hormone is taken in a female to male (FtM) transsexual, no such transformation occurs in MtF transsexuals taking female hormone. In FtM’s facial hair grows and occasionally a male pattern baldness also occurs. Despite the fact that male features are generally larger and less delicate, the changes produced with male hormone seem adequate enough to produce the desired result for most FtM’s. Since there are specific anatomical characteristics that must be addressed when doing facial feminization, I will now point these out.

"For A More Thorough Explanation About Male Facial Feminization" See Guide.

The female face has a fuller frontal hairline without the temporal recessions seen in males. There is no significant ridge of bone noted above the eyebrows, which characterizes the male skull. And the eyebrows in a female are arched rather than flat. To produce these changes, a forehead or brow lift is performed to raise and arch the eyebrows. At the same time, the (supra-orbital) ridge of bone can be reduced. Various hair techniques, including skin excision with rotation of scalp flaps or hair transplantation, are some of the options to reverse the male pattern baldness.

Proceeding down the face, we note that females generally have more prominent cheekbones than males, as well as a finer, more delicate nose which is usually slightly rotated at the tip. To reach these goals, cheek implants or fat transfer may be employed along with a rhinoplasty (nosejob).

Further down the face we come to the angles of the jaw, the lips and the chin. Women tend to have less prominent jawlines and chins with fuller lips. Reducing the bony angles of the jaw is rarely performed. Occasionally, injections of Botox in this area are done to accomplish a similar effect by shrinking the soft tissue components. Chin reduction, however, is a definite option for the right candidate. And finally, there are numerous lip procedures that can augment the upper and lower lips, change the shape of the lips and even produce a slight upward rotation or pout to the upper lip. In many instances, the area between the bottom of the nose and upper lip can be reduced by skin/muscle excision to further enhance the results.

A final word should be said about the “laryngeal shave”, often mistakenly called a “tracheal shave”. Though not a facial feature since it’s part of the neck anatomy, reducing this prominence (Adam’s apple) goes a long way towards completing the feminization transformation.

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Procedures

Rhinoplasty

Being centrally located, the nose should blend harmoniously with the other facial features and not draw attention to itself.
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Neck Lift

The necklift is a procedure to tighten and better define the jawline and the areas below it. In some instances, this effect can reach all the way down to the collar bones
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Face Lift

Surgeons use the term "facelift" to describe any procedure on the face that results in a tighter, more youthful appearance.
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Revision Rhinoplasty

The operation consists of correcting areas of asymmetry and deformity resulting from a prior surgery.
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Eyelid-Brow Lift

The eyes are the first features noted when people meet. And having puffy, sagging or wrinkled eyelids can convey a false image of being tired, sad or old.
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Lips

The lips should be full and wide with the upper lip slightly rotated, revealing the lower portion of the front teeth.
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Articles

The Telltale Signs of a Bad Rhinoplasty

Having revised thousands of rhinoplasties, I have noticed certain features common to all.

Even a structurally symmetric, aesthetically pleasing nose can be a poor result if it is out of proportion with the other facial features by being too small or too large. However, the real clues to a poor result are the asymmetries, malpositions, disproportions and decreased function that are seen. We can see collapse of the side walls and/or nostrils producing a “pinched look” or asymmetry between the two sides. The bridge can be too low or too high, and the tip can be overly rotated or not rotated enough. There can be too much “nostril show” from aggressive cartilage resection causing upward migration of the nostril rims. Or too much nostril show from failure to raise the columella (area between the nostrils). Also, irregularities or distortions in the nasal tip can occur which can present technical challenges to the revision surgeon. There can be deflections or angulations of the tip or the entire nose. As mentioned above, nostril asymmetries are particularly common with one nostril appearing higher or wider than its companion. Finally, there can be a worsening of breathing , especially if a reductive rhinoplasty was performed. Making a nose smaller has to be accompanied, many times, by measures to assure that the airflow is not compromised. This means correcting any septal deviations and/or turbinate enlargement, as well as maintaining adequate openings through the nostrils and the areas above called the internal valves. I’ve included photos of a nose showing most of these deformities with the subsequent post-operative results, after I corrected them.


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