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.

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.