Facial Feminisation

Facial Feminisation

Feminine features are distinct; they are more elegant, delicate and have a gentler appearance.
Naturally, you will be able to recognise ‘male’ or ‘female’ facial features, regardless of a person’s gender preference. However, for some, these defining aspects do not align with their gender.

It is important for everyone to feel comfortable in their own skin and love the face they see in the mirror. Facial feminisation aims to facilitate just that.

Facial feminisation surgery at the Plastic Surgery Clinic can help you feel like your outer reality reflects your true inner self. The term refers to a combination of maxillofacial and plastic surgery techniques designed for facial gender confirmation and facial harmonisation.
Facial feminisation surgery has become increasingly sought after by transgender women. However, while many of our patients are transgender, we do also perform similar techniques on women who are simply self-conscious of their facial features, which they may feel appear more masculine.

Although procedures needed to achieve an individual’s goals are at the discretion of a patient and their doctor, common alterations include the forehead, cheeks, nose, lips, eyes and jaw.

Before considering these procedures, one must have a good understanding of the differences between a masculine and feminine face. A good way to think about this, is to break the face up into thirds:

(I) upper third, spanning from hairline to brow
(ii) mid third, spanning from brow to bottom of the nose
(Iii) lower third, spanning from the bottom of the nose to the chin

For each of these facial thirds, there are various distinguishing features that reflect male vs female characteristics.

Forehead Reduction and Brow Lifting (Upper third)

In the upper third of the face, the hairline, forehead shape and brow all need to be considered during facial feminisation surgery.
The placement and shape of the eyebrows is an identifying gender trait. Women tend to have higher, more arched brows than men. Men have lower, heavier and more prominent brows. A broad and long forehead can also be a masculine trait or the result of a receding hairline.

A brow lift can complete the feminisation of the upper face; framing the eyes gracefully. An eyebrow lift performed in conjunction with hairline lowering can result in a shorter, more feminine forehead.

When viewed in profile, a male forehead also tends to have a more prominent brow region. This is because the forehead bone situated under both brows tends to be more prominent in males. These sex differences in forehead contour and brow prominence is highlighted in the images below.

Facial Feminisation can therefore entail surgery to reduce or conceal the prominence of one’s brows.

Small brow prominences can be addressed by shaving down the underlying bone. Larger prominences entail reshaping the forehead bone in the brow region. This can be done by repositioning pieces of the forehead bone or by using bone substitutes to conceal the prominent area.

Rhinoplasty and Cheek Augmentation (Mid third)

If one is to consider the nose, there are various features that typically characterise a female nose. A more feminine nose often exhibits the following distinguishing features:

  • A slightly concave profile to the nasal bridge
  • Narrower nasal bridge
  • Narrower nostrils
  • Smaller nose relative to the rest of the face
  • A slightly upturned nasal tip
  • The glabella angle (between forehead and nose) tends to be more obtuse

Rhinoplasty, commonly known as a nose job, has been used for many years to shape, refine and sculpt the nose. As part of facial feminisation, this surgical procedure can recontour the bridge of the nose to create a more classically feminine shape and size. Dr Reddy takes the utmost care in balancing the features for a natural result.
A rhinoplasty can either be an open (where your nose is opened during surgery) or closed procedure depending on your surgical requirements. The procedure is performed under general anaesthetic for both the comfort of the patient and the precision of the surgeon. Further information about rhinoplasty, can be accessed here.

Another aspect of the midface that needs to be considered relates to the contour and prominence of the cheek bones. A female face is historically described as having a rounder and softer contour in the cheekbone region. This in contrast to the more squared off appearance that a male face often exhibits in the mid-face region. This is highlighted in the following images:

Achieving the appropriate contours in the cheekbone region during facial feminisation surgery can be achieved by way of volume augmentation or cheek bone repositioning. Volume augmentation can be effectively achieved with facial fat grafting or the use of dermal fillers – facial implants are another option. Facial fat grafting can play a very important role in achieving softer contours in the under eye and cheek bone regions. When compared to dermal fillers, facial fat grafting has the big advantage of producing long lasting results. Some individuals also report improvement in skin quality and skin texture due to the effects of stem cells.

Lip Lift, Chin Reduction and Jaw Reshaping (Lower third)

If one is to consider the lower third of the face, there are again, various aesthetic ideals that distinguish a female face from a male face. A female face often exhibits the following features:

  • A shorter upper lip with a slight upturn
  • Upper teeth show
  • Less prominent chin
  • Narrower lower jaw
  • Less prominent jaw angle

If one is to consider the lip region, reducing lip length and showing more upper incisor teeth can be achieved by undertaking a lip lift procedure. A lip lift will not only shorten the space between your nose and your top lip but turn your top lip up slightly, giving it a more noticeable curve. Lip lifts are also used in some facial rejuvenation procedures; they correct the drooping of the top lip that can sometimes appear with age. The procedure is typically performed under local anaesthesia in the clinic setting, without requiring hospital admission.

If one is to consider the chin region, in those individuals who might have more prominent chin, achieving a more feminine facial profile typically entails reducing chin prominence.
Chin reduction surgery, also referred to as sliding genioplasty, is designed to moderately reshape the bone and other structural tissues to create a more balanced facial contour. This is done by shaving back the underlying bone. This is feasible provided only a small reduction is required. Larger chin reductions require repositioning of the bone itself by way of a sliding genioplasty procedure. Further information about sliding genioplasty can be accessed here.
Important anatomical factors, such as skeletal shape and teeth position, will be taken into account before chin reduction surgery is undertaken.
There are various techniques described to determine ideal chin position, particularly if one is to compare the ideal position in a male vs female. One well known technique compares chin position to lower lip position. In a male the chin ideally sits in line with a vertical line drawn vertically through the lower lip margin. This is in contrast to the ideal chin position in a female, which sits slightly behind this vertical line. This is depicted in the diagram below.

It is important to note however that this assessment tool should be taken as a guide only as there are other parameters, including important anatomical factors, such as skeletal shape and teeth position that need to be accounted for, rather than relying on lower lip position alone to determine ideal chin position.
Dr Reddy will be able to advise you on what may be required and which procedure will be feasible in achieving appropriate correction of your chin position.

The remaining aspect that needs to be considered in a facial feminisation assessment of the lower third of the face relates to the shape and width of the lower jaw.

In females, when the jaw is viewed from the side, the angle of the lower jaw is typically more obtuse, with less backward projection of the jaw. This is shown in the diagram below.

Achieving the above usually entails shaving down the back surface of the lower jaw. This can be performed via incisions inside the mouth.

When the face is viewed from the front, the male jawline tends to be wider, with a more prominent jawline. In some individuals, feminising the face may therefore involve reducing the width of the lower jaw. This can be done by shaving down the outside surface of the lower jawbone. This can also be performed by placing incisions inside the mouth.

In some individuals, this type of bone shaving procedure is not required or not preferred. In these cases, a reduction in lower jaw width may be achieved by thinning the muscle (masseter muscle, also known as the clenching muscle). Muscle thinning can be achieved non-surgically with anti-wrinkle injections. There are advantages and disadvantages of each approach, and Dr Reddy will discuss these options with you in further detail during the consultation process.

What to expect during your consultation

The process of facial feminisation begins with an in-depth, detailed consultation with Dr Reddy. During this private consultation, Dr Reddy will assess your concerns and will discuss your goals, and what is medically possible.

Dr Reddy prides himself on tailoring his techniques to each patient’s unique facial features, achieving the best possible and most natural looking result. He places a strong emphasis on short scar techniques and the importance of a tailored post-operative treatment plan to optimise your results.

Please feel free to reach out when you are ready to embark on your facial feminisation journey. Dr Reddy has a great deal of respect for these procedures and understands that this can be a very important decision in your life during the transition process.

While Australian Medical Guidelines rightly say that we cannot guarantee patients will experience psychological benefits as a result of an elective treatment, we cannot ignore the positive effects which we have personally observed in past patients and their quality of life.

We pride ourselves on providing a caring and well-supported environment during the consultation, surgery, and aftercare process. We understand that many individuals may travel overseas to have these procedures for cost reasons. Whilst having surgery overseas may appear to be a cheaper option, in our experience, significant unexpected costs tend to arise for patients when they have to address complications once back in Australia. An important aspect to consider is that these procedures require strict attention to detail, experience, and readily available aftercare, particularly during the first few months after surgery. Surgery in Australia also ensures compliance with the necessary surgical standards and strict hospital sterilisation and accreditation processes.

Given the life changing nature of these procedures and the requirement for stringent aftercare, we pride ourselves on ensuring thorough and readily accessible post-surgical care over the longer term.