Facial Masculinization Surgery (FMS)
Typically, with female-to-male transitioning, hormone therapy is the most effective way to change secondary sex characteristics and achieve a more masculine facial appearance. However, facial masculinization surgery (FMS) is gaining popularity. This procedure involves making features more prominent and hence more masculine in appearance. Examples include chin and nose augmentation, cheek augmentation, jaw contouring, and lowering of the eyebrow ridge/forehead lengthening.
Chin and nose augmentation
Generally, female noses tend to be smaller, less prominent, and slightly pointed. In facial masculinization, the nose and chin are augmented and widened to create a more masculine appearance. A cartilage graft is used to change the size and shape of the nose. A variety of techniques can be employed for the chin, which includes the use of a chin implant, osteotomy (cutting and shaping of the chin bone), or fat graft.
In FMS, the cheeks can be made more angular and prominent in order to mimic a masculine facial bone structure. While not all patients require this procedure, it can be helpful in achieving a more harmonious profile with the use of cheek implants. The placement and size of the implant will depend on the individual patient’s facial anatomy.
This procedure reshapes the jaw line, increases facial width, and creates an angular, more masculine jaw line. The entire of scope of jaw contouring procedures are done from incisions made inside the mouth. In the case of patients with more narrow mandible angles, jaw implants are used to create a more defined jaw structure. This procedure is often done in conjunction with chin reshaping. A narrow chin can be augmented using a combination of techniques, which include bone shaving and/or osteotomy.
Forehead lengthening/Hairline Change
Males tend to have wider and longer foreheads than females. Forehead lengthening is a procedure, which elongates the forehead, increasing the distance between the brow ridge and hairline. This is done by stretching the skin of the forehead and utilizing laser hair removal in order to eliminate the previous hairline move it further up on the scalp. In extreme cases, a tissue expansion is used to achieve the desired effect.
Facial Feminization Surgery (FFS)
Facial Feminization Surgery, or FFS refers to any combination of reconstructive surgical procedures used to alter masculine facial features and transform one’s appearance to become more feminine. Surgical techniques for FFS are rooted in cosmetic, maxillofacial, and reconstructive surgeries. Procedures typically associated with FFS include rhinoplasty, brow lift, correction of frontal bossing, lip augmentation/shortening, and malar augmentation or cheek implants. FFS can also include forehead shortening, which brings down the hairline, in addition to tracheal (Adam’s apple) shaving and chin feminization.
While there are no hard and fast rules when it comes to a feminine or masculine facial aesthetic, there are some general secondary sex characteristics that are attributed to females as opposed to their male counterparts. For example, a female face tends to have softer more delicate features, including a smaller nose, a more pointed chin, a softer, low hairline, less angular jaw line, and a vastly different skull/forehead shape, which affects the skins contour and how skin rests on the bone. These differences ultimately distinguish ones features as primarily male or female.
FFS is often considered a vital component of transitioning from male to female (MTF) and is also utilized by transgender men who elect not to undergo gender reassignment surgery. In fact, FFS has been proven to be a necessary component in gender reassignment surgery, as it helps with social integration when undergoing the MTF transition.