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 is a set of cosmetic procedures done to soften typical male facial features and provide more classically feminine features to the face and neck. FFS is typically sought by the transgender population but can be performed for anyone seeking to soften their facial features. The selection of procedures is customized for each person based on their aesthetic goals. Some of the most popular procedures performed by Dr. Totonchi include:
- Tracheal shave (thyroid cartilage reduction)
- Upper lip lift/lip augmentation
- Forehead contouring (frontal bone contouring)
- Hairline advancement
- Cheek augmentation
Tracheal Shave: A tracheal shave reduces the size of the Adam’s apple to achieve a smoother, more elongated appearance of the neck. A tracheal shave is done through a small incision on the anterior neck which Dr Totonchi uses to “shave” down the tracheal cartilage. Tracheal shave is one of the simplest surgeries done to obtain feminine features and can be performed under local anesthetic.
Genioplasty: Transgender genioplasty is performed to transform a wider, flatter, longer, and more squared masculine chin to a narrower, shorter, more rounded female chin. The chin plays a crucial role in the proportions and balance of facial features.
Rhinoplasty: Rhinoplasty can be a key element in transgender facial feminization. The male nose, like the masculine chin, is typically longer, wider, and larger than the female nose which is generally shorter, narrower, and smaller in relation to female features. The nasal tip is generally adjusted to give a upward feminine appearance rather than the typical male downward nasal appearance.
Upper lip lift/Lip augmentation: The upper lip lift is generally done in combination with the rhinoplasty procedure. A small incision is made under the nose to lift the upper lip and decrease the distance between the nose and the upper lip. Decreasing the distance between the nose and upper lip gives a more feminine balance to the face.
Forehead contouring (frontal bossing): Forehead contouring involves “shaving” down the frontal bone and altering its pronounced shape. Masculine foreheads have a heavy bony ridge above the eyes, just below the eyebrows. Forehead contouring typically removes this ridge and softens the appearance of the forehead and facial features.
Hairline advancement (scalp advancement): Scalp advancement is a procedure done to move the hairline forward, decreasing the prominence of the forehead. The procedure is used to decrease the distance between the hairline and the eyebrows giving a more youthful, feminine appearance.
Brow lift: The brow lift/forehead lift gives the most dramatic FFS results. The brow lift procedure moves the eyebrows to a higher set position on the forehead, giving a softer, wide eyed, feminine appearance. The brow lift can be used in combination with the scalp advancement procedure to give a more youthful feminine aesthetic outcome.
Cheek augmentation: Cheek augmentation can be achieved with fat grafting and/or implants. Cheek augmentation helps to round out the face giving it a feminine appearance. The incisions used to insert cheek implants or fat grafting are made through the mouth so there is no evident scar on the surface of the face.
What should I expect after facial feminization surgery?
Facial feminization surgery has a wide range of recovery time depending on the combination of procedures that are chosen. Generally speaking, the recovery time is approximately 2-3 weeks when involving one of these procedures or a combination of these: forehead contouring, hairline advancement, brow lift, rhinoplasty or genioplasty.
The combination of these procedures, however, does not increase the recovery time. The recovery time remains 2-3 weeks. When adding the rhinoplasty procedure, nasal splints and stents are kept in placed for 2 weeks before removal.
The tracheal shave procedure performed alone does not have any “downtime”.
While you are considering facial feminization surgery, make a plan for yourself. Determine what it is that you like or dislike about your look. What are the masculine features that you would most like to soften and make more feminine? At your consultation, Dr. Totonchi will meet with you and discuss your aesthetic goals openly and honestly, and explain what is possible and attainable for you. He will assist you in choosing the best surgical plan to attain your desired outcome.
Call and make your consultation appointment with Dr. Totonchi to discuss your FFS needs, call office at 216-778-2262.