Facial feminization surgery (ffs)
Sometimes, it is observed that a woman’s face does not have feminine elegance and the woman partly develops a masculine face due to genetic reasons or diseases that increase male sex hormones. Excessive growth of facial hair, changes in the skin, such as thickening of the skin, and changes in the facial bony skeleton (such as forehead protrusion, jaw growth, etc.) are among the changes that may appear in women by increasing male hormones.
On the other hand, some men who need gender change due to medical reasons need facial feminization to marry and return to the normal state of a woman in society after going through the legal procedures of gender change and undergoing the relevant surgery.
Some of the measures for facial feminization are taken only using pharmaceutical methods or non-surgical procedures. Unfortunately, these measures are not applicable to all people and do not yield the appropriate results. However, the surgical methods could fortunately solve the problems of many people for whom non-surgical methods were not beneficial.
Effect of different facial elements on its sense of femininity
The first step to be taken for these people is to diagnose and control the underlying factors. It means that any factor that causes an increase in the level of male sex hormones should be detected and treated in such a way that leads to a reduction in the level of male sex hormones. When the hormonal changes in women are controlled and treated, some of their facial masculine features disappear or fade away (e.g., facial hair becomes thinner and their density decreases). However, we know that some of the changes (e.g., facial skeleton changes) have permanent effects on the skin that are not removed by themselves. Therefore, in these cases we use other methods to return facial femininity.
In this article, attempts were made to mention some of the differences between male and female faces and provide a brief explanation about face feminization in each of the facial elements.
Forehead
Forehead and eyebrows are generally different in women and men. This part is one of the most important face differences between men and women. The men have a protrusion in the brows area and a flat region between the two brows protrusions. This can create a concave shape in the profile view, while the forehead in women is convex and this can be seen from different angles of the face. The edge the bone above the eye in men is a little more prominent than in women and may need to be corrected.
Hairline
The distance between the eyebrows and hairline is shorter in women than in men. This state can also be seen even in adolescents who have not experienced masculine hair loss yet. The distance is approximately 5cm and 7cm in women and men, respectively. Therefore, although a high forehead is normal in men, but it is not beautiful at all in women. These causes the women with high foreheads to fail to easily pull their hair back completely (ponytail hairstyle), and they always hide part of their forehead by putting their hair under a full set of bangs.
Bringing hairline forward
The aim is to shorten the forehead and the distance between brows and hairline. By doing this in a high forehead woman, not only the face looks younger, but also the face femininity increases. One of the supplementary measures to be taken during the surgery is to lift forehead and eyebrows simultaneously. This causes the face to look younger and fresh, especially in older women.
In this surgery, an incision is made in front of the hairline. The incision is usually faded to the extent that no trace of surgery can be seen in most patients. But a hair transplant in the incision site can remove the surgery trace in patients who worry about remaining the incision marks.
This can also be done without anesthesia, and the patient can be discharged on the same day of surgery.
Face feminizing, eyebrows form correction
Eyebrows in women are naturally higher than in men, and the distance between eyes and brows is more in women than in men. In young women (without droopy eyebrows), the eyebrows are higher than the edge of the bone above the eye. But in men, it is placed right on the edge above the eye or a little lower than that. Lifting eyebrows in masculine-face women can make the face more feminine.
Feminizing rhinoplasty
In General, women have smaller noses than men. The presence of a big nose in the face makes the face masculine and reduces the feminine elegance in women’s faces. The nose skin is thinner in women as compared with men, and the angle between nose and upper lip is wider in women than in men. Although the presence of a nasal dorsal hump in men is natural, the back of the nose in women had better be flat or have a gentle arch. Besides other face feminization measures, rhinoplasty can greatly help feminize the face.
Face feminizing, cheek form correction
Cheek protrusion is very different between men and women. The cheek augmentation in men indicates the protruded skeleton and there is less soft tissue on the cheeks. Therefore, in these cases the cheeks are augmented laterally, but the protrusion in frontal view is not obvious that much. Additionally, the bony area of the cheeks is more visible in men, causing men’s faces to be more attractive. The contrary is true for women. Women have more facial soft tissue and cheeks look protruded in frontal view more than men and the bony area of the cheeks is not so visible. By changing this feature of the cheeks, the cheeks can be augmented in such a way that makes a masculine or feminine face. This should be considered when cheek augmentation is done using cheek prosthesis or other methods.
Different types of prostheses, fat injection, or gel injection can be used for cheek augmentation. According to the above mentioned points, fat injection is more effective than prosthesis in face feminization as it increases the soft tissue on the cheeks and hides the bony area.
Cheek prosthesis implantation can be done under general anesthesia, but fat injection can be performed without general anesthesia (under local anesthesia and by being put to sleep).
Face feminizing, chin form correction
In full view, the chin is narrower and slightly sharper, and its vertical length is shorter in women than in men, while the chin is wide and round and its vertical length is longer in men than in women. In profile view, the men’s chin is more augmented forward as compared with women’s. While forward chin protruding makes the men’s face more attractive, this reduces the facial elegance in women. By changing chin dimensions (its height, width and forward augmentation), the chin can become more feminine. This may require shaving a part of the chin bone or implanting a special type of prosthesis (prosthesis implantation).
Face feminizing, jaw prosthesis implantation
The jaw angle is more prominent and jaw muscles are stronger in men than in women. In fact, the strong muscles in the jaw angle cause the bone in this area to grow outwards and makes the mid face wider. Therefore, the mid face is narrower in women than in men and the jaw angle muscles are more delicate and smaller in volume.
Changing the jaw angle (jaw angulation) plays an important role in facial feminization. By decreasing the jaw angle tissues, the face can become more feminine. For this purpose, a part of the jaw angle bone and muscle is removed in such a way that no change is made to its normal and vital activities. This is done intraorally and without making any skin incision.
Of course, in the common models of some western countries, augmentation of the jaw angle is today very welcome among men and women. Therefore, contrary to what was mentioned above, some women in western countries may be applicants for the jaw angle augmentation. However, jaw angle augmentation should not be performed in an exaggerated way.
Face feminizing, laryngeal prominence augmentation
Laryngeal cartilage is more prominent in men than in women. In most women, laryngeal cartilage prominence is not seen at all. The prominence of this part in women will adversely affect the beauty of the neck. Excessive protrusion of laryngeal cartilage can even have adverse effects on the beauty of the neck in men.
In order to correct this prominence, part of this cartilage is shaved down or changed through an incision made in the neck. This can be performed without anesthesia.
Face feminizing, laryngoplasty (masculine to feminine voice change)
Finally after the face was feminized, the probable problem for a woman may be a masculine voice. We know that a woman’s voice has higher frequency than a man’s. In other words, women speak at a higher pitch and men at a lower pitch.
Due to the form of the larynx and vocal cords, some women have a very low-pitched masculine voice. By some changes in the larynx, we can change the sound frequency in a way that high-pitched feminine voice is produced. This surgery is performed without anesthesia and it can be done in such a way that is reversible (i.e. the previous sound is returned if the patient requests).
Face feminizing, complementary changes
In addition to taking the above mentioned measures, we can do other things for face feminization, including hair transplantation, fat injections in different parts of the face and neck, facial gel injection, etc.
Finally, in order to choose the best method for facial feminization, it is recommended that the applicants consult with an experienced physician in this field and then select the most appropriate method given their conditions.
