Facial Feminization Surgery
Facial feminization surgeries by Del Rey Aesthetics Center are performed by Dr. Kyle Keojampa, M.D., FACS. Dr. Keojampa is one of few surgeons with extensive experience in facial feminization surgery (FFS) procedures including forehead reduction Type 3, jaw contouring and facial implants. He trained with Dr. Jeffrey Spiegel, an internationally renowned facial plastic surgeon and the foremost expert in FFS in the world. During his training with Dr. Spiegel, he completed more than 200 cases of facial feminization surgery.
We provide Skype consultations for patients who are interested in FFS but are unable to visit our office for an initial consultation. Requests for Skype consultations can be made by completing the consult request form.
Facial Feminization Procedures
Below are some of the surgeries we may perform to help you in the process of gender confirmation. Not all procedures are needed for all patients, and Dr. Keojampa will work with you to recommend the specific set of procedures that is best for you:
In males the hairline is often higher than in females and usually has receded corners above the temples that give it an “M” shape. The hairline can be moved forward and given a more rounded shape either with a procedure called a “scalp advancement”wherein the scalp is lifted and repositioned
The forehead is the facial region most important for sex identification. Males tend to have a horizontal ridge of bone running across the forehead just above eyebrow level called the brow ridge or “brow bossing” while female foreheads tend to be smoother, flatter and have less bossing, or bossing that projects just below eyebrow level. The outer segments of the bossing that the eyebrows sit on are called the “supraorbital rims”. The supraorbital rims are usually solid bone and can simply be ground down. The section of bossing between the eyebrows (the glabella) sits over a hollow area called the frontal sinus. Because the frontal sinus is hollow it can be more difficult to remove bossing there. Dr. Keojampa has been trained in Type 3 Forehead contouring which involves creating an osteoplastic flap to maximally set back the forehead without compromising the integrity of the frontal sinus bone. Many surgeons simply grind down the forehead bone. However, if the wall of bone is too thin it may not be possible to grind the bossing away completely without breaking through the wall into the frontal sinus, which can have adverse consequences.
Men tend to have lower eyebrows relative to the position of their brow ridges when compared to women. Men’s eyebrows tend to be below their brow ridges while women’s eyebrows tend to be above their brow ridges. Accordingly, FFS to raise the eyebrows results in a face with a more womanly appearance.
Rhinoplasty (“nose job”)
Males tend to have larger and wider noses than females, and the base of the female nose will often visibly point slightly upwards when compared to a male. Standard rhinoplasty procedures are generally used to successfully feminize a masculine nose. Rhinoplasty is effective in achieving female facial profiles for patients undergoing male-to-female sex reassignment.
Females often have more forward projection in their cheekbones as well as fuller cheeks overall. Sometimes cheek implants are used to feminize cheeks. Implants come in various sizes and can be placed in different positions depending on the needs of the patient. Sometimes a fat transfer is performed where fat is removed from another part of the body and injected into the cheeks to make them fuller.
The distance between the opening of the mouth and the base of the nose tends to be longer in males than in females. When a female mouth is open and relaxed, the upper incisors are typically exposed by a few millimeters. To feminize the mouth, an incision is usually made just under the base of the nose and a section of skin is removed. When the gap is closed it has the effect of lifting the top lip, placing it in a more feminine position and often partially exposing the upper incisors.
Females often have fuller lips than males, so lip filling is often used in feminisation. There are many methods of lip filling, including injecting fat and fillers.
Chin and Jaw Contouring
Males tend to have taller chins than females and male chins tend to be square with a flat base and two corners. The chin can be reduced in height either by bone shaving or with a procedure called a “sliding genioplasty,” where a section of bone is removed. The square corners can usually be shaved down. Sometimes liposuction is also used to remove fat that some people have underneath the chin. Males’ jaws tend to be wider and taller than female jaws and often have a sharp corner at the back. The back corner can be rounded off in a procedure called “mandibular angle reduction”; bone can also be shaved off along the lower edge of the jaw to reduce width and height and the chewing muscles (masseter muscles) can also be reduced to make the jaw appear narrower.
Adam’s Apple Reduction
Males tend to have a much more prominent Adam’s apple than females although small Adam’s apples are more common in males than many people realise. The Adam’s apple can be reduced with a procedure called a “tracheal shave” or “Chondrolaryngoplasty”.
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