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Female face

Surgical reshaping of the face is an important part of the physical transformation of the transgender patient. For the male to female transgender patient it is largely a reductive approach for softening the structural aspects of the forehead, brow, nose and jawline. Conversely in the female to male transgender patient it is more of an augmentative approach to create stronger skeletal facial features. In either approach it take invasive surgery to make the facial metamorphosis.

Given the widespread use of many non-surgical procedures today for facial enhancements, it is a relevant question as to how they may apply to the transgender   patient. This can be done either in lieu of surgery or as in addition to after surgery.

In the May 2019 issue of Aesthetic Surgery Journal, an article was published entitled ‘Nonsurgical Management of Facial Masculinization and Feminization.’ In this paper the authors reviewed existing medical literature for nonsurgical techniques in transgender facial reshaping. For the most part this means injectable therapies using either neurotoxins and synthetic fillers. Only four (4) articles were found and there was a relative paucity of published work in this regard as was initially suspected. As a result injection techniques for cisgender patients was used to supplement the review.

For facial feminization injectable fillers have a role for soft tissue lip augmentation and bony cheek augmentation.  Botox can be used to create various amounts of eyebrow reshaping/elevation as well as reduce wrinkles in the forehead and crow’s feet. For facial masculinization injectable fillers have useful roles for brow bone, chin, jaw angle/jawline and nasal augmentation.

While non-surgical approaches do not offer the profound effects that surgery does, they can create some favorable facial reshaping effect even if they are temporary. This provides a means for some patients to initially ‘try’ a few changes or to supplement their prior surgical results.

Dr. Barry Eppley

Indianapolis, Indiana

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