Q: I am interested in facial feminization surgery. I will be starting hormone replacement therapy in the next few months and as part of this I would like to know which surgical procedures I can benefit from. f you could list them in priority would be greatly appreciated. I need to prioritize my surgeries based on finances and benefit. Thank you so very much for providing this service, it will be such a stress reliever and I am looking forward to your recommendations. I have attached a front and side view picture of me to review.
A: Thank you for sending your pictures. In looking at your pictures, I would recommend the following facial feminization surgery procedures and would place them in the following order of importance and value.
1) Forehead Contouring/Brow Reduction and Brow Lift – This is almost always one of the most important areas as you have a classic male forehead and appearance with a low horizontal brow shape, mildly prominent brow bones and a dip in the forehead shape. A more feminine appearance comes from smoothing donw the brow bones with a lateral wing effect, cranioplasty to make the forehead more convex, and a browlift to create an arch to the eyerows with a lateral swoop. This can dramatically change the way the eye and forehead area looks, creating a very softening effect. Because this has to be done through an open scalp incision, you will need to consider potential hair transplantation later. But this may have been on your list anyway at some point.
You would also benefit from an upper blepharoplasty to get rid of the extra skin and create a better eyelid shape to go with the forehead/brow reshaping.
2) Rhinoplasty – The thick skin and shape of your nose needs substantial refinement. That is a challenge with your thick nasal skin and underlying cartilages but significant improvement can still be obtained.
3) Chin Contouring – Tapering the chin bone to make it less square would provide a softening effect.
4) Necklift – Tucking up the loose neck skin would help the chin and the neck angle to be more defined.
As outlined above, the Forehead, Brow and Nose are really important in our case and would be the first set of procedures you should do. I have attached some rough computer imaging which gives a general idea but would probably look better in real life as there are limits to what moving image pixels around can do.
Dr. Barry Eppley