Non-Transgender Female Feminization
Q: Dr. Eppley, I am interested in jawline reduction surgery and rhinoplasty for a facial feminization effect. I am a female but I look too masculine. Perhaps this is a bit silly, but my friend photoshopped my face to look much more oval. I’d like to go for a more oval jaw (if possible) and smaller. He did nothing to the nose, but I’d still prefer a more refined nose and think the current nose would not fit well with a more refined jaw. I’d like my nose to be thinner all the way down and also more refined at the tip. I’m sending an example photo, which I realize might not be the best fit for my face (or maybe it would be). I hope this is helpful. If you need a side view of my nose, which is very straight, I can send that as well. Anyway, I’ve had a few people mistake me for a male when I’m not wearing make-up. To me that’s distressing and that’s the motive for seeking additional cosmetic surgery.
A: Thank you for sending your pictures and delineating your goals…which I completely understand and concur. My current comments are as follows:
1) I would agree that the nose and jawline are tied together in terms of the overall goal of facial femininization. Reducing one will make the other look bigger.
2) The nose and jawline are two of the three main keys to any form of facial feminization surgery. (the forehead is the other one)
3) Using the ideal morphed image (which I have attached a direct comparison) shows that the degree of jawline reduction would be hard to achieve. That is a 1 cm vertical reduction of the anterior jawline. The location of the tooth roots and nerve will not permit that much reduction. A panorex x-ray is needed to make measurements to see how much can be done.
4) Regardless of the amount of reduction, the issue in the ‘older’ patient is how will the overlying soft tissues adapt to a reduced bone structure. This is relevant as it makes for a critical decision in how the jawline reduction is approached. (intraoral vs submental) If you like carefully at most jawline reductions they are done in younger patients with good skin elasticity and contraction. The intraoral approach requires that such tissue contraction will occur. Because of your age and that you have already had a facelift, this raises the issue of whether a submental approach should be done which can better help with soft tissue reduction in the chin should that be needed. (and it is most certainly will)
Dr. Barry Eppley