What Facial Feminization Procedures Do I Need?

Q: Dr. Eppley, I am interested in facial feminization with bone work. My issues are:  brow bone, orbit bone, recessed mandible, uneven face/jaw, flat midface/maxilla, low ears, floppy skin under chin, hollow temporal area, hairline, low brow, chin recess short, Skin texture/pores. Suggestions? Really look forward to hearing back.

A:Thank you for your inquiry and sending all of your pictures. Based on your areas of facial concern as well as the overall objective of female feminization I can provide the following initial comments:

1) Your brow bone protrusion is primarily in the lateral bro and not centrally. This requires hey bone burning reduction in detail of the brow which could be combined with opening up some of the lateral orbital wall as well.

2) Your recessed chin is best addressed by a sliding genioplasty as that will keep it narrow in shape but just as importantly will allow the deep labiomental fold from becoming even deeper…. which is what will happen with an implant. The sliding angioplasty will also best address the loose skin under the chin which gets eliminated as the chin bone moves forward.

3) The flat midface can be addressed by paranasal – maxillary implant augmentation.

4) The low set ears cannot really be repositioned higher. I’ve tried to do that many times and have never found a successful technique to do so. However the earlobe can be reduced and that will create the perception of a less long or higher positioned ear to a minor degree.

5) you have the classic female temporal hollowing which is best treated by a style II 4 mm extended temporal implant.

6) You have mentioned the hairline with a low brow and I am going to assume this means a brow lift would be favorable. It is unclear to me whether you want to keep the hair line at its current position or have a higher or lower. That is important information to know is that will influence how the browlift is done.

7) The only effective way to decreased pore size in combination with improving skin texture is laser resurfacing.

These are some of my initial comments and I have done some initial imaging in the left oblique view to reflect some of these potential changes.

Dr. Barry Eppley

World-Renowned Plastic Surgeon