You might not have heard of facial feminisation before Caitlyn Jenner created an Internet crash of her very own earlier this year. Here Emma Bangay explains what’s involved in this incredibly intricate procedure.
For several decades, Bruce Jenner was part of the American celebrity zeitgeist – first as an Olympian, then as stepfather to the Kardashian clan. Then in what seemed like an overnight transformation, although rumours pre-empted it for many months, the world was introduced to Caitlyn.
Australian Facial Feminisation Surgeon, Dr. Paul Gerarchi, points out, Caitlyn was no doubt decades in the making, as the psychological, emotional and surgical steps during transition are in-depth and take time.
‘A rigorous psychological evaluation needs to be completed before any individual embarks on the transgender journey,’ Dr Gerarchi explains. ‘This is commonly followed by hormone therapy as prescribed by an Endocrinologist – who deals specifically with hormones and endocrine glands,’ he explains, adding that in most cases, facial feminisation is the next step.
What Is Facial Feminisation Surgery?
Facial feminisation surgery (FFS) is a series of reconstructive and aesthetic surgical procedures that alter the face to reduce its masculinity and increase its femininity. These surgeries can involve many variations but generally include full reconstruction of the forehead, nose and jawbone as well as soft tissue work such as dermal fat augmentation (artificially filling areas of the face where volume and contours have been lost with age), lip lifts and possibly facelifts.
‘Non-surgical adjustments can also be made to feminize the face including administering Botox to the forehead and mandible (the jaw area) and injectable fillers to soften up the face,’ explains Dr. Gerarchi. ‘Many of the procedures can be combined and often a number of the procedures are done together at the one time,’ he adds, noting that most only have a downtime of two to three weeks.
Five Steps To Facial Feminisation:
Forehead: ‘The angle of the forehead, prominence of the brow and ridge position of the eyebrows are major indicators of a feminine or masculine appearance,” explains Dr. Gerarchi. ‘These can be feminised and softened at the same time as laryngeal surgery or face lifting.’
The Nose: Smaller, less prominent noses are deemed more feminine. ‘This procedure can be done at the same time as a face lift, fat transfer, laryngeal surgery or chin surgery,’ Dr. Gerarchi explains.
Reconstruction of Mandible: The mandible refers to the jaw, particularly the lower jaw that is generally stronger in men. The reconstruction process decreases the hard angle, prominence and strength of the male jaw and chin, making it appear more feminine. ‘Often this is done as a separate procedure but can be done at the same time as laryngeal surgery or fat transfer,’ notes Dr. Gerarchi.
Lip Lift: This procedure ‘turn’s the lips, showing more of the internal red part, and creating fullness and plumpness.
Face Lift: This helps with tapering the face and smoothing out lines as well as giving a more defined jawline, says Dr. Gerarchi, and is commonly done alongside a lip lift, rhinoplasty or fat transfer.
Non-Surgical Facial Feminisation:
‘Botox is often administered in the forehead to soften and somewhat weaken the muscles in this region,’ he explains. ‘It’s also used around the eyes to give a more feminine and less coarsely wrinkled appearance and into the masseter muscles (those that run through the rear part of the cheek from the temporal bone to the lower jaw) to help with tapering of the jawline and angle of jaw,’ he explains. Injectable fillers are also a favoured procedure for filling out cheeks, lips, under the eyes and around the temples.
The Obstacles
‘Cost and downtime,’ are big obstacles transgender patients face when considering facial feminisation procedures, admits Dr. Gerarchi. ‘However most individuals are highly motivated and dedicated to the procedure due to its life-changing effects.’
The Benefits:
‘The individual develops an appearance that is more akin to the identity that they have of themselves,’ Dr. Gerarchi explains. ‘Having a more feminised appearance also facilitates their new everyday life.’