Case report: feminizing the male face

Sex reassignment surgery is accepted in properly planned cases to change facial appearance in accordance with a new gender. Although changing the hairdo or makeup, and depilation, give satisfying cosmetic results in many patients, hard and soft tissue facial surgeries are needed in most cases. Unfortunately, few studies on facial corrections have been published and feminizing a male face is still considered an arbitrary undertaking. We present a useful surgical protocol to feminize the male face.

Ten male-to-female transsexuals aged 20 to 32 years (average 23 years) were referred after gender reassigning for facial feminization (1990-2007). Clinical examination of the patients revealed variable degrees of common masculine features such as long square faces, broad chins, excessive projection, frontal bossing, prominent flaring gonial angles, high hairlines, and low-set eyebrows. After complete clinical assessment and paraclinical workup including cephalometry, the patients were admitted for feminizing surgery. The face was outlined in geometric proportions. It was aimed to round the male face using a sequence of staged surgical procedures for both hard and soft tissues.

Ten male patients aged 20 to 32 years (average 23 years) underwent facial feminization using basic surgical guidelines. Various amounts of soft and hard tissue changes were required for individual patients and were tailored for each case according to the preoperative workup and standard parameters.

All 10 patients were satisfied with their improvement in appearance; the degree of impact these procedures may have on lifestyle remains to be assessed.