Facial Gender-Affirming Surgery: Facial Analysis and Procedures for Facial Masculinization

Feminine facial features may be a source of significant gender dysphoria in certain patients. A masculine appearance includes an M-shaped hairline, wider and taller forehead, supraorbital bossing, larger and wider nose with a large dorsal hump, broader chin, wider mandible with a sharper angle, thinner lips, presence of facial hair, and prominent thyroid cartilage. Given these critical differences between feminine and masculine facial features, a comprehensive and systematic way of evaluating these distinct structures is necessary before facial gender-affirmation surgery. While no single approach to facial masculinization surgery exists due phenotypic diversity of masculine features and unique individual preferences, select anatomic features can be augmented through nonsurgical and surgical techniques to create a harmonious face that better aligns with a patient's identified gender. Here, the authors describe a standardized method for facial analysis and review anatomic sexual dimorphism and procedural and surgical facial masculinization.