For facial feminization surgery, Dr. Sidhbh Gallagher tailors her approach to the personalized needs and preferences of the patient.

She will discuss with her patients in-depth about what options they have and then formulate an individualized plan from her vast knowledge of different procedures that feminize the face.

These Facial Feminization Surgery Techniques (Starting From the Top Down) May Include:

• Scalp Advancement/Hair grafting
• Forehead Osteotomies/Reshaping
• Brow lift
• Orbital reshaping
• Blepharoplasty
• Rhinoplasty
• Cheek implants or fat grafting
• Facelift/neck lift
• Lip lift/augmentation
• Jaw contouring
• Genioplasty

Dr. Gallagher does not believe in a “one size fits all” model for these procedures. Instead, she will use her trained eye to recognize which facial features will benefit most from feminization. That way, the patient can maintain their individuality and achieve the desired results. 

Many of these same techniques are performed as anti-aging procedures, especially in patients over 40.

Non-Surgical Options

Injectables like Botox and/or fillers have been wildly popular in cosmetic surgery and treatments for anti-aging. They have been quite successful in helping feminize the face. These techniques are clearly not as effective as plastic surgery but can still be quite affirming for patients who are ready to undergo surgery or cannot access it. 

Injectables

As previously mentioned, using fillers for anti-aging effects can create a more feminine look. In addition, as we get older, we lose volume from our cheeks, and by replacing it, we can enhance the cheek contour. It also helps reduce lines and bags. 

It is also possible to plump the limps with injections and to make the vermillion or red part of the lip larger.

Botox

Usually, Botox is used to soften lines, which gives a younger look. However, did you know that it can also soften a square jaw? In some patients, the angle of the jaw, which can have a square appearance, is made up of not just the jaw-bone but the masseter muscle as well. Botox injections (approximately three per side) can shrink the muscle and provide a more feminine, oval facial shape. 

It’s essential to keep in mind that Botox effects are temporary but can last up to six months.

Facial Feminization Surgery Options

Facial feminization can be a lengthy procedure, where a full day of anesthesia is needed. As a result, some surgeons will opt to do the surgery in different stages. On the other hand, some patients may take a slower approach in their transition journey and have procedures done here or there. 

An overnight hospital stay will likely be required. There can be some pain and discomfort, depending on whichever surgery was performed. There may also be bruising and swelling within the first few weeks of surgery. 

According to recent studies, transgender women who choose facial feminization procedures have a higher satisfaction rate and improved quality of life.

A Closer Look at the Procedures

Scalp Advancement / Hair grafts

Female faces have lower hairlines than males do. Therefore, for many of the upper face procedures, a big ear-to-ear incision is made across the head to move the scalp forward.

Forehead Osteotomies/ Reshaping

A prominent brow bone is indicative of a masculine face. In medical terms, it is known as the “frontal boss.” Dr. Gallagher will make a big coronal (ear to ear) incision either at the hairline or the scalp to avoid face cuts. 

One common misconception is that this bone can be “shaved down.” However, this fact is only true in approximately 5% of patients. In addition, the “frontal boss” is located at the frontal sinus for about 95% of patients. As a result, the skull that remains there is made up of three layers: a thin layer of bone, the “anterior table,” and the “posterior table.” 

In essence, if a plastic surgeon were to “shave” the anterior table, there wouldn’t be much difference, or they might “shave” into this sinus which would leave a hole in the forehead. 

Dr. Gallagher may order X-rays or a CT scan before the procedure to determine the size of the sinus. To create a difference, an “osteotomy” (hole in the bone) will be needed. 

For the most part, Dr. Gallagher will cut the anterior table, perform a reshaping, and position it to go back into the frontal sinus. Plates and screws are generally used for putting it back into place. Dr. Gallagher may also, if required, shave down and contour other areas of the forehead.

Orbital Reshaping

The orbit (a patient’s eye socket) usually is different in shape for men and women. Therefore, for a more feminized face, there will be a wider look. To achieve this “doe-eyed” look, osteotomies (cuts in the bone) of the orbit will be performed to open the aperture.

Brow Lift

Female brows have a more arched look. A brow lift can create this result for a more feminized face. There are various methods to achieve this appearance, and Dr. Gallagher will use an anchoring device to hold the brow in place and prevent it from lowering. These anchors come in the form of sutures or “tacking” devices.

Blepharoplasty

A blepharoplasty is a standard plastic surgery method that fixes droopy upper or lower eyelids. This procedure is unnecessary for every transgender woman, but many over the age of 40 find it beneficial.

For the upper lids, there will be an incision made over the lid skin and extra skin. In some cases, fat is removed. This skin heals quickly, and there is usually no trace of a scar. 

Dr. Gallagher will go from inside the lower eyelid to lift or eliminate fat that creates bags under the eyes to approach the lower lids. Sometimes, skin is removed during this surgery. 

Rhinoplasty

Rhinoplasty, aka a nose job, is a standard procedure performed by Dr. Gallagher. She uses various techniques to minimize the size of the nose, reshape a person’s side profile, and reduce the tip. 

Osteotomies will likely be needed to minimize the nose’s size. A splint will be used to protect the nose during the healing process. During surgery, small cuts will be used at the nose’s base. 

Cheek Implants or Fat Grafting

Cheek implants or fat grafting can provide sharper and stronger cheekbones, depending on the patient’s anatomy and what they prefer. 

If implants are required for surgery, they will be placed through incisions hidden in the mouth. Another standard procedure is taking away fat from somewhere in the body and have it processed and then injected into the cheeks.

Not all patients need to have this step done. Dr. Gallagher will use their expertise and keep subtlety in mind so that a patient doesn’t have over-pronounced “Pinocchio “cheeks.

Face and Neck Lift

For most patients over the age of 40, a face and neck lift will be added to their surgery. It can provide a younger and feminine look. 

Face and neck lifts take away loose extra skin that has drooped below the jawline. They also smooth out any lines or jowls. 

Another benefit of face and neck lifts is that they can give a cervical-mental angle. This angle is the shape that forms on a profile where the neck and chin area meet. An angle of 105-120 will provide a more feminine and youthful appearance. 

The face and neck lift will likely be done with various incisions in front of and behind the ear. It is usually a small incision under the chin and will reach the neck if needed. This same incision can also double up as the tracheal shave incision is required for the person undergoing surgery. 

Lip-lift or Augmentation

The space between the nose and the red of the lip (or the “vermillion”) is shorter in women than it is for men. As we get older, the distance becomes longer. Minimizing this distance can be an excellent way to feminize the face. This procedure, called the lift lip, is done through a small incision along the nose’s base. It will show more of the patient’s vermillion, which gives the appearance of more prominent and fuller lips. 

Most patients will choose lip injections. It is possible to put in implants at the time of surgery. However, it depends on the type of implant. Some implants may come out or dissolve after some time. 

A patient’s fat could also be injected into the lips, but it is uncertain how well this fat will stay in place over time. 

Jaw Contouring

A square jaw is characteristically male, whereas the female face is more oval. To change this appearance, the jaw bone will need to be reshaped with osteotomies through the mouth.

Genioplasty

Genioplasty is a procedure that changes the chin’s shape. This surgery is performed through the mouth and will likely require reducing the chin. Chin reductions can provide a softer appearance. However, chin implants or moving the chin forwards or backward (osteotomy) may also be used instead, depending on the patient.