Medical Director for the Center for Transgender and Gender Expansive Health Dr. Fan Liang answers frequently asked questions on facial feminization surgery. Questions include: What is the first step in facial feminization surgery (FFS), What do you look at when evaluating the face, What is involved in FFS, What will recovery look like, and if the process is similar to facial masculinization surgery.
So the first step if you're interested in facial feminization is to get in contact with us through our main access line. That's the number listed on our website. And I'll put you directly in touch with one of our access agents who will then set you up for an intake with one of our staff members. Every individual has their own aesthetic. And I think it's important when you're choosing your facial feminization surgeon to make sure that their aesthetic aligns with your aesthetic. One of my mentors once equated facial surgery to choosing an interior designer, there's not necessarily a right or a wrong answer, but there's a preference and there is a sense of self that makes you feel the most comfortable, the most affirmed and the most beautiful. My personal aesthetic is one really of natural beauty. Um I really shy away from an overdone look and my goal is to have you walking down the street and for somebody to say, wow, that's a beautiful woman that just passed me by. My goal is not for somebody to say that's a woman. I wonder what surgical procedures she has had done that. Philosophy underlines a lot of the surgical decisions that I make. The goal is to enhance and accentuate and for everything to come together in a really beautiful harmony. When I meet a patient for the first time, I really like to just get a general assessment and overview of what the facial proportions are. I think it's easy to get lost in the details. But as a surgeon, I'd like to take a step back and gain an overall aesthetic of the face. Is the face long is the face short? Is it round, is it square? What are some of the features in the face that are fundamentally already very beautiful and feminine to begin with? And how can I accentuate those features? My goal as the surgeon is really to uncover an underlying feminine beauty that's already pre existing in the face and to draw that out. So when I think about the face, I like to think about the upper middle and lower thirds. When we're talking about the upper third, we're really talking about the shape of the hairline, the length of the forehead, the arch of the eyebrows and the softness around the eyes. And there are things that I can do in terms of scalp, advance, bony contouring or bony set back and modifications around the eyes to really open them up, make them seem more feminine and really softer to contribute to the overall aesthetic of the face. When we're talking about the middle third of the face. The areas that I'm really focused on are the nose and the cheeks. The cheeks are interesting in that you don't always think about them when we talk about feminization. But they can make a really tremendous difference in creating a heart shaped aesthetic to the face and heart shaped proportions um and softening up the face to make it seem more gentle, more feminine and overall, more beautiful. So I really like to address the cheeks for the middle third. Finally, when it comes to the Rhinoplasty, there's many techniques for feminizing rhinoplasty to make them no smaller and more petite. And that goes a long ways towards feminizing the facial proportions. When we're talking about the lower third, we are talking about the lips, we're talking about the chin, we're talking about the jaw and the goal angles. Uh And then for the lower third, you know, there are many techniques including a lip lift to augment the upper um lip volume and upper lip contour. Um we can also make the chin more tapered by decreasing its width um and improving its facial harmony proportions. And then also we can decrease the overall width of the lower face by doing bony reduction along the goal angles. Other adjunctive procedures can include things like buckle fat removal, esoteric reduction. And then in the lower third as well, we can talk about uh chondral angop Plasty, which is the tr shave to decrease the prominence of the Adam's Apple when it comes to scarring, uh there's always going to be scars with surgery. But the good news is that I do my very best to camouflage the scars or to hide them in a way that they're not apparent, especially as the scarring process matures. And you're about six months out, 12 months out from surgery, the scars are hidden along the hairline and they're also hidden within the mouth so that they become virtually invisible to anybody that you're interacting with or talking to. Once the recovery is complete facial masculinization, surgery is a component of gender affirming care. And although there are some similarities between facial masculinization and facial feminization. Fundamentally, facial feminization is a more reductive approach. We're trying to make the face smaller, we're making the nose smaller. We're really trying to open up the eyes and open up the mouth when it comes to facial masculinization. The goal is to augment some of the structures that we are trying to diminish from facial feminization. So this becomes things like augmenting the jawline, augmenting the shape and prominence of the Adam's Apple, augmenting the brow ridge. The approach to the surgery can be similar. I try to hide the scars inside of the mouth and along the hairline. But the actual procedure itself is the opposite of what we're trying to accomplish with facial feminization. Again, the concepts of facial harmony play a very important role and the decision of what to embark upon for the surgical plan is arrived at through a long discussion between myself and you the patient.
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