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Putting Your Best Face Forward:
The Facial Feminization of the Transperson


By Sheila Kirk, M.D.



(This is the first of a 3 part series that will deal with discussion of the surgeries available to those who desire facial feminization. In December, Part 2 will deal with the bony remodeling and re-sculpturing surgical techniques available. January's column will provide insight into soft tissue revision and alterations.)

The face and hair are the regions of the body that draw initial and long lasting attention. In the process of feminization, it can be more important for a considerable number of MTF individuals to give attention to these very revealing areas before they move on towards GRS.

The differences between genetic males and females in soft tissue and the bone structures beneath can be very striking. While just a few genetic males have some and even many of the special features known to be very characteristic of genetic females, most do not. In fact, some features are so strikingly masculine, no amount of makeup and/or hair arrangement can disguise these areas. Hence it is in the interest of many to seek advice and consultation to change the facial appearance in the most effective ways possible.

Plastic and reconstructive surgeons are the most innovative and imaginative of all surgeons. They can visualize the changes that will benefit the most and then undertake to implement those changes. They literally take away, add bone, utilize implants and remodel skin and tissue beneath to bring about striking alterations. But two things have to be always kept in mind. The first is that a realistic attitude about what is possible and what will result in the surgery is essential. Helen of Troy's face is not possible for everyone - and surgeons can't always promise it. Nor should each prospective patient expect it! To be sure however, a great deal can be done. The second item to know and understand is that cosmetic surgery to the face and scalp is costly and not covered by third party payers. This can be a real barrier and one has to plan and choose the surgical avenues possible over time.

But a beginning in those choices starts with the consultation visit - one designed to look at the potential for creating a female face, as nearly so as possible.

Keep in mind that when you ask for the evaluation, you want assurance that the plastic/reconstructive surgeon understands that the goal for you both is not to demasculinize your features but to feminize your face. This is a subtle but a vital point. You want not just a smaller or more or less prominent jaw and chin-you want it to approach that of a female as completely as possible and it's all to be discussed with this in mind.

Many times there is no need for x-ray studies although on occasion it can be of great importance. Once more: these evaluations can be costly. There is the need to know how they will add to the evaluation. It is tremendously important that the surgeon look at the overall effect of changing this feature or that one. Often to change one area of anatomy and not look to the effect of that change upon other features is a great mistake. Just as important is the consideration that to change too many things can be a failure to accomplish the very best.

"Cookie Cutter" approaches that offer you a standard list of surgical procedures with no regard to your individual facial assets are to be avoided. When you meet with your surgeon, planning should take into consideration the uniqueness of your certain anatomic features and their need to be augmented or reduced has to be the focus in that consultation. It is equally as important that your best features are accentuated and enhanced as well as feminized. Your surgeon must balance his knowledge and experience against what you bring to him to work with.

The very first features of your face to be evaluated by those meeting you for the first time and times thereafter, are your eyes. What shape are they? Are the lids clearly seen? Are there wrinkles and ridges and bulges around them? Is change really needed and if so will they "look" manufactured when the surgery is complete. Next, your nose and mouth are the focus for those around you. What shape and size is your nose? Does it command undeserved attention because of how it appears in the middle third of your face. You lips may be too thin, hard and unappealing. What of your brows? Are they prominent and heavy? And consider the size and shape of the forehead and the distance you have between hairline and eyes. Do you have a proper hairline? Is there too much skin laxity or too much fat deposition in the neck and jowls? Will changing one feature enhance another properly or adversely? A host of questions should be asked of your surgeon and complete and informative answers should be available to you.

Facial cosmetic surgery often needs to be approached in stages. Surgical techniques can't always be lumped together. Many times the surgeon suggests that several areas are to be modified and then allowed to heal. The plan for more surgery may then be re-evaluated after the healing from the 1st and 2nd stage is complete. Maybe nothing more is necessary. You become a team: your surgeon and you. You can suggest and request. He or she can evaluate and discuss with you what is possible and within limits of skill and natural healing.

Above all-don't become addicted to surgery. I'm acquainted with some who have had three nose operations and several face lifts and a tuck here and a revision there with surgery done just about every year for life. Bone and soft tissue have but a limited reserve to be rearranged and then to heal. Once again, realism is essential when you enter into this transformation process.

Is it then all worth it? The time, the cost, even the pain? It certainly will be for those with distinctly heavy masculine features. Softening, re- modeling, re-building all can benefit you remarkably. But become a good "consumer" and a sensible one. Plan it and save for it if need be. Remember your observed anatomy, your face, open and seen by all can be much more important to consider than any other part of your body.


Sheila Kirk, MD recently made Trans-history by forming the first Transgender Surgical & Medical Center (TSMC Center) developed and directed by a Trans surgeon. In addition, Dr Kirk is the first Trans-surgeon performing MTF GRS surgeries, breast augmentation and related surgeries. Together with her partners she also performs rib removals, male pattern baldness correction, craino-facial feminization, body and facial contouring and corrective procedures. You can receive more information about the TSMC Center or ask Dr. Kirk questions on your treatment and care, by contacting her at TSMC@aol.com, by phone (412) 781-1092, fax (412) 781-1096 or snail mail: TSMC P.O. Box 38366, Blawnox, PA 15238.

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