The future is feminine

Reporter Becki Murray investigates how facial feminisation surgery is powering impressive surgical and non-surgical aesthetic innovations, for the benefit of the transgender community and beyond

When a client looks in the mirror post-surgery, the truest reflection of a successful treatment is that they feel like the best possible version of themselves. Nowhere is that truer than when the procedures they choose are designed to affirm their gender identity.

“Female feminisation surgery (FFS), also known as facial feminisation surgery, is a set of surgical and/or non-surgical procedures aimed at altering the facial features to make them appear more feminine,” explains Dr Verna Kugan from the Pico Clinic London. “It is typically sought by transgender women or non-binary individuals assigned male at birth, who wish to align their physical appearance with their gender identity.”

Of course, no female face looks the same – even identical twins show subtle differences – and the concept of ‘femininity’ varies across cultures and individual preferences. Still, there are some aesthetic hallmarks that practitioners tend to consider:

“Generally, a feminine face is characterised by softer and rounder contours; smaller and more delicate features such as the nose, chin, and jawline, as well as fuller lips, and larger eyes,” says Dr Veerle Rotsaert from Injectuals. “Feminine foreheads tend to be smoother and rounder, with a less prominent brow ridge and higher eyebrows,” continues Dr Kugan. “Plumper, rounder cheeks can create a softer, more youthful look, and a smoother, less angular jawline with a more tapered chin is also associated with femininity.”

THE OPTIONS

With this in mind, “the procedures commonly used in FFS include a brow lift, forehead contouring, rhinoplasty, cheek augmentation, lip lift, jawline reduction, and/or chin reshaping. Non-surgical treatments include lip filler, cheek filler, chin filler, temple filler, jawline slimming injections and tear trough improvement,” lists Dr Rotsaert, who recommends and works with MaiLi’s premium hyaluronic acid range.

“Feminisation treatments can also benefit cis-women who may have features that they feel are not feminine enough or are causing them discomfort,” Dr Rotsaert continues. “Procedures such as rhinoplasty, chin reshaping, and lip augmentation can help cis-women achieve a more balanced and harmonious facial appearance, boosting their self-confidence.”

While FFS is not a new technique, it is generating more conversations of late – particularly online due to the wider discussion around trans issues – and the tools that practitioners have at their disposal are also improving: “There have been significant advancements in FFS techniques and technology, such as 3D imaging, computer-assisted surgery, and minimally invasive procedures, that, when backed by scientific evidence and approached with caution, can improve the precision, safety, and outcomes of the surgery,” says Dr Rotsaert.

PERSONALISATION

What’s more, FFS’ focus on truly bespoke treatment plans is also becoming a leading example within the whole aesthetics industry as it moves to deliver greater personalisation – a key demand from potential clients whatever their aesthetic concern.

“Personalisation is crucial for FFS because every person’s facial structure, skin type and proportions are unique, and the procedures needed to achieve a desired outcome can vary significantly,” explains Dr Rotsaert. “As a surgeon, I work with clients to determine their goals for feminisation, assess their facial anatomy and proportions, and recommend the most appropriate procedures to achieve their desired outcome.”

Moreover, “considering different ethnicities and cultures have their own unique facial features and aesthetic norms, personalised FFS ensures that the practitioner can create a result that preserves the patient’s cultural identity while achieving a more feminine appearance,” continues Dr Kugan. “By carefully selecting the most appropriate techniques, the practitioner can create the best possible result.”

It’s not surprising then that even practitioners not currently specialising in FFS procedures are increasingly seeing the benefit of the FFS approach. “The personalised and combined approach of FFS can serve as a model for other areas of plastic surgery and medicine,” affirms Dr Rotsaert. “Instead of applying a one-size-fits-all approach, practitioners can tailor their treatment plans to the needs, preferences, and goals of each patient, leading to better outcomes and patient satisfaction.”

MENTAL HEALTH

What’s more, FFS is also driving awareness around the key role that aesthetic treatment can have within the complex dynamic between our outer appearance and mental wellbeing. For example, the American transgender activist and content creator Dylan Mulvaney – who underwent FFS performed by the world-renowned doctor Dr Harrison Lee – recently covered her experience on social media, placing particular emphasis on her mental health.

“It’s still me. It’s just a little bit softer of a version,” said Mulvaney after revealing her facial feminisation on TikTok. “This is an extremely privileged procedure and I want to stress that this is not just typical plastic surgery. Had I not been trans, these wouldn’t have been changes that I would have sought out, but because of my gender dysphoria, I felt I needed it. I just hope that all trans and non-binary people can get the gender-affirming resources that they need because this is life-changing and sometimes lifesaving. It has truly already brought me so much peace.”

It’s a sentiment shared by the experts too: “FFS can significantly impact a patient’s emotional wellbeing, as it can help alleviate gender dysphoria and improve self-esteem, contributing to their overall mental health,” says Dr Kugan.

Importantly though, the mental health toll of the process can be significant, requiring practitioners to be suitably informed and trained to avoid worsening a patient’s self-image. This is especially true considering that body dysphoria is traditionally a sign not to treat, as it could be damaging to the health of a patient. FFS thus provides a unique challenge – whereby the risks and rewards of addressing dysmorphic thoughts should always be kept firmly at the heart of each consultation and aftercare appointment.

Furthermore, both practitioners and clients need to be suitably aware of the potentially significant downtime of surgical FFS – swelling, bruising and necessary lifestyle changes are all common. Thorough aftercare is also integral to avoid any mental health consequences if the results are not immediately apparent.

“Undergoing FFS is a significant and life-changing decision that can have a profound impact on a person’s emotional well-being. It’s crucial to address mental health during this process,” agrees Dr Kugan. “The weight of emotional stress during the process of transitioning, seeking medical care, and undergoing surgery can be emotionally and physically stressful. Patients may face challenges with family, friends, work, or society, which can contribute to anxiety and depression. It is also important to set realistic expectations about the outcomes of FFS. Mental health support can help patients understand the limitations of surgical and non-surgical procedures and manage their expectations, leading to better satisfaction with the results. If patients have preexisting mental health conditions then these need to be addressed and managed before, during, and after the FFS process,” says Dr Kugan.

“It’s essential to approach feminisation procedures with sensitivity, respect, and inclusivity, and provide a safe and supportive environment for patients,” continues Dr Rotsaert. “The decision to undergo FFS or any other cosmetic procedure should be made after careful consideration and with realistic expectations. As a practitioner, my goal is to help individuals achieve their desired outcome while prioritising their health, safety, and emotional wellbeing.”

Luckily, both in-clinic and online via content creators such as Mulvaney, the FFS community is not shying away from the fact that FFS is a journey that requires a commitment to reap the best rewards. And, if practitioners continue to observe and benefit from the bespoke and mental health-aware approach of FFS, the aesthetic industry could provide even more impressive results and happy clients in the future.