Gender identity and facial proportions

Clinical educator Bryony Elder looks at facial proportions and considerations for injectable non-surgical aesthetic treatments in transgender patients

The use of non-surgical aesthetic treatments can have a positive impact on an individual’s sense of self and personal identity. As a result, aesthetic practitioners need to approach the treatment of transgender patients with care and responsibility. This involves providing appropriate advice and treatment that is tailored to the individual’s needs and goals, while also adhering to ethical considerations. By doing so, practitioners can help to encourage and support transgender individuals in their journey towards greater self-affirmation and well-being. In this article, let’s examine the difference between the female and male face and how non-surgical treatments can provide changes to contour, proportion, and dimension for the transgender patient.

GENDER DYSPHORIA

Gender dysphoria is a condition where a person experiences significant distress and discomfort because their gender identity does not match the sex they were assigned at birth. It can manifest in a range of ways, including feelings of anxiety, depression, and social isolation. People with gender dysphoria may feel a strong desire to transition to a different gender and may pursue medical or psychological treatments to do so.1

The Office for National Statistics estimates that 200-500 thousand trans people are living in the UK, although no robust data exists.2

GENDER-AFFIRMING CARE IN THE UK

Currently, the NHS has established ‘Gender identity services for adults (non-surgical interventions)’ guidelines that outline various forms of care, such as speech and language therapy, hair treatment, hair removal, and psychological support for transgender patients. However, there are currently no non-surgical options available for facial augmentation, leaving surgery as the only option.

Non-surgical treatments offer a range of benefits to trans patients, including lower risks, reversibility, and quicker results, which can provide a sense of affirmation. Furthermore, non-surgical interventions can also be beneficial to gender-diverse individuals, such as non-binary, trans-feminine, trans-masculine, genderqueer, non-gender, and others. Such individuals may struggle to access conventional healthcare pathways but still require gender-affirming treatments.

IMPORTANCE OF THE CONSULTATION: BARRIERS TO THE CONSULTATION

An understanding, open and ethical consultation is key to the management of a trans patient. Special care must be taken to assess suitability and ensure valid consent is gained. If the individual is undergoing psychological evaluation, it is important to discuss the patient’s suitability for treatment with other healthcare professionals.

It is also imperative to discuss the patient’s procedural wishes and manage expectations appropriately. Discuss potential outcomes of treatment with the patient, as well as the need for ongoing sessions, potential complications, and cost. Often a staged treatment plan is the most beneficial to the patient, to allow for emotional and psychological adaptation.

NEO-CLASSICAL CANONS OF FACIAL APPEARANCE

The neoclassical canons are a set of facial proportion guidelines that have been used for centuries to define ideal beauty standards. They are based on the ancient Greek and Roman principles of symmetry, harmony, and balance.4,5 However research has shown that neoclassical canons are not relevant to current gender presentations.6 Farkas et al suggested that anthropological studies on individuals do not follow the standard neoclassical norms that are typically followed.

MASCULINE VS FEMININE PERCEPTION

When treating gender-diverse individuals with non-surgical treatments, it is important for the individual to feel perceived as their gender. Therefore, research to support feminine and masculine perception is more relevant rather than typical canons of anthropological measurements.

Application of proportional differences in gender to treatment planning with Dermal Filler (^7,8,9)

The table above provides recommendations for addressing gender-proportional changes through neuromodulation and dermal fillers. A staged approach is often recommended, as combining these two treatments can yield the best results for the patient.

Combination approach to treatment

By using neuromodulation and dermal fillers in combination, aesthetic practitioners can effectively address a variety of gender-related concerns, including forehead feminisation or masculinisation, cheek augmentation, and jawline contouring. This approach is particularly helpful for patients who seek more comprehensive facial feminisation or masculinisation, as it allows for tailored treatment plans that meet individual patient needs.The research highlights the importance of providing gender-affirming care for transgender individuals by understanding their psychological needs and taking a staged approach to treatment. The use of neoclassical canons can help guide treatment, but it is also important to consider the patient's individual wishes and tailor treatment plans accordingly. The ethical considerations of such treatments are emphasised throughout the research. Overall, the main message is that careful consideration and understanding of the journey of treatment for transgender individuals is essential for providing effective and ethical care

REFERENCES
1. Jordan J. Bannister, Hailey Juszczak, Jose David Aponte, David C. Katz, P. Daniel Knott, Seth M. Weinberg, Benedikt Hallgrímsson, Nils D. Forkert, and Rahul Seth.Sex Differences in Adult Facial Three-Dimensional Morphology: Application to Gender-Affirming Facial Surgery.Facial Plastic Surgery & Aesthetic Medicine.Dec 2022.S-24-S-30.
2. assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721642/GEO-LGBT-factsheet.pdf
3. england.nhs.uk/wp-content/uploads/2019/07/service-specification-gender-dysphoria-services-non-surgical-oct-2022.pd
4. Farkas, L. G. (1994). Anthropometry of the Head and Face in Medicine. Elsevier Science.
5. Ritter, E. F., & Muñoz, C. J. (2015). Analysis of the American population. Plastic and reconstructive surgery, 135(2), 375-382.
6. Farkas, L. G., Hreczko, T. A., Kolar, J. C., Munro, I. R., & Vertical, E. M. (1992). Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plastic and reconstructive surgery, 90(4), 592-602. doi: 10.1097/00006534-199210000-00004
7. Jeroen H.F. Liebregts, Maarten Timmermans, Martien J.J. De Koning, Stefaan J. Bergé, Thomas J.J. Maal,
8. Three-Dimensional Facial Simulation in Bilateral Sagittal Split Osteotomy: A Validation Study of 100 Patients, Journal of Oral and Maxillofacial Surgery, Volume 73, Issue 5, 2015, Pages 961-970,nister JJ, Juszczak H, Aponte JD, Katz DC, Knott PD, Weinberg SM, Hallgrímsson B, Forkert ND, Seth R. Sex Differences in Adult Facial Three-Dimensional Morphology: Application to Gender-Affirming Facial Surgery. Facial Plast Surg Aesthet Med. 2022 Nov-Dec;24(S2): S24-S30. doi:10. 1089/fpsam.2021.0301. Epub 2022 Mar 29. PMID: 35357226; PMCID: PMC9529307.
9. Binder WJ, Dhir K, Joseph J. The role of fillers in facial implant surgery. Facial Plast Surg Clin North Am. 2013 May;21(2):201-11. doi: 10.1016/j.fsc.2013.02.001. PMID: 23731582.