More than skin-deep

Sophie Brooks considers the transformative power of gender-affirming aesthetics

Gender-affirming aesthetics is about far more than shaping a face, it’s about helping individuals see themselves more clearly and feel more at home in their skin. For many trans and non-binary people, aligning physical features with gender identity can be a vital part of their journey toward confidence and self-acceptance.1

WHY GENDER-AFFIRMING AESTHETICS MATTERS

My interest in gender-affirming aesthetics was a key driver for entering the field of aesthetic medicine. From the outset of my training, it was clear that there was a significant gap in education and understanding when it came to treating trans and non-binary patients.

Much of the training I received focused heavily on avoiding the feminisation of male faces or the masculinisation of female ones, but there was little discussion about patients who may actively want those outcomes.

It highlighted a clear oversight in how our industry approaches gender diversity.

I recognised a growing need for aesthetic practitioners who are not only clinically skilled but also culturally competent and sensitive to the unique goals of trans and non-binary individuals. I aim to offer treatments that help patients feel more aligned with their gender identity, while also setting a standard for inclusive, respectful, and affirming care.

A PATIENT-CENTRED, IDENTITY-FOCUSED APPROACH

My approach to treatment is grounded in the same principles I apply to all my patients: a person-centred, holistic lens with a strong emphasis on listening. When working with trans or non-binary individuals, I begin by asking the right questions; not just about aesthetic goals, but about what causes dysphoria, and what helps them feel most affirmed. That gives us a starting point.

I then use a mix of anatomical knowledge and gender-based facial analysis, not to enforce ideals, but to explore which physical markers may help align the patient’s features with their gender identity. From there, we collaborate to create a treatment plan that reflects them, not a cookie-cutter ideal.

One of the biggest barriers in traditional aesthetic spaces is a lack of understanding that not everyone is chasing a heart-shaped face, the “perfect” 1.16 phi ratio, or conventional beauty trends.2 For many patients I work with, the goal isn’t perfection, its authenticity.

Much of the work I do goes beyond injecting. It’s about creating a space where patients feel accepted and understood. That starts with being authentic myself, showing up with curiosity, warmth, and a willingness to ask questions even when

I might get something wrong. I also work closely with local grassroots and third-sector organisations to ensure that my patients are supported holistically and can access other resources if needed. I am also proud to say that my Gender-Affirming Services have been co-created in collaboration with trans and non-binary patients, ensuring they are truly for the community, by the community.

CASE STUDY: KAT’S JOURNEY

Kat first came to see me two years ago, before I had officially launched my gender-affirming services and shared that her goal was to feel more at home in her face; to be recognised and read in a way that reflected her identity as a woman.

At the time, she was still early in her transition. Her features were already soft and delicate, but she was looking for subtle ways to enhance her femininity and feel more confident in herself. Together, we took a full-face approach using dermal fillers, gradually shaping and refining her features in a way that honoured both her natural beauty and her goals.

CHEEKS

The primary goal was to lift and laterally position the apex of the cheek, mimicking the contour typically seen in individuals assigned female at birth. A study published in Plastic and Reconstructive Surgery Global Open discusses the role of cheek augmentation in gender-affirming facial surgery. It highlights that high cheekbones and a full malar area are considered desired feminine features.3 I began with Stylage XXL, chosen for its high G-prime, which allowed for maximum projection with a minimal amount of product.

To further refine and sculpt the area, I transitioned to Stylage XL, a more malleable filler that allowed for detailed shaping and softening of the midface.4 Kat already had a relatively defined zygomatic arch with some temporal hollowing, so my focus was on enhancing volume in the medial cheek to support overall facial balance.

CHIN

Kat naturally had a rounded chin, though it was on the shorter side and presented with some dimpling caused by a slightly overactive mentalis muscle. Because we had already added volume and lateral lift to the cheeks, leaving the chin untreated would have created an imbalance in the lower third of the face.

To harmonise the overall proportions and elongate the chin in a way that aligned with Kat’s goals, I used a combination of Stylage XXL and XL. XXL provided the projection needed to lengthen and define, while XL allowed for more refined sculpting. This approach also helped to smooth the dimpling by supporting the soft tissue and reducing tension in the area, creating a softer, more feminine contour that complemented the rest of the face.

LIPS

Kat’s natural lip shape included a relatively weak vermillion border, so earlier treatments focused on defining the border and expanding volume gradually using Stylage S. This allowed us to enhance shape over time while reducing the risk of overfilling or migration.

During this most recent treatment, Kat expressed a desire for more pout and volume. Because the foundational structure was already well-supported, we opted for Stylage Lips Plus, a filler with a higher hyaluronic acid content and thicker consistency, to achieve more projection and fullness.

Rather than re-injecting into the border, I focused on the body of the lip. Using a tenting technique and injecting slightly lower than previous treatments, I was able to create a plumper, more defined pout while preserving a soft and natural look.

TEMPLES AND BROW CONSIDERATION

Kat had a naturally prominent zygomatic arch, which, while aesthetically desirable in many contexts, created a stark contrast with the surrounding hollowed temple area. To harmonise the upper third of the face and soften the transition between the cheekbones and the temporal fossa, I added subtle volume to the temples using Stylage M.

Given that the temple is considered a high-risk injection area, I opted for a 25G cannula for improved safety, using a gentle fanning technique to distribute the product evenly. The temple houses several critical structures, including the superficial temporal artery, middle temporal artery, and branches of the facial nerve. Inadvertent injection into these vessels can lead to severe complications such as vascular occlusion, skin necrosis, localised alopecia, and even blindness.5

The result was a more rounded and cohesive appearance that complemented the previous cheek enhancement and restored balance across the lateral face.

Although we didn’t carry out a brow lift treatment during this session, it’s something Kat and I have discussed for the future. In individuals assigned female at birth, the brow typically sits higher on the orbital rim, whereas those assigned male at birth may have a lower-set brow and a more prominent supraorbital ridge.

Had we opted to proceed with botulinum toxin for a brow lift, I would have treated the procerus and corrugator supercilii to soften the depressor muscles and achieve a subtle medial lift. For lateral elevation, I would also inject superficially into the orbicularis oculi at the supraorbital ridge to reduce the downward pull. These adjustments would help elevate the brow subtly while preserving natural expression.6

IN HER WORDS: A PATIENT’S PERSPECTIVE

“Gender-affirming aesthetics is important for trans folk. A lot of us aren’t able to transition as early as we’d like due to societal pressures, so we go through the wrong puberty; one that doesn’t match our gender.

“That kind of puberty causes real distress. These effects can be minimised or even alleviated by expensive surgical treatments, or much more affordable non-surgical means like aesthetics.

“Since meeting up with Sophie and undertaking some painless procedures, I feel much happier when seeing my face in the mirror or in photos.

“Sophie explains everything well and is very well trained in the field of aesthetics. She has a really good understanding of the trans community and gives good advice on what is feasible and reasonable to achieve. She gives me the results I hope for and I’m very happy to put my face in her hands, so to speak. I won’t go anywhere else.”

A CALL FOR INCLUSIVE PROGRESS

The trans community is currently facing more societal backlash than ever with an 11% rise in hate crimes against the trans community in 2023 totalling 4,780.7 This figure is even more concerning when compared to the 313 incidences reported in 2012/2013. Meanwhile, NHS waiting lists for gender-affirming care remain years long, and even then, services like facial surgery are not included.

Private facial feminisation surgery in the UK can cost between £20,000 and £45,000, pricing many people out of access, with risks including nerve damage, hair loss and infection, with a reported 12% incidence rate in facial feminisation surgery, compared to an estimated 0.02-0.04 in dermal filler treatment.8,9,10,11,12

Not only are injectable gender-affirming treatments more affordable, they pose fewer risks and complications and offer a gradual alternative that can be tailored to each person’s needs, but we still need more education, more inclusivity, and more clinics willing to meet these patients with respect and care.

As the aesthetic medicine industry continues to evolve, we must go beyond trend cycles and “perfect ratios.” We need to ask who is being excluded, and what we can do to create safer, more affirming spaces. Thank you to Kat for allowing me to share your story and for helping me to create such a worthwhile and needed service.