Treating trans patients

Dr Steven Land considers the power of non-surgical gender-affirming aesthetic treatments

In aesthetic medicine, we talk a lot about making the outside reflect how someone feels on the inside. Most of our patients come to us because they feel they look tired, saggy or older than they are, and that doesn’t match their internal reality. So, when it comes to our transgender patients, the principle is the same. It’s about alignment, it’s about confidence, and most importantly, it’s about choice.

Not every transgender person wants surgery and not every person can have it. Surgery might be inaccessible due to health, finances, or waiting lists. But non-surgical treatments give people a real alternative. They offer flexibility, reversibility, and importantly, they offer patients autonomy over their journey.

Gender-affirming aesthetics isn’t about pushing someone into a box. It’s about listening and offering tailored solutions that help each individual feel more comfortable in their skin. For many transgender patients, especially those in the early stages of their transition, facial features might feel dysphoric – a misalignment with how they identify. This goes far beyond simply “looking better” in a general cosmetic sense. It’s about safety, wellbeing and mental health.

Non-surgical treatments can act as an interim solution while someone waits for hormone therapy or surgery – or as an end goal for those who don’t want or need to go down the surgical path at all. And we need to remember some of the treatments we use every day are gender-affirming. We’re just not always framing them that way.

FEMINISING THE FACE: MTF (MALE-TO-FEMALE) APPROACHES

We already know the classic features associated with a more feminine face: fuller cheeks, heart-shaped contours, higher brows, a narrow chin, defined cupid’s bow and plump lips. These are goals many of our cisgender female patients already seek. For our transgender female patients, the technique doesn’t change – it’s the intention and communication that becomes even more critical.

Cheek filler helps us build volume and width across the zygomatic area, while a narrow chin with subtle projection can help soften the jawline. Chin and jawline filler are often overlooked but can transform the lower face, creating that slimmed, V-shaped profile. A well-placed toxin brow lift can add femininity without exaggeration, and lip augmentation helps frame the mouth in a more traditionally feminine way.

Forehead filler deserves a special mention here – it’s not commonly requested, but it can do wonders in softening the brow ridge and creating that gently curved forehead typical of feminine facial anatomy.

LASER HAIR REMOVAL AND SKIN HEALTH

Laser hair removal can be a huge confidence boost for transgender women. It offers long-term reduction in facial and body hair, reducing the discomfort and daily challenges of shaving. But we always ensure patients are under gender specialist care before beginning this process, since the effects are permanent.

For those who experience hormonal acne or pigmentation due to shaving and hormone fluctuations, tailored skin treatments like peels, calming facials or LED therapy can support skin health and restore balance.

MASCULINISING THE FACE: FTM (FEMALE-TO-MALE) APPROACHES

On the flip side, when we talk about masculinisation, it’s often about strength, structure, and flatness – stronger jawlines, wider chins, flatter cheeks and heavier, straighter brows. Again, these are aesthetic goals that cisgender male patients often seek as well. But with transgender male patients, it’s about using the same tools with intentionality.

Jawline filler is the treatment to spotlight here. This can be used to build out width and squareness to create a bolder silhouette. Chin filler adds structure and strength. We must remember not to lift the brows too high during toxin treatments, as a high arch can look unintentionally feminine. Instead, aim for a flatter, straighter brow which is something we see a lot in male facial anatomy.

Cheek filler can be used to create angularity and reduce anterior projection, helping shift the facial balance away from roundness. And don’t underestimate the power of small tweaks in the forehead and temples to achieve a more structured look.

WORKING WITH (NOT AGAINST) HORMONE THERAPY

For transgender men undergoing testosterone therapy, the face will naturally change over time. Muscle mass increases, bone density shifts, and this all contributes to a more stereotypical, masculine look. However, those changes don’t happen overnight. That’s where aesthetic medicine can offer a supportive “fast track”, helping bridge the gap between how someone feels and how they look right now.

Importantly, as these hormone-driven changes take shape, our follow-up and maintenance treatments need to adjust. What worked early in someone’s journey might need rebalancing later and that’s okay. It’s all part of the process.

SKIN CONFIDENCE AND TEXTURAL CONCERNS

Skin health is another important factor, especially for those experiencing ‘beard shadow’ from hormone therapy or irritation from shaving. Treatments like microneedling, laser resurfacing and medical-grade skincare can address pigmentation, reduce redness and boost skin confidence. These aren’t gendered treatments, they’re person-centred ones.

CONSULTATION, COMMUNICATION, AND CARE

The foundation of any good treatment plan is a thorough consultation. With transgender patients, that means taking the time to listen, ask the right questions, and reflect their language and goals back to them.

Using correct names and pronouns is the bare minimum, not a ‘nice to have’. It sets the tone for trust and safety. We also make sure to document language, preferences and goals very clearly, especially in case of future practitioners picking up their care.

Gender-affirming treatments aren’t handled differently in a medical sense. We still use the same tools, anatomy and planning. But we approach with a sensitivity to the emotional stakes involved. This is about far more than vanity.

There’s no real difference in aftercare – swelling, bruising and follow-up are the same. But expectation management is crucial. As with all patients, we need to be honest about what results are achievable. Treatments vary in longevity, subtlety and effectiveness based on each individual.

It’s better to under-promise and over-deliver than the other way around. Our transgender patients deserve the same clarity, honesty and support that we offer to everyone else who walks through our doors.

The truth is, we already know how to do this. We feminise and masculinise patients every day, we just don’t always realise it. So, if you’re unsure where to start, just describe what the treatment can do. Say, “We can use jawline filler to create a more defined, angular appearance, or to slim and elongate the chin depending on the look you want.” That opens the door. The patient will tell you the rest.

If this makes you uncomfortable, that’s okay. Educate yourself. Ask for training. Seek advice. But don’t exclude an entire group of patients because of fear or unfamiliarity.

At the end of the day, transgender patients come to us for the same reason anyone else does: they want to feel better when they look in the mirror. And if we can help them achieve that, it’s not only a privilege, it’s a responsibility.

DR STEVEN LAND

Dr Steven Land is an award-winning aesthetic doctor and owner of Novellus Aesthetics in Newcastle upon Tyne. His extensive medical training, spanning over two decades in medicine, more specifically emergency medicine, eventually led him to a passion for aesthetic medicine, where he found a unique way to empower individuals by enhancing their appearance.

As the clinic director at Novellus Aesthetics, Dr Land is committed to guiding clients through every step of their aesthetic journey. From initial consultations to achieving natural, bespoke results, he leverages his artistic sensibility, anatomical expertise, and advanced techniques to fulfil each client’s unique vision, ensuring a personalised, informed and satisfying experience.