LIPO GENDER AFFIRMING INJECTABLES

GENDER AFFIRMING INJECTABLES

Far beyond beautification or anti-ageing, gender-affirming injectables can have a profound impact on confidence, comfort and identity. Editor Kezia Parkins spoke to experts Dr Veerle Rotsaert and Dr Natasha Berridge to discover the role injectables can play in supporting transgender and gender-diverse patients.

Not all aesthetic treatments are for the sake of looking fresher, younger or more conventionally attractive.

Sometimes these treatments can be lifesaving. In the case of those suffering from gender dysphoria, injectables can play an important role in one’s gender transition or affirmation journey alongside surgery and other aesthetic intervention.

Unlike traditional cosmetic procedures, gender-affirming treatments are often rooted in helping patients feel more aligned with how they identify and wish to be seen.

“Gender-affirming work is much more personal and identity-led,” explains Dr Veerle Rotsaert, plastic surgeon and co-founder of Tempus Belgravia, Injectual and Transjectual – a highly specialised trans and gender diverse aesthetic clinic.

“It’s about making patients feel more comfortable in their own face and being perceived in a way that aligns with how they see themselves, which changes the entire consultation dynamic. The emotional and psychological side of treatment becomes just as important as the technical side,” Dr Rotsaert continues.

Research shows that treating dysphoria through medical intervention can have a big impact on the quality of life of transgender and gender diverse patients by improving comfort, confidence, and also safety. But, while many patients would like to go ahead with surgery, it is not always a viable first step.

“Quite often, patients who come to see me are at the start of their journey and either do not want, or do not have the finances, to invest in really costly surgical procedures,” explains Dr Natasha Berridge consultant maxillofacial and facial plastic surgeon with a specialist interest in gender affirming surgery and injectables.

“Injectables can be an absolute game changer for them.”

UNDERSTANDING PATIENT GOALS

The goals and motivations of patients seeking gender-affirming care often differ greatly from those pursuing traditional rejuvenation treatments.

Every patient has their own personal transition journey. Not everybody wants dramatic visible change. There are patients who have not come out in public or with family or friends, and therefore subtlety and a gradual approach is the key.

Dr Rotsaert says that she most commonly hears patients saying: “I want people to see me the way I see myself on the inside.”

“That can mean very different things depending on the patient,” she says. “Some transfeminine patients want softer facial contours or less angularity. Some transmasculine patients are looking for more structure or definition. Non-binary patients often want something less easily categorised altogether.”

“This is about listening to the patient’s expectations and goals for treatment,” adds Dr Berridge.

“In the case of some of my non-binary patients, it may simply be reaffirming an androgynous look. On the outside, it might not be hugely obvious to you and me, but for the patient it means absolutely everything because it is that small step towards affirming exactly how they view themselves.”

“Small changes in facial balance can make a significant difference to how someone is perceived socially without looking obvious,” continues Dr Rotsaert.

“That’s one of the reasons injectables can work so well in this space. They allow patients to evolve at their own pace. Sometimes the best result is when someone looks in the mirror and feels more like themselves, but nobody else can quite identify what has changed.”

“The important thing is not to impose a template. I spend a lot of time listening before discussing treatment. I look at facial proportions, skeletal structure, soft tissue distribution and how hormone therapy may already be influencing the face.”

CONSULTATION AND COMMUNICATION WITH TRANSGENDER AND NON-BINARY PATIENTS

Both of our experts say that adapting how we communicate with patients suffering with gender dysphoria coming for treatment is absolutely critical.

“A lot of transgender and gender diverse patients have had the experience of not feeling safe or heard in healthcare settings,” explains Dr Berridge. “So it is not only important as part of the consultation process, or the transaction between clinician and patient, but it is also so important for every member of the team, whether they are administrative or clinical, to get this right.”

“Simple things matter like using the correct name and pronouns, not making assumptions, and allowing patients to describe themselves in their own words,” adds Dr Rotsaert. “I think people sometimes underestimate how stressful medical environments can feel for transgender patients, particularly if they’ve had dismissive or uncomfortable experiences in the past.”

“The consultation should feel collaborative and safe. Patients should never feel they need to educate their clinician in order to receive respectful care.”

“Mistakes happen but it’s important to acknowledge this, apologise and move on. Don’t make a big deal of it. If there is good intention, people understand we sometimes slip up.”

Both Dr Berridge and Dr Rotsaert have gone to great lengths to ensure that their clinics are safe spaces for trans patients and those suffering with gender dysphoria.

“Inclusivity has to extend beyond the procedure room,” says Dr Rotsaert. “It’s reflected in how staff communicate, how forms are written, how consultations are conducted and whether patients feel genuinely welcomed rather than simply accommodated. We must create an environment where patients don’t feel judged, rushed or tokenised.”

“I also think honesty is essential. Gender-affirming patients are often vulnerable to overpromising within the aesthetics industry, and ethical practice matters enormously in this area.”

SUPPORTING EVOLVING IDENTITY

It’s important to note that gender affirming treatments are never as simple as traditionally considered female features versus male features.

“Within the wider aesthetic industry, there’s sometimes an oversimplification of gendered facial features,” says Dr Rotsaert. “Good gender-affirming work requires restraint, anatomical understanding and emotional intelligence not just adding volume in stereotypical places.”

“Faces are incredibly varied naturally, and patients don’t necessarily want stereotypical outcomes. Some want very subtle shifts while others want stronger changes. The artistry lies in understanding the person rather than applying formulas.”

Faces are incredibly varied naturally, and patients don’t necessarily want stereotypical outcomes…

A transition journey, like any other, is rarely linear. For many patients, gender affirmation is an evolving process of bringing their outward appearance into closer alignment with their identity.

“Not every patient arrives with a fixed endpoint in mind, and that’s completely valid. My role isn’t to define someone’s identity for them, it’s to help them explore treatment safely and responsibly if they choose to do so,” continues Dr Rotsaert.

Here lies the benefit of injectables for transitioning patients.

“They give patients room to evolve. We can make small changes gradually, reassess, and continue only if it still feels right for them,” says Dr Rotsaert. “Sometimes the most responsible decision is to slow things down rather than rush into treatment.”

FACIAL FEMINISATION VERSUS MASCULINISATION USING INJECTABLES

Facial feminisation usually involves trying to soften transitions and create more curvature and light reflection through the face. Feminisation may involve restoring volume to the temples and cheeks, refining the chin or softening the lower face.

Meanwhile masculinisation tends to focus more on structure and definition, strengthening the jawline, increasing chin projection, creating flatter cheeks or enhancing width in specific areas.

“For feminisation, I often prefer softer products that integrate naturally within the tissue, especially in the cheeks and lips,” says Dr Rotsaert. “For masculinisation, firmer fillers can work very well for the jawline and chin where more structural support is needed.”

Feminisation

Typically feminine faces tend to be more heart shaped, with soft features and contours.

“The bizygomatic width is often much wider than the bigonial width,” says Dr Berridge.

“ I can often achieve this with botulinum toxin, which I use to feminise the upper part of the face. We can elevate the brows, open the eyes, and stimulate chemodenervation of the masseter muscles to reduce posterior jawline width.”

Dr Berridge also uses toxin to feminise the upper lip and the red vermilion, and to soften the transition between the labiomandibular fold and the chin. “This helps lengthen the chin and make it more heart-shaped.”

Hyaluronic Acid (HA) gels/fillers can aid feminisation by adding softer contours to areas that are typically much more acute in male-to-female patients.

“In the upper part of the face, I use HA to soften the contour in the supraorbital region and the central brow region, where there is often notable bossing of the brow bone,” adds Berridge. “I also like using HA in the temples to create a much softer contour when looking at the face from the front and in profile.”

“A lot of my patients want hyper-feminine looks, so I use filler to create a beautiful high-arched cheek line and fullness in the mid-face. This supports the lower eyelid and creates an apple of the cheek.”

“You can also really feminise lips that are naturally thin and not showing much red vermilion with filler.” Masculinisation

With masculinisation, the approach can often be much the opposite with patients wanting to add volume to create sharper angles and definition.

“For masculinisation, toxin works beautifully because it can create a slightly angrier or more masculine look in the upper part of the face, and it can also drop the brow,” says Dr Berridge.

By their nature of attracting water, HA fillers can add volume which when placed correctly, can create harsher and sharper angles often associated with male looks.

“Overall, I would say that HA gels are more primary tool for masculinisation than they are for feminisation,” adds Dr Berridge.

The artistry lies in understanding the person rather than applying formulas.

COMBINATION AND COLLABORATION

Changing facial form and structure are not the only ways to support transitioning patients. The best care pathway involves a multidisciplinary team that can help the patient holistically.

“Quite often, we forget that there are skincare needs for transgender and gender diverse patients who are going through hormonal fluctuations when they start hormone replacement therapy,” says Dr Berridge.

“Skin texture, hydration and overall skin health can significantly affect how masculine or feminine a face is perceived,” adds Dr Rotsaert.

“The best outcomes nearly always involve a multidisciplinary approach. Depending on the patient, that might include hormone specialists, laser practitioners, dermatologists, psychologists, voice coaches or surgeons specialising in gender-affirming procedures.”

“Alongside injectables, skin rejuvenation, regenerative medicine and surgical facial feminisation or masculinisation can all play a role. Gender-affirming care works best when practitioners communicate with one another and view the patient holistically rather than focusing on isolated procedures.”

THE FUTURE OF GENDER-AFFIRMING AESTHETIC MEDICINE

As awareness and accessibility continue to grow, both experts believe that the future of gender-affirming aesthetics will become increasingly individual and less reliant on rigid binary beauty ideals.

“The field is moving away from binary beauty standards and much more towards personalised, identity-based beauty,” says Dr Berridge.

“For me, that means there is much less emphasis on male faces looking male and female faces looking female, and more acceptance of self-identity and authenticity.”

“We need better education in transgender and gender healthcare and more research on gender-affirming treatments. Particularly the impact they have on comfort, confidence, and levels of dysphoria.”

“I think there’s growing recognition that gender-affirming aesthetics sits within legitimate healthcare, not just cosmetic medicine,” concludes Dr Rotsaert. “There’s still a long way to go in terms of education and representation, but overall I’m optimistic. The future of aesthetic medicine should be about helping people feel more at ease in themselves, whatever that looks like for them individually.”