Non-Surgical Options for Facial Feminization

Injectables such as Botox and dermal fillers have revolutionized the world of cosmetic surgery and these anti-aging techniques can also be used for Facial Feminization, especially in patients over 40. While injectables aren't as effective or as long lasting as surgery, non-surgical options can be very affirming in those who are either not ready or are unable to have Facial Feminization Surgery.

Benefits of a Non-Surgical Approach to Facial Feminization

According to Dr. Thomas Satterwhite, a FFS Surgeon in San Francisco, there are benefits of non-surgical options for Facial Feminization that shouldn't be overlooked:

• Injectables produce powerful results with minimal risk and downtime.
• For patients who are unsure about having surgery, injectables are a reversible treatment that can also show patients what kind of results they could expect from surgery.
• Many FFS surgeons prefer patients to undergo a mental health evaluation and hormone therapy prior to facial surgery. Injectables are available throughout this timeline while hormonal changes are taking effect.
• Injectables may be the only option for Facial Feminization in patients who are not surgical candidates.

Botox For Facial Feminization

A prominent lower jaw gives the face a square, masculine look. Jaw Recontouring surgery reduces the size of the jaw, making it rounder and narrower at the square corners near the back of the jawbone. Surgery isn't always required though.

Neurotoxins, also known as Botox, Dysport, and Xeomin, are injectable solutions that temporarily block nerve receptors in muscles, preventing lines and wrinkles from forming. Botox is commonly used to soften lines and wrinkles for anti-aging effects. In some cases, it can also help soften a square jaw line. The square appearance of the jaw is determined by the jaw bone and the masseter muscle. Botox injections can be used to shrink this muscle down to give a more feminine, oval shape to the face.

Arisce is a world-renowned transgender supermodel who made history as Spiegel catalog's first transgender covergirl, had her very own spread in Vogue Germany and starred in the Oxygen television show Strut. Despite these huge successes, Arisce was only booking roles that showcased her body. She felt that Facial Feminization Surgery was the next logical step for her career.

Part of Dr. Michelle Lee's treatment plan for Arisce included Botox injections to the masseter muscles to give the appearance of a V-shaped jawline. "When most people think of Botox they think of wrinkle relaxers but actually if you have very developed masseter muscles you can soften those muscles by using Botox," says Dr. Lee. "A lot of times you don't have to go straight to surgery."

Within only a couple of months, Arisce was booking twice as many roles as before her procedure and feeling better than ever! Since then, she has become the face of a big skincare campaign.

Botox effects are temporary, lasting up to 6 months before another treatment is needed. Because trans women have thicker male-type skin, larger filler doses may be required.

Other Uses of Fillers For Facial Feminization

• Augmenting volume in the cheeks with facial fillers conceals lines and bags and improves contour. Voluma or Radiesse are good options.
• The lips can be enhanced with injections that plump up and enlarge the red part of the lips. Popular lip fillers include Juvéderm Volbella and Restylane Silk.
• Fillers can be used to enhance eyebrow contour and volume and raise the eyebrow arch. Botox is good for this.
• Fillers can be used to treat deep wrinkles of the forehead and achieve a smooth, flat and feminine contour.
• Non-surgical Rhinoplasty can be achieved with small volume filler injections such as long-lasting Bellafill.

Laser Treatments for Facial Feminization

Laser treatments to remove hair and improve skin quality are another example of non-surgical approaches to Facial Feminization.

Laser hair removal is non-invasive and produces stronger results than waxing or shaving, and only requires occasional maintenance. It can take anywhere from 6-12 sessions to see a significant reduction in facial hair growth. An alternative for hair removal is electrolysis, which may be the only option for some, especially those with light or grey hair.

Laser Genesis is a non-invasive laser skin rejuvenation treatment. This laser gently heats the layer just beneath the skin's surface in order to stimulate natural collagen regrowth. Dr. Alain Ramirez at Restore Med Center in Miami recommends Laser Genesis for trans female patients who are interested in reversing sun damage, tightening pores, and improving skin tone and texture.

Other Non-Surgical Treatments

• Platelet-Rich Plasma uses your body's own blood cells to stimulate the skin's production of collagen and elastin for a more youthful appearance. Recommended as a way of improving the overall look of your skin or to correct common skin issues such as acne or rosacea.
• Microneedling uses tiny microneedles to stimulate your skin's natural healing response. By making tiny micro wounds in the skin's surface, your body reacts naturally by producing new collagen and tissue to repair the skin from the inside-out. Microneedling is an effective treatment option for common skin concerns such as acne scars, fine lines and wrinkles, or large pores.

Watch Dr. Alain Ramirez discussing non-surgical options for Facial Feminization:

While Facial Feminization Surgery offers the most potential for powerful facial transformation, exploring non-surgical options is a great way to start realizing your Facial Feminization goals and in fact may be the only gender-affirming facial treatments you end up needing.

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References

Nonsurgical Management of Facial Masculinization and Feminization.
Ascha, M., Swanson, M. A., Massie, J. P., Evans, M. W., Chambers, C., Ginsberg, B. A., Gatherwright, J., Satterwhite, T., Morrison, S. D., & Gougoutas, A. J. (2019). Aesthetic surgery journal, 39(5), NP123–NP137.
Facial Feminization can be achieved through injectables such as neurotoxin and fillers for lateral brow elevation, lip augmentation, malar augmentation, and improvement of rhytids. Facial masculinization can be achieved with injectables used for genioplasty, jawline augmentation, and supraorbital ridge augmentation. One must develop best practices for these techniques in the transgender patient population and increase awareness regarding nonsurgical options.

Dr. 90210 Recap – EPISODE 1, Perk Plastic Surgery Blog, December 17, 2020.

Last updated: 03/01/22