FEMINIZATION AND MASCULINIZATION

DEPARTMENT OF FEMINIZATION AND MASCULINIZATION

The Instituto Português da Face has a multidisciplinary surgical team to achieve the best results by performing facial sculpture according to individual needs.


Feminization Facial and Masculinization Facial surgery consists of a series of surgical procedures designed to soften and modify exaggerated or non-harmonious facial features that are decisive in identifying visual facial gender.


These procedures are indicated in the gender changing process or to highlight the desired facial gender. Procedure such as changing the frontoplasty capillary line, forehead or frontal bossing, cheekbones, rhinoplasty, jaws and contouring or chin will be indicated according to each case.

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THE FEMINIZATION AND FACIAL MASCULINIZATION

The face is our identity card, enabling us to define the masculine and feminine face through specific facial standards. In facial feminization, surgery can include modification of prominent laryngeal cartilage or "Adam 's apple" and changing voice.


After surgery, follow-up by Aesthetic Medicine will be important to enhance the effects of the surgery.


You will be required to undergo monitoring via physical therapy, endocrinology and sometimes psychology.

SYMPTOMS

  • Prominent forehead
  • Square chin
  • Prominent Adam’s Apple
  • Male chin

FACIAL FEMINIZATION

Feminisation face covers a set of skeletal bone and soft tissue surgical procedures such as in the front region, malar region, nose, lips, jaw and chin, to alter the male facial traits, harmonizing the features in a female face.

FACIAL MASCULINIZATION

On the other hand, facial masculinization enables turning a female face into a male face through surgical procedures in the area of the cheekbones, jaw and chin. Virtual planning enables designing the facial structural movements and placing prostheses to enhance the male traits adapted to each case.

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FACIAL FEMINIZATION

FRONTOPLASTY

FEMINIZATION OF THE FOREHEAD

Are there differences between male and female foreheads?

There are gender differences with the female forehead generally being shorter and the male being longer. We also find differences in the form of implantation of the capillary (region), where women tend to have crown shape while men have an "M". Another point of divergence between man and woman is the forehead’s shape, where men have a hump or elevation, in the central region of the forehead above the implantation of the nose, with the sides of the nose and the upper contour of the eye being more pronounced. We also find differences in eyebrows, with women’s eyebrows being more open in relation to the eye, highlighting one of the areas of most aesthetic impact on the woman's face, her gaze. Men’s eyebrows are more horizontal.


Can we change these differences to have a female forehead?

When our goal is to reduce the height of the forehead or capillary (line) shape, our frontoplasty surgery can eliminate up to 2 cm of skin. This intervention requires the preliminary testing of the elasticity and quality of the skin, and it is performed on the capillary line (between forehead and hair). In some patients with an “M” implantation line, it will be necessary to follow this technique with a hair transplant. Our current techniques have shown excellent results with a very comfortable and fast postoperative period. In cases where a change in the forehead’s shape is desired, the indicated technique is cranioplasty or modelling of the forehead bones, which require 3D bone tomography for a correct diagnosis of the points that we are going to eliminate and the virtual planning of the surgery.


How long does the postoperative stage last?

With our current techniques of virtual planning and ultrasonic surgery (using pre-surgery equipment), the postoperative stage is very fast, with life normalizing in 15 days - 3 weeks.

FAZER PRÉ-MARCAÇÃO

RHINOPLASTY

FEMINIZATION OF THE NOSE

Nose feminization surgery is one of the most common procedures in facial feminization. The surgical procedure is a feminization rhinoplasty. The aim is to make the nose more delicate by making other areas of the face stand out, such as the eyes. It is often said that the beautiful nose is one that does not attract attention when we look at a face.


To understand feminization rhinoplasty, it is necessary to know the differences between the male nose and the female nose.

Male Nose

  • Larger dimensions
  • Straight nose
  • Pronounced angle between forehead and nose
  • Closer angle between nose and upper lip

Male Nose

  • Larger dimensions
  • Straight nose
  • Pronounced angle between forehead and nose
  • Closer angle between nose and upper lip

The male nose is usually larger and wider than the female nose and most often has a nasal hump. The female nose is smaller, narrower, the back can be slightly curved (concave) and can present the so-called supratip break (a small depression immediately above the nasal tip), which gives an even more feminine touch. In addition to reducing the nasal tip, feminization of the nose may include a reduction in the width of the nostrils (alar base reduction).


The angle between the nose and the lip (nasolabial angle), which determines the rotation of the nasal tip, is typically greater than 90º in women and should not exceed this angle in men.


Thus, the feminization of the nose usually consists of reducing the nose and making it more harmonious with the face.

All details are important, but the reduction of the dorsum and the reduction and rotation of the nasal tip are the most important. A reduction of the frontal hump is often concurrently performed, which further improves the final appearance of the nose by making the transition between the forehead and the nose more vertical.


Nose feminization surgery is usually performed under general anaesthesia and, often, at the same operative time as other feminization procedures in the areas of the face and/or neck (forehead, jaw, larynx).


A piezoelectric instrument (popularly known as ultrasonic rhinoplasty) is used for the remodelling of the nasal dorsum, which enables sculpting the bones without trauma, with consequent less swelling and practically without bruising (without "black eyes").


What is extraordinary about this procedure is that it is practically painless. There may be discomfort in the first 2 days associated to not being able to breathe so well through the nose due to the presence of silicone splints that are removed 48 hours postoperatively. The dressing and nasal splint are removed after 6-7 days, allowing you to have an idea of how your nose will look.

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BICHECTOMY

FEMINIZATION OF THE FACE

This surgical procedure is indicated for those who want to improve the contour of their face by reducing the volume of the cheeks, giving rise to a thinner face.


Bichectomy is performed under local anaesthesia.


Part of the Bichat ball is extracted, in a volumetrically symmetrical way, through a small intraoral incision.

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V-LINE - FEMALE JAW

FEMINIZATION OF THE JAW

One of the most important parts of gender aesthetics is the jaw, with the woman having a thinner jaw in relation to the face, highlighting one of the woman’s most important features, the eyes. The aesthetically speaking man has a more robust lateral and anteroposterior jaw.


There is an aesthetic line of the chin's lateral conformity with the nose in women, and in men, the aesthetic shape of the chin in conformity with the mouth. Concerning the body and angle of the mandible in women, the angle is more open in a profile view and looking from the front it should be much less projected laterally than in men. In summary, female facial morphology should be triangular with vertex downwards and the male should be a squarer shape.


V-Line surgery is indicated to make the face more feminine and delicate by reducing the volume and thickness of the jaw. Surgery was popularized in South Korea, as the Asian population has the broadest and most projected upper jaw bone. Currently, a first 3D tomographic study is carried out, followed by an impression of facial bones and finally, through ultrasonic surgery, the excess bone part is eliminated (basilar jaw osteotomy), achieving a modelling of the mandible contour at the angles level up to the chin. It may also be necessary to reduce the chin in height and projection (chin reduction).


This surgical procedure is indicated for men and women seeking a reduction, both in height and in thickness, of the jaw. The goal is to make the face more delicate, tapered and harmonious.


The choice of technique depends on several factors and must be made after facial analysis and virtual planning. Frequently, patients who undergo V-LINE surgery are simultaneously submitted to other procedures, such as: Bichectomy and/or Submental Liposuction.

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WITHDRAWAL OF ADAM'S APPLE

FACIAL FEMINIZATION

The Adam's Apple or laryngeal prominence is a protrusion of the upper and anterior region of the larynx, an organ of the neck that encases the vocal cords. Like the chin and jaw angles, laryngeal prominence is an anatomical point of distinction between men and women and, depending on the configuration of the neck, if more elongated, thinner and located lower, it can be very visible externally.


What makes laryngeal prominence more prominent in men than in women is the development of the adult larynx influenced by male hormonal exposure during adolescence. The male development of the larynx not only leads to a greater laryngeal prominence, but also to a more elongated configuration and a greater mass of the vocal cords, resulting in a lower fundamental frequency of the voice (deeper voice) typical of men.


Since both of the male characteristics described above (laryngeal prominence and voice) are due to actual anatomical changes, the only way to change them is through surgery. That is why even if transgender patients start using hormones, it is unlikely that the characteristics of the larynx will change, unless they start taking hormones before or at least during adolescence.


Surgery to feminize laryngeal prominence consists of removing the most prominent portion of the thyroid cartilage from the larynx, making the anterior surface of the neck as smooth as possible. Depending on the case, access may be considered through the mouth, thus avoiding an incision in the neck and also associating this surgery with procedures for voice feminization. This is a very well-tolerated procedure, requiring only 1 week of recovery. It may also be associated with other facial feminization procedures, without adding any extra hospitalization or recovery time in this case.


On the other hand, surgery to masculinize laryngeal prominence consists of inserting a custom-made prosthesis fixed on the thyroid cartilage to anatomically project its upper and anterior region, simulating a real Adam's apple. This surgery cannot be associated with voice masculinization at the same operative time, but it can be associated with other facial masculinization procedures and, in this case, likewise, it does not increase the length of hospital stay or postoperative recovery.

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VOICE FEMINIZATION

FEMINIZAÇÃO DA VOZ

Each of us have a unique voice. This is due to the fact that many factors influence the configuration of an individual's final voice: the anatomy of the mouth/nose and other resonance cavities, configuration of the vocal cords, personal habits such as smoking, a person’s culture and the society in which she/he operates. But when you hear the voice of a stranger, even without seeing the person speaking, you can recognize whether you are listening to a child or an adult, a young or old person and, of course, a man or a woman.


Transgender patients who wish to change their voice must initially undergo a detailed otorhinolaryngological assessment of the anatomy and functioning of the vocal cords to screen for possible diseases and flaws, which are very common in the general population. Then, detailed analysis is required of the normal voice, spoken and in effort, taking into account any professional use, or not, of the voice, and the patients’ expectation in relation to how they would like their final voice to sound.


A voice change can be done with surgery and/or speech therapy. The vocal assessment, preference and expectation of the patient and other feminization procedures will be considered when deciding which technique and when to perform surgery/speech therapy. As mentioned earlier, the anatomy of the vocal cords is definitely altered during adolescence by hormonal influence, so there is a physical limit (which the anatomy of the vocal cord allows) as to what speech therapy can possibly do. The greater the desired change in the voice, the greater the effort in speech therapy required by the patient (which may lead to flaws in the use of the voice and vocal tiredness) and loss of quality/purity in the voice.


For patients who need or want changes greater than their anatomy allows, surgery may be the most suitable solution. There are several surgical techniques available to change the voice and, in general, are based on the principle of sound produced by the vibration of a string, in this case the vocal cord. Like the string of a guitar, if we decrease the mass, if we stretch or shorten it, we will make the sound produced by its vibration higher (feminization). On the other hand, if we increase the mass, if we enlarge or stretch it, the sound produced will be more serious (masculinization).

All techniques have advantages and disadvantages, some techniques cannot be used in some patients and some cannot be associated with other surgical procedures and the results are never absolutely predictable, but the detail of the previous evaluation enables us to get as close as possible to the desired result.


The main contraindication for voice alteration surgery is for singers. This is because all surgery leads to a scar and this scar will always be more rigid than the patient's normal tissue. This leads to a reduction in the plasticity of the voice, which is the fundamental characteristic of singing. On the other hand, due to having greater plasticity and mastery of the use of the voice, singers also obtain better results with speech therapy.

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