facial masculinization cover image

What is facial masculinization surgery or FMS?

Facial masculinization surgery (FMS) describes a group of procedures that are performed to masculinize the face. These operations are commonly performed for transgender men and can be performed for cisgender men. The operations usually consist of multiple procedures including those listed below:

Forehead augmentation (increase in forward protrusion of the brow)
Rhinoplasty (to augment or lengthen the nose)
Jaw augmentation
Genioplasty (chin surgery)
Adam’s apple augmentation

These procedures can be performed in isolation or they can be combined together during one or more operations.

Which facial features commonly differ between cisgender men and women?

Many facial features differ between cisgender men and women. These are usually taken from population averages and do not describe an individual person. Some features may be more or less prominent in individual cisgender men or women and there can be significant variations within genders. The features also vary significantly between individuals with different ethnic backgrounds. The features that can be addressed during facial masculinization surgery are listed below:

Forehead – Cisgender men generally have a higher hairline with a different shape than cisgender women.[1] Male hairlines tend to be M-shaped and female hairlines tend to be rounded. Cisgender men commonly have more prominent brow bossing.[2]

M-shaped hairline
Rounded hairline
Moderate brow bossing
Minimal brow bossing

Nose – Cisgender men generally have a more acute nasolabial angle than cisgender women.[3] Men generally prefer less of a supratip break than women.[4]

Minimal supratip break
Greater supratip break

Mandible – Cisgender men generally have larger mandibles (lower jaw).[5] This includes the height at the back of the jaw, the height at the front of the jaw, the width at the back of the jaw, and the width of the chin.[5,6]

Thyroid cartilage – Cisgender men generally have more thyroid cartilages (Adam’s apples) that are more prominently angulated than cisgender women.[7,8]

Larger thyroid cartilage angulation
Smaller thyroid cartilage angulation

What surgical procedures can be performed for facial masculinization surgery?

Facial masculinization surgery usually consists of augmenting the facial skeleton with implants. The implants can be off-the-shelf or customized to the individual. Facial implants to masculinize the face are most effective when placed at the brow, mandibular angles, and chin.

Illustration of a skull prior to undergoing facial masculinization with implants
Illustration of a skull with implants placed for facial masculinization

A rhinoplasty can be performed to create a straighter nose when seen in profile and rotate the nose as seen in profile to decrease the nasolabial angle.

Simulation of a patient before undergoing facial masculinization.
Simulation of a patient after undergoing facial masculinization with brow augmentation, rhinoplasty to straighten the nose and rotate the tip, and chin augmentation.

How much does facial masculinization surgery cost?

The cost of facial masculinization can be extremely variable. The costs depend on multiple factors, which are listed below.

–       Whether insurance is covering all or part of the operation
–       The number and types of procedures being performed during the operation
–       The duration of the operation
–       Variations in pricing between individual surgeons

The best way to get an estimate for the cost of facial masculinization surgery is to contact a gender-affirming facial surgeon to discuss your specific situation.  

Click here to contact the office of Dr. Mittermiller.

How do I prepare for surgery?

The first step is to have a consultation with a surgeon who specializes in gender-affirming facial surgery. They will discuss the facial features concerning to you and may suggest additional procedures.

A CT scan may be performed to evaluate the bones of the face. This allows the patient and surgeon to better visualize the underlying bone structure of the face to best tailor a surgical treatment.

If the surgery is being performed for gender dysphoria, letters from one or more health providers may be necessary to state the need for facial masculinization to help relieve symptoms of gender dysphoria.

During the workup, you will commonly be asked about your medical history. This includes any medical problems that may exist, whether you have previously had surgery, what medications you take, which allergies you have, and whether you have any habits such as smoking or drinking.

How is the recovery from facial masculinization surgery (FMS)?

Recovery from facial feminization surgery is based on the number and types of procedures that are performed during the operation.

In general, recovery from facial masculinization surgery is much easier and less painful than recovery from facial feminization surgery.

The recovery is easiest with fewer procedures. It becomes progressively more difficult as additional procedures are added. The recovery becomes more involved when larger procedures are performed, such as an osseous genioplasty (chin surgery without implant). It is best to look at each individual procedure to see how the recovery will be after that procedure.

Many of the effects from facial masculinization surgery will be seen immediately after surgery. There will be swelling and bruising after the operation that can last for a few weeks. There is subsequently minor residual swelling of the face that can persist for over a year.

How painful is recovery?

The amount of pain is dependent on the procedures that are performed. Patients commonly describe osseous genioplasty (cuts in the bone to reshape the chin) to be one of the more painful procedures. You will receive pain medications following the procedure to make you comfortable.

How much time do I need off work?

For many surgeries, taking at least one week off work is ideal. This allows the swelling to subside and for the incisions to become less noticeable. However, depending on the extent of surgery and the desire for privacy, some people opt to take a few weeks off work to allow the incisions to heal more completely and for the swelling to subside more significantly.

What are the risks?

The risks of facial masculinization surgery are related to the individual procedures themselves. In general, facial masculinization consists of augmenting the facial skeleton. With the augmentation procedures, there can be a risk of infection or nerve damage.

How long will the results last from facial masculinization surgery?

The procedures performed for facial masculinization surgery will produce results that are permanent. Your body will continue to age though. Aging will result in standard changes, but the facial structures will be permanently different than they were before the operation.

Who is a candidate for facial masculinization surgery?

It is important to discuss facial masculinization surgery with your surgeon to determine your candidacy. There are a multitude facial features that can be addressed to varying degrees. Individual preferences often play a major role in determining which components of facial masculinization surgery are right for you.

Can cisgender men get facial masculinization surgery?

Yes! See link here.

How do I find a surgeon who offers facial masculinization near me in Los Angeles or Long Beach?

Dr. Mittermiller is a fellowship-trained craniofacial surgeon with experience in facial masculinization surgery. He can be seen at the practice’s offices in Marina del Rey and Long Beach.

Contact Dr. Mittermiller today for a virtual or in-person consultation

Citations

1. Rodman R, Sturm AK (2018) Hairline Restoration: Difference in Men and Woman-Length and Shape. Facial Plast Surg 34 (2):155-158. doi:10.1055/s-0038-1636905

2. Ousterhout DK (1987) Feminization of the forehead: contour changing to improve female aesthetics. Plast Reconstr Surg 79 (5):701-713. doi:10.1097/00006534-198705000-00003

3. de Freitas DS, de Freitas MR, Janson G, de Freitas KM, Cardoso CL (2014) Nasolabial angle at rest and upon smiling. J Oral Maxillofac Surg 72 (12):2567 e2561-2565. doi:10.1016/j.joms.2014.07.034

4. Barone M, Cogliandro A, Salzillo R, List E, Panasiti V, Tenna S, Persichetti P (2019) Definition of “Gender Angle” in Caucasian Population. Aesthetic Plast Surg 43 (4):1014-1020. doi:10.1007/s00266-019-01366-w

5. Direk F, Uysal, II, Kivrak AS, Unver Dogan N, Fazliogullari Z, Karabulut AK (2018) Reevaluation of Mandibular Morphometry According to Age, Gender, and Side. J Craniofac Surg 29 (4):1054-1059. doi:10.1097/SCS.0000000000004293

6. Siddapur KR (2016) Gender Identification Study of a Dry Human Mandible by Assessing its Measurable Dimensions. Indian Journal of Forensic Medicine & Toxicology 10 (1):89-93. doi:10.5958/0973-9130.2016.00020.7

7. Sagiv D, Eyal A, Mansour J, Nakache G, Wolf M, Primov-Fever A (2016) Novel Anatomic Characteristics of the Laryngeal Framework: A Computed Tomography Evaluation. Otolaryngol Head Neck Surg 154 (4):674-678. doi:10.1177/0194599815627781

8. Glikson E, Sagiv D, Eyal A, Wolf M, Primov-Fever A (2017) The anatomical evolution of the thyroid cartilage from childhood to adulthood: A computed tomography evaluation. Laryngoscope 127 (10):E354-E358. doi:10.1002/lary.26644

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