Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition

Considerations for the Use of Minimally Invasive Aesthetic Procedures for Facial Remodeling in Transgender Individuals

“…6 Transgender patients seeking minimally invasive injectable procedures should receive personalized initial consultation and follow-up, with instruction that maintenance treatments will be required to retain physical changes provided by these procedures. 5 Maintenance is extremely important to preserve the desired and achieved facial features, but patients must also appreciate the economic consequences of repeated facial treatments. 2 Because the lack of or reduced insurance coverage for aesthetic procedures in many countries may create limitations for some patients, clinicians may need to help patients prioritize their aesthetic goals.…”

“…20 Each area of the face (upper, middle, and lower) has distinctly feminine or masculine features that together affect gender perception. 5,21 For the upper face, the approximately 20% larger cranium in males relative to females lends males a broader forehead, flattening above the eyebrows and sloping toward the hairline. 5,16 Male eyebrows are flat and rest on or below the more prominent supraorbital ridge, whereas the female forehead (rounded, with a mild forward projection) slopes smoothly into the orbit.…”

“…5,21 For the upper face, the approximately 20% larger cranium in males relative to females lends males a broader forehead, flattening above the eyebrows and sloping toward the hairline. 5,16 Male eyebrows are flat and rest on or below the more prominent supraorbital ridge, whereas the female forehead (rounded, with a mild forward projection) slopes smoothly into the orbit. 16,[22][23][24] Female eyebrows arch in the lateral-third aspect over a subtle supraorbital ridge, and the orbit is oval.…”

“…19 Magnetic resonance imaging studies of soft tissue distribution have shown that the mean thickness of the medial cheek in a female face is approximately 50% greater than the lateral cheek (15.9 vs 10.9 mm in young women), whereas the soft tissue is more evenly distributed in the male face. 29,30 In the lower face, males have an overall squared-off angularity, 5,27 including larger masseter muscles and a broader mandible anterolaterally, with a prominent flexure at the mandibular ramus. 31 The male chin is also wider, larger, and flatter with increased anterior projection.…”

“…2,3 Transgender individuals may seek facial aesthetic modifications during their transitioning process by considering ideals that relate to looking more feminine or masculine. 4,5 They want their outward appearance-the face they present to the world-to reflect how they feel about themselves. 4 Differences between masculine and feminine faces have a hormonal basis: high estrogen levels result in high cheekbones, a proportional nose, full lips, as well as a relatively small and narrow chin, whereas high testosterone levels result in prominent supraorbital ridges, linear eyebrows, a flat midface, a more prominent nose, thin lips, and a squared jawline with a strong chin.…”