Perception of femininity and attractiveness in Facial Feminization Surgery

Abstract

Background: Facial Feminization Surgery (FFS) alters bone and soft tissue to feminize facial features of transgender females. This study aims to evaluate perceptions of femininity, attractiveness, and ideal surgical outcomes in transgender females, non-transgender females and plastic surgeons. Methods:The data was extracted from a survey of transgender females (n=104), non-transgender females (n=192) (completion rate of 48.4%) and plastic surgeons who performed FFS (n=23) (survey response rate of 31.5%). Five virtually-modified forms of three facial features, the nasal tip width, supratip break, mandibular gonial angles, and the composite images of the above features of an individual, assigned male at birth, were used. Respondents were requested to select and rank images based on personal perceptions of femininity and attractiveness.Results: Transgender females chose a narrower nasal tip width as more attractive (P≤0.001), and evaluated a more acute supratip angle, and more obtuse mandibular gonial angle as both more feminine and attractive (all P≤0.023) compared to non-transgender females. Plastic surgeons chose a more obtuse mandibular gonial angle as more feminine (P=0.007) and a more ideal surgical outcome (P=0.046), compared to transgender female respondents. In the assessment of composite images, non-transgender female ranked the options with more obtuse mandibular gonial angle as more feminine (all P≤0.036) than transgender females.Conclusions: Acknowledging the difference in transgender females' perceptions of facial femininity and attractiveness from non-transgender females and plastic surgeons could assist plastic surgeons in managing expectations of surgical outcomes.

Perceived Age and Gender Perception Using Facial Recognition Software Following Facial Feminization Surgery

“…For instance, the perception of femininity can vary widely depending on cultural or societal norms, and thus there is no universal standard for what constitutes a “feminine” face 16,17 . Second, transgender females’ perceptions of facial femininity and attractiveness may differ from non-transgender females 18 . The outcomes of FFS are highly dependent on the individual’s unique facial features and the specific procedures performed, making it challenging to compare patients and surgeons.…”

“…16,17 Second, transgender females' perceptions of facial femininity and attractiveness may differ from non-transgender females. 18 The outcomes of FFS are highly dependent on the individual's unique facial features and the specific procedures performed, making it challenging to compare patients and surgeons. Despite these obstacles, most studies have reported high levels of patient satisfaction following facial feminization.…”

Technique for Cephalometric Analysis of the Craniofacial Skeleton Following Facial Feminization Surgery

“…16 However, other studies have noted differences in the perception of facial femininity between surgeons and transgender females. 17 Eye tracing technology has shown that transgender patients fixate on the fronto-orbital complex and mandible when assessing gender. 18 Further studies are needed to assess the degree of bony changes needed to establish optimal feminine facial qualities and the relationship to patient-reported outcomes.…”

Developments in facial feminization surgery

“…Ching et al [12 ▪▪ ] report an interesting study on gender perception by comparing the perception of three facial features which have not been shown by previous studies to contribute to ideal surgical outcomes. The facial features evaluated were nasal tip width, angle of the supratip break, and gonial angle.…”