“Facial feminization” is a phrase generally used to describe procedures — from adding volume to the cheeks to mandibular contouring to rhinoplasty — used to shape and resize masculine features to more typical female features. But it’s not limited to the treatment of transgender patients. One surgeon expert says he uses also uses feminization principles to treat female patients.
“A lot of women want to look more attractive, therefore more feminine,” says Vartan Mardirossian, M.D., F.A.C.S., owner of Mardirossian Facial Aesthetics in Jupiter, Fla., which has a patient base of about 50% transgender individuals.
Dr. Mardirossian tells The Aesthetic Channel that these procedures are works of art. “However, you also need to have a profound knowledge of anatomy and physiology and surgery,” he says. “But there is a moment when you have to visualize what looks good. There is no mathematical ratio to achieve great outcomes.”
A good starting point is to simply examine how light reflects off of the face. “A pleasant light reflection will show the roundness of the forehead and the attractiveness of the cheekbones, the tip of the nose and the lips,” Dr. Mardirossian explains.
Based on the premise that the eyes are the center of the female face, “You want to have nicely developed cheeks that look symmetrical and reflect the light in the eyes,” Dr. Mardirossian says. “You also want to eliminate bony overhangs or excess skin around the eyes, so that the eyes themselves are the center of attention.”
Facial feminization procedures are especially popular around Christmas because patients use their vacation time for recovery, according to the surgeon. For weddings or reunions, patients undergo procedures several months ahead. “People do not want to look like they have had recent surgery or injectables,” Dr. Mardirossian says.
Feminizing the Face
Soft-tissue surgical options include upper and lower blepharoplasty, rhinoplasty, facelift and neck lift. “Although these are somewhat standard procedures, if used appropriately they can really feminize and make the face more attractive,” Dr. Mardirossian notes.
For example, some women present for rhinoplasty. “They say ‘I want to look more attractive. What can you do for my face and what can you do for my nose, in particular?’” Dr. Mardirossian relates. “We can work on the tip and create a gentle scoop of the nose and refine its structure to make the nose look more feminine.”
Bone-contouring options include cheek contouring, mandibular contouring and forehead contouring. “These are procedures that are very safe and change the contour of the bone,” Dr. Mardirossian says. “They are core procedures within the realm of facial contouring.”
Some women are unhappy with how the angles of their jaw protrude. “With mandibular contouring, we can reduce those angles and make their face more heart-shaped and attractive,” Dr. Mardirossian says.
For adding volume to the cheeks, Dr. Mardirossian often uses injectable fillers but sometimes employs fat or facial implants instead. Such cheek augmentation places the accent on the eyes and makes the eyes more visible. “It also adds volume and contour to the upper cheeks,” Dr. Mardirossian says. “Whereas fillers create just volume, facial implants create both contour and volume.”
Likewise, because the lips in a younger woman reveal the upper teeth, “you want to create a full, kissable lip by performing a lip lift with or without augmentation of the lips,” Dr. Mardirossian says.
To enhance the center of the face, the eyes, one nonsurgical option is Botox to the forehead and around the eyes. “If there is a little bit of excess skin of the upper eyelid, a [Botox] browlift can easily take care of that,” Dr. Mardirossian says.
Other options include injectables for the lower and skin tightening procedures with radiofrequency energy.
Still, every procedure has risks, “so you need to inform the patient,” says Dr. Mardirossian, an assistant professor of surgery at Florida Atlantic University in Boca Raton. “You also need to have high surgical training and experience to perform these procedures efficiently and safely.”
Dr. Mardirossian educates his patients about prioritizing procedures. “You kind of take a step back and look at their face and the contour of the face and the shape of the face,” he says. “Moreover, everyone comes in with a different idea of how much recovery time they want, so you need to take that into account when proposing individual procedures. Overall, you want to establish a good relationship with a patient.”
The No. 1 fear of patients is downtime, according to Dr. Mardirossian. “For something as simple as a facelift, the downtime will be about 7 to 10 days,” he conveys. “But for more complicated facial contouring procedures, the downtime can extend to 3 weeks.”
On the other hand, injectables are often considered “lunchtime” procedures. “If the patient is concerned with bruising or swelling, topical anesthesia, icing and Arnica gel can help,” Dr. Mardirossian says.
Through the years, Dr. Mardirossian has refined his techniques so that recovery is predictable and faster. However, one of the challenges of scheduling many of these procedures is for the patient to find an adult willing to spend the first night with them at home for recovery.
“I really care about my patients,” says Dr. Mardirossian, whose practice relies mostly on word of mouth. “If they look good, then we look good.”