Dr. Spiegel Article on FFS for Time Magazine

What’s all this talk about Facial Feminization?
What it means for transgender women,
and what it might mean for you.

Recently people have been talking a lot about transgender women and what is involved with successfully transitioning from a man to a woman. To an extent the speculation and news about Bruce Jenner has been a catalyst for this as tabloids and reporters have considered what may be the motivation for Bruce to have possibly undergone an Adam’s apple reduction and other “feminization” procedures.

To understand this transformation, we need to consider what it means to be a transgender woman and what it means to look feminine.

Transgender women know they are women. They feel it and know it with the same strength and conviction as any woman.
As a physician I strive to help people and ease suffering. As a scientist I’m intrigued to understand what in a face determines gender and beauty. And, as a facial plastic surgeon I want to help my patients be the most attractive, confident, and comfortable people they can be.

I’ve learned that beauty isn’t only skin deep. The facial skeleton creates important shapes and shadows that convey gender cues. For example, men have a more prominent brow ridge (the bone low on the forehead on which rests the eyebrows). This feature shadows the eyes and gives men a more aggressive appearance. It’s also judged to contribute to making a woman’s face less attractive. Smoothing out this region (which typically involves removing and recreating part of the front of the skull) greatly improves the femininity and attractiveness of all women’s faces. At the same time that I reduce the size of the forehead I round out and advance the hairline (reducing the appearance of male pattern baldness) and lift the eyebrows into a more youthful, feminine, and attractive appearance.

Men tend to have large jaws, while a smooth tapered jawline and chin is considered more feminine. In Korea, for example, this jaw shaping or v-line surgery has become one of the most popular aesthetic procedures. I do many of these each week in order to help biologic women and transgender women look their most feminine.

There are many other procedures to consider. We need to feminize the nose (making it smaller, smoother, softer), enhance the cheeks (cheek shape should be a gentle curve regardless of the angle at which we see the face), and reduce the size of the Adam’s apple (using a special fiberoptic camera to protect the voice). Sometimes I’ll also do a surgical procedure to raise the pitch of the voice by tightening the vocal cords. I also need to help the person look younger as advancing age reduces femininity, so an eyelid lift, facelift, or neck lift may be needed.

Another area worthy of special consideration is the lip. Women have fuller lips, yes, but importantly they are also shorter. That is, the distance from the nose to the red (vermilion) border of the lip is shorter for a woman and this results in visible teeth when the mouth is open (look at photos of fashion models in any magazine). By shortening the length between the nose and the lip we can create a face that is more feminine, attractive and youthful.

Applying these and other surgical techniques I’ve helped hundreds and hundreds of transgender women to live their lives with confidence that other people see them the way they see themselves. I’ve also applied these same techniques to biologic women and have been able to help many who thought their goals unachievable.

There is much more to know, but I feel blessed to have been able to learn so much about how we identify gender and attractiveness, and to have applied these findings to the creation of surgical procedures that have helped so many women of all types.

Jeffrey H. Spiegel, MD