Facial Feminization among Cis and Transgenders: A Single Centre Experience by Dr. S.M. Balaji

Recent years have seen an unprecedented rise in demand for Facial Feminization Surgery (FFS), both

in transgender and cisgender populations. FFS procedures now represent one of the fastest-growing

segments of craniofacial and aesthetic surgery

A growing number of cisgender women seek facial feminization to soften features and harmonize facial

proportions—without changing their gender identity. Across this diverse patient group, one constant

remains: As the face is both our most visible organ and the most intimate carrier of self-image. The

expectations—whether conscious or subconscious—stem from a desire to match facial traits with one’s

perceived or desired personality, status, or gender identity.

These shifts highlight a new paradigm in aesthetic practice—one that blends surgical expertise with social and psychological nuance. The quest for facial aesthetics has been shaped by deep psychological and sociocultural forces. Today, it is modulated by social media and the need to meet the expectation of self and peers. Patient are seeking subtle facial contouring that aligns with their desired identity or social persona.

Facial Feminization Surgery – What’s New?

Facial feminization traditionally includes modifying the skeletal and soft tissue structures—frontal bone,

brow, nose, lips, cheeks, mandible, and chin—to bring them in harmony with feminine facial norms. The

expectations and anatomy of cisgender and transgender patients vary, requiring nuanced and individualized approaches. Facial feminization is not simply about “looking female.” It is about harmonizing the face with the individual’s internal self-image, often in ways that are nuanced, culture-specific, and psychologically loaded.

For transgender patients, this may involve dramatic transformation—forehead bossing reduction,

mandibular angle correction, rhinoplasty, and hairline advancement—bringing features into alignment

with feminine norms. For cisgender patients, particularly those in media-facing professions or global

corporate roles, requests are more subtle: refinement of the chin, brow softening, or cheek enhancement

to appear more “approachable,” “elegant,” or “less severe.”

Key Innovations in Practice:

• Piezoelectric bone reshaping: Greater control, less trauma, and faster healing

• 3D simulation + AI-assisted planning: Preoperative modeling and outcome preview

• Hybrid approaches: Combining surgery with fillers, threads, or fat grafts, especially popular among

cisgender patients

• Endoscopic-assisted techniques: Used for brow lift and hairline lowering with minimal visible scars

• Frontal Contour Reduction: Sculpting the frontal bossing and supraorbital ridges with osteoplasty as

cultural needs. Use of titanium mesh where needed.

• Hairline Advancement: Tension-free advancement with natural camouflage using oblique scalp

incisions, again as per cultural needs

• The Psychological Layer: Our studies and my experiences show a fascinating overlap between facial

features and personality perceptions. A strong jawline may be seen as dominant, while a delicate nasal

tip and wide eyes convey trustworthiness. Patients may not say “I want to look feminine”—they say, “I

want to look kind,” “less tired,” or “more confident.” Surgeons must translate these personality cues

into surgical goals.

• Modern FFS is more than aesthetics: It is a psychosocial alignment. Surgeon must -Read the facial map of the mind; Balance biomechanics with identity; Know when to refine vs. reconstruct

• Multiple interviews for assessment and Consent is a must.

Clinical Case & Practical Applications

Transgender Woman (Age 27)

Comprehensive FFS including male baldness correction, hairline advancement, Frontal bossing correction, supra-orbital rim reduction, orbital lateral width reduction, rhinoplasty, mandibular angle reduction with masseter debulking, genioplasty + double chin correction and bull horn procedure.

> Recovery: 3–4 weeks

> Outcome: Significant alignment with gender identity

Global Trends & Who’s Leading the Way?

• India: A rising destination for both transgender and cisgender facial feminization procedures. Patients

from Southeast Asia, the Gulf, and Africa now travel to India for comprehensive care.

• USA & Thailand: Known for full-spectrum transgender surgery with protocolized systems

• France & Germany: Leading more conservative and subtle feminization procedures for cisgender

women

• Brazil: Strong in aesthetic harmony and hybrid soft-tissue techniques

Today, non-binary and fluid-identity patients are also seeking partial or selective feminization—pushing

the field beyond binary surgical thinking.

How This Changes Your Practice?

Why This Matters for Practitioners?

• Serve a broader range of patient identities and expectations

• Learn flexible surgical strategies for both subtle and full feminization

• Stay relevant in a global aesthetic market demanding inclusivity

• Integrate cutting-edge tools like piezoelectric systems and AI-driven modelling

• Build ethical, identity-affirming treatment pathways with long-term satisfaction

See It Live at AIME Congress 2025

• Join me on Thursday, June 19th at 08:30 AM for the featured session: “Facial Feminization – Sculpting

Beauty from Bone to Soft Tissue”

• Co-chaired by Prof. Mohammad Sartawi and myself

• Proudly endorsed by the International College of MaxilloFacial Surgery (ICMFS)

What you’ll gain:

• A deep dive into real surgical cases from both cis and trans patients

• Advanced tools and planning methods to improve precision and outcomes

• Insights into building a culturally competent and inclusive practice

• Techniques that are changing lives—not just faces

Let’s shape the future of facial aesthetics—ethically, scientifically, and beautifully.

See you in Paris!

AIME CONGRESS