Transgender patients frequently require adaptation of standard cosmetic procedures and the use of specialized procedures to meet their goals. A brief outline of procedures specialized for the transgender patient is included here. Of course the appropriate selection of procedures performed for a given patient is based on a thorough consultation and preoperative assessment of each patient.
Transgender patients often receive breast augmentations. Below are pictures of before and after breast augmentations of a transgender surgery patient.
Forehead re-contouring and feminization of the brow and hairline
Correction of the male prominence of the brow is generally one of the most important procedures in facial feminization and is recommended in the majority of transgender patients. Re-contouring of the boney forehead along with repositioning of the brow and hairline are commonly performed together through a single incision. The combination of these procedures enables Dr Murphy to create in a powerful way a feminized upper face. Through an incision along the hairline and extending to the temporal scalp the typical masculine prominent brow can be reduced by re-contouring the bones. As the scalp is advanced to achieve a more feminine hairline the brow tissues are released and elevated into position. Dr. Murphy’s extensive experience in upper facial rejuvenation is invaluable in these kinds of procedures. Recovery is limited by swelling and bruising but the results are typically very dramatic and worthwhile.
Mandible and Lower face re-contouring
Masculine contours of the lower face and jaw line are more likely variable from patient to patient. Typical findings include prominence of the chin, excessive width of the chin and prominent mandibular borders or a square jaw. Dr. Murphy helps his patients to achieve a refined, more feminine lower facial shape by re-contouring the mandible bone, including reducing prominence and width of the chin and frequently reducing boney prominence along the jaw line. These procedures are commonly achieved by incisions inside the mouth and occasionally a small incision beneath the chin. Sometimes patients may alternatively have a more recessive chin requiring a chin implant. Selection of the appropriate lower facial contouring procedure is based upon Dr. Murphy’s skillful, experienced assessment of each patient.
Reducing the prominence of the Adam’s Apple could be considered the signature procedure of the male to female transgender transformation. Removal of excess cartilage of the front surface of the larynx or voice box helps to achieve a more pleasing, smoother, feminine contour of the central neck. The tracheal shave procedure can be performed alone or in combination with other procedures such as a neck lift or facelift. When performed alone the incision is hidden in a transverse wrinkle of the neck overlying the voice box and if the reduction is combined with a neck lift procedure the incision is hidden beneath the chin. Skillful removal of just the right amount of cartilage so as to achieve as smooth a contour as possible while taking care not to damage the underlying vocal cords is necessary and helps to avoid any permanent voice change.
Typically the shape and size of the earlobe and even the entire ear can be reduced and feminized at the same time of other facial rejuvenation procedures. Small discrete incisions achieve a nice improvement in the balance of the ear by removing excess tissue. Not uncommonly this can be combined with an otoplasty which will reduce the overall prominence of the ears.
Buccal fat pad removal
Removal of the fat pad of the mid-cheek is occasionally added to facial feminization procedures to help achieve facial balance and reduce mid-face fullness commonly seen in full faced individuals. This procedure can give a more feminine contoured appearance while emphasizing the cheekbone area. Buccal fat pad removal is performed through a small incision inside the mouth with an easy recovery.
Buttock and Trunk Re-Contouring with Liposuction and Fat Grafting
The “female hourglass figure” is inherently different from the male torso. Removal of fat from the midriff/waist area can help to feminize the male torso, but “sealing the deal” with skillful re-introduction of the harvested fat into the buttock and perhaps lateral thigh area can help Dr. Murphy achieve the difference between a good and great result. Careful assessment of each patient’s existing fat deposits along with an understanding of the difference between the typical female and male fat distribution helps Dr Murphy achieve you best result.