Many people are somewhat familiar with the breast augmentation procedure, an important component of gender reassignment surgery, required for our Toronto trans-female patients. But many are unaware that techniques and considerations are truly different as compared to our cis-females contemplating the same breast augmentation procedure.
That being said, little is mentioned about the other crucial components of their surgical transformation: facial and body. I have been working with the LBGTQ community for more than 14 years, and most of my fellowship training in Paris and Los Angeles was in facial aesthetics, so it’s very dear to me.
The Trans-Female (MTF) Patient’s Journey
At my Toronto practice, breast augmentation is often the first procedure performed, and one has to adapt the breast augmentation procedure to the different chest shape, height and width; a new inframammary fold also needs to be created, and careful measurements must be taken into consideration so that the scar remains well hidden and doesn’t ride high on the breasts. Size also matters, and one has to go larger in most situations to accommodate an often larger chest.
For the body, I often recommend hip augmentation with hip implants, fat grafting, or a combination of both.
Buttock augmentation is also frequently combined with hip augmentation to obtain the Brazilian buttock look; buttocks can be enhanced with implants, fat grafting or both.
The Kardashian “derrière” is quite a feminizing feature, everyone will admit.
If a tummy tuck is needed, I will tighten the abdominal muscles higher than I would do on a male, to create the Marilyn Monroe hourglass silhouette in my trans-female patients.
How Facial Feminization Surgery Fits In
For the face, various procedures are available — the so-called Facial Feminization Surgery — and each patient will require a different approach, depending on their original facial structure.
I find raising the outer eyebrows with a brow lift (aka a forehead lift), along with reducing frontal bossing and scalp advancement, to be a very powerful procedure for feminizing a face. This is all done via one single forehead incision.
Rhinoplasty is also a commonly needed procedure to make the nose smaller and shorter; narrow the nostrils; give the nose a gentle, concave curve; and raise the tip to create the female lip-nasal tip angle.
Tracheal shave is important for most patients; this is achieved via a small, well hidden incision under the chin, and the cartilage is trimmed, sculpted and polished to be flatter and less noticeable.
To all those procedures, I often add fat grafting to the cheeks, chin, and jawline to create fullness, curves, and a less “bony” contour. Soft edges are not only more youthful but also more feminine.
The chin is interesting, as I will sometimes shave the chin when it is too long or too projected, but I will also sometimes suggest a chin implant to lengthen the vertical height of the female lower face and to “ovalize” it, a classic feminine feature.
These are all transformational and life-changing procedures for my patients in Toronto. They require a plastic surgeon who is both classic and open minded, with an artistic approach, so it is important to consult with a surgeon who has experience in these complex yet gratifying procedures!
Dr. Marc DuPéré
