Some people are born with a biological gender that they do not identify with, and this physical state may be very traumatic to them. For certain individuals, an overwhelming desire to change their external appearance to match their internal identity develops over time. This phenomenon, sometimes called transsexualism, is increasingly recognized as a medical and psychological entity. As acceptance has grown within the medical community, a complex array of surgical procedures have been developed to help patients with this difficult process. Until recently, patients were largely limited to hormone therapies. While careful management of exogenous hormones can provide some benefits (such as changes in hair growth, skin texture, and breast tissue), these treatments have no effect on facial structure.

An increasing body of literature shows that certain facial characteristics and relationships between structures are perceived as overwhelmingly “masculine” or “feminine.” These include the shape and prominence of the brow region, the size and shape of the nose, the fullness and prominence of the lips, the angle and definition of the lower jaw (mandible), and the position and prominence of the cheekbones (malar eminences) and chin (mentum). Each of these areas can be addressed with specific procedures performed by Dr. Ransom, alone or in combination.

The brow region in a “masculine” face has a more anterior projection with a greater distance between the flatness of the forehead (frontal bone) and the prominence of the frontal bar. In addition, the eyebrows (hair-bearing region) sit lower on the forehead and closer to the eyes. Feminizing this area involves shaving down the frontal bone and raising the brow soft tissues (by performing a browlift). In certain cases where the anterior hairline is high or has receded, the hairline may need to be lowered. This can be accomplished during the brow and forehead lift by a technique known as hairline lowering.

The nose is addressed using rhinoplasty techniques. Rhinoplasty is the surgical modification of the shape of the nose, also known as nose job surgery” or nose reshaping. The specific approach is determined by the specific goals of the patient, as well as any functional or anatomic issues which require certain techniques. The overall goal, in most cases, is to make the nose somewhat smaller (reduction rhinoplasty), remove any “bump” or prominence of the nasal bridge, and increase the rotation of the nasal tip. Septoplasty (fixing a crooked or broken nasal septum) can be performed along with either an open or closed rhinoplasty.

For the lips, both the shape and volume must be addressed. This can be accomplished with a lip augmentation and lip lift. The lip augmentation may be performed with soft tissue fillers, microlipoinjection (facial fat grafting) using your own fat cells, or via a surgical technique (V-Y lip augmentation), depending on the specific case. Adding a lip lift allows for a more defined and sensual Cupid’s bow, and increases the prominence of the red part (vermillion) of the upper lip.

The jawline and lower jaw bone are addressed in select cases. For some, a facelift (rhytidectomy) is the best way to improve this contour. In other cases, where the bony anatomy is very prominent, the bone must be shaved down (reduction mandibuloplasty). The chin area (mental prominence) is often a distinctly “masculine” feature, and can be reduced through a small incision on the inside of the lip or underneath the chin. The cheekbones (malar eminence) may be more flat in the “masculine” face than in the “feminine.” This area may be augmented with cheek implants or by microlipoinjection (facial fat grafting) using your own abdominal fat cells.

Who is a candidate?

Anyone who wants to change their facial features to a more “feminine” appearance may be a candidate for facial feminization. It is essential to recognize that many of the procedures used in facial feminization involve permanent changes to the face. Deciding to pursue facial feminization can be an important and meaningful step for transgender patients. This decision, however, must be taken very seriously and requires a stable and healthy mental state, as well as a strong support network. We are happy to work with you throughout this important process.

Frequently Asked Questions

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

Your postoperative period will differ depending on the specific combination of procedures selected. You will likely feel tired for a couple days and should limit your activities and concentrate on resting and recovery. In cases that include nose reshaping, you will have a cast on the nose for about a week after the procedure. This helps to protect the nose from accidental trauma, and also stabilizes the bones during the initial healing phase. Contact sports, racket and ball sports, heavy lifting, and straining must be avoided until Dr. Ransom gives you the “okay” – this is typically a few weeks. If a browlift and/or browplasty have been performed, sutures will be removed one week after the procedure. A soft cotton bandage is worn overnight for the first night, followed by a lighter supportive dressing throughout the next few days. If chin or cheek implants are placed, specific care for these areas will be required. Please see the procedure pages and FAQs corresponding to each individual procedure for more detailed information, including faceliftlip augmentation, and lip lift.

The specific recovery time depends on the procedures selected during your consultation with Dr. Ransom. The recovery time for each of the specific procedures will vary, but most of the healing takes places in the first two weeks. An exception is the nose reshaping – most plastic surgeons agree that the final result of a rhinoplasty is not seen for at least six months, and it is common to see subtle changes up to a year from the surgery. Dr. Ransom works closely with his patients in the postoperative period to ensure the best aesthetic outcome possible.

Reduction rhinoplasty (making the nose smaller or more “feminine”) offers some challenges. Dr. Ransom, however, is a nose specialist and uses this knowledge to make sure that his patients’ breathing is not negatively affected by nose reshaping. This may involve using specific grafts or functional techniques to keep the nasal airway open and well-supported. In some cases where the septum is crooked or the airway is too narrow before surgery, Dr. Ransom can actually improve your breathing during your rhinoplasty. Any issues pertaining to breathing can be discussed during your confidential consultation.

Double Board Certified Plastic Surgeon at

Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.