XV Harry Benjamin International Gender Dysphoria Association Symposium

The State of Our Art and the State of Our Science

Gender confirming facial surgery. Part I

Basic cross-gender differences with emphasis on planning of surgical corrections

By Alfred G Becking, DDS, MD*; J Joris Hage, MD+ ; D Bram Tuinzing, DMD, PhD*
*Department of Oral and Maxillofacial Surgery
⁺ Department of Plastic and Reconstructive Surgery, Free University Hospital,
POBox 7057, 1007 MB Amsterdam, The Netherlands

To facilitate passing in public as a member of the opposite sex, male-to-female transsexuals ask for feminizing surgical procedures in the face. Since 1990, bony facial corrections were carried out empirically in our hospital with promising results. To create a scientific base for gender confirming facial surgery several studies were conducted to compare the masculine and feminine face. Surprisingly very little literature on these differences could be found.

From anthropologic and forensic studies, several differences could be noted for the facial skeleton, the subcutaneous tissues and the skin. In absolute measures almost all dimensions of the female skull and face are smaller compared to the male features. Relating the absolute measures of the male and female face to the lower facial height several, surgical correctable differences could be identified. Resulting contours were reported to be more rounded in females, especially in the orbital area, with more prominent malar bones and less prominent mandibular angles.

In the upper part of the face, due to a more prominent supraorbital area the nasofrontal angle is more obtuse in women, while the position of eyebrows is more cranial and has a stronger curvature.

In the middle part of the face, the angles of the nose differ substantially, especially at the tip portion. The facial width is relatively large in women than in men. In the lower part of the face the most dominant differences are found in the chin region. The male chin is larger in every dimension. The mandibular width does not seem to be different in males and females in the relation to the lower facial height. The latter is surprising, since this is not in concord to anthropologic and forensic finding and in conjunction with our results which will be discussed in part II.