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Facial Gender & FFS:
• In a Nutshell
Hair and Hairline
• Forehead
Adam's Apple
• Facelifts
Hormonal Effects
• Ethnic Variations

• Virtual FFS FAQs
• General FFS FAQs

My Facial Feminisation Thesis

My Top Tips for FFS Patients

Disclaimers, Promises and My Qualifications

Body Dysmorphic Disorder and FFS




Gender Differences:

The apple of the cheeks (fleshy part) tends to be fuller and rounder in females than males because it contains more fat – masculine cheeks are often quite hollow. Hormones will add fat to the apple and in many cases trans women who are on hormones don't need any additional help here.

The cheek bones themselves tend to be a somewhat heavier in males, but this is not really visible from the outside so it's not a significant gender sign.

The width of the cheeks is also about the same in men and women when compared to the distance between the eyes. See more on this in the "Some Questions" section below.




Surgical Options:

1. Fat Transfer:
If the apple of the cheeks needs to be fuller and more rounded you can have fat from another part of the body injected into the area. This is called a "fat transfer" or sometimes a "fat graft". Using your own fat means that there is no risk of rejection or allergic reaction. However, there is some unpredictability involved with fat transfers because some of the fat is reabsorbed by the body. The amount that remains varies from person to person and is quite unpredictable - it can be anywhere from about 30% to about 80%. So the surgeon will usually put in a little more than you need at first and will then top up as necessary a few months later. That way, you gradually build up the permanent layer until what remains is the amount you need.


2. Solid Implants:
Solid implants are used to enhance the cheekbone, or to add fullness to the cheeks. They are available in several shapes and can be placed over or under the cheekbone or lower down near the sides of the nose according to the needs of the patient. However, they can look unnatural if the implants are too big, and it is sometimes possible to see the outline of them under the skin if you don't have enough fat in your cheeks to hide the outline of the implants. This can look unnatural and quite strange. The incisions for cheek implants are made inside the mouth.


Important Note:

Because hormones make the cheeks fuller and rounder, it's usually best to give hormones plenty of time to work on your cheeks (a year or so on a full dose in my opinion) before you consider cheek augmentation. So an FFS surgeon should ask you about your hormone status before they recommend cheek augmentation! And they should not recommend procedures to fill the apple of your cheeks until the hormones have had a chance to work. There may be exceptions to this where there is a clear problem with your cheekbones that can be corrected at any stage during your hormonal treatment, but as a rule, give the cheeks a chance to feminise on hormones before you try to alter them surgically.


Naso-labial Folds and Marionette Lines:

Naso-labial folds are the 2 creases that come down from the corners of the nose, and marionette lines are creases that come down from the corners of your mouth. Both males and females can have these lines and they tend to get deeper with age. Filling or reduction of these creases, especially the naso-labial folds, is sometimes offered as part of FFS. This has no feminising effect (so don't let surgeons try to sell you the procedures as feminisation!) but it can have a mildly rejuvenating effect.

You can fill them with a temporary filler like hyaluronic acid, or your own fat for a more permanent effect. They will also be reduced to some extent if you have a facelift.


Bichat Fat:

There is a pocket of fat in the lower part of the cheek called the "bichat fat pad" or sometimes the "buccal fat pad". It is possible to have this reduced but it doesn't generally have feminising effect. In fact, it is more likely to have a masculinising effect because it will create more hollowness in the cheeks. Another problem with removing bichat fat, is that we tend to lose fat in the cheeks as we age, so later on, the cheeks can look too thin and that can make you look older.

I would only recommend bichat fat reduction in a case where the lower cheeks are unusually fat.


Some Questions:

Is cheekbone reduction feminising?
It is quite widely believed that male faces are a little wider across the cheekbones than female faces but this is only true if you compare the width across the cheekbones to the width of the cranium (the round part of the skull) which is not a part of the head you can usually see because it's hidden by people's hair. If you compare the width of the cheeks to things you can see clearly like the distance between the eyes, then male and female cheeks are about the same width.

There is also confusion because sometimes in some scientific papers, when they refer to the "width", they are not talking about the distance across the cheekbones, but about the thickness of the cheekbone itself.

So, cheekbone reduction is not generally feminising, and it's also worth remembering that wide and/or prominent cheekbones are commonly associated with beauty, which means that reducing them might have a negative impact on your beauty. Reducing them also removes some of the support for the soft tissues and that could potentially have an ageing effect.

I have had silicone injections in my cheeks. Can it be removed?
Removing silicone is extremely difficult because it often doesn't sit there in a single pocket that you can access with a needle or cannula to suck it out. It's usually distributed in droplets throughout different layers of soft tissue including skin, muscle and fat. Every case is different though, and you would need to speak to your surgeon about the possibilities in your case.