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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:

A masculine chin tends to be taller, wider and has more of a square shape, while a feminine chin tends to be shorter, narrower and more rounded. Many people think feminine chins are V-shaped, but on average, they are actually U-shaped.

Men's chins also protrude forwards a little more than women's, but I don't think that chin projection is as important as the size and shape of the chin when it comes to gender recognition.





Surgical Options:

Chin surgery is called “genioplasty” or “mentoplasty”.

1. Height and Shape:
Chin corners can usually be removed by burring and/or cutting the bone.

If the chin needs to be reduced in height, most surgeons will cut a section of bone off the bottom, but some still use an older technique where they remove a horizontal section of bone from the middle of the chin and then close the gap.

One reason sometimes given for using the older technique is that you don't have to detach the muscles from the chin bone in order to shorten it because they remain attached to the lower section that you are no working on, but that also means you can only change the height of the chin and not the shape of the lower section, and in most FFS cases, you need to change the shape too.

2. Receding Chin:
A receding chin is not really a masculinity or a femininity - it is mainly a beauty issue, and that means it's down to your personal taste whether or not you like it, but if you are having a feminising genioplasty, you can take advantage of the incisions to have the chin moved forwards at the same time.

There are 2 ways of moving the chin forwards. One is to move the chin bone itself. This is called a "sliding genioplasty". The advantage with this technique is that it doesn't involve implants, but if it is not done properly, it can leave an indented area on either side of the jaw behind the chin. The other technique is to add an implant. This is simpler, but there are potential complications associated with implants - for example they can slip, they can become spontaneously infected even years after they were put in, and they can wear down the bone they are sitting on. For those reasons, I usually recommend a sliding genioplasty rather than an implant.

An added benefit of moving the chin forwards is that it tightens up the soft tissues under the chin, and that helps to prevent any slackness in the tissues caused by chin or jaw reduction.

Sometimes the issue is not a receding chin, but an underdeveloped lower jaw, when the jaw itself has failed to bring the chin forwards enough. However, on this page I am only talking about a situation where the jaw is normal, but the chin itself lacks projection.

3. Projected Chin:
Some people have a chin that projects forwards much more than average. As with a receded chin, this is more of a beauty issue than a femininity issue, but it is possible to remove bone from the front of the chin, or slide the chin backwards in a sliding genioplasty to reduce the chin projection. One downside of reducing chin projection is that it can cause more slackness in the soft tissues, so I don't generally recommend it unless the chin projection is severe enough to have an obviously detrimental effect.

4. Fat Under the Chin:
There is a pocket of fat under the chin called the "submental fat pad". It's not a femininity issue and everyone has one, but it can vary a lot from person to person, with some people naturally having more fat in this area than others.

The most common cause of a very large submental fat pad is being overweight, and in that case, the ideal solution is to lose weight. However, weight loss is not always possible, and some people have an excess of fat here despite not being overweight. In those cases, liposuction under the chin is a way of reducing it.

5. Slack Soft Tissue Under the Chin:
A similar problem to fat under the chin is excess skin under the chin, and again, it's not really a femininity issue - it's usually something you develop with age. The only way to fix it is with a neck lift. However, it is important to have any lifting done several months after chin and/or jaw surgery, and not before or during.

6. V-Line chin surgery:
V-line chin surgery involves taking a vertical section of bone out of the centre of the chin, then bringing the sides together to close the gap. The idea is to narrow the chin strongly and give it a V shape. Many people think this is a particularly powerful technique that allows for greater changes than other techniques, however, you can achieve the same result by removing bone from either side - basically, it's the position of the nerves that limits the amount of change, rather than the particular technique.

Also, it's important to understand that typical feminine chins are U-shaped rather than V-shaped.

7. Labio-mental fold reduction:
The "labio-mental fold" is the horizontal crease between the chin and the bottom lip. If you feel that yours is too deep, you can have it reduced. This can be done with an injectable filler or even by adding a small bone graft during chin surgery in some cases. This is a cosmetic treatment and has no particular effect on femininity.


Chin Clefts:

A small study I made suggests chin clefts might be a little more common in men than women. This simply involved counting the chin clefts on 50 male and 50 female faces – all randomly selected and I found that 58% of males had a visible cleft against 38% of women (a larger study might come up with different figures).

So although they are a little more common on men, they are still very common on women and I don't think they can be considered an important masculinity - they are really more of personal preference issue.

There are procedures that can remove a cleft but it is often not possible to remove a one completely. This is because a it typically exists not just in the bone, but also in the soft tissue layers. For example, there is usually a cleft in the muscle too. This makes correcting it quite difficult, however, you can usually reduce it during surgery, and then reduce it further once everything is healed by using an injectable filler like your own fat.


Facelifts and Chin Surgery:

For older FFS patients, chin and jaw surgery can leave the soft tissues around the lower face and neck more slack than they were before. This happens partly because the bones have been reduced but also because chin and jaw surgery can cause quite a lot of swelling and that swelling stretches the soft tissues. Younger patients don't have this problem as their soft tissues are very elastic and will easily tighten back up around the new jaw and chin as the swelling goes down.

The age at which you might need to consider a facelift after chin and jaw surgery will vary from person to person – one 50-year-old for example, might have very elastic soft tissues while another 40-year-old might already be having noticeable sagging.

It is very important to have any lifting done after jaw/chin surgery and not before it, or during it. There are 2 main reasons for this:
Chin and jaw surgery cause a lot of swelling and it's impossible to know in advance how much swelling a particular patient will experience.
It's not possible to know in advance how well your soft tissues are going to adapt to the new bone structure. You can certainly make a guess based on the patients age and by feeling how elastic the tissues are, but there is still a lot of guesswork involved.

This means that the best way to achieve the optimum result is to wait a few months for the swelling to go down and for any re-adaptation to take place - you can then see clearly exactly what, if anything, needs to be done with the soft tissues.

And remember that you don't need to go to an FFS specialist for a facelift - there are only a handful of good FFS surgeons, but there are very many good facelift surgeons.


The Nolichi Rule:

In both males and females, the opening of the mouth is, on average, just under a third of the distance between the base of the nose and the base of the chin - the male chin is taller, but the lip to nose distance is also longer so the proportions are actually the same. I call this the "Nolichi rule" and you can read more about it in part 5 of my thesis.

The balance between these features is important because if you shorten a chin, you can make the lip to nose distance seem longer by comparison and conversely, if you shorten the lip to nose distance, you can make the chin look proportionately taller so these features usually need to be considered together.


Some Questions:

Where should the incision for chin surgery be?
To access the chin, the surgeon can either make an incision in the mouth ("intra-oral"), or under the chin. An incision in the mouth is the more advanced technique and will not leave a visible scar. It is also safer to work through the mouth for the following reasons:
1. You can't reposition the chin muscles from below, and this can be important because in some cases, not repositioning the muscles correctly can leave them drooping. This is called "chin ptosis" or a "hanging chin".
2. There is a very important nerve that gives movement to your chin and bottom lip (mandibular branch of the facial nerve) and it is much easier to traumatise this nerve when working from below. This can cause some paralysis of the chin and bottom lip (this is quite a common complication with this approach) and if the nerve is severely damaged, the paralysis may be permanent.
3. You can't work on the area where the chin blends into the jaw from under the chin and in some cases that means that you will feel a step between the chin and jaw after the surgery.
For these reasons, I always recommend finding a surgeon who puts the incision inside the mouth.

Can you do chin surgery through the same incision as Adam's apple surgery?
Technically, yes you can, however, it is still best to do the chin surgery through the mouth for all the reasons listed above, but also because the small incision that is used for Adam's apple surgery has to be made a lot bigger to do the chin, and that means a bigger scar.

Which is more important - the shape of the chin or the height?
Something I have discovered through doing Virtual FFS is that in terms of feminisation the shape of the chin is more important than the height. This partly because a square chin has a flat base and this flat base clearly underlines the height of the chin, while a rounded shape gives a more vague sense of height. Another reason is that rounding a chin by removing the corners does actually reduce the height of either side of the chin – it's only the central point is left at the same height as before so more of the chin is shortened than is left the same.

Is a chin reduction done by cutting the bone, or by shaving it down?
Usually, when the surgeon has to remove bone from the bottom of the chin, they cut it off, but if they have to remove an area of bulging bone from somewhere on the chin, they shave it down.

Is it true that some surgeons are able to use ultrasound to cut the bone?
Ultrasound is a highly advanced way of cutting bone - it's much more accurate than a conventional bone saw, and it doesn't cause damage to the surrounding soft tissues. That means there is less risk, much less swelling and bruising, and that means a quicker and easier recovery with fewer risks of complications. Not all FFS surgeons use ultrasound cutters, so it's well worth searching for one who does.

Can a sliding genioplasty also reduce the projection of the chin by sliding the chin backwards?
Yes, that is possible, but there's no need because you can remove bone from the front of the chin to achieve the same effect.

Does chin surgery cause permanent numbness?
The “mental nerve” exits through the chin about 2 cm or so below the corners of your mouth. It is a branch of the “inferior alveolar nerve” which runs along inside the jaw and it supplies sensation to the chin, lower incisors and bottom lip. As long as the surgeon is using the correct technique and avoids the mental nerves you should have no problem. However, temporary numbness after chin surgery is normal and it can take a few weeks or even months for sensation to fully return. It's partly caused by swelling - this presses on the nerves and stops them working temporarily. It's the same effect as you experience when your arm goes numb in your sleep because you have been lying on it.

inferior alveolar and mental nerve

Can chin surgery cause a "hanging chin"?
If the surgeon doesn't take care to reattach the soft tissue under the chin, the soft tissues can droop down after the surgery. This is called a “witches chin” or “chin ptosis”, but there are techniques that can correct it like “mentopexy”.