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Facial feminization surgery may be a part of a treatment plan for gender dysphoria. Initial mental health assessment must occur. Referrals for hormonal therapy may then be made if appropriate. No guidelines exist for timing of facial feminization surgery. Generally, recommendations are for individuals to undergo hormonal therapy and live in a gender-congruent role for at least 12 months before surgical intervention. Referral letters meeting World Professional Association of Transgender Health guidelines must be made regarding the treatment course and goals. Informed consent must be obtained; patient should understand how surgical alteration fits into their overall treatment goals., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Facial features remodeling surgery is performed to obtain feminization of the face that corresponds to the gender perceived by patients. This includes techniques and findings to remodel the forehead and orbital rim to change the expression of the eyes, correction of the frontonasal angle in relation to rhinoplasty, hairline feminization, and eyebrow lift to correct the position and aesthetic dissatisfaction or the effects of aging., (Copyright © 2019 Elsevier Inc. All rights reserved.)

There exist several known anthropometric differences between the male and female facial skeleton and soft tissues. In general, the female face is less robust, rounder or heart shaped, with a shorter forehead, no supraorbital bossing, a smaller nose, more pronounced zygomatic prominences, fuller lips, a smaller mandibular width, and a more tapered chin. A method for analyzing these differences is critical for offering facial gender confirming surgery to the gender dysphoric patients, both for preoperative planning, as well as for setting postoperative expectations., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Craniofacial procedures to the midface in conjunction with work to the upper face and skull, and if needed the lower jaw, are a permanent and effective way to achieve feminization of the face in transgender patients. Although the surgery is more complex than other procedures, it should be considered for select patients. Further improvement of cosmesis may be considered a separate surgical entity and is not limited in scope or time by having undergone midface osteotomies. When carefully planned, bony surgery to the midface is safe and results in long-term predictive results and a favorable appearance as the patient ages.", (Copyright © 2019 Elsevier Inc. All rights reserved.)

Facial gender-affirming surgery can have significant impact on patient quality of life for some gender-dysphoric patients. Lower jaw contouring can be used to harmonize the face during facial gender-affirming surgery through masculinization or feminization. During feminization, the mandibular angle and body and chin are reduced in width and size. During masculinization, augmentation of the mandibular angle and body and chin are completed with alloplastic implants, fat, or bone. Complications are minimal. Further research is needed on outcomes of these procedures., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Most surgeons who are not routinely treating gender dysphoric patients are more likely to see an isolated rhinoplasty consultation rather than a request for full facial gender confirmation surgery (FGCS). Different from other aspects of FGCS, the surgical basis of rhinoplasty is almost the same as for the cisgender population. Despite technical overlap, the care for patients seeking rhinoplasty for the indication of gender dysphoria vastly differs from that for the cisgender population. This review includes comments on gender norms and outline considerations for the preoperative work-up and operative execution as well as a comprehensive literature review., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The male upper lip has a distinctly longer cutaneous height from the nasal base to the upper vermilion border than its female counterpart. The subnasal indirect lip lift using the bullhorn technique or its modifications allows for shortening of this height to feminize the lower face, creating a more aesthetically pleasing upper lip secondary to increased vermilion height and lip pout. Patient selection is critical, taking into account lip height, vermilion height, alar base width, skin type, upper incisal show, and maxillary height. Precise measurements, controlled excision of the planned resection, and meticulous reapproximation of skin provide an aesthetic result, while minimizing visible scarring., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Chondrolaryngoplasty, also known as tracheal shave, is a surgical procedure performed for a prominent Adam's apple, usually in transfeminine patients with gender dysphoria to this marker of male sex. Although laryngeal anatomy is complex, knowledge of landmarks and techniques discussed in this article results in a safe procedure with rare complications and improvement in quality of life., (Copyright © 2019 Elsevier Inc. All rights reserved.)