WATCH THE VIDEO tracheal shave procedure

Tracheal Shave

An Adam’s apple is a prominent notch in the thyroid cartilage. This notch is visible in some women, but can be very prominent in men. Therefore, it is considered by many to be a masculine characteristic. Shaving the notch, also known as a tracheal shave, can provide a softer, more feminine contour to the neck.

Procedure: With tracheal shave surgery, a tiny incision is placed in the crease of the neck below the chin. This allows the scar from the incision to be minimally visible. The thyroid cartilage is reduced by shaving the most prominent area along with the rim of the upper border of the trachea while protecting the vocal chords.

Location: This surgery can be done under twilight sedation in our fully accredited in-office surgical suite or in our surgical center. The procedure will take approximately 1 hour.

Recovery: Post-operatively, you will experience some swelling during the first 24-48 hours. An ice pack applied to the area along with medications that Dr. Sturm may suggest will keep discomfort to a minimum. Mild voice weakness can also occur in the first few days following surgery.

Return to work/activities: You should be able to return to your normal daily activities one week post-operatively. However, you should avoid vigorous exercise for 4 weeks after surgery.

WATCH THE VIDEO jaw and chin contouring

Jaw Contouring

Masculine features of the jaw vary from person to person. There are many beautiful women with a square face, rather than oval or heart-shaped. However, a prominent, wider lower jaw that flares outwards can give the face a square and more masculine look. While a feminine face can have a narrower jawbone and less bulky chewing muscles. The jawline can be softened with jaw contouring.

Hormone treatment can cause changes in the bone without surgery, so you should determine the effects hormone therapy will achieve first. Also, Botox can also be used to soften the chewing muscles in the office with minimal downtime. Your individual facial structure will be reviewed and your future goals will be discussed with Dr. Sturm during your consultation.

Procedure: During surgery, incisions are made between the gum and cheek to expose the jaw, also known as the mandible. A pre-determined section of the jaw bone is cut and/or shaved to achieve a well-rounded contour of the jawline, curving down from back to front. Patients over 40 may experience loose skin around the jaw or chin after a jaw shave. This can be tightened after the original jaw shave procedure with a lower face-lift.

Location:Jaw contouring surgery requires general anesthesia and will need to be performed at an out-patient surgical center or hospital.

Recovery: After surgery, you will experience swelling. The amount of swelling varies patient by patient, in some instances there may be visible bruising. Your mouth will need to be cleaned a few times a day with mouthwash. It may take four to six weeks before the cosmetic improvement will be obvious due to the swelling.

Return to work/activities:You should be able to return to your normal daily activities in about one week.

WATCH THE VIDEO jaw and chin contouring

CHIN Contouring

Similarly to the jaw shape, a smaller, narrower chin can indicate femininity. Depending on the size and shape of the chin, it can be simply shaved or the bone can be moved back to make it smaller and less pronounced.

Procedure:Access is gained to the chin from an incision inside the mouth. Then the bone is either shaved down or moved using a “sliding genioplasty.” During the surgery, the chin is cut from front to back, separating a horseshoe-shape of bone. This piece can be moved backward to make the chin less pronounced. The angle of the cut affects the final height of the chin. To make the chin shorter a section of the bone can be completely removed.

Location: Chin contouring surgery requires general anesthesia and will need to be performed at an out-patient surgical center.

Recovery:You will likely have some swelling and bruising. The chin and lower lip can feel “tight” for about a month. Extensive bone surgery may require four to five weeks to heal.

Return to work/activities:You should be able to return to your normal daily activities within five to seven days post-operatively.

CHEek implants

Fullness in the mid-face area can give your face more of the desired feminine heart shape. Cheek implants are a simple procedure that can give you “apple cheeks” long term.

Procedure:To insert a cheek implant, Dr. Sturm will make an incision inside your mouth, between upper gums and cheek. She creates a pocket over the cheekbone. Then, she slides the implant through the incision and stitches it in place. The implant is made of medical-grade plastic in a roughly triangular shape and is very safe. There are several different types, and Dr. Sturm will select one to complement your facial structure, yet meet your goal for improved facial feminization.

Location:Cheek Implant surgery can be performed and will need to be performed at an out-patient surgical center.

Recovery: After surgery you may feel some tightness or numbness around your cheeks for a few weeks and you will have some swelling. Swelling subsides gradually and your new look continues to reveal itself over a couple of months.

Return to work/activities: You should be able to return to work and daily activities in one week. However, you should avoid vigorous exercise for 4 weeks.

Browlift and Hairline Shaping

The relationship of the hairline, brows and eyes convey a lot of information about who we are. The eyebrows frame the eyes, where most people look first on the face. The feminine brow lies above the orbital rim (brow bone) and arches on the sides, rather than having a flatter shape at the brow bone.

The hairline frames the face. Masculine hairlines tend to be lower in the middle and higher in the sides because of the testosterone effect. To feminize the hairline, the sides, and sometimes the middle, are brought forward to a softer, more round shape, making the forehead smaller. This can be done with scalp advancement, hair transplantation or a combination of the two.

We talk about the hairline and the brows at the same time, because we can use techniques to raise the brows, lower the hairline, or do both with the same procedure. Each face is different, so Dr. Sturm will tailor the techniques for each patient.

Endoscopic Browlift

Procedure: Dr. Sturm will often use an endoscopic technique with minimal incisions just behind the hairline. She will place a special scope under the forehead area to clip frown muscles. Using sutures, she pulls up the brow and forehead to a higher, more open level.

Location: The brow or forehead lift is normally performed under general anesthesia at a nearby out-patient surgical center.

Recovery: For about ten days after surgery, you will have swelling and some bruising. Between seven to fourteen days following surgery, your sutures will be removed in our office.

Return to work/activities: You should be able to return to work and daily activities in 7-14 days following surgery. However, you should avoid vigorous exercise for 4 weeks.

Scalp Advancement Surgery

Some patients undergo scalp advancement surgery to bring forward and reshape the hairline for a more feminine appearance.

Procedure: During surgery an incision is made along the hairline, the scalp is then lifted and pulled forward and the excess forehead skin removed. Micro-hair grafts may be placed in front of the incision if needed. However, the scar heals to a fine, faint line that is often not noticeable. However, there is a limit to how far the scalp can be moved during a single surgery. For some patients, more than one surgery may be needed several months after the initial surgery.

Location:Scalp enhancement surgery is performed on an outpatient basis with IV sedation, “twilight”, in our fully accredited in-office surgical suite. If the patient prefers general anesthesia, the surgery will be performed at a nearby outpatient surgical center under general anesthesia.

Recovery:Most patients experience some bruising, swelling and numbness of the scalp that resolves. Discomfort is mild and managed well with pain medications.

Return to work/activities: You should be able to return to work and daily activities in 7-14 days following surgery. Straining and exercise should be avoided for 4-6 weeks.

Hair Transplantation

Hair transplantation is useful to move the hairline forward and make it more feminine. While more infrequent, hair transplants can also be used to fill in and make incisions even less visible. The newest technique, Mini-grafts, can give you a natural look that also has a more feminine hairline.

As a general rule, hair-restoration surgery works best if you have healthy hair-growth areas to serve as donor places; typically this means that the sides and back of your head need to have some hair from which to "harvest" grafts.

Procedure:Dr Sturm uses the popular follicular-unit mini-grafts. She takes hair from dense hair-growth areas, like the back of your head, and replants grafts in thin areas, creating a fuller look. In certain cases, the hairs can be taken without incisions!

It may take a few surgical sessions to achieve the degree of hair fullness you want. If that is the case, you will wait a few months between each session for healing. There are many variations on hair-replacement surgery that may be appropriate. When you come in for your consultation with Dr. Sturm, she will develop a treatment plan that is specific to your needs.

Location:Hair transplant surgery can be done on an outpatient basis in our fully accredited in-office surgical suite under local anesthesia.

Recovery:Hair transplantation is associated with minimal pain. You will have tiny areas of swelling and healing around each implanted hair that is easily covered with a hat.

Return to work/activities:You should be able to return to work and usual activities in one week.

WATCH THE VIDEO forhead contouring

Forehead Contouring Surgery

A prominent bony ridge under the brows is seen in some masculine foreheads. This is called “frontal bossing”. It can be quite prominent, moderate or not present at all. When it is present it can give a masculine appearance. Depending on the size of the bony ridge, the ridge can be shaved down or set back and completely reshaped. In some cases an implant or injectable filler is used to round out a flat forehead for a more feminine appearance.

Procedure:An incision is made at the hairline or within the hair depending on your specific hairline shape. If the bone is thick and the bossing is moderate, the ridge can be filed down with a burr. When the bone is thinner and the bossing is more prominent, the bone is set back into a position to give a softer, rounder shape to the forehead, while taking care to protect your frontal sinus. The bone is held in place with a small titanium screw and your own tissues. Scalp advancement or brow-lift can be performed at the same time through the same incision.

Location:Since general anesthesia and an overnight stay is required, forehead contouring surgery is performed at a nearby hospital.

Recovery:You will spend one night in the hospital. Most patients experience some bruising and swelling, and numbness of the scalp that resolves. Discomfort is mild and managed well with pain medications.

Return to work/activities:You should be able to return to work and daily activities in 10-14 days. You should avoid straining and vigorous exercise for 6 weeks.

Rhinoplasty

Changing the appearance of your nose can have a significant impact on achieving a more feminine look. Rhinoplasty, commonly known as a nose job, is one of the most popular cosmetic surgery operations, yet it is one of the most challenging. Male noses tend to be larger and fuller; for facial feminization it requires changing the nasal contour to make it smaller and more refined. This is a difficult and complex surgical procedure, so it is extremely important that you select a facial plastic surgeon with experience and specific training in Rhinoplasty surgery, like Dr. Sturm, to give you confidence in a successful outcome.

Procedure: A rhinoplasty procedure can be performed using a “closed” technique with no external incisions or an “open” technique with a small incision under the tip of the nose just above where it meets the upper lip. This incision heals very well and is nearly imperceptible in most people. Rhinoplasty is a very individualized surgery, because no two noses are the same. The surgical technique selected will be based on the anatomy of your current nose and your individual surgical goal.

Location: Rhinoplasty surgery is normally performed under general anesthesia at a nearby outpatient surgical center.

Recovery: A splint is placed over the nose for 5-7 days to protect it in the early phase of healing. After this comes off, tape is placed over your nose to reduce swelling until the tenth day. Some patients experience swelling and/or bruising around their eyes depending on how easily they bruise. The nose will be swollen in a manner that you and I will know, but that other people generally don’t notice. Approximately 90% of the swelling goes down in 3 months and the rest resolves over one year. Pain is minimal and controlled with pain medications.

Return to work/activities: You can return to work in 10 days. You can resume light lower body exercise, like a light workout on an elliptical machine, at 4 weeks and impact exercise, like running or yoga, at 6 weeks.

Eyelid surgery

Eyelid surgery or Blepharoplasty, is a relatively straight forward operation that can make a big difference in your look. Removing bags and hooding can provide a more feminine look and create a brighter appearance.

Procedure: For the upper lid, extra skin is removed from an incision that hides easily on the crease of the upper eyelid. The incision lies just below the lashes in a crease that most people already have for the lower lids. Excess skin and fat is removed making the lower eyelids smooth and even.

Location: Eyelid surgery can be done under IV sedation, referred to as “twilight” sedation in our fully accredited surgical suite in our office.

Recovery: Pain is minimal and most patients do not use the pain medications that they are given. Many people experience swelling and bruising that resolves in approximately one week.

Return to work/activities: You should be able to go back to work and resume daily activities in 1 week. However, you should avoid vigorous exercise for 4 weeks.

Otoplasty

Pinning back prominent ears can give you unlimited options for hairstyles. Many people who are concerned about ears that protrude tend to wear their hair longer and plan their hairstyles to cover their ears. With an Otoplasty, you will be able to put your hair in an up-do or ponytail without even thinking about your ears.

As a facial plastic surgeon, specializing in the head and neck area, Dr. Sturm has a keen anatomical eye for proportion and symmetry which is essential for successful Otoplasty surgery.

Procedure:The incision is hidden behind the ear. The cartilage is reshaped and held in place with permanent sutures.

Location: The procedure can be performed on an outpatient basis with local or IV sedation, “twilight”, in a nearby outpatient surgical center or at our fully accredited FPSA surgical facility.

Recovery:Following surgery, patients experience mild pain, although your ears may feel a bit tender for several weeks. You can expect some discoloration and swelling, and at first, the ears look flat against the side of the head.

Return to work/activities:You will be able to go back to work and resume daily activities in about a week after surgery. However, you should avoid vigorous exercise for 6 weeks.

FACELIFT

A facelift lifts the excess skin of the face and neck giving you a more elegant neck and defined jawline. The term, facelift, is better named a face and neck lift, because it re-supports the cheek, jawline and neck. Lifting a more square facial shape, resulting from descent of the cheeks and jowls, to a more oval or heart shape feminizes the entire face. Facelifts are often combined with other procedures such as blepharoplasty, cheek implant and brow-lift.

Procedure:To achieve the most natural, long-lasting results, a facelift requires meticulous dissection done in layers. The sagging skin is repositioned and the underlying muscles re-supported, while the excess skin and fat is removed. Dr. Sturm uses a special surgical technique to hide incisions in natural skin lines and creases so scars will fade until barely noticeable, if at all.

Location: Facelifts are done under general anesthesia at a local hospital and require an overnight stay.

Recovery:You will have swelling and bruising, which will disappear in a few weeks.

Return to work/activities:You will be ready to go back to work and your usual activities in about 2 weeks. You might want to allow 4 weeks before a big social event. And, you should avoid vigorous exercise for 4 weeks.

Lip Augmentation

There are both surgical and non-surgical lip augmentation approaches to obtain a more feminine look. Surgical approach is permanent and can involve implantation of a biological scaffolding (acellular dermis) to augment lips or a lip lift. Some patients prefer a non-surgical approach to augmentation with injectable fillers. Fillers can last about 6-9 months.

Procedure:In the masculine lip, the distance between the nose and top lip is often longer and the red lip is smaller than in the feminine lip. To reduce the distance and make the red lip fuller and more pouty, an incision is made just under the nose and a section of skin is removed which raises the lip. Alternatively, an incision can be made at the edge between the red and white parts of the lip, known as the Vermilion border. The incisions can be placed inside the lip, but only the red lip can be made fuller and the distance between the nose and upper lip is not changed. Augmentation can also be achieved with a semi-permanent filler of acellular dermis, a scaffolding of proteins and sugars naturally found in your skin, that lasts for approximately 5 years.

Location: Lip augmentation surgical procedures can be performed under local or IV sedation, “twilight”, in our fully accredited in-office operating room.

Recovery:Patients who have lip lifts experience swelling and soreness of the lips for a few weeks. You may experience bruising.

Return to work/activities:You can return to work in about one week. However, you should avoid vigorous exercise for 4 weeks.

Injectable Fillers and Wrinkle Reducers

For a more refined, gentle and feminine face, many trans and gender non-conforming patients will have Botox injections, also known as neurotoxins or wrinkle reducers, to smooth out frown lines in the forehead and around the eyes. There are now numerous competitors to Botox, so the most appropriate product selection can be determined by you and Dr. Sturm.

There are also a wide range of injectable fillers that are most effective in different areas of the face. Fillers, such as Sculptra and Voluma, have longer lasting effects, up to two years. Other injectable fillers, such as Juvederm and Restylane, last about 9-12 months. Injections can be used in combination with surgical options for the best overall result.

About Facial Feminization Surgery (FFS)

There are certain characteristics of a face that are identified as feminine. Facial feminization surgery (FFS) encompasses the spectrum of facial plastic surgery procedures that can provide assistance to patients to affirm their feminine identity. There are also non-surgical treatments that can help a patient look more feminine for those that do not want to pursue surgical solutions. You may benefit from a combination of both surgical and nonsurgical facial feminization procedures.

Many facial feminization surgery procedures are well known cosmetic surgery procedures, including; facelift, neck lift, brow lift, lip augmentation, cheek and chin implants or reduction, rhinoplasty, and eyelid surgery that many plastic surgeons perform. However, there are some procedures that are specific to feminization, including; jaw contouring, tracheal shaving, chin contouring and forehead contouring, that not every plastic surgeon performs.

Dr. Sturm specializes in surgery of the face, but she collaborates with other plastic surgeons who perform breast enhancement, hip curvature procedures, liposuction and other body surgeries. Depending on your surgical needs and the amount of time needed to perform them, it may make sense financially to have two or three procedures performed at the same time, assuming you are healthy and do not have any significant medical problems. Also, combining surgeries gives you the advantage of undergoing only one anesthesia session and one period of recovery.