Facial Feminization Procedures

Hair Replacement

This procedure is often performed at the same time as a hairline forehead lift for patients will some frontal hair loss. It is essentially a lowering of the hairline. In some instances, there is not enough elasticity in the scalp to provide adequate advancement, so we will place a tissue expander under the hair bearing scalp. The expander is then filled slowly, over time, to create the adequate of amount of scalp needed for proper placement of the hairline.

Hairline Forehead Lift

A forehead lift is often performed on transgender female patients to raise the brows to a more feminine position. Orbital bony contouring, or a reshaping of the bone underneath the eyebrows, is often combined with a forehead lift to soften the area around the eyes. (For these patients we will require a skull x-ray prior to surgery). In addition, many of our patients would like to lower their hairline (since men tend to have a larger forehead than women) and we often combine a forehead lift with hairline lowering.

Orbital Bony Contouring

Orbital bony contouring provides a very dramatic feminizing result, along with the forehead lift and hairline lowering procedures, pioneered by Dr. Mayer more than 25 years ago. This has a striking result — truly transforming the appearance of the upper third of the face. A masculine forehead has a heavier brow ridge and, by softening this, a lighter, softer more feminine appearance is obtained.


As with the other components of Facial Feminization, nasal surgery is primarily performed to soften this feature. Our goal is to provide you with a more feminine nose, but at the same time, not give you an artificial or overly scooped or pinched look. Each patient’s nose is unique and there are a variety of techniques to “feminize” a nose. We evaluate each patient individually. The extent of the nasal surgery will depend on the patient and what is necessary to both feminize the nose and to bring the nose into balance with the face without creating an artificial appearance.

Rhinoplasty Revision

In Beverly Hills, rhinoplasty revision is a delicate surgical procedure that is offered by The Beverly Hills Institute of Aesthetic & Reconstructive Surgery. Dr. Mayer has many years’ experience helping rhinoplasty revision Beverly Hills patients achieve the elegant, proportionate nasal contours they desire. His reputation as one of the best Beverly Hills rhinoplasty revision surgeons attracts numerous patients every year.

Cheek Implants

There is not particular cheek shape or definition that most men or women have. In general a fuller, more prominent cheek is the ideal for the Facial Feminization process. There are 3 different main types of implants, which come in a variety of sizes so that each patient can receive a customized fit.

Chin Implant/Augmentation

The chin and jawline are as variable as the nose in men and in women. While some believe that men tend to have a wider chin and squarer jaw, and women a more pointed chin with a narrower jaw, we do not feel that this generalization is accurate. We see a large number of women with a wider, square jaw and men with a narrow jaw and pointier chin.

Chin Reduction/Contour

Many transitioning girls think a small jawline and small chin will change their life and give them the exact feminine look that they are seeking – almost to the point of being obsessive about it. Very often reducing the size of the jawline and the chin will actually throw the entire face out of balance making the upper half of the face look too large for the lower face. Chin contouring can include reducing height, width, and length from the chin. This procedure, to shave the chin, has a much lower potential of complications/risks than the sliding genioplasty.

Lip Augmentation

Lack of fullness in the lips can be an inherited characteristic or the result of the aging process. Fat augmentation will make the lips look fuller and softer. In most of the patients who have lip augmentation the result is permanent; in the some patients more fat may need to be added at a later time. Collagen may also be used for lip enhancement but it only lasts an average of three months, requiring repeated injections to maintain the desired fullness.

Thyroid Cartilage Shave/Adams Apple

This procedure involves a reduction or shaving of the upper portion of the trachea known as the Adam’s Apple. This procedure is performed on a large number of transgender patients. The tracheal shave is performed through an incision in one of the natural creases of the neck and creates a flatter appearance to the Adam’s Apple. This procedure can be performed with any of the above procedures

Voice Modification

It has been more than fifteen years since that first transsexual patient asked me if there was not some operation I could do to modify her voice. Her body surgery had been successful, and I was about to perform both hair restoration surgery and nasal surgery to complete the physical transformation. Yet, she was still quite distraught about her voice.

That was more than fifteen years ago, and since then several hundred patients have undergone similar surgery with a success rate of more than 95%. (The remainder do not achieve a significant change in voice pitch.) This voice modification surgery is unique, it was developed by me, and no other surgeon I am aware of uses this technique.

Breast Augmentation

Enlarging the size of the breasts, to bring them into balance with the rest of the body, is very commonly associated with feminizing the body. We work very closely with colleagues who perform this surgery, and we can coordinate this procedure to occur at the same time as your other procedures.


Recontouring your body through the use of liposuction is a common procedure in the Feminization process. We use the Power Assisted Liposuction technique, which is the latest advancement in liposuction technology. This device gives us greater control during the procedure which results in better contouring and sculpting of the areas. The patient experiences less bruising and swelling, and therefore a faster recovery period. Unlike Ultrasonic liposuction, which can burn the skin, it is very safe for the patient.

Fleming Mayer Flap

For patients with more extensive frontal baldness, we can perform our renowned Fleming/Mayer Flap procedure to give the patient a full head of their own hair –with their own natural density A second flap may be needed to address more extensive baldness. In some cases, a Tissue Expander may also be required prior to the flap procedure. We also recommend that all of our flap patients undergo Micrografts (1-3 hair per transplant) to the hairline to soften the hairline for the most natural result possible.