Gender-Typing of Isolated Horizontal Facial Thirds Before and After Facial Feminization Surgery
Jose F. Palacios*1, Nicole Schiraldi2, Kenneth Pessino3, Nissim Hazkour2, Joseph Tarr3, Nicholas Bastidas3
1Zucker School of Medicine at Hofstra/Northwell, Jackson Heights, NY; 2SUNY Downstate College of Medicine, NYC, NY; 3Northwell Health, New Hyde Park, NY
Facial gender typing is often done subconsciously based on boney and soft tissue features along the entire face. In this study, we surveyed the general public using a crowd sourcing platform to determine how facial feminization surgery (FFS) altered the gender-typing of isolated upper, middle, and lower thirds of the face.
Standardized frontal and lateral images of isolated horizontal facial thirds from two controls and eight consecutive patients before and after FFS were prepared (n = 108). Reviewers were asked to determine if segment images were of a man or woman, indicate how confident they were in their response on a scale from 0 - 10, and specify if a particular feature influenced their answer.
A total of 4182 image ratings were collected from 43 survey respondents. For all horizontal segments, there was a statistically significant increase in female gender typing after FFS (P < .001). Confidence in female gender typing increased significantly for the middle (P = .046) and bottom (P = .041) segments and decreased significantly (P = .006) for male gender typing of the middle segment after FFS. Male gender typing of the upper segment was significantly higher than the middle and bottom regardless of FFS status (P < .001). For the upper third, male gender typing was most commonly influenced by the hairline while the eyebrows influenced female gender typing after FFS.
Facial feminization surgery effectively increases female gender typing of horizontal facial thirds. However, feminization of the upper third of the face may be limited by the ability to produce a feminine hairline. Additionally, rough skin texture and ungroomed facial hair also limit feminine facial appearance. Offering hair transplantation, hair removal and skin resurfacing treatment may represent that final component of comprehensive facial feminization.
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