From Alexandra’s Virtual Facial Feminisation Surgery service

Hi Joyce.

Please remember that these virtuals are not and could not be 100% accurate but I hope they will give you a good idea of the possibilities and take you a long way towards planning how best to proceed.

The eye takes a little while to tune-in to facial changes so you may be disappointed at first glance. It is best to spend a few days getting used to the pictures before you make any decisions and it is important to imagine the face in a more feminine context with a little make-up and female hairstyle.

You have suffered a lot of hair loss and unfortunately it is probably too late to regain a useful head of hair. Having said that, it is worth talking to a good hair transplant surgeon about the possibilities - he/she can look at the density of the remaining hair and advise you if transplants would be helpful. I have not been able to do anything with your hair - there is not enough there for me to work on.

You have mild bossing over the frontal sinus but none over the orbital rims. I have set back the frontal bossing to bring your forehead into normal female ranges. You also have a strong vertical frown line between your eyebrows. I have reduced this for you and this should be achievable with an injectable filler. Getting rid of this line will soften and feminise your expression.

Your eyebrows already sit in a high feminine position so you do not need a brow lift, however they are thick so I have thinned them by plucking along the underside to give them a thinner and more feminine arched shape.

The soft tissues above your eyes are a quite heavy and are hiding your upper eyelids. I have given you an upper blepharoplasty to correct this and reveal your upper eyelids. You also have bags under your eyes so I have given you a lower blepharoplasty to reduce them. This is not strictly speaking feminisation because these kind of eye features are common to both sexes but blepharoplasties can soften the face and a softer is generally more feminine.

Your nose is fairly symmetrical and in good proportion to your face. From the side it has a slightly humped bridge. From the front there are no notable problems. I have lowered the bridge to remove the hump and I've given it a fairly straight profile. I have also given the tip a gentle turn-up by angling the base upwards a touch more.

Your cheekbones are perhaps a little flat and I think you might benefit from cheek implants to build them up a bit. However, hormones will make your cheeks fuller and rounder and I have simulated this for you. It is impossible to predict exactly how the hormones will affect you (everyone's different) but I've given you an idea of the kind of change you can expect. I would wait until you have been on a full dose of hormones for a good year or so to see how your cheeks develop before you decide on cheek implants.

The overall shape and fullness of your lips is OK but the distance between your top lip and the base of your nose is too long. I have given you a lip lift to correct this. I have also rolled the top lip out a little to give it a fuller and more feminine shape. You could consider plumping up the lips a little depending on your personal taste but I have not simulated that.

The height of your chin is OK but the shape is very wide and square with a flat base and 2 corners and it protrudes forwards too far. I have shaved off the corners to make your chin a lot narrower and to give it a more rounded and feminine shape and I have set it back a little. The cleft is more problematic - different surgeons take different approaches to the problem. I think it should be possible to reduce it but I do not think it will be possible to remove it completely and I have reflected this in the pictures. Chin clefts are only mildly masculinising so it is not a huge problem.

Your jaw is good overall but it is a little wide at the corners. I have narrowed this area for you but this might not require any surgery because hormones can sometimes help with the jaw width - they don't alter the bones but they do reduce muscle mass and if this affects the chewing muscles it can effectively narrow the jaw a little at the back. It will be worth waiting until you've been on a full dose of hormones for a good year before you make any final decisions about jaw surgery.

Adam's apple:
I don't see an adam's apple problem in these pictures.

Other points:
You still have quite a strong beard shadow and I have reduced this for you. I can't get rid of it completely without making your skin look plastic but I have made a big improvement. I have also removed some of the hair from the back and sides of your neck. Laser would be a good option here.

One thing you can't see in these pictures is the full potential effect of hormones. These can have a strongly feminising effect on the face and on top of narrowing the jaw and filling the cheeks, they add layer of fat that rounds off your features and makes the skin texture itself feminine - these two together are really quite powerful, especially when added to beard removal. The baldness will strongly bias you eye to see male in these pictures so you need to be aware of that and concentrate of the facial features.

Try to see the pictures as plans rather than predictions. They are just a starting point and neither you nor your surgeon has to agree with my suggestions.

See also
Dr. North’s surgical assessment
Dr. East’s surgical assessment