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Feminization of the face: Cosmetic surgery for transgender people in Tunisia

Feminizing facial surgery (FFS) is a term that encompasses a range of procedures that feminize the male face. However, there are a number of anatomical differences between male and female faces and skulls. The male face is larger, squarer and with sharper angles than the female. The nose in the male is larger and has a pronounced nose bridge. The female face is smaller, more oval, often heart-shaped and has softer lines. The eye sockets are larger and the eyebrows are placed higher and the highest point is more towards the lateral third.

FĂ©minisation du visage pour transgenre Tunisie

Quand on regarde les crânes faciaux de l’homme et de la femme, on retrouve les mêmes traits. Le crâne masculin a un menton proéminent et haut, des angles de mâchoire fermes avec un angle presque droit et un épaississement osseux au-dessus des orbites appelés bossages When we look at the male and female facial skulls, we find the same features. The male skull has a prominent and high chin, firm jaw angles with an almost right angle and a bony thickening above the orbits called frontal bosses . The female skull has a rounder, straighter forehead, a less pronounced chin and rounded jaw angles.frontaux . Le crâne féminin présente un front  plus arrondi et plus droit, un menton moins prononcé et des angles de mâchoire arrondis.

With most cosmetic procedures, people want to improve their appearance, but mostly want to remain as themselves. When performing facial feminization procedures, the transgender person wants to change dramatically.

Feminization of the face

The figure below shows in blue where there is excess bone in the male skull compared to the female skull. The red area shows where bone volume can be added to make the skull more feminine.

Surgery that makes the face more feminine can help transgender women integrate into society in their female role, as the face is crucial in the perception of a person as male or female. FFS focuses on the facial skeleton as well as the soft tissues (skin, muscles, connective tissues) and encompasses a range of techniques different from oral and reconstructive surgery, but also from plastic and cosmetic surgery.

This may include:

FĂ©minisation du visage transgenre Tunisie

Reduction of forehead bumps in Tunisia : Prominent eyebrow arch

The upper third of the face largely determines whether a face is recognized as female or male. Typical masculine features such as the receding hairline, frontal hump (bony prominences above the eye sockets) and the position and shape of the eyebrows can be adjusted by a coronal approach. This is an entry to the forehead through an incision that crosses the head from ear to ear and is hidden as much as possible in the scalp.

This access allows for the removal of forehead bumps, enlarged eye sockets, the eyebrow positioned higher and more feminine in shape and the forehead reduced by sliding the hairline forward.

FĂ©minisation du visage transgenre Tunisie : Mentoplastie

Feminization of the chin in Tunisia

The female chin is more pointed, narrower and less high than the male chin. In facial feminization, the chin can be adjusted via intraoral access (along the mouth) with corrective osteotomies. The detached bone fragments are moved to adjust this shape and are reattached with titanium plates.

The jaw angle in males is greater due to a thicker masticatory muscle that engages it, but mostly due to a more pronounced bony structure of the lower jaw at this location that is more extended backward, downward and outward than in females. The jaw angle can be reduced via intraoral access, without visible scarring, by means of a corrective osteotomy where excess bone is removed.

Through a combination of relocation of the upper and lower jaw bone structures, volumes can be altered in the middle and lower thirds of the face. These changes can add volume to the mid-face and round out the face. This procedure also makes the chin less prominent, the jaw angles less pronounced and the upper front teeth can be made more visible. This procedure is also done without visible scars, all incisions are in the mouth. Also, the displaced bone pieces are reattached with titanium plates.

The nose is generally larger in males than in females. The bridge of the nose is straighter and the angles to the forehead and upper lip are sharper. During forehead correction, the angle between the nose and the forehead is already made more obtuse, and the angle between the nose and the upper lip can also be made more obtuse by orthognathic surgery. If the effect on the nose of these procedures proves to be too weak, a nose correction can be performed in a second phase in which the nose is made smaller, the bridge of the nose is made less prominent and the tip is made more elevated.

Women tend to have slightly more prominent cheekbones than men, but correcting the cheekbones alone does not have a huge feminizing effect. Raised cheekbones are considered attractive in both women and men and are primarily performed for this purpose.

This procedure is also performed via intraoral access, so there are no visible scars in this operation either.

Usually, a combination of procedures is performed during facial feminization surgery, depending on what is needed to make the patient’s face look more feminine. The entire procedure normally takes between 4 and 8 hours, depending on the extent of the operation. It is recommended to stay in the hospital for 1-2 nights after facial feminization surgery.

If the transgender woman has a pronounced Adam’s apple, this can be reduced through surgery. Adam’s apple correction is a simple operation in which a prominent Adam’s apple is corrected by a small incision through the Adam’s apple. This harmonizes the proportions in the neck and creates a better neck contour. The scar is small and almost invisible, as the skin of the neck usually heals well. The procedure can be done in combination with the voice enhancement procedure or in combination with the FFS. Please note: If a voice enhancement procedure is desired, it is recommended that the Adam’s apple reduction not take place before the voice enhancement procedure.

Allow at least two weeks for most of the swelling to go away. Work can be resumed after three weeks. Some people report feeling tired for up to a month after the procedure.

Price of facial feminization procedures for transgender people in Tunisia

To date, this form of surgery has not been reimbursed. The cost of the different procedures available for FSS varies greatly, and also depends on the number of facial feminization procedures to be performed. In general, the price per procedure is between 4,000 and 7,000 euros.

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