Download PDF
Facial Plast Surg
DOI: 10.1055/a-2605-7963
Original Article

Considerations for Maximizing Perioral Aesthetics in Gender-Affirming Surgery

Torin Thielhelm
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
,
Katherine Liu
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
,
Maria Mavrommatis
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
,
Joshua D. Rosenberg
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Aims and Background

Perioral aesthetics are a critical component of facial gender-affirming surgery (FGAS). The goal of this paper is to review the philosophy, techniques, and evidence supporting perioral aesthetics in FGAS with specific attention to the lips, chin, and submentum.

Anatomy

Masculine appearance is typically associated with greater upper lip height, labial volume, and mouth width, whereas female appearance exhibits increased upper incisor show with a softer, tapered chin shape. The masculine chin is wider and taller with greater anterior projection, whereas the feminine chin is typically more narrowed. The contour of the submentum is impacted by skeletal and soft tissue differences, with males displaying a more angular profile.

Techniques

Techniques for lip feminization include the subnasal lip lift and various injectables for altering lip contour. For chin contouring, several genioplasty techniques exist, including the T-genioplasty. These procedures may utilize virtual surgical planning. Submental liposuction and platysmaplasty can refine the submental area to highlight underlying osseous structures. Augmentation of the mandible, typically using implants, can be utilized for masculinization of the perioral region.

Conclusion and Clinical Relevance

Careful attention to the lips, chin, and submentum can help achieve desired outcomes in both facial feminization and masculinization. A comprehensive understanding of perioral anatomy and an individualized technique selection are vital for achieving optimal FGAS outcomes.

Keywords

perioral aesthetics - facial feminization - gender affirmation - virtual surgical planning


Publication History

Accepted Manuscript online:
12 May 2025

Article published online:
29 May 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Anic-Milosevic S, Mestrovic S, Prlić A, Slaj M. Proportions in the upper lip-lower lip-chin area of the lower face as determined by photogrammetric method. J Craniomaxillofac Surg 2010; 38 (02) 90-95
    PubMedSearch in Google Scholar
  • 2 Salibian AA, Bluebond-Langner R. Lip lift. Facial Plast Surg Clin North Am 2019; 27 (02) 261-266
    CrossrefPubMedSearch in Google Scholar
  • 3 Nassar A, Naba J, Demian J. Lip feminization: a review. JPRAS Open 2024; 41: 311-319
    PubMedSearch in Google Scholar
  • 4 Penna V, Fricke A, Iblher N, Eisenhardt SU, Stark GB. The attractive lip: a photomorphometric analysis. J Plast Reconstr Aesthet Surg 2015; 68 (07) 920-929
    PubMedSearch in Google Scholar
  • 5 Raphael P, Harris R, Harris SW. Analysis and classification of the upper lip aesthetic unit. Plast Reconstr Surg 2013; 132 (03) 543-551
    CrossrefPubMedSearch in Google Scholar
  • 6 Suryadevara AC. Update on perioral cosmetic enhancement. Curr Opin Otolaryngol Head Neck Surg 2008; 16 (04) 347-351
    PubMedSearch in Google Scholar
  • 7 Perkins SW, Sturgill RL. Perioral rejuvenation: lip lifts, corner of mouth lifts, and vermillion advancements. Facial Plast Surg 2025; 41 (01) 134-140
    PubMedSearch in Google Scholar
  • 8 Bruce V, Burton AM, Hanna E. et al. Sex discrimination: how do we tell the difference between male and female faces?. Perception 1993; 22 (02) 131-152
    PubMedSearch in Google Scholar
  • 9 Barnett SL, Choe J, Aiello C, Bradley JP. Facial feminization surgery: anatomical differences, preoperative planning, techniques, and ethical considerations. Medicina (Kaunas) 2023; 59 (12) 2070
    PubMedSearch in Google Scholar
  • 10 Tettamanzi M, Muratore G, Arrica G. et al. Advancements in face and neck contouring: integrating radiofrequency-assisted liposuction with FaceTite and buccal fat pad excision for facial slimming. Aesthetic Plast Surg 2024; 48 (22) 4667-4674
    CrossrefPubMedSearch in Google Scholar
  • 11 Baumann L, Shridharani SM, Humphrey S, Gallagher CJ. Personal (self) perceptions of submental fat among adults in the United States. Dermatol Surg 2019; 45 (01) 124-130
    CrossrefPubMedSearch in Google Scholar
  • 12 Deschamps-Braly JC. Approach to feminization surgery and facial masculinization surgery: aesthetic goals and principles of management. J Craniofac Surg 2019; 30 (05) 1352-1358
    PubMedSearch in Google Scholar
  • 13 Jones EA, Sturm A. Selecting the right technique for the treatment of submental adiposity. Facial Plast Surg 2025;
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Telang PS. Facial feminization surgery: a review of 220 consecutive patients. Indian J Plast Surg 2020; 53 (02) 244-253
    PubMedSearch in Google Scholar
  • 15 Pavlidis L, Spyropoulou GA, Dionyssiou D, Demiri E. Full facial feminization surgery: patient satisfaction assessment based on 180 procedures involving 33 consecutive patients. Plast Reconstr Surg 2016; 138 (04) 765e-766e
    PubMedSearch in Google Scholar
  • 16 Andréasson M, Georgas K, Elander A, Selvaggi G. Patient-reported outcome measures used in gender confirmation surgery: a systematic review. Plast Reconstr Surg 2018; 141 (04) 1026-1039
    PubMedSearch in Google Scholar
  • 17 Ascha M, Swanson MA, Massie JP. et al. Nonsurgical management of facial masculinization and feminization. Aesthet Surg J 2019; 39 (05) NP123-NP137
    CrossrefPubMedSearch in Google Scholar
  • 18 Goel A, Rai K. Male lip filler-aesthetic enhancement is not just limited to females: a case report. J Cosmet Dermatol 2021; 20 (10) 3173-3176
    PubMedSearch in Google Scholar
  • 19 Mojallal A, Shipkov C, Braye F, Breton P, Foyatier JL. Influence of the recipient site on the outcomes of fat grafting in facial reconstructive surgery. Plast Reconstr Surg 2009; 124 (02) 471-483
    PubMedSearch in Google Scholar
  • 20 Marinelli L, Bichiri A, Cagnina S, Castella L, Ghigo E, Motta G. Efficacy of topical minoxidil in enhancing beard growth in a group of transgender assigned female at birth individuals on gender affirming hormone therapy. J Endocrinol Invest 2024; 47 (11) 2843-2850
    PubMedSearch in Google Scholar
  • 21 Patel V, Nolan IT, Card E, Morrison SD, Bared A. Facial hair transplantation for transgender patients: a literature review and guidelines for practice. Aesthet Surg J 2021; 41 (03) NP42-NP51
    PubMedSearch in Google Scholar
  • 22 Hwang K. Importance of the chin in lower facial contour: narrowing genioplasty to achieve a feminine and slim lower face. Plast Reconstr Surg 2013; 132 (05) 877e-878e
    PubMedSearch in Google Scholar
  • 23 Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol 1957; 10 (09) 899-909
    PubMedSearch in Google Scholar
  • 24 Pokrowiecki R, Šufliarsky B, Jagielak M. Esthetic surgery of the chin in cis- and transgender patients-application of T-genioplasty vs. single-piece segment lateralization. Medicina (Kaunas) 2024; 60 (01) 139
    PubMedSearch in Google Scholar
  • 25 Chang EW, Lam SM, Karen M, Donlevy JL. Sliding genioplasty for correction of chin abnormalities. Arch Facial Plast Surg 2001; 3 (01) 8-15
    PubMedSearch in Google Scholar
  • 26 Escandón JM, Morrison CS, Langstein HN, Ciudad P, Del Corral G, Manrique OJ. Applications of three-dimensional surgical planning in facial feminization surgery: a systematic review. J Plast Reconstr Aesthet Surg 2022; 75 (07) e1-e14
    PubMedSearch in Google Scholar
  • 27 Kuruoglu D, Yan M, Bustos SS, Morris JM, Alexander AE, Sharaf B. Point of care virtual surgical planning and 3D printing in facial gender confirmation surgery: a narrative review. Ann Transl Med 2021; 9 (07) 614
    CrossrefPubMedSearch in Google Scholar
  • 28 Tawa P, Brault N, Luca-Pozner V. et al. Three-dimensional custom-made surgical guides in facial feminization surgery: prospective study on safety and accuracy. Aesthet Surg J 2021; 41 (11) NP1368-NP1378
    CrossrefPubMedSearch in Google Scholar
  • 29 Hoang H, Bertrand AA, Hu AC, Lee JC. Simplifying facial feminization surgery using virtual modeling on the female skull. Plast Reconstr Surg Glob Open 2020; 8 (03) e2618
    CrossrefPubMedSearch in Google Scholar
  • 30 Gray R, Nguyen K, Lee JC. et al. Osseous transformation with facial feminization surgery: improved anatomical accuracy with virtual planning. Plast Reconstr Surg 2019; 144 (05) 1159-1168
    CrossrefPubMedSearch in Google Scholar
  • 31 Salgado CJ, Nugent AG, Satterwaite T, Carruthers KH, Joumblat NR. Gender reassignment: feminization and masculinization of the neck. Clin Plast Surg 2018; 45 (04) 635-645
    PubMedSearch in Google Scholar
  • 32 Wo LM, Garcia Jr O. Ultrasound-assisted lipoplasty. Clin Plast Surg 2024; 51 (01) 13-28
    CrossrefPubMedSearch in Google Scholar
  • 33 Chinta SR, Brydges HT, Laspro M, Shah AR, Cohen J, Ceradini DJ. Current trends in deep plane neck lifting: a systematic review. Ann Plast Surg 2025; 94 (02) 222-228
    PubMedSearch in Google Scholar
  • 34 Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex 2006; 51 (03) 53-69
    PubMedSearch in Google Scholar
  • 35 Capitán L, Simon D, Berli JU. et al. Facial gender confirmation surgery: a new nomenclature. Plast Reconstr Surg 2017; 140 (05) 766e-767e
    PubMedSearch in Google Scholar
  • 36 Ainsworth TA, Spiegel JH. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. Qual Life Res 2010; 19 (07) 1019-1024
    CrossrefPubMedSearch in Google Scholar
  • 37 Bannister JJ, Juszczak H, Aponte JD. et al. Sex differences in adult facial three-dimensional morphology: application to gender-affirming facial surgery. Facial Plast Surg Aesthet Med 2022; 24 (S2): S24-S30
    PubMedSearch in Google Scholar
  • 38 Glogau RG, Glaser DA, Callender VD. et al. a double-blind, placebo-controlled, phase 3b study of ATX-101 for reduction of mild or extreme submental fat. Dermatol Surg 2019; 45 (12) 1531-1541
    CrossrefPubMedSearch in Google Scholar
  • 39 Humphrey S, Sykes J, Kantor J. et al. ATX-101 for reduction of submental fat: a phase III randomized controlled trial. J Am Acad Dermatol 2016; 75 (04) 788-797.e7
    CrossrefPubMedSearch in Google Scholar