The lower third of the face, which comprises that part of the face from the nose to the chin, is extremely important in facial feminisation. The brain is programmed to differentiate between a male and a female face so not surprisingly the appearance that the male face takes on following puberty and during adolescence when it grows more rapidly than the female face is quickly identified as a male characteristic.

Male face with square chin   

Female face with more tapered chin

Not all facial shapes are alike and some males and females have square faces, long faces, round faces, concave or convex faces. What is uppermost in a transwoman’s mind is to be able to avoid the “double take” because an observer has noted something incongruous in her facial appearance. There are certain facial features that are regarded as cues for identity. One of these is the square chin and it is easy to identify the male face from the female face in the diagram. However, this is a little simplistic because there are plenty of attractive women with square chins and strong jawlines. There are other facial features then that might attract the observer’s attention. An obvious one is facial hair but this can be managed with electrolysis for example; the texture of the skin is another and this can be improved with oestrogen therapy, but an important male characteristic is the volume of the lower face. The male lower face tends to be bigger in proportion to the rest of the face compared to the female.
The male jaw is wider and more angular with a square chin whereas the female jaw appears softer with more rounded angle and chin.

There are several techniques for reducing the volume of the lower face. The skeletal structure of the lower face comprises the upper and lower jaw which varies in shape and size, particularly noticeable between the male and female.

The most common operation to soften the appearance of the lower face is to round off the angles of the jaw and the chin. This procedure is referred to as jaw recontouring. The intention of surgery is to soften the jawline to make it more feminine in appearance.

However sometimes this is not enough and there are ways of shortening the face using orthognathic surgery. Orthognathic surgery encompasses a variety of surgical procedures on the jaws to correct jaw disproportion and is most commonly employed when an individual has a malocclusion but it can be adapted to reduce the volume of the lower face in the process of facial feminization. Using a combination of jaw recontouring and orthognathic techniques the lower face can be significantly reduced in volume in all three dimensions.