Facial Augmentation in Transmasculine and Transfeminine Patients: Customization of Facial Implants and Increase in Facial Masculinization Surgery

Facial augmentation is a key component of masculinizing and feminizing transgender faces. This article reports a single surgeon's experience with malar, chin, and mandibular angle augmentation in transmen and transwomen. Patients undergoing facial feminization surgery (FFS) and facial masculinization surgery (FMS) were retrospectively evaluated and categorized based on region of facial augmentation and type of facial augmentation as follows: fat grafting, stock silicone implants, and custom titanium implants. Fat grafting cases were limited to the malar region. Over a 2.5-year period, 211 patients underwent FFS or FMS. Of these, 207 (98%) were FFS patients, and 4 (2%) were FMS patients. Of FFS patients, 41 (19%) had facial augmentation. Except for a stock silicone chin implant in 1 patient, all FFS augmentation occurred in the malar region as follows: fat grafting (n=20, 49%), stock silicone implants (n=10, 24%), custom titanium implants (n=10, 24%). Of FMS patients, all had facial augmentation as follows: stock chin implants (n=1, 25%), custom malar and chin implants (n=1, 25%), custom chin and mandibular angle implants (n=2, 50%). In total, 75% of FMS cases occurred in the final 6 months of the study. Augmentation of the malar region is a common component of FFS surgery, while augmentation of the chin, mandibular angles, and malar region is a mainstay of FMS surgery. Custom implants provide the advantages of patient-specific augmentation and precise fixation with increased materials costs. FMS cases are increasing in incidence.