Facial feminization surgery does not come in a “one size fits all” package. Each patient’s facial anatomy and lifestyle is different and therefore requires a different surgical plan to meet their individual expectations. Dr. Spiegel offers an extensive number of procedures in order to meet every patient’s needs. These include:
Forehead Contouring and Scalp Advancement
The eyes, eyebrows, and foreheads are likely the most important areas in presenting gender. There are noticeable differences in hairline pattern, eyebrow shape, size of the eyes, and shape of the forehead between men and women.
Forehead contouring surgery is one of the most dynamic and advanced surgeries offered by Dr. Spiegel. The technique is very powerful with the ability to truly transform the appearance of the forehead. Masculine foreheads typically have a heavy bony ridge in the area just above the eyes and beneath the eyebrows. This is often referred to as “brow bossing” can extend through to the middle of the forehead. Forehead contouring surgery involves shaping the forehead bones and orbital bones (bones around the eye) to remove the ridge, open up the appearance of the eyes, and create a more naturally feminine, softer appearance.
Beginning with mastery of the techniques of forehead surgery employed by surgeons of the past, Dr. Spiegel has used new technologies to innovate a method of shaping the hairline, forehead bones, eyebrows, and eye region that is safe, effective, rarely (if ever) requires permanent man-made implants (such as metal plates or polymers), and provides remarkable results.
To access the forehead bone, a fine incision is made along the hairline from temple to temple. The incision is done in front of the hairline so that Dr. Spiegel can preserve all of the hair you have while advancing the scalp and hairline to a more feminine position. Through this incision Dr. Spiegel is able to reshape the bones around the eye and forehead to a natural feminine shape. Utilizing his expertise in sinus surgery, Dr. Spiegel is able to reposition the forehead bones while minimizing any disruption of the sinus function.
Once the forehead bones are shaped, balanced with the nose and face, and repositioned where Dr. Spiegel intends, they are held in place with the body’s natural tissues and a special “bone cement” which helps the bones to more rapidly heal in their new position. This technique greatly reduces the risk of forehead “numbness” sometimes associated with forehead surgery. In fact, most patients regain full sensitivity on the top of their head by three months after surgery though others have had to wait 4-6 months.
As mentioned, once the bone has been adjusted to the desired appearance the tissue around it is positioned to keep the bones in place while they heal. At this point Dr. Spiegel is able to shape the hairline by advancing the scalp in areas where it is receded. A natural result is obtained which typically eliminates the need for any fat grafting in the temporal area. At the same time, Dr. Spiegel carefully lifts the eyebrows to their natural feminine position on the new forehead. The look is subtle and not overly pulled; rather it gives patients a beautiful result highlighting their eyes and new, smooth forehead.
For those who don’t need scalp repositioning, forehead contouring and brow lifting can be achieved through an incision that is nearly invisible. Additionally, for some, minimal brow shaping and brow lifting is all that is needed and this can be done with an endoscopic approach. Dr. Spiegel is expert at use of surgical endoscopes and has published papers relating to their surgical use.
Following surgery, a soft dressing is placed around the forehead and left in position overnight. The dressing is then replaced with an ace bandage for 7-10 days after surgery. The bandage reduces swelling and helps protect the area. Most patients spend one night in the hospital and return to their home or hotel the next day. Pain is commonly mild and well managed with prescription pain medication. Showering and gentle washing of the hair are permissible but must be done with care. It is important to towel dry and comb your hair towards the incision line (so as not to stretch it) and to only use a blow-dryer on the “cool” setting (unheated).
Sutures are removed 6-8 days after surgery at a first post-operative visit with Dr. Spiegel. Most patients feel well enough to return to work 8-9 days after surgery; however, if the surgery is combined with multiple procedures then it may be advisable to wait two weeks before returning to work. Strenuous activity (causing sweating or rise in blood pressure) and light exercise should be avoided for at least two weeks. More vigorous exercises like yoga, pilates and running should be avoided for 6 weeks.
Infection after surgery is extremely rare; however, antibiotics are used to avoid any potential problems. Swelling and bruising on the forehead and around the eyes is common. The majority of this swelling and bruising will last under two weeks; however, it is normal to having some minor swelling even after several months. After one week cover-up makeup is allowed to mask any residual bruising.
Mandible Contouring—Chin and Jaw
Next to the forehead and eye area, the most significant characteristic of a feminine face is overall face shape. To a large extent, this is determined by the shape of the jaw. Men have square chins, and wide prominent jaws that support their larger muscles for chewing. Women tend to have a narrower, tapered, delicate shape to the jaw. Having your mandible contoured can reduce the appearance and size of the jaw, making it rounder and narrower at the square corners near the back of the jaw and along the chin. The procedure involves reshaping the bone around the corners of the jaw and adjusting the shape of the chin to provide a narrower, softer, more feminine appearance. In some instances the procedure may involve reducing the large masseter muscles to further narrow the area.
This procedure is done through incisions inside the mouth so that no scarring is visible after the procedure. During the procedure, incisions are made between the gum and cheek to access the mandible (jawbone). Areas of prominent bone are shaped with a surgical rasp, drill, or micro-saw, curving down from back to front to achieve a well-rounded contour. Once the proper amount of bone and muscle has been removed the wound is closed with self-dissolving stitches. Chin work typically requires an incision in the front of the mouth along the gum line and is also closed with self-dissolving stitches. Dr. Spiegel has devised a technique that shapes both the bone and soft-tissues of the chin for a natural feminine result.
A dressing or ace bandage is placed after surgery to help minimize excessive swelling and help contour the area. In some cases skin tightening (e.g. a neck or facelift) may be advisable to fully show-off the new jaw shape.
After the surgery the mouth must be cleaned with a prescription mouthwash several times a day. Most patients stay in the hospital for one night after surgery. The face will be moderately swollen immediately following surgery. Swelling and bruising will peak 2-3 days after surgery. The jaw and neck may become very swollen and this is normal and expected. The majority of the swelling will dissipate two weeks after surgery; however, some of the swelling may take several more weeks to disappear. It may take 4-6 weeks for the improved contour to become obvious, but the result is worth the wait!
Softer foods like soup, pudding and applesauce are the easiest and most comfortable options for the first few days after surgery. Patients can return to their usual daily activities after approximately one week; but exercise and strenuous (causing sweating or rise in blood pressure) activity should be avoided for 4-6 weeks after surgery.
Possible complications from surgery include bleeding and swelling. Infections are uncommon but antibiotics are routinely administered during and after surgery. Careful assessment and a complete set of fine surgical instruments can help prevent over cutting of the bone but it is a possible risk. Permanent injury to the sensory and motor nerves (nerves controlling facial muscles and sensation) is a risk however Dr. Spiegel works to protect against any complications and has had great success.
Chin and mandible shaping are just part of the many ways that Dr. Spiegel is able to help you present yourself as you desire. Please feel free to contact us with any questions or to learn if this procedure is right for you.
Rhinoplasty
Noses come in many shapes and sizes and there is no one perfect nose. What’s important is that your nose fits your face. A nose that is too large, crooked, bent, or rounded can detract from an otherwise beautiful face. For feminization purposes, it is important that the nose has a softness to it.
There are many characteristics to the nose that can be changed: the size, the projection (how far the nose sticks out), the size and shape of the tip, the curvature of the nose, the presence or absence of a bump on the nose, the angle that the nose makes with your lip. Our goal is provide you with the nose that will best fit your face.
Depending upon what you would like done, nose shaping usually takes only 1-2 hours. Working through your nostrils I can straighten the septum in a way that should allow you to breathe much more easily. We are able to make subtle changes to the dorsum and tip to create the desired look of the nose. You may experience some mild bloody drainage for 48 hours after surgery, and because of swelling inside the nose, many people find it takes a week or more until they notice that they breathe better.
To reshape the nose a small fine incision may be necessary on the bottom of the nose (an area called the columella). Depending upon what you wish to change about your nose, you may or may not have some bruising and swelling around your eyes afterwards. In all cases you can expect to wake up from your surgery with a small “cast” on your nose. This piece of plastic stays on your nose to protect it after surgery and to help hold your nose precisely where we want it during the initial period of healing.
General anesthesia is typically used during the surgery and makes the experience quick and comfortable. Patients over the age of 60, those with significant medical conditions, or those who are having multiple procedures may require a pre-surgery appointment with the anesthesia department to ensure maximum safety. In all cases, patients with questions regarding anesthesia can review them with an anesthesiologist prior to surgery.
Immediately after surgery your nose will be tender and often is congested so breathing through your nose may be difficult or impossible. The congested feeling is due to swelling. This will improve daily and by carefully cleaning out the nose and keeping it moist with a nasal spray.
Icing is suggested for the first few days after surgery to reduce as much swelling and bruising as possible. This bruising and swelling usually lasts 7-10 days. Stitches and the “cast” are removed 6-8 days after surgery. At this time, your nose will already look good, but will continue to heal and look better. During the next several weeks you don’t need to wear the cast, but you do need to take extra care not to bump or hit your nose. Patients are usually able to resume their normal daily activities after one week. Exercise, especially ball sports, should be avoided for 6 weeks after surgery.
If you know somebody who had rhinoplasty surgery in the past, or from a surgeon other than Dr. Spiegel, they may have told you about having their nose “packed”. These people had their nose filled with gauze or another material after surgery, and this can be very uncomfortable. Our patients almost never need any packing in their nose, which makes the recovery period from nose surgery easier and much more comfortable. Most of our patients tell us that recovery from their nose shaping surgery was not very uncomfortable. Rhinoplasty can be an easy way to make a dramatic improvement in your appearance and happiness with your overall look!
Browlift
You look tired or upset and you’re not. You think your upper eyelids are sagging too much. The horizontal lines on your forehead are getting out of hand. If any of these things are happening to you – somebody might tell you to get a facelift, or your eyes done, or get some injections. However, what you may need is a browlift.
For feminization surgery, a browlift is an extremely important component to transforming the face since a low eyebrow position not only can prematurely age a person but also appears very masculine.
With a browlift it is possible to tighten a drooping brow, smooth horizontal forehead lines and subtly lift the position of the brow making you look more feminine, attractive and many cases, much younger. There are two methods used for a browlift. One common technique requires just two small incisions hidden in your hair and is known as an endoscopic browlift. The specialized instruments and camera used during the procedure allow for minimal incisions while still providing full aesthetic improvement in the forehead and brow area. The other method requires a longer incision and is commonly performed with the forehead contouring procedure and scalp advancement since an incision placed in front of the natural hairline is already needed to access the forehead and advance the scalp.
If you are a candidate for a brow lift, we will meet and discuss the goals you hope to achieve with the procedure. A brow lift alone may be all you need, but can also be performed in conjunction with other procedures, such as an eyelid lift, to achieve the best overall improvement. In fact, some people who think they need an eyelid lift find that they would actually benefit more from a brow lift.
Patients typically experience some forehead numbness (temporary) after the procedure. Pain medication can control any minimal discomfort around the incision; however, most patients do not require it. Cold compresses help reduce swelling or bruising that may occur in the days that follow. The few hidden stitches are typically removed after six-eight days. Most patients are back on their feet in a day or two and back in their usual routine within a week.
Patients over the age of 60, have significant medical conditions, or are having multiple procedures will require a pre-surgical appointment with the anesthesia department. At this time, patients with questions regarding anesthesia can review them with an anesthesiologist and any necessary labwork will be administered.
After surgery we’d like you to rest as much as possible for the first few days. Most people feel ready to return to a regular routine in about 6 or 7 days, though in some rare cases swelling or bruising can last longer. All strenuous activity, such as exercise, should be avoided for four weeks following the procedure. Intense exercise like running, yoga, pilates and weightlifting should be resumed after 6 weeks.
The aim of a brow lift is to enhance your natural beauty, create a more feminine eye and make you look better without making you look different. People will notice how much better you look, and the new, younger-looking brow will help lift your entire face, giving you a more youthful and beautiful appearance.
Facelift or Necklift
There’s no way to avoid it. Heredity, years of expressing emotions, facing the world (gravity, sun, wind, and the elements), and the simple passing of time lead to wrinkling and loosening of the skin. You may notice a softer jawline, a looser neck, folds on the neck, or deeper grooves around the nose. Perhaps crow’s feet are appearing by the corners of your eyes, or thin forehead creases are deepening. You could be in your thirties, or in your eighties – you just don’t feel like you like yourself anymore. To some people, these wrinkles and folds are considered signs of character, but you may look older than you feel. And, can’t you have character without the wrinkles?
Facelifts are among the most commonly desired facial plastic surgery procedures, and are not as involved as you might think. However, not everybody who wants a facelift actually needs a facelift. Sometimes, a neck lift, or a mini facelift (sometimes called a weekend face lift) is the right choice. In other situations, liposculpture is all that is needed. And sometimes, a simple filler material is enough.
If a facelift is right for you, we will discuss in detail what to expect before, during, and after the procedure. Of course, each individual person has a different experience as the surgery is customized to fit his or her needs. After our initial consultation, photographs will be taken and a detailed medical history and examination is done. Bruising history, blood pressure problems, smoking, and any medications you are taking are important considerations to ensure the best results. Patients over the age of 60, those who have significant medical conditions, and those who are having multiple procedures may require a pre-surgery appointment with the anesthesia department.
For a full facelift, an incision is made in a crease just in front of the ear, and the remainder is hidden behind the ear and into the scalp. The skin is raised and underlying muscle and connective tissues are tightened. Excess skin and fat are removed to provide a smooth and natural facial contour, and the incisions are closed with fine sutures. Then, a large fluffy protective dressing is applied for overnight.
You can go home the same day as your facelift, but many patients choose to stay with us overnight. The hospital has comfortable quiet rooms with friendly, helpful nurses who can attend to your needs and allow you to rest and relax. Cold compresses will be used to keep swelling and bruising to a minimum, and while most patients experience very little pain after surgery, pain medications are available. Bruising and swelling around the face and neck is common and will resolve itself over time. The majority of the swelling and bruising will fade after 10-14 days; however some minor swelling may take several months to resolve. Some loss of facial sensation is also common following surgery but will typically return on its own relatively quickly. Dr. Spiegel utilizes many techniques to make sure that you are looking and feeling your best as soon after surgery as possible. In fact, many patients have commented on how comfortable and quick the healing process was.
For the next week, a soft compressive dressing (like an ace wrap), is worn as much as possible. This help reduces the swelling and lifts the neck to provide you with the best result possible. Sutures are typically removed after one week, and most patients feel well and ready to get back to their normal routines at this point. Still, patients should wear the soft wrap at night while sleeping for another week and avoid vigorous activity, such as heavy exercise, for 6 weeks.
With time, the incision site scars heal into thin lines that are usually not very noticeable, and these thin lines are hidden in natural skin creases or in the hair. A facelift sets the clock back by restoring your facial skin and underlying tissues to where they once were, but the clock doesn’t stop and relaxation will continue to occur with the passing of time. My approach with facelift is to make you look the way you did before, not like somebody else. Expect to look and feel your best!
Blepharoplasty
Eyelid surgery can help correct drooping upper eyelids or the puffy skin under the eyes that can make us look older and more tired than we really are. As we age and our skin looses its elasticity or succumbs to external forces (such as sun damage, gravity, air pollutants), so the eyes can look prematurely aged.
The good news is that corrective surgery for this common trouble spot may be simpler than you think. If the main problem is puffiness, we may be able to do a simple eye procedure where no visible incisions are used to correct the problem. The puffiness is commonly caused by excess fatty tissue deposited underneath the eyes. This tissue is simply removed and the skin is gently tightened. If your primary concern is fine lines and wrinkles around the eyes (which some begin to see as early as in their 20’s or 30’s) a “mini” eyelift may be all that is needed. This quick procedure provides rapid correction with minimal recovery time. There aren’t even any stitches to remove, and the whole procedure can be done comfortably in under an hour, often times with only local anesthetic if desired. Both types of surgery use incisions that are made inside the eye or along the lash line giving you a “scarless” surgery.
Upper eyelids appear heavy on many people, this is caused by both heredity and aging. We are able to remove some of the excess skin and tissue above the eye using a small incision in the crease of the eyelid. Because the incision is so fine, the scar heals extremely well and after a few months is not visible.
If an eyelift procedure is right for you, we will discuss in detail what to expect before, during, and after the procedure. We customize each procedure to meet the unique needs of the individual, so each patient will have a somewhat different experience. The procedure usually takes between one and two hours. An incision is made along the natural lines of your eyelids and excess fat and tissue causing the bagginess, drooping, wrinkling or sagging around the eyes is trimmed. Fine sutures are used to carefully close the incision. All surgery is performed by Dr. Spiegel.
Patients over the age of 60, those having significant medical conditions, and those who are having multiple procedures may require a pre-surgery appointment with the anesthesia department. At this time, patients with questions regarding anesthesia can review them with an anesthesiologist and any necessary medical tests will be ordered.
Your eyelids may be swollen or feel somewhat tight for the first days after the surgery. Pain medication is offered to control any temporary discomfort – but most patients do not need it. Use of cold compresses during the first days are encouraged in order alleviate any excessive swelling or bruising. Stitches are typically absorbable and will dissolve on their own.
While you can go home shortly after the procedure, it’s best to plan on resting for the first few days. Most people feel ready to return to a regular routine in about 6 or 7 days, though in some rare cases swelling or bruising can last longer. All strenuous activity, such as exercise, should be avoided for four weeks following the procedure. Intense exercise like running, yoga, pilates and weightlifting should not be resumed before 6 weeks.
The aim of the procedure is not to make you look different, but to make you look better. My goal is to have people see you and ask “have you lost weight?” or “did you go on vacation?” because their perception is that you look healthier, happier and fresher. Your eyes will glow, looking as youthful and vibrant as you are!
Lip Lift and Augmentation
Did you know that the upper lip lengthens with age and is longer in men than in women? Dr. Spiegel has designed a unique approach to lip lifting, which lifts the upper lip and creates a fuller more voluptuous and youthful shape. To shorten the distance between the nose and top lip, an incision is made just under the nose, a section of skin is removed and the gap is carefully closed. The technique that Dr. Spiegel uses permits the lip to roll up and out in order to provide a better projection (i.e. plumper lip) in additional to shortening the distance of the upper lip.
There are a number of different options for implants (natural, synthetic, solid or injected) that can be added to provide additional fullness to the lips. The most common implant Dr. Spiegel uses is called a dermal fat graft. This is a mixture of your own fat, skin and soft tissue. Since the implant is made from your own tissue there are fewer allergies, infections, or other reactions to worry about. The results are long lasting and the lips feel completely natural!
Cheek Augmentation
Cheek augmentation is a simple and subtle option for those who are looking to accentuate the upper face and give their face a more heart-shaped look while diminishing the appearance of the lower face. This is ideal in feminization surgery since our goal is to draw the focus to the eyes and away from the wider jaw angle.
This “scarless” procedure begins with small incisions made in the mouth. A tight pocket is created and solid silicone implants are placed under the soft tissue over the cheekbones. The implants are available in several shapes and can be placed over and under the cheekbone or closer to the nose. In some cases a bone-filler paste is used and this can be molded to its desired shape.
Once the implants are properly placed, the incisions are closed with absorbable stitches. The implants are stitched in place and the tissue covering them acts as a natural adhesive to keep the implants in place. Patients are swollen for a few weeks following surgery but are able to eat immediately after surgery and can return to their daily activities just a few days after surgery. A mouthwash is used after surgery to keep the incision healthy and clean and antibiotics are prescribed to avoid infection.
Cheek augmentation is a quick and easy procedure that can dramatically improve the overall shape of the face, enhance the appearance of your eyes and add that something special to your look.
Chin Augmentation
A beautiful face is balanced – every part fits with every other part. If the chin is too large, it can throw off the harmony of the face and distract from an otherwise beautiful appearance. If the chin is too small, a great nose may look too big, and a small chin can detract from the appearance of the neck and jawline. In this situation, reshaping the chin can contribute greatly to helping you look your best.
The chin can be reshaped in a number of different ways, the most popular of which is with an implant or by recontouring the bone and tissue surrounding the bone.
For either option, a small incision is made in the mouth between your front lower teeth and the bottom of your lip. In some rare cases, an incision can also be made under the chin. Dr. Spiegel is able to gently contour the bone and tissue by excising the excess and reshaping it to a more pointed and balanced chin. When an implant is used, he makes a small pocket by the chin and a natural feeling surgical implant is then placed to add just the right amount to your chin. These implants come in a variety of sizes so we can ensure we have the right one for you. Then, a few stitches are placed to close the incision and permanently conceal the implant and/or tissue. Finally, a bandage is placed over your new and improved chin; this is to keep everything in place while it heals. In some situations, a small piece of your own jawbone can be moved forward to achieve the same result.
After surgery your chin may be swollen and tender for one to two weeks. The swelling will slowly resolve itself over time. Some bruising is possible, but not common. A mouthwash is used after surgery to keep the incision healthy and clean and antibiotics are prescribed to avoid infection.
While you can go home shortly after the procedure, it’s best to plan on resting for the first few days. Most people feel ready to return to a regular routine in about 5 or 6 days, though in some rare cases swelling or bruising can last longer. All strenuous activity, such as exercise, should be avoided for four weeks following the procedure. Intense exercise like running, yoga, Pilates and weightlifting should be resumed after 6 weeks.
Chin surgery is not something you may have thought about, but might be just what is needed to make your nose look great, make your neck look better, and to restore the overall facial balance of your beautiful face.
Otoplasty
Do your ears stick out too far? Do they lack the subtle detail – the peaks, valleys, and curves – that they should have? You can try to hide your ears with long hair, a scarf, or a hat, but why limit yourself in this way when ear reshaping (otoplasty) is readily available?
If an ear reshaping procedure is right for you, we will discuss in detail what to expect before, during, and after the procedure. Typically the ears can be repositioned through small hidden incisions (in creases behind the ear). It doesn’t take long to improve your image and appearance.
The procedure itself consists of making a small incision at the back of the ear, sculpting the cartilage, and then using stitches to help maintain the ear’s new shape. The procedure is typically performed in the hospital under general anesthesia in about two hours and you are able to return home that same day.
Patients over the age of 60, have significant medical conditions, or are having multiple procedures will require a pre-surgical appointment with the anesthesia department. At this time, patients with questions regarding anesthesia can review them with an anesthesiologist and any necessary labwork will be administered.
You will need to wear a soft bandage around your head to help protect the restored shape of your ears while they heal. Discomfort is minimal and of course, pain medication can easily control any discomfort you may experience. Sutures are removed after one week.
Most patients can return to their regular routine after one week. Patients are urged to avoid strenuous activity in which the ear might get bent for at least one month. A faint scar behind the ear is difficult to see, but visible after the procedure. This will fade over time.
The aim of the procedure is not to radically change how you look, but by reshaping your ears, we will improve your overall appearance and confidence. Our goal is to work with your natural look and help you to be your best.
Trachea Shave
A trachea shave can be an effective, satisfying and long-lasting solution to a large Adam’s apple for men and women. Dr. Spiegel’s specialized technique is able to remove the absolute most cartilage while keeping the vocal cords untouched. A trachea shave can be performed alone or in conjunction with other procedures. The surgery generally takes less than one hour in the operating room.
A small incision is placed on the upper crease of the neck or in a wrinkle in the skin. The incision is placed in one of these locations in order to hide the small scar as much as possible, and this approach works. Using a tiny video camera, Dr. Spiegel locates the vocal cords and marks the location on the neck. He then exposes the thyroid cartilage and removes all of the prominent cartilage and its borders above the vocal cord marking. This way he is able to remove as much as possible while minimizing the risk of voice change. The incision is then closed and cleaned and a small bandage is placed over the incision following surgery.
During the first 24-48 hours after surgery it is common to experience some bruising and swelling as well as a sore throat. Discomfort is typically minor; however, pain medication is given in order to keep the patient as comfortable as possible. Mild voice weakness may occur in the first few days after surgery but should not be long term. Patients are encouraged to rest their voices and apply an ice pack to the treated area for the first couple days following surgery. The incision area may be red and thick for the first few weeks and this will improve with time. Tightness and lumpiness around the neck is common and simply takes time to settle. Once the swelling and bruising has dissipated patients can enjoy their new, smooth neckline!
The most important consideration in addressing the Adam’s apple is voice protection. Using his method, Dr. Spiegel can ensure maximal results with maximal safety.
Learn more about Dr. Spiegel's technique in the article below.
