Transgender Aesthetic Procedures Private Clinic Nottingham Minimally Invasive Facial Treatments Research Article

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When conducted with sensitivity and attention to individual patient goals at varying stages of transition, facial procedures can be of great benefit in enhancing patients’ self-perception and overall quality of life. Source: Considerations for the Use of Minimally Invasive Aesthetic Procedures for Facial Remodeling in Transgender Individuals (2021 publication)

Received 28 January 2021
Accepted for publication 21 April 2021
Published 13 May 2021 Volume 2021:14 Pages 513—525
DOI https://doi.org/10.2147/CCID.S304032
Checked for plagiarism Yes
Editor who approved publication: Dr Jeffrey Weinberg

Abstract: There is increasing demand among transgender individuals for minimally invasive aesthetic procedures, such as injectable facial fillers and neurotoxins, for facial remodeling and transformation. These procedures may increase transgender individuals’ satisfaction with their appearance and allow them to more effectively harmonize their physical appearance with their perception of self. There is currently a lack of information in the medical literature regarding guidelines for the use of these products in transgender patients. In this report, the authors provide experience-based treatment considerations and recommendations for use of minimally invasive facial aesthetic procedures in transgender patients, including case studies illustrating the use of these procedures for both male-to-female and female-to-male transitioning patients.

This report highlights the success of minimally invasive methods for assisting transgender patients in achieving their facial remodeling goals. Clinicians play an integral role in the transitioning process for transgender patients, and facial transformation is a key element of this process.

When conducted with sensitivity and attention to individual patient goals at varying stages of transition, facial procedures can be of great benefit in enhancing patients’ self-perception and overall quality of life.

Keywords: transgender persons, hyaluronic acid, neurotoxins

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The proportion of individuals who identify as transgender or gender-diverse ranges from 0.1% to 2.7% depending on the age, inclusion criteria, and geographic location.1 Among these individuals, there is increasing demand for minimally invasive aesthetic procedures, such as injectable facial fillers and neurotoxins, for facial transformation.2,3 Transgender individuals may seek facial aesthetic modifications during their transitioning process by considering ideals that relate to looking more feminine or masculine.4,5 They want their outward appearance—the face they present to the world—to reflect how they feel about themselves.4

Differences between masculine and feminine faces have a hormonal basis: high estrogen levels result in high cheekbones, a proportional nose, full lips, as well as a relatively small and narrow chin, whereas high testosterone levels result in prominent supraorbital ridges, linear eyebrows, a flat midface, a more prominent nose, thin lips, and a squared jawline with a strong chin.6 Some transitioning patients receive hormonal therapy and gender-affirmation surgery, with the most dramatic changes in facial anatomy achieved through surgery. However, the use of minimally invasive facial aesthetic procedures may increase transgender individuals’ satisfaction with their appearance and yield aesthetic enhancements that meet desired feminizing or masculinizing goals as patients start or complete their transition.5,7 A number of transgender individuals identify with the traditional binary notions of gender; however, some individuals do not identify with the classic binary gender roles and may choose to be gender-diverse or to express themselves somewhere on the spectrum between feminine and masculine;8 they do not want to look vaguely feminine or masculine, preferring instead to pass as their self-identified gender.4 Minimally invasive procedures such as botulinum toxin, injectable fillers, skin resurfacing, and topical skin care products are essential in this regard, accomplishing the fine detail work necessary not only to transition to feminine or masculine faces, but also for self-affirmation. These procedures complement the structural changes accomplished by surgery, smoothing overly sharp transitions, softening edges, and filling in details.

The medical literature on the transgender use of fillers, toxins, and other minimally invasive aesthetic procedures is currently lacking.4,9 A review of the existing literature indicated that the most-studied transgender research topic was “therapeutics and surgeries,” with the majority of the research in this area focusing on case studies investigating issues such as outcomes of surgeries, hormone treatments, and silicone injections.10 Although high interest exists for the technical aspects of surgery on the sexual organs, there is dramatically less interest among the medical community in the transition of facial characteristics.10 Thus, there is a need to develop treatment plans and recommendations for minimally invasive aesthetic procedures. These procedures help to achieve the facial transformation goals of transgender patients, including matching outward appearance with self-perception, ultimately improving their quality of life.7

It’s important to know all about anti-wrinkle botox injections, dermal and lip fillers, including how long they last. Below, we’ve listed some important facts which we think you should know. Questions? Call now on: 03301 132 2640 or send a message online with your postcode, we will be in touch shortly.

Book via text if you prefer on 07537 416 110 (SMS only).

Book lip fillers, wart removal, Botox anti wrinkle aesthetic treatments at a local licensed clinic location of Medskin Clinics. Our staff are time served, fully qualified, and experienced NHS and Private Nurses. If you feel like dermal fillers or Botox could be the best route for you, schedule a free consultation at one of our Medskin Clinics based in Chesterfield, Newark and Nottingham. Our nurses travel throughout these regions and may have an outreach clinic that’s very close to your location.

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Part 1: Considerations for Facial Aesthetic Modifications in Transgender Patients

Optimal Care for the Transgender Patient

Although transgender patients may seek feminizing or masculinizing effects, the clinician must be aware that the aesthetic preferences of transgender individuals may not conform to traditional binary standards of facial beauty.⁷ A key element of transgender aesthetic goals may not be the achievement of femininity or masculinity itself, but rather acquiring feminine or masculine attributes that align with the patient’s self-affirmation; transgender individuals commonly seek aesthetic procedures to avoid being misgendered or identified incorrectly. The goals of transgender patients may also be associated with the desire to convey certain positive character attributes with associated social, professional, cultural, and economic advantages.⁶

Transgender patients seeking minimally invasive injectable procedures should receive personalized initial consultation and follow-up, with instruction that maintenance treatments will be required to retain physical changes provided by these procedures.5

Maintenance is extremely important to preserve the desired and achieved facial features, but patients must also appreciate the economic consequences of repeated facial treatments.2 Because the lack of or reduced insurance coverage for aesthetic procedures in many countries may create limitations for some patients, clinicians may need to help patients prioritize their aesthetic goals.9,11

For confidential and friendly, experienced advice don’t hesitate to call 03301 132 2640 or send a message online

Understanding the aesthetic concerns and psychological well-being unique to the transgender population is important for providing optimal patient care.12 Transgender patients may experience “gender dysphoria” or distress about their assigned sex at birth.12 Inclusive and compassionate patient communication is key when working with transgender patients and managing treatment expectations. Clinicians should also realize that communication may differ between transgender and cisgender male/female patients. Staff should be trained to address transgender patients using the patients’ preferred pronouns and identifiers, and intake forms should request information about “gender” rather than “sex,” with a write-in option for “other.”4 The authors also recommend self-reflection for clinicians to ensure their own comfort with and acceptance of transgender patients before working with them, as well as improved professional training for healthcare providers to better understand and address the healthcare needs of transgender patients.13 Otherwise, a lack of compassion or acceptance may subtly emerge during patient interactions, possibly to the detriment of patients’ psychological well-being.

Clinicians should be aware of and sensitive to the different steps of the transition process that transgender patients may undergo, understanding that the transition process is fluid and ongoing, with patients often needing to “grow into” their new looks.11,14 There are currently no formal guidelines regarding the timing of when during the transition process of facial feminization or masculinization nonsurgical procedures should occur. Many physical changes resulting from hormone therapy do not fully develop until 2 years after therapy initiation.4 Patients may therefore be seeking aesthetic facial procedures at various stages during the process, from those who have not yet started hormone therapy because they are still exploring the idea, to those who have been on hormone therapy for less than 6 months, for 6 to 18 months, or for many years. The needs and expectations of patients at each stage will be different, and treatment approaches should take into account the significant changes in facial structure, soft tissue distribution, and skin quality brought about over time by hormonal therapy.5,7

Part 2: Technical Recommendations for the Use of Minimally Invasive Injectable Procedures for Facial Remodeling in Transgender Patients

With support from existing literature, the authors offer several treatment recommendations using injectable fillers and toxins for when an assigned male or female at birth is feminizing or masculinizing, respectively (Table 2). When the individual is transitioning from male to female (ie, transwoman), larger doses of both fillers and toxins may be required because facial skin and muscle mass tend to be thicker in cisgender males than in females.^33,34 Based on these inherent genetic differences, more frequent maintenance injections of toxin may also be needed for patients undergoing male-to-female transition⁹ to maintain an appearance that communicates youthfulness and femininity.³⁵ In addition, the type of product and doses for medical aesthetic treatments will need adjustment depending on the patients’ stage of the transition process and the time-dependent effects of hormonal therapies, as discussed above.⁷

When performing injectable facial remodeling procedures in transgender patients, clinicians should consider different injection sites and properties of dermal fillers and toxins. Injection sites for fillers include the zygomaticomalar region, anteromedial cheek, nose, and submalar regions, as well as chin, jawline, temples, supra-orbital brow, forehead, tear trough, nasolabial folds, and melomental folds.^5,34,41 Clinicians should consider the rheologic properties of fillers when selecting the most appropriate filler for the desired outcomes. For proper placement of toxins with a genderizing approach as the goal, it is often necessary to adjust the distribution and placement of injections outside of standard injection points. For example, being more conservative with injections in the frontalis muscle in men can prevent eyebrow ptosis.³⁴ In addition, retaining frontalis muscle activity above the lateral one-third of the brow can lift the eyebrow, providing a feminine arched eyebrow.⁹ Consideration should also be given to smoothing the skin for males transitioning to females, such as decreasing pore size and fine lines, as well as improving skin tightness, using lasers, peels, and cosmeceuticals because smooth skin looks younger and thus more fertile and feminine.^35,42

Case Study #1 (Facial transformation in a 40-year-old male-to-female transgender patient )

Facial transformation in a 40-year-old male-to-female transgender patient (Figure 2). The patient received 12 units of onabotulinumtoxinA at the crow’s feet lines to lift her eyebrows, 12 units in the glabella, and 8 units in the chin. She also received the HA dermal filler VYC-20L for left temple hollow filling (1.5 cm³), malar and zygomatic augmentation (2 cm³), nonsurgical rhinoplasty to straighten the nose (0.5 cm³), and chin sculpting (1.5 cm³). The patient also underwent lip augmentation with 1 cm³ of HYC-24L. The outcome for this patient was a subtle feminization of her face. Midface volumization brought the cheek apex into a more superolateral position, creating a soft and feminine ogee curve, as well as a more oval shape to the face. Brow elevation gave her a slight arch to the lateral one-third of her eyebrow. Her nose became smoother, straighter, and more delicate via tip elevation and camouflage of the dorsal hump. Lastly, the lower face was feminized by lip augmentation, as well as tapering and narrowing of the chin.

Discussion

Minimally invasive injectable procedures are an important complement to hormonal therapy and gender affirmation surgery for patients undergoing gender transition. These procedures allow the fine detail work necessary on the face to assist transgender patients in matching their outward appearance to how they perceive themselves. The importance of this aspect of the transition process is highlighted in the existing medical literature, including a survey-based assessment of 327 transgender individuals, which reported that facial modification was often a greater priority than other procedures on other body locations, especially for men transitioning into women.⁴ Some patients, especially those who have just embarked on their gender transition journey, appreciate a temporary, reversible modality such as injectables, which gives them the possibility to try out a more subtly feminine or masculine look prior to committing to the more permanent and dramatic changes of surgery.⁵ Furthermore, some transgender patients may not be ideal surgical candidates, and injectables may be the only option for their facial transformation.⁴ Subtle and effective changes can be achieved with minimally invasive injectable procedures; these procedures can produce results with minimal risk and downtime, thus greatly aiding the transition process.^4,9

Conclusion

This report highlights the success of minimally invasive methods for assisting transgender patients in their facial remodeling goals and in the progress of their transition journey. Clinicians play an integral role in the transitioning process for transgender patients, and facial transformation is a key element of this process.

Different facial fillers last for varying amounts of time, so a free consultation with our nurses will help you decide which is best for you in terms of longevity and the final look you want to achieve.

NEW 2021 Blog Post – What are the different types of Dermal Fillers? What aesthetic and beauty benefits does each type provide? If you want your lips to look plump for as long as possible, tell our nurses so they can accommodate your wishes (as long as your lips are suitable for that specific filler).

How Long do Lip Fillers Last? 6 months

On average, lip fillers last for 6 months. They will be bruised for a few days after the procedure, so you’ll start to notice the results after about a week. They do gradually fade over time, so you may feel like your lips are getting smaller in the month before you get them re-filled.

The length of time fillers last depends on the person

The size of lip fillers does depend on people’s individual metabolisms. This means that while your lip fillers may last 6 months, they could last for 8 months on someone else. It is an individual process, and if you get lip fillers repeatedly, you’ll gradually learn how long they work for you.

Lip Filler Injections After Care Tips

If you wish your lips were a little plumper, lip fillers could be an ideal option for you. They add volume and give you more definition while still maintaining the natural shape of your lips. However, after the procedure, it’s important you follow your doctor’s instructions to make your recovery as pleasant and stress-free as possible. Here we’ve listed some common aftercare tips to consider.

Apply ice and stay hydrated

Bruising, swelling, and redness are normal after the treatment. To help manage these side effects, apply an ice pack covered in cloth to your lips. This will also help with any pain that you may have. Staying hydrated is imperative to getting good results. Hyaluronic acid from dermal fillers draws water from your body to the treated cells for a fuller effect, so drink lots of water and eat hydrating fruits and vegetables.

Do not fly for a holiday (advice on green and amber European countries notwithstanding – June, 2021)

It is recommended that you wait a few weeks before flying. This is because flying can be very dehydrating and interferes with tissue pressure, again increasing bruising and swelling.

Avoid strenuous activities – For the first 24 to 48 hours after getting lip fillers, avoid activities that might elevate your heart rate and blood pressure to minimise swelling. To prevent sweating, stay away from saunas and steam rooms as well.

Avoid smoking and alcohol – Smoking increases the risk of infection, so do not smoke until you are completely healed. Alcohol causes inflammation, so it can increase bruising and swelling. It also acts as a blood thinner and should be avoided before and after the procedure.

Avoid makeup – To avoid infection, avoid using any lip products for at least 24 hours. Keep the area clean by using a gentle cleanser or whatever your doctor recommends.

Know the warning signs – Dermal fillers are a non-invasive treatment, but like any other medical procedure, there are risks involved. If you experience intolerable pain, intense swelling and bruising, bleeding, and excessive heat to the lip area, contact your doctor immediately.

Qualified Nurse-Led Treatments at Mesdkin Clinics

Here at MedSkin Clinic, all of our practitioners are qualified to administer the treatment and are here to support you through your recovery. Contact us today to book your free consultation.

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Article Authors: De Boulle K, Furuyama N, Heydenrych I, Keaney T, Rivkin A, Wong V, Silberberg M

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