HI,
Some possible help... In your appeal, start with this! Work with you surgeon as well.
The goal of Facial Feminization Surgery (FFS) in a patient suffering from severe gender dysphoria, is not to look beautiful (the goal of cosmetic surgery) but to look female. This is a fundamental difference and Fundamental difference Often, in the hands of a skilled surgeon, the patient looks like a sister, mother or other close relative. Although the surgical techniques are identified with the same name, the application of the technique is very different and requires physicians/surgeons specifically trained in FFS surgery to achieve quality results. This is accomplished by removing or filling in the distinct facial characteristics of a male skull to make it appear female and is often accompanied by reduction of the Adams Apple. While all differences cannot be changed, if enough are changed, visual cues will result in the patient being identified as female and the goal of FFS is accomplished. (
Stress This!!!!!!! I can't say this enough!!!!!)Differences Between the Male and Female Skull: Male and female skulls develop differently due to the influence of testosterone (male) or estrogen (female). A detailed discussion of the differences between the two sexes was provided by the Smithsonian recently and this discussion follows that guide (Smithsonian's The Secret in the Cellar an educational resource from the Written in Bone exhibition, February 2009 – 2014, accessed online at
https://anthropology.si.edu/writteninbone/comic/activity/Skeleton_male_or_female.htmThe differences between a male and female skull are shown below: Grab the drawings for illustration. Basically, look at the difference between male and female skulls, and give them the surgical procedure that corrects this difference.
Skull (Cranium and Mandible)
Male Skulls
Generally larger than female (Can't Do Anything, no surgical correction)
Larger brow ridges, with sloping, less rounded forehead (facial bone reduction to smooth ridges, possible shaving or smoothing of forehead)
Greater definition of muscle attachment areas on the back of the head (Can't Do Anything, no surgical correction)
Larger projections behind the ears (mastoid processes) (Possible reduction)
Square chin with a more vertical (acute) angle of the jaw (reshaping jaw)
Drawings of male skulls (frontal and side views) with arrows pointing to the chin, the brow ridge, forehead, angle of the chin, mastoid process and muscle attachment area at the back of the head.
Figure 3. Male skulls. (Source: Smithsonian Institution, illustrated by Diana Marques) (Want the patient to look like this)
Female Skulls
Smoother bone surfaces where muscles attach
Less pronounced brow ridges, with more vertical forehead
Sharp upper margins of the eye orbits (
Smaller projections behind the ears (mastoid processes)
Chin more pointed, with a larger, obtuse angle of the jaw
Drawings of female skulls (frontal and side views) with arrows pointing to the chin, the brow ridge, forehead, angle of the chin, mastoid process and muscle attachment area at the back of the head.
Figure 4. Female skulls. (Source: Smithsonian Institution, illustrated by Diana Marques)
What Do You Think?
Comparing the skull from the cellar in Figure 5 (below) with the illustrated male and female skulls in Figures 3 and 4, check Male or Female to note the sex depicted by each feature.
Frontal and side views of the skull from the cellar.
Figure 5. Skull of the skeleton in the cellar. (Source: Smithsonian Institution)
Drawings of female skulls (frontal and side views) with arrows pointing to the chin, the brow ridge, forehead, angle of the chin, mastoid process and muscle attachment area at the back of the head.
(Note: I need to find a reference about noses of men vs. women (womens noses are smaller relative to total facial area).... While not called out in the Smithsonian site, there is a difference between male and female cheekbones (see
https://forensicoutreach.com/library/4-ways-to-determine-sex-when-all-you-have-is-a-skull/). I don't know what to call this. However, this is why cheek implants may be added to the surgery, depending on the degree of widening below the eye.
Hugs,
Jen
