Facial Feminization Surgery (FFS)
in McLean, VA

The forehead is the most gender-defining feature of the face. This is because the eyes are the most important feature of the female face, and a prominent forehead casts a shadow over the eyes, thus obscuring their inherent beauty. Men typically have a prominent ridge of bone in the center of the forehead and at the eyebrows called a brow ridge, which casts a shadow over the eyes (in an evolutionary sense, to maybe hide the direction of their gaze) while female foreheads tend to be smoother, flatter, and with no bossing. The bony rims that the eyebrows sit on are called supraorbital rims. The supraorbital rims are shaved down by a variable degree during a forehead contouring procedure. The prominent bone of the central forehead often serves as the anterior wall of a sinus cavity called the frontal sinus.

To achieve a perfect oval contour of the forehead, Dr. Mardirossian would actually set back the anterior wall of the frontal sinus (Type 3 reduction cranioplasty). The thickness of the anterior sinus wall is not reduced but it is simply placed in a more posterior position to give the forehead the desired smooth oval contour while maintaining its strength. A typical setback ranges between 1 and 2 cm. The formal name of this technique is Type 3 Forehead feminization or Group 3 reduction-recontouring after Osterhout. This is the technique that Dr. Mardirossian currently performs in 90-95% of his patients. This strategy does not apply only in the patients in which the frontal sinus is actually missing (3-5% of the population).

Eyebrows are usually horizontal in men while in women they are arched with the highest point corresponding to a line passing through the lateral edge of the iris of the eye. Along with advancing the hairline and contouring the forehead, Dr. Mardirossian performs a brow lift to elevate the brows above the orbital rims; this improves the appearance of the eyes and underlines their inner beauty.

Generally, men tend to have bigger and wider noses than women, and the nasal tip is bulbous and pointing down. The female nose is smaller, refined, and delicate compared to male noses. The attractive female nose has a slight scoop at the dorsum, and the tip is slightly turned up (or rotated) and less prominent (or less projected) than a male nose. The beautiful female nose is unnoticeable on the face – it is neither too big or too small, but just fits well with the rest of the facial features.

Women’s cheeks are fuller, with a more defined contour and projection than men. This is especially true for the area of the cheeks under the eyes. This portion of the cheeks is very important because, when fuller, it reflects light into the eyes to make them more attractive. Fillers, fat grafting and cheek implants are all viable options for cheek augmentation. Buccal fat removal will further define the contour of the face in select patients who tend to have a rounder and therefore less refined facial contour. The fat is accessed through two small incisions in the mouth with no visible incisions left, the procedure slims and refines the face of the patient. It is a procedure that we routinely combine with cheekbone reduction.

Women’s voices are more melodic while men’s voices are more monotonous. In speech training terms, this means that women have an overall higher voice frequency, and they change the frequency of their voice much more frequently than men. The voiced speech of a typical adult male will have a fundamental frequency from 85 to 180 Hz, and that of a typical adult female from 165 to 255 Hz. The voice feminization surgery by means of Vocal Fold Shortening and Retro­displacement of the Anterior Commissure (VFSRAC) is a safe and reliable method, practiced by Dr. Mardirossian. In VFSRAC, the vocal folds are not only sutured together to create an anterior glottic web, but the entire anterior commissure of the vocal folds is moved posteriorly to create more tension and thinning of the vocal folds to increase their fundamental frequency. No skin incisions are necessary. The outer surface of the vocal folds is removed, and they are then sutured together tightly with a very fine permanent suture material to accomplish their tightening and the creation of a feminine geometry to the larynx.