Jaw and chin recontouring

Like the forehead, there are specific traits that are generally more common in male chins and jaws. Dr. Ousterhout's "Feminization of the Transsexual" brochure illustrates the chin difference very well.

The back corners of male jaws tend to be fuller. The bone tends to have a sharper angle and flares out away from the face. Women's jaws tend to be rounded or straight from ear to chin, and they tend to be less full and square in the back.

Female chins tend to come to one point in the middle. Men's tend to have two points directly below the canine teeth and a flat part between the points . This adds to men's chins looking fuller and more square, and women's looking more tapered. Male chins also tend to have more vertical height, so their chins then to be longer from the lower lip to the bas of the chin.

The procedures:

These are all done from inside the mouth through incisions all the way around the lower gum. The surgeon then uses a device to stretch the skin open and expose the jawbone.

Ramus reduction, or angle of mandible reduction, involves removing bone from the flared angle back near the ears. In genetic males, this corner is much more pronounced, where in genetic females it tends to be more rounded, even nonexistent. Also, in genetic males, this bone tends to flare outward, due to a combination of genetics and masseter muscle development.

Sometimes, they perform masseter muscle reduction. Clench your teeth while you have your fingers on the jaw angle, and you can feel your masseter muscle. Reducing this can further taper the face. Masseter reduction can be done without detaching the tendon from the bone, because it's attached on the inside of the ramus

While surgeons occasionally remove some of the muscle, many generally prefer to avoid it, since the associated postsurgical pain and swelling increase greatly when this is done, and it usually only gives an incremental improvement. Additionally, it sometimes restricts range of motion after, among other possible permanent changes.

A sliding genioplasty is a procedure done to alter the shape of the chin. Think of the tip of the chin as the letter U. The bone is cut at an angle. This piece is then again cut, and the smaller piece is placed on the main part of the jaw and secured with wires and screws. Depending on your chin, this small piece will be slid forward or backward from its original position. This reduces the vertical height and makes it look more tapered. The sliding genioplasty also helps reduce the squareness of the jaw, making the overall face shape a bit more like an upside-down egg.

This procedure has several effects. It reduces the vertical height from lips to chin, which tends to be higher in genetic males. It can help reduce the look of a "long" face as well. It also makes the chin more pointed and feminine-- genetic male chins tend to have bilateral symmetry, so they come to two points with a flat part across the base of the chin.

Some surgeons combine a genioplasty with removing a vertical wedge from the center of the chin to further taper the tip.

A procedure that's more rare is to add a mandibular implant into the jaw if it's too narrow. This is usually a solid silicone prosthetic or an acrylic fill.

Another option is orthodontic work to correct bit problems. This can have a significant impact on the shape of the face.

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My experiences

You can read my own surgical journal and view the effects in the photo series listed at the bottom of the page.

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Recovery

Swelling is expected and varies greatly by individual. Swelling usually takes a significant amount of time with these procedures. If you've ever had oral surgery like wisdom tooth removal, the "chipmunk cheek" look from swollen jaw muscles is common and lasts a week to three weeks. Swelling at and around the bone may take many months to resolve.

Bruising is generally light on the forehead, but drainage from the site can cause bruising to show up below the eyes and on the neck and chest. Usually this resolves in one to three weeks.

Usually there is temporary tightness in the skin.

Women usually experience limited range of motion in the jaw. When you awaken from surgery, you will have a bandage on your jaw, plus the jaw muscles are very tight from being stretched during surgery. They feel like they're cramped.

You will have limited bite strength following surgery

Some women experience temporary speech slurring following surgery

Most women experience temporary numbness in the entire chin. This often recedes from the corners of the mouth inward until there is a small strip from lip to chin that remains numb for as many as six months. One must take extra care with hot and cold foods and liquids if lips are numb.

Complications

Some have a permanent change in sensation-- not necessarily numbness, but things just feel different. This might include itchiness, increased or reduced sensitivity, pain or tenderness. With the genioplasty, this is especially common in the lower six front teeth.

A reader writes:

For your interest , I managed to get hold of this link:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11573165&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11573165&dopt=Abstract

This has a range of orthognatic surgery abstracts reports available , many of which are concerned with bony cuts to the chin and jaw and resulting nerve damage. When you go to the link, click on associated or related documents to see them.

Poor cosmetic outcomes include too much or too little revision, uneven revision. Remember, no surgery will guarantee you will pass. There are many other factors involved.

More serious complications include rejection of or reaction to implants or fill, hematoma, infection, permanent change in muscle range of motion, permanent speech changes, death.

See my general complications page for more.