Gender-Affirming Facial Surgery Lower Third of the Face

Lower facial surgery is a critical component within the compendium of gender -affirming facial surgery procedures. Lower facial procedures are specifically focused on addressing both the soft tissue and bony contributions to facial dimorphism that exists between a masculine and feminine face. A wholistic understanding of facial gender morphology and measured appraisal of each individual patient's presenting concerns in relation to their baseline facial anatomy is essential to develop a treatment plan which achieves the desired outcomes. Selective skeletal reduction is often necessary to soften the angular qualities of a masculine face, but care should be exercised to avoid iatrogenic destabilization of the overlying soft tissues resulting in a prematurely aged appearance. The craniofacial principle of skeletal expansion to fill the overlying soft tissues is readily applicable within lower facial gender -affirming surgery and can synergize with concurrent upper facial surgery to achieve dramatic feminization of the face which can alleviate gender dysphoria, increase mental health, and improve quality of life. 26,27,46