Non-Surgical Facial Feminisation For Transgender Women

Facial feminisation is an important step for many male-to-female (MTF) transgender patients - trans women.

Having a more traditionally “feminine” look can play a vital role in helping trans women to 'pass' as female. By having their appearance reflect their preferred gender presentation, you can help MTF patients on many levels.

Whilst surgical options for gender-affirming care do exist, they are often costly and involve significant downtime. This is why non-surgical facial feminisation is a popular choice for trans women. Additionally, surgery often has lengthy wait lists, so injectable medical aesthetics treatments can provide a speedier solution during this period.

This is an important and nuanced area of aesthetic medicine. It's one that speaks to the deeper purpose behind our work as aesthetic practitioners: helping people feel aligned with how they see themselves. Read on to find out more about how you can best help this specific patient cohort, as well as how they can help cisgender women to counteract the masculinising effects of ageing.

Popular non-surgical facial feminisation treatments

There is no “correct” way to transition, it is an entirely individual experience. There is also no “one size fits all” approach when managing the feminisation process for trans women.

Knowledge of the anatomical differences between a female and male is key. Attention to a considerate consultation, discussing expectations and also perhaps transcending your own preconceptions of beauty, is also of paramount importance. This includes asking your patient for their preferred pronouns, too – always ask and never assume!

Managing these multi-area cases really allows you to connect with your artistic skills. However, one aspect must remain at the forefront of your treatment planning: your patient's goals. Take the time to really explore these in detail, including how quickly they're looking to achieve them. Transitioning is a process, and one they must feel ready for at every step.

"Rewarding treatments to administer"

Dr Tristan Mehta, Founder & CEO of Harley Academy, shares: “Treating transgender patients is an area many aesthetics practitioners are nervous, or simply under-educated about. It is important to get to grips with this area of aesthetic medicine, however, as injectables can make an incredible difference to this cohort’s quality of life. They are also extremely rewarding treatments to administer as an aesthetics specialist so it’s a win-win situation! I thoroughly recommend investigating this treatment area and learning as much as you can in order to refine your approach and provide a particularly worthwhile service to this underserved, and frequently misunderstood, community.”

Here we outline some key information for injectors looking to offer injectable facial feminisation solutions to their MTF patients.

Assessing trans women's facial shape

It’s always useful to first consider facial shape as a whole. For instance, the traditional “feminine” heart shaped, full face versus the more sharp, square shape and hollowed appearance associated with men; the female face often involves smooth curves rather than the angular features of the male.

Considering proportions is also helpful, for instance, the bizygomatic distance is wider than the bigonial distance in females, and more equal in males. Cis men have a more exaggerated mass in the lower face, whilst with cis females, volume is concentrated in the mid-face.

In feminisation, we often shift focus upwards, lightening the lower third and enhancing the upper two-thirds. This is relevant for:

• Softening a prominent chin or jaw
• Lifting volume into the temples, brows, and cheeks
• Reducing visual weight around the mouth and jowls

The approach is similar, whether the cause is linked to skeletal structure or age-related descent. To be effective as a clinician, you're looking to rebalance to harmonise.

Once you've considered your patient's natural facial shape, you can plot your treatment plan for specific regions of the face. This must always be done in collaboration with your patient to get the best possible outcomes.

Jawline and chin filler can create more feminine facial contours

In Western society, a wide, square jaw is seen as being traditionally masculine, whereas a softer, pointier chin is considered to be more feminine. As such, treating the jawline and chin plays a large part in helping a masculine-looking face appear more feminine.

Although, bear in mind that some of those considered to be the world’s 'most beautiful' women, such as Angelina Jolie and Salma Hayek, have quite masculine jawlines by this definition.

The best approach for using soft tissue filler to create a more feminine jawline involves:

• Building a rounder chin within the medial intercanthal distance
• Softening the jawline.

Botulinum toxin can also be used to reduce the masseter bulk to narrow the jawline.

If mid- and lower face sculpting is an area you’d like help with, to really refine your technique and get more experience under your belt, consider our Facial Contouring Masterclass.

This Injectables Masterclass is a dedicated multi-area filler course that allows you to elevate your skills. You'll learn the keys to achieving holistic results - from the consultation and treatment planning, to the evidence-based injection techniques and product selections.

Cheek filler to provide midface structure and balance

Midface filler treatments can add support and definition to the cheeks, helping to provide a visual lifting effect which creates more 'feminine' contours. This is especially true when considered in combination with the jawline.

Cheek filler can be placed deep in the medial cheek to give the patient more rounded, forward-projecting “apple” cheeks. This treatment can also support the under eye region as the first step to managing hollowing in the tear trough area.

This can help give the patient’s face a rejuvenated, fresh look; something also typically seen as desirable in a woman’s appearance.

Lip fillers for a fuller, more feminine lip shape

Lip fillers can enhance the patient’s natural lip shape and, when placed carefully, can create a more feminine contour without looking overdone.

This type of lip augmentation involves creating volume in the middle medial intercanthal distance and reducing the distance between the nose base and upper lip. Subtle exaggeration of the cupid’s bow and philtrum columns will also feminise lip appearance.

The potential for Keyhole Lips can also be explored.

Botulinum toxin treatments to smooth and lighten a heavy brow

Men who are not transgender tend to have a straight forehead and heavy brow. As such, treatments for smoothing and lifting a heavy brow can be beneficial to trans women. These include achieving an arched, higher brow with a more open eye aperture by manipulating the muscular action around the region using botox.

Forehead filler for trans women

The female forehead is associated with a rounded more vertical appearance.

Forehead filler is a more advanced procedure that can be used to manage the light and shadow of a masculine forehead, for instance, balancing frontal bossing typical of the male forehead.

Temple filler for a youthful, feminine appearance

Never underestimate the power of temple filler in creating a more youthful appearance! This can also be used to restore – or create – volume in the temple area for a more feminine look.

The goal is to soften the transition from temple hollows to the zygomatic region. It can also create some lift to the tail of the eyebrow using needle or cannula techniques.

This advanced filler treatment is one of those subtle tweaks where people notice your patient looks 'better' somehow, but can't work out why.

You can watch an expert multi-area filler treatment demonstration in our Claire: Full Face Filler Case Study. This includes midface, forehead and temple filler, as well as a non-surgical rhinoplasty, and more!

Masculinising effects of ageing

Ironically, the cumulative effects of ageing create changes that masculinise female facial features over time. So the concepts of facial feminisation will also apply to your ageing cis female patients to counteract the effects of time.

“I often ask students to draw a ‘male face’ and a ‘female face’ using step-by-step drawing tutorials. It really helps embed the artistry and sculptural differences between these faces,” notes Harley Academy alum, Dr Kalpna Pindolia.

Similarities between facial feminisation for cisgender and trans women

In ageing cisgender women, facial fat loss and bone resorption can flatten natural curves and create a more angular, traditionally “masculine” appearance. For trans women, baseline facial structure may start from a more angular, flat, or wider bone pattern.

In each case, as aesthetic practitioners, we're generally looking to enhance the same areas:

• Malar projection
• Mid-face volume
• Orbital framing
• Chin refinement.

Both cohorts may seek injectables to achieve goals such as:

• A more delicate jawline
• Reduced heaviness in the lower face
• A smoother, less angular forehead
• Fuller, more arched brows.

These adjustments reflect commonly perceived feminine features though, of course, 'femininity' is culturally and individually defined.

From a technique standpoint, we may be using similar products, planes and treatment sequencing. But emotionally and psychologically, the context is different.

For a trans woman, this may be part of her identity integration. It's one of the most visible steps in her journey. For a cisgender woman, it may be about feeling rejuvenated, visible, and like herself again.

In each case, your role as an aesthetic practitioner is not just technical. It’s human. You’re helping someone come into alignment, not with an ideal, but with their own reflection.

Treating transgender aesthetics patients

Another aspect it's vital to understand when treating transgender patients is the language you use. We highly recommend reading our guide to Creating a Safe Space for LGBTQIA+ Patients as part of ensuring you have a respectful and understanding approach.

Once you have obtained your Level 7 Diploma in Cosmetic Injectables and move on to learning more advanced aesthetics techniques, there are additional treatments you may want to explore here. These include injectable hand treatments, neck filler and non-surgical rhinoplasty. 

Whilst we only discuss non-surgical facial feminisation injectables here, holistic treatment plans often involve skincare, semi permanent makeup and hair treatments, too. As an aesthetics practitioner, you can have a profound impact on an individual’s quality of life, making these treatments so rewarding to provide.

As we've said, the tools and techniques may be the same, but the power lies in your understanding of context, intent, and identity. This is what elevates aesthetics beyond surface work into something profoundly affirming for both patient and practitioner.

Don’t forget, if you’d like to refer back to this article in future, you can do so easily by saving our post on this over on the Harley Academy Instagram account.

All information correct at the time of publication