INTRODUCTION
Non-invasive dermatological procedures such as botulinum toxin, soft tissue augmentation, and hair removal are valuable components of gender-affirming care.1 Given increasing restrictions on gender-affirming care in the United States, it is crucial for dermatologists to understand how they can help transgender and other gender diverse people achieve their affirmation goals. Although dermatological procedures such as soft tissue augmentation are often portrayed as purely cosmetic, these procedures can substantially impact social functioning and improve mental health among transgender patients. These procedures help align gender identity with expression and are an important component of life-saving care for gender-diverse patient populations.1 Most of the research on filler use focuses on cisgender populations, contributing to a substantial knowledge gap regarding direct applications to the care of gender-diverse individuals. This study reviews existing literature to evaluate the role of injectable fillers in facial feminization among transgender women.
MATERIALS AND METHODS
A literature search was conducted to evaluate the use of injectable fillers among transgender women. The search terms "transgender, trans woman, transwomen, gender diverse, transfeminine, injectable filler, soft tissue filler, facial feminization, and facial filler" were used in PubMed, Google Scholar, and Scopus. A total of 8 studies documenting the use of injectable fillers in facial feminization were included in the present study. Studies were not included if they did not explicitly discuss filler use, did not include transgender women in their cohort, or were not published in English. All study types (ie, case reports, case series, case-control, cohort studies, cross-sectional studies) were included in the search criteria.
RESULTS AND DISCUSSION
Anatomical Considerations
Injectable filler is commonly distributed throughout the upper, middle, and lower face with distinct aesthetic goals in the pursuit of facial feminization. In the upper face, filler was most commonly utilized to smooth and flatten the forehead, soften the brow ridge, and improve temporal fossa volume.3 Eyebrow reshaping through softening the brow ridge and lifting the upper one-third of the brow was particularly effective in achieving facial feminization of the upper face.3-5
In the middle facial region, particular emphasis was placed on the reconstruction of the nose and zygomatic arches.4,5 Filler was frequently injected directly into the zygomatic arch to produce a lifted and prominent cheek contour.4-6 Malar filler was also used to create a more feminine apex that peaks superolaterally.4 Filler was also frequently injected directly into the nasal ridge to produce a more prominent nasofrontal ridge and slimmer nasal contour.4,5
In the lower face, augmentation of lip volume was achieved through direct injection, particularly in the philtrum to achieve a fuller and more projected lip contour.5 Perioral filler was also used to reduce the appearance of rhytids and improve lip contour.5 In efforts to make the chin appear less square and round, filler was frequently injected into the chin tip to achieve a more pointed, slim facial architecture.4-6
It is crucial to understand the unique experiences and goals of care when considering the use of injectable fillers among transgender women. In this section of the review, motivations for seeking care, injection techniques, and complications of injectable filler use among transgender women will be reviewed. It is important to recognize that while transgender individuals may undergo these procedures in the context of medically necessary gender-affirming care, they may also pursue such procedures in a broader cosmetic or general aesthetic context as well, indicating the value of individualized, patient-centered care.
Motivations for Seeking Care
Transgender women report both similar and different reasons for acquiring injectable facial fillers when compared to cisgender women. A recent study among cisgender women found that factors such as social pressure from popular media outlets and perceived social benefits of larger lips played a role in their decision to seek injectable filler.7 While social pressure also influences transgender women, it is important to consider how additional factors, including gender dysphoria, play a unique role in the decision to pursue injectable fillers.
As components of gender-affirming care, injectable procedures can help mitigate gender dysphoria and align gender identity with expression for transgender patients.8 It is important to underscore that soft tissue augmentation may be sought by cisgender patients for the purpose of affirming one's gender
Injectable filler is commonly distributed throughout the upper, middle, and lower face with distinct aesthetic goals in the pursuit of facial feminization. In the upper face, filler was most commonly utilized to smooth and flatten the forehead, soften the brow ridge, and improve temporal fossa volume.3 Eyebrow reshaping through softening the brow ridge and lifting the upper one-third of the brow was particularly effective in achieving facial feminization of the upper face.3-5
In the middle facial region, particular emphasis was placed on the reconstruction of the nose and zygomatic arches.4,5 Filler was frequently injected directly into the zygomatic arch to produce a lifted and prominent cheek contour.4-6 Malar filler was also used to create a more feminine apex that peaks superolaterally.4 Filler was also frequently injected directly into the nasal ridge to produce a more prominent nasofrontal ridge and slimmer nasal contour.4,5
In the lower face, augmentation of lip volume was achieved through direct injection, particularly in the philtrum to achieve a fuller and more projected lip contour.5 Perioral filler was also used to reduce the appearance of rhytids and improve lip contour.5 In efforts to make the chin appear less square and round, filler was frequently injected into the chin tip to achieve a more pointed, slim facial architecture.4-6
It is crucial to understand the unique experiences and goals of care when considering the use of injectable fillers among transgender women. In this section of the review, motivations for seeking care, injection techniques, and complications of injectable filler use among transgender women will be reviewed. It is important to recognize that while transgender individuals may undergo these procedures in the context of medically necessary gender-affirming care, they may also pursue such procedures in a broader cosmetic or general aesthetic context as well, indicating the value of individualized, patient-centered care.
Motivations for Seeking Care
Transgender women report both similar and different reasons for acquiring injectable facial fillers when compared to cisgender women. A recent study among cisgender women found that factors such as social pressure from popular media outlets and perceived social benefits of larger lips played a role in their decision to seek injectable filler.7 While social pressure also influences transgender women, it is important to consider how additional factors, including gender dysphoria, play a unique role in the decision to pursue injectable fillers.
As components of gender-affirming care, injectable procedures can help mitigate gender dysphoria and align gender identity with expression for transgender patients.8 It is important to underscore that soft tissue augmentation may be sought by cisgender patients for the purpose of affirming one's gender
