The Importance of Facial Gender Confirmation Surgery

To distinguish the phenotypic sex of a newborn, observers typically inspect the primary external genitalia and pronounce the child female, male, or intersex. Throughout maturation, and most notably during exposure to increased gonadal hormones during puberty, secondary sex characteristics develop (Table 10.1). These include the development of patterned body hair, the presence or absence of breasts, change in muscle mass, and differentiation of the skeleton, including the face and skull. Among all the secondary sex characteristics, facial features are the most visible in social life and have a significant impact on a person’s vision of themselves in the mirror. They are also the most difficult to alter. This chapter outlines the importance and implications of facial gender markers from a social, historical, and patient perspective.