madman
Super Moderator
Abstract
Background: Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients.
Objectives: The aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients.
Methods: A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted included patient demographics, techniques, outcomes, complications, and patient satisfaction.
Results: We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations.
Conclusions: Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with the use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after the initial transplant to achieve the desired density.
With the transgender population gaining more visibility, clinicians have been increasingly tasked with serving the needs of this patient population.1,2 In addition to the genitalia and torso, the face has become an area of interest for providers caring for transgender patients because masculine and feminine facial features are highly salient cues for signaling gender identity.3 Transgender individuals can experience significant facial gender dysphoria from facial features that do not match their identified gender. Incongruous facial features may also result in misgendering or being “outed” as transgender, which may result in discrimination from others.2,4-7
Gender-affirming therapies, including both surgical and medical modalities, have been shown to be efficacious in treating the burden associated with facial gender dysphoria.8,9 Facial feminization surgery (FFS), which encompasses a wide array of procedures, has become an increasingly popular option for transfeminine individuals, with the goals of flattening the forehead, reducing the width of the nose, and creating a short and more pointed chin.10-15 On the other hand, facial masculinization surgery (FMS) aims to increase forehead width and supraorbital bossing, and to create an angled, rectangular chin and a proportionately wide nose, which are generally accepted as masculine traits.3,13,16-18
Although not studied nearly as extensively as FFS, FMS has begun to appear in the surgical literature, mainly with case reports showing improvements in patient satisfaction, but lacking the sample size to be able to generalize the findings.16-18 Although it is clear that more research about FMS is necessary, providers have found alternative ways to “masculinize” patients’ faces, including fillers and fat grafting.19,20 One modality that could serve to augment FMS or as a standalone intervention is hair transplant to the face (mustache, beard, goatee) because the presence and density of facial hair contribute to a perception of masculinity.10,21 In early studies that determined which facial features were masculine and which were feminine, all evidence of facial hair was removed because this would be a give-away of a male face.10,22,23 Furthermore, recent studies have shown that increased facial hair is associated with increased perception of masculinity.24
Acknowledging the importance of facial hair in creating a masculine appearance, providers have begun transplanting hair to the face of transmasculine patients, with the hopes of providing a facial aesthetic that is more in accordance with their gender identity. Despite this, there is no study describing the timing, technique, and utility of these procedures for transmasculine patients. The purpose of this study is to review the existing literature regarding facial hair transplantation and develop guidelines for practitioners caring for transmasculine patients.
*Timing of Facial Hair Transplant for Transmasculine Patients
*Initial Consultation
*Transplantation to the Beard
*Postoperative Care
*Complications
-Poor Regrowth
-Angulation
-Donor Site
CONCLUSIONS
Facial hair transplantation has become a promising option for transmasculine patients wishing to enhance their masculine appearance. Currently, we recommend waiting at least 1 year after initiation of testosterone therapy before pursuing facial hair transplantation. Furthermore, transplant surgeons should engage in open discussions about patient plans to pursue facial masculinization surgery because such surgery would inform the appropriate timing for transplantation. In the last decade, FUE has emerged as the preferred technique, due to the absence of linear scars, although transplant surgeons should use whichever technique best suits patient goals and surgeon experience. Complications such as poor angulation and low regrowth rates are common but can be addressed after the initial procedure and limited with proper technique.
Background: Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients.
Objectives: The aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients.
Methods: A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted included patient demographics, techniques, outcomes, complications, and patient satisfaction.
Results: We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations.
Conclusions: Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with the use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after the initial transplant to achieve the desired density.
With the transgender population gaining more visibility, clinicians have been increasingly tasked with serving the needs of this patient population.1,2 In addition to the genitalia and torso, the face has become an area of interest for providers caring for transgender patients because masculine and feminine facial features are highly salient cues for signaling gender identity.3 Transgender individuals can experience significant facial gender dysphoria from facial features that do not match their identified gender. Incongruous facial features may also result in misgendering or being “outed” as transgender, which may result in discrimination from others.2,4-7
Gender-affirming therapies, including both surgical and medical modalities, have been shown to be efficacious in treating the burden associated with facial gender dysphoria.8,9 Facial feminization surgery (FFS), which encompasses a wide array of procedures, has become an increasingly popular option for transfeminine individuals, with the goals of flattening the forehead, reducing the width of the nose, and creating a short and more pointed chin.10-15 On the other hand, facial masculinization surgery (FMS) aims to increase forehead width and supraorbital bossing, and to create an angled, rectangular chin and a proportionately wide nose, which are generally accepted as masculine traits.3,13,16-18
Although not studied nearly as extensively as FFS, FMS has begun to appear in the surgical literature, mainly with case reports showing improvements in patient satisfaction, but lacking the sample size to be able to generalize the findings.16-18 Although it is clear that more research about FMS is necessary, providers have found alternative ways to “masculinize” patients’ faces, including fillers and fat grafting.19,20 One modality that could serve to augment FMS or as a standalone intervention is hair transplant to the face (mustache, beard, goatee) because the presence and density of facial hair contribute to a perception of masculinity.10,21 In early studies that determined which facial features were masculine and which were feminine, all evidence of facial hair was removed because this would be a give-away of a male face.10,22,23 Furthermore, recent studies have shown that increased facial hair is associated with increased perception of masculinity.24
Acknowledging the importance of facial hair in creating a masculine appearance, providers have begun transplanting hair to the face of transmasculine patients, with the hopes of providing a facial aesthetic that is more in accordance with their gender identity. Despite this, there is no study describing the timing, technique, and utility of these procedures for transmasculine patients. The purpose of this study is to review the existing literature regarding facial hair transplantation and develop guidelines for practitioners caring for transmasculine patients.
*Timing of Facial Hair Transplant for Transmasculine Patients
*Initial Consultation
*Transplantation to the Beard
*Postoperative Care
*Complications
-Poor Regrowth
-Angulation
-Donor Site
CONCLUSIONS
Facial hair transplantation has become a promising option for transmasculine patients wishing to enhance their masculine appearance. Currently, we recommend waiting at least 1 year after initiation of testosterone therapy before pursuing facial hair transplantation. Furthermore, transplant surgeons should engage in open discussions about patient plans to pursue facial masculinization surgery because such surgery would inform the appropriate timing for transplantation. In the last decade, FUE has emerged as the preferred technique, due to the absence of linear scars, although transplant surgeons should use whichever technique best suits patient goals and surgeon experience. Complications such as poor angulation and low regrowth rates are common but can be addressed after the initial procedure and limited with proper technique.
