Soft Tissue Filler for the Transgender Patient

Introduction

There are approximately 1.4 million self-identifying transgender individuals in the United States as of the year 2016. Many of these individuals suffer from gender dysphoria, a condition of psychological distress described by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-V ) as an incongruence between gender identity and sex assigned at birth. Transgender individuals may choose to pursue social, legal, medical, or surgical affirmations of their gender through an extensive process called “transition.”

Difficulty accessing healthcare providers who are knowledgeable and culturally sensitive to transgender concerns may hinder the transition process. This has led to reports of transgender youth and adults seeking “back-alley” procedures from unlicensed providers who administer unspecified or unapproved materials such as silicone, paraffin, and oils. Such substances are injected into various parts of the face and body for the purpose of enhancing masculine or feminine features. This may lead to disfigurement or life-threatening complications.

Compounded with poor access to health care, the transgender population is at higher risk for substance abuse, suicide, and other health comorbidities. However, dermatologists are uniquely positioned to provide safe, ethical, and aesthetically appropriate care for the transgender population. Culturally competent, transition-related care has been shown to vastly improve quality of life and may include the use of soft tissue fillers for enhancing gendered features. In this chapter, we will review gender differences in facial anatomy and offer recommendations for transgender-specific treatment strategy with soft tissue fillers.

Anatomy

There are distinctly masculine or feminine features of the upper, mid, and lower face. Each anatomic location will be reviewed, but overall, the male face is more angular with stronger muscle mass, a thicker dermis, and higher density of hair follicles and sebaceous glands. The female face is more tapered and contains less muscle mass, fewer hair follicles and sebaceous glands, but more subcutaneous fat.