title: Facial feminization - Surgical modification for Indian, European and African faces.
abstract: BACKGROUND
  Gender reassignment surgery for facial feminization is being increasingly sought out by males with gender nonconformity issues. Noninvasive camouflage measures such as changing hairstyle, makeup, and filler inserts often do not fetch desired long lasting effects and surgery is sought as a last resort. The facial feminization surgery (FFS) for Indian faces, has no definitive protocol till date and largely remains as an arbitrary undertaking based on individual patient's perception, expectation, and surgeon's ability. This manuscript aims to present a series of the Indian FFS and compare the same with European and African counterparts to highlight the Indian expectation of FFS and thus its modifications.
  
  
  METHODS
  Seven patients confirming to gender nonconformity status, seeking FFS, aged between 21 and 36 years (mean 26.3 ± 4.2 years; median 25 years) were surgically treated during 2007-2014. Of them, five were of Indian origin and the rest two from the Europe and Africa. After investigation and para-clinical workup, FFS were carried out in stages with due modifications.
  
  
  RESULTS
  Basic surgical guidelines were followed accommodating Indian parameters of facial profile as well as expectations. Various amounts of soft and hard tissue changes were required for individual patients, depending on their individual perception.
  
  
  CONCLUSIONS
  All seven patients were satisfied with their feminine faces. The challenges and differences in planning and performing Indian FFS are described.
authors.affiliation: Director and Consultant Maxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India.
authors.forename: S M
authors.initials: SM
authors.lastname: Balaji
keywords: Facial feminization; face sculpting; facial re-contouring; feminine faces