Joshua D. Rosenberg, MD

Short answer, Yes.

Your goals are reasonable and achievable. I would consider a preservation approach to your nasal bridge.

Go for it, you will look great!

Your family is right, you do have a very feminine appearance.

“Need” is challenging word here. It really depends on your goals. If having the most feminine appearance possible is that goal, then some aspects of feminization surgery may help you achieve it.

Brow/orbit reduction would likely be the most powerful procedure for you. The prominence of the brow and orbital rims is a strong subconscious indicator of masculine vs feminine for most people. Reducing this and creating a smooth transition from the brow to the nose and midface will definitely help you look more feminine.

Depending on the height of your hairline the incision for this surgery can be hidden in the hair, making this essentially “scarless.”

If you are decidedly surgery adverse, consider Botox to your masseter muscles. It will be a nice touch for you.

Finally, jaw and chin reduction could also be nice for you but I would consider them a second priority to your brow.

Your surgeon will likely check if there is enough cartilage left in your septum. The classic septoplasty typically removes most of the septal cartilage that could be used as grafts during rhinoplasty. But, this is not always the case. If sufficient septal cartilage remains, my assumption is this would be your surgeon’s first choice.

If there is not enough septal cartilage, ear or rib cartilage is typically the second choice. Ear cartilage has limited utility and rib cartilage is really the best secondary option. Finally, some surgeons use cadaveric rib cartilage. The plus side is that there is no rib donor site (at least for you). The downside is that it has some characteristics that make slightly inferior to your own rib cartilage. It’s also not always available.

Good luck. Do keep in mind that the rib donor site is fairly minor. If you go forward with surgery, I’ll be you will love your new nose way more than you care about the donor site.

There is no data proven, scientifically correct answer to this question, but I strongly prefer liposuction  

Liposuction can be done in a precise manner to address the excess fat in your chin/neck/jawline with near immediate results.  It is designed as a one time treatment. The recovery is straightforward and fairly quick. 

Kybella typically causes significant swelling and soft tissue “induration” (firmness and inflammation at the treatment area) than can last for weeks +. Needing multiple treatments is not uncommon. The results develop over time. 

From your history and photographs any treatment plan needs to be focused on actual skin tightening, not fat removal  It is important to understand that although there are a number of reasonable non surgical options, non provide the dramatic results of surgery. Your expectations have to be line with this reality  


I would consider either ultrasound based skin tightening such as Ulthera or radio-frequency based skin tightening, perhaps coupled with non ablative laser treatments such as IPL.