I'm a trans woman (MTF) started HRT on March 6 2018 and I'm 38. What FFS do I need to look feminine? (photos)

Thank you for sharing pictures.  The two areas I would focus on first are the upper and lower part of your face.  The combination of a Brow Reduction and Brow Lift could help reduce the prominence of the brow bone and lift your brows for a more feminine look.  You have a very strong jawline.  A Chin Reduction and Jaw Reduction could certainly help soften your lower face.  Rhinoplasty could be considered to refine the shape of your nose and a lip lift combined with filler for adding volume to your lips.  Be sure to seek an experienced Facial Plastic Surgeon who specializes in your desired procedures to achieve the best possible results.Best of luck,Philip Solomon, Solomon Facial PlasticToronto, Canada 

Shyla,Congratulations on beginning your journey.    It is a long road but just getting started is the hardest part.  The most powerful procedure for you will be brow bone reduction.  With this I would typically recommend for someone like you a brow lift and a small hairline advancement with significant hairline reshaping to create a rounded feminine hairline.  Next I would recommend mandible contouring to make your jaw more feminine.  A feminizing rhinoplasty (nose job) would be helpful and likely an upper lip lift - I would need to see your lip in a few more positions to be sure.  You have nice cheek bones, but they are flat on the front which is a masculine feature.  Hormone therapy can lead to some fat redistribution, so this may improve some over the next 6 months.  If you don't get some good cheek rounding you could consider augmentation with fat grafting or implants.  Finally, I don't see a large adam's apple in these photos, but if it's larger than it looks here you could consider a reduction there as well.  Hope this helps.  -Dr. Rolfes

I would suggest, start with your forehead, chin reduction, nose job and face lift. Lip lift could be great for you too.

I think there are a few areas that you can focus on based on these photos. Forehead reduction and contouring and brow lift can really feminize the upper part of the face. For the midface, I would consider cheek augmentation and rhinoplasty with a lip lift and conservative lip augmentation. Your jaw is quite strong and jaw contouring can make a big difference for the lower face. The hormones should help the skin and hair so that will benefit you as well. Consult an FFS surgeon when you feel you are ready. Best wishes.

Hello Shyla38! Thank you for your photos and question. Based on your photos, it looks like you already have good skin texture and tone with very few fine lines. If you haven't already started, but sure to begin the process of facial hair removal which makes a huge difference. As far as surgery goes, I would recommend setting back the brow bone, lowering and rounding off the hairline, and raising the eyebrows. I considering these three procedures as one and call it the forehead package. Research shows that this procedure makes the biggest impact in determining gender, and it is what I notice first on your face in particular. Other things you may want to consider are a rhinoplasty to make the nose smaller, a lip lift with augmentation to shorten and fill in the lips, and chin and jaw reduction. You have great cheekbones, and I don't see much in the way of an Adam's Apple. 
With this combination of procedures, you will want to plan to take at least 2 weeks off of work at a minimum. Most take 1 month off to fully recover. The nose and jaw take the longest to heal because of swelling. 
Best of luck to you in your journey!
Sarah Saxon, MD