Finishing transition - Fat transfer, lift and genioplasty or just genioplasty and fat transfer? (Photos)

Question

Ive already consulted a few surgeons internationally and it has left me absolutely confused. As per my transition I want to finish my process and get my mid to lower face harmonized/feminized. My primary concern right now is my cheek area and chin prominence. I’m confused whether or not to actually get an endoscopic mid face lift along with my procedures and i feel like people look extremely artificial after them. Should I just get a lower bleph instead of the lift? i need more expert opinions on this. I’m open to any other appoaches

Randal Haworth, MD, FACS · Answer

It makes sense you’re confused, you’re being offered very different tools, and they’re not all solving the same problem.
From your photos and what you described, your priorities are 
(1) cheek/midface softness and 
(2) reducing chin prominence / improving lower-face harmony. In many patients, you can make a big feminizing change with structure + volume before adding any “lift.”
Often the Best Foundation
Genioplasty (chin reshaping) if chin projection/length is a key masculinizing feature
Fat transfer to the midface/cheeks to add feminine fullness and soften angles
These two alone can create a more harmonious, natural result for many people.
When a Midface Lift Is Actually Useful
A midface lift is most helpful when there is true descent/sagging of cheek tissues, typically more common with aging. If you’re younger and the issue is primarily flatness/volume deficiency, then a lift can be unnecessary and can risk an “operated” look if overdone or if it’s not the right indication.
Lower Bleph vs Midface Lift
A lower bleph addresses the lower eyelid (bags, bulging fat, laxity), not cheek shape. If your main concern is the cheek area, a lower bleph won’t replace cheek augmentation or structural changes — it’s a different target.
My Simple Guidance
If your goal is natural feminization (not “pulled”):
Start with genioplasty + midface volume (fat transfer) if you’re a good candidate
Only add a lift if you truly have midface descent or laxity on exam
Choose a surgeon who does a high volume of facial feminization and can show consistent, natural results
An in-person exam is essential to decide whether you need lifting at all, versus just reshaping and restoring volume. I’d recommend a consultation with a qualified, board-certified facial plastic surgeon or plastic surgeon experienced in facial feminization to map out the least invasive plan that achieves your goals.
Good luck!

Finishing transition - Fat transfer, lift and genioplasty or just genioplasty and fat transfer? (Photos)

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