Trans women resort to facial feminization and claim lack of medical preparation

“People point out in the street and laugh when they see women [trans] with so-called masculine characteristics, we become jokes for that”, said influencer and model Bruna Andrade, 25. This scenario, which demands that trans women be feminine, means that gender change in Brazil is still associated with body surgery.

As a result, many of these women find it difficult to accept their own image, and they still suffer from gender dysphoria — an acute discomfort some trans people feel about their bodies. According to experts, this sensation can be even greater in relation to the face.

Therefore, trans women have resorted to surgeries and aesthetic treatments for facial feminization, which make the features of the face similar to those of cisgender women. Many say, however, that Brazilian doctors lack knowledge to perform the procedures. Specialists consider that the treatment is not suitable for everyone, but it can be an ally.

“To soften what is visible is not just for the aesthetic standard, but to avoid the constraints that arise when someone notices in public that the person who is there is transgender due to a certain physical characteristic”, says Keila Simpson, 57, transvestite and president of ANTRA (National Association of Transvestites and Transsexuals).

Simpson recalls that a large part of the trans public does not have the resources for the procedures – an old problem that is worsened by the influence of social networks in the beauty industry. For her, the needs of trans people have never been taken seriously by Brazilian medicine.

“They don’t know how to care because they haven’t researched the trans body. Turning a blind eye and telling the patient to look for someone who does the procedure is not the answer that a doctor should give. Sooner or later, these professionals will get in touch with this population, whether to take care of your physical and psychological health or your aesthetic health”, ponders Simpson.

Influencer Bruna Andrade reflected for four years before deciding to perform surgical facial feminization. Although there are specialist doctors, she says that the aesthetic market is not sufficiently developed to serve this public.

“We are still very marginalized and without access to the formal job market, but in 5 or 10 years we will be a more expressive group in terms of marketing and doctors need to see this as an opportunity”, says Andrade.

Actress and singer Verónica Valentino, 38, has long been afraid to touch her face. In addition to the high cost, she was afraid of not liking the result. She would have liked to, but she didn’t want to overdo it.

“Even because, when you get somewhere to make a change in your body, the references they have are often cisgender bodies”, highlights the singer.

Valentino was one of the participants of an unprecedented Brazilian study published in the international scientific journal Clinical, Cosmetic and Investigational Dermatology. The document talks about non-invasive feminization procedures, such as through the application of botulinum toxin (botox).

According to the doctor Bianca Viscomi, 42, author of the research and member of the SBD (Brazilian Society of Dermatology), standardizing trans beauty by the traditional feminine, discarding individual characteristics, can worsen the acceptance of the patient’s own image.

“In my mind, trans women wanted to make the changes to have a cis female face. As feminine as possible, from looking and thinking they are cis women, but this only happens with a part of the patients”, she says.

Viscomi concluded that non-invasive aesthetics help people identify what they really like before opting for a more aggressive surgical transition, and understand if they really want a definitive change.

The qualitative study was carried out with five volunteers and established three basic steps over 90 days: treatment of muscles, ligaments and facial fat repositioning with botox; skin improvement with collagen biostimulators; and filling with hyaluronic acid for anatomical changes.

The objectives, however, were individualized. “The man’s frontal bone is straight and the woman’s has a slight concavity. One of the patients always wanted to change it and we did it with the filling. In the end, she said that she was ready for the surgical advance. The important thing is that she managed to do it. experiment for three years and the transition process softened the impact when it went to the final”, says Viscomi.

The dermatologist argues that in addition to building a literature that has so far been little discussed, the project sought to reinforce the occupation of conventional offices by trans people. “It is very important for this person to be called properly and naturally, to have their social name in the medical record, to have access to a neutral bathroom”, she points out.

Roberta Maria de Padua, 28, publicist, another study participant, agrees that medical knowledge is outdated. She considers that it is important that professionals seek the production of a national science for trans bodies.

“I accepted to participate in the study because I questioned it. It didn’t transform my face into something else, it softened expressions respecting the anatomy of my face and highlighting my beauty “

The cost of dermatological feminization is around up to BRL 30,000 – the research involved the donation of materials from a specialized pharmaceutical company, Merz Aesthetics Global, to complete. A complete face and body surgical procedure in Brazil, in turn, can cost up to R$150,000 on average.

Surgeon Jose Carlos Martins Junior, founder of the Transgender Center Brazil and author of the book “Transgender: Medical Guidelines for a Safe Transition”, says that 90% of trans patients who seek surgery at his clinic do not seek sex reassignment, but are focused on the appearance of the face.

“What is suitable for a trans woman may not be suitable for another. Out of 10, for example, only one or two will do it. [a raspagem do] Adam’s apple. Now 100% do the forehead, reshape the skull, the orbits, pull the hair forward, do the facial contour”, says the doctor.

He reinforces that gender dysphoria is not a disease, but can lead to serious loss of reality and even suicide. Every procedure performed on trans women, according to Martins Junior, should aim to control dysphoria.

“More than operating, it is understanding the patient, her need and her moment. A poorly executed, poorly performed indication will lead the patient to become even more dysphoric, making the case worse. A trans woman does not need surgery to be trans and not should go into sadness or depression because he didn’t have any surgery”, reinforces the specialist.