Facial Masculinization Surgery (FMS)

Artistry is equally at the heart of male face optimization because all of Dr. Rad’s patients want to look naturally balanced and enhancing masculinity of the face is paramount. Therefore, for male patients Dr. Rad focuses his technique on chiseling features rather than softening them, sharpening the neck and jawline, enhancing male jawbone width and angularity rather than the petite heart-shape that women desire, maintaining a relatively flat midface rather than rounded apples of the cheeks, and keeping eyebrows low and horizontal rather than upwardly arched as female brows tend to be. With these aesthetic features in mind, Dr. Rad relies heavily on neck lift and deep neck sculpting to reverse bottom heavy necks and define the jawline, jaw and chin implants, under eye implants with blepharoplasty, and buccal fat reduction. This combination often creates a defined neck and jawline, strong facial angularity, chiseled mid-lower face contour and deep set eye appearance that many men want. Rhinoplasty is often an important component of face optimization for men who have a dorsal hump, drooping tip or otherwise unaesthetic nasal proportion. Like Greek and Italian Renaissance sculpture, oftentimes a classic straight bridge and strong, non-diminutive nasal shape and size can enhance the masculinity of a face. This is in distinction from the “ideal” female nose which is petite, slightly curved and has a more lifted tip.

All surgeons have a different degree of aesthetic sense, some more than others, and Dr. Rad’s eye is trained to evaluate a male face from the lens of maintaining naturalness yet enhancing the details that give a male face robustness, a commanding presence and strong features. Dr. Rad’s eye is attuned to seek asymmetries and he makes subtle modifications to his surgical plans to address them. In total, with a holistic approach to male aesthetics, Dr. Rad routinely strikes a balance of facial harmony and robust masculinity with results that are permanent and last for many years.

Dr. Rad spends time with you to formulate the best plan to achieve your goals. This often requires a combination of procedures, from deep plane face and neck lift, blepharoplasty (eyelid lift), as well as fat grafting. Each procedure is intended to correct subtle signs of imbalance. But keep in mind that the art lies in the hands performing the procedures, not the procedures themselves. Just as a beautiful piano concerto stands in its own beauty, it’s the pianist who brings it to life, some better than others. Likewise, surgeons have different skill levels and aesthetic nuance, and bring to life the best results to varying degrees of ability. The level of artistry required to achieve natural, beautiful and long lasting results requires tremendous nuance. As Dr. Rad frequently says, “millimeter changes throughout the face can synergize beautifully into stunning yet natural results.” These details are reflected in surgeons’ before/after photographs which is why you must evaluate these with an aesthetic eye. You have only one face and so listen to your instincts when you look at surgeons’ results.

Depending on the procedures that Dr. Rad recommends for his male patients, he often takes the following surgical approach:
1. Lower face and neck lift with deep neck sculpting are a common component of his male face optimization work. In this technique, Dr. Rad routinely uses a deep plane facelift method with deep neck sculpting for optimal results. He makes exact incisions along natural contours behind the ears (possibly in front if skin laxity is too much to avoid it), deftly navigating the sideburn and beard so that incisions are hidden from view and the hairlines are not distorted. Through these incisions, Dr. Rad elevates the skin within the subcutaneous fat plane in order to expose the muscle layer, the SMAS, and the platysma. Often Dr. Rad uses a short under-chin incision to gain access to the saliva glands and reduce them (called “deep neck sculpting”), to tighten neck muscles and also to reduce fatty deposits which creates sharpened neck contours.

2. In combination with deep neck sculpting often Dr. Rad will enhance the jaw and chin structure with implants. This can make a male face more robust and stronger appearing while synergizing with neck lift for an optimized lower facial frame. Dr. Rad routinely places porous polyethylene implants through hidden internal lip/cheek incisions to key in over the back of the jaw bone, and secures the implants to the jaw bone with permanent titanium screws. These implants are biocompatible and last forever. Screws do not cause problems with MRI scans or TSA metal detectors, since titanium is an inert metal that is used in all forms of bio-implant materials such as prosthetic joints.

3. Once the facial frame is correct, Dr. Rad focuses on the eyes which are the key to an optimized face. For patients with bulging appearing eyes, deep tear troughs and under eye bags, often times they need implants to enhance this eyesocket and cheekbone structure. Dr. Rad routinely places “inferior orbital rim” porous polyethylene implants to enhance the bone structure of the eyesocket. This is a crucial step in correcting the appearance of fatigue, hollowing and unattractive eyes for patients with “negative vector” eyesocket bone morphology. Fat grafting or midface lift don’t provide a complete solution when the bone structure is deficient. Dr. Rad is the only surgeon in the country with special expertise in using porous polyethylene implants. While most surgeons use silicone for their flexibility and ease of placement, problems of bone erosion and encapsulation, as well as higher chance of infection, limit the use of silicone. Porous polyethylene implants do not suffer these limitations.

4. Along with midface and orbital rim augmentation, oftentimes Dr. Rad will also perform a lower blepharoplasty with fat grafting in order to smooth contours from the lower eyelid and midface especially for those with very thin tissues over the eyesocket and cheek bones. This is crucial for a smooth appearance.

5. Finally, rhinoplasty plays an important role in male face optimization because of its central position. Men with a hooked nose, dorsal hump and/or drooping tip benefit from closed rhinoplasty to provide optimal shape, contour and proportion and is like “icing on the cake”. Dr. Rad usually leaves rhinoplasty to the last step because the facial foundation first needs to be correct before rhinoplasty can be done. It’s like building a tower on a solid foundation first, you can do it in reverse.

Care post-surgery is important for both your recovery and results whether at your home or at a hotel. For your safety, as you’ll be somewhat sleepy, you will need a responsible adult to stay with you for at least the first night. If you’re interested in having an experienced private duty nurse, we can help facilitate this care.

Once home or in a hotel, you will mostly rest, although you should be able to perform “activities of daily living,” meaning being up and about and doing basic self care. Since your head will be wrapped, you’ll defer showering until your first post-op appointment with Dr. Rad 1-2 days after surgery.

During the daytime you should walk 10-15 minutes each hour and should not be on bed rest. Pain is relatively mild and most patients need a mild pain medicine to help them sleep. Tissues react with swelling and bruising that distorts facial appearance and causes facial muscles not to work normally, but this is normal and temporary. Cold compresses and head elevation helps with comfort and swelling.

Since nausea is not uncommon after anesthesia, no matter how light the anesthesia given, nausea prevention is essential and straightforward by taking an anti-nausea medicine such as Zofran (Ondansetron). Nausea side effects typically wear off in 24-48 hours. Other side effects of anesthesia include feeling a bit groggy or “out of it”, but this is relatively mild and wears off quickly. Dr. Rad recommends not planning important work-related activities or phone calls as you will not feel your sharpest.

Drinking liquids is most important to maintain hydration. Dr. Rad recommends Gatorade, or Drip Drop and Liquid IV electrolyte replacement powders mixed in water. If neck lift has been done then patients often feel some neck tightness that is normal, common and temporary. You will see Dr. Rad within the first few days to check on your early healing.