Beverly Hills Feminization Procedures

Beverly Hills Feminization Procedures

Our highly qualified Beverly Hills facial feminization specialist treat many men who wish to transform their appearance into a more feminine one!

With over years of experience in the field of plastic surgery, Toby G. Mayer, M.D., F.A.C.S. works to provide their patients with the most up-to-date surgical techniques on the market, as well as specialized personal care.

The Feminization Process

At The Beverly Hills Institute of Aesthetic & Reconstructive Surgery, more and more transsexual men are seeking the help Dr. Mayer for their feminine transformation.

As a leading Beverly Hills facial feminization professional, our doctor can perform various surgical procedures that can yield a more female look in men. Some procedures may include cheek augmentation and rhinoplasty, also known as "nasal surgery."

If you wish to alter the pitch of your voice, you might want to consider Dr. Mayer as your Beverly Hills voice modification expert. With his help, you can achieve complete feminization.

Dr. Mayer is board certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) and the American Board of Otolaryngology (ABOto). Because of his vast expertise in the field of plastic and reconstructive surgery, you can rest assured that your cosmetic needs are in good hands!

Interested in scheduling a consultation with our Beverly Hills voice modification physician? Feel free to contact our office at (310) 278-8823 or toll-free at (800) 854-8823. You can also e-mail us with any questions or concerns. In addition, please browse through our many before and after photos and patient experiences.

Facial Procedures

Below is a list of the most commonly performed procedures for Facial Feminization and a brief description of each procedure and how it is used in this process. For additional information on any of these procedures, go to or contact us.

Forehead Lift

A forehead lift is often performed on transgender female patients to raise the brows to a more feminine position. Orbital bony contouring, or a reshaping of the bone underneath the eyebrows, is often combined with a forehead lift to soften the area around the eyes. (For these patients we will require a skull x-ray prior to surgery). In addition, many of our patients would like to lower their hairline (since men tend to have a larger forehead than women) and we often combine a forehead lift with hairline lowering.

Through the unique hairline forehead lift procedure we developed, these procedures can all be performed at the same time allowing us to resolve these related problems simultaneously. The incision is naturally concealed within the hairline.

Please note that some patients have more extensive male pattern baldness that may require other hair replacement procedures to correct. These procedures can often be done in conjunction with a forehead lift as well.

Cheek Augmentation

There is not particular cheek shape or definition that most men or women have. In general a fuller, more prominent cheek is the ideal for the Facial Feminization process. There are 3 different main types of implants, which come in a variety of sizes so that each patient can receive a customized fit.

• Cheek implants (malar): These are placed directly on the cheek bones to increase prominence or give "high" cheek bones.
• Below the cheek (submalar): These are placed just under the cheek bone to correct a hollow or sunken-in appearance and to create more fullness
• Combined (malar/submalar): These implants go over and below the cheek bone to increase prominence and to correct hollowness under the cheek.

This procedure is usually performed through incisions inside the mouth so there are no visible scars.

Nasal Surgery (Rhinoplasty)

As with the other components of Facial Feminization, nasal surgery is primarily performed to soften this feature. Our goal is to provide you with a more feminine nose, but at the same time, not give you an artificial or overly scooped or pinched look. Each patient’s nose is unique and there are a variety of techniques to “feminize” a nose. We evaluate each patient individually. The extent of the nasal surgery will depend on the patient and what is necessary to both feminize the nose and to bring the nose into balance with the face without creating an artificial appearance.

Chin/Jawline Surgery

The chin and jawline are as variable as the nose in men and in women. While some believe that men tend to have a wider chin and squarer jaw, and women a more pointed chin with a narrower jaw, we do not feel that this generalization is accurate. We see a large number of women with a wider, square jaw and men with a narrow jaw and pointier chin.

There are several ways of reshaping the chin and jaw area to soften their appearance.

• Chin implant: This redefines the shape and softness of the chin.
• Chin/jowl implant: This redefines the shape of the chin and the jowl area. It is often used to correct depressions in the jowl
• Pre-jowl implant: This reshapes the jaw without changing the chin

This procedure is usually performed through an incision under the chin, where most of us have a naturally occurring crease. There is less chance of infection than when the incision is placed in the mouth.

Tracheal Shave (Thyroid Cartilage Reduction)

This procedure involves a reduction or shaving of the upper portion of the trachea known as the Adam's Apple. This procedure is performed on a large number of transgender patients. The tracheal shave is performed through an incision in one of the natural creases of the neck and creates a flatter appearance to the Adam's Apple. This procedure can be performed with any of the above procedures

Tracheal Shave

The tracheal shave procedure is performed under a local anesthetic. An incision is made in a natural crease in your neck. The trachea is shaved and tiny stitches are used to close the incision. Stitches are removed six days later. (Once it is healed, you won't even be able to find the incision.)
Dr. Mayer can also use a technique similar to the technique used in hemming a skirt. He would make a loop in one end and in six days after surgery you would just pull the end and the stitches would come out. In that case, you would only need to be here let's say Monday for your consultation/pre-operative appointment, Tuesday for your procedure, Dr. Mayer would check you on Wednesday and you could fly out that day. The following Monday, you would just pull the end to release the stitches.

Hair Replacement Procedures

Unfortunately, transgender patients do not escape the perils of male pattern baldness completely. The good news is that once hormone therapy has been started, the progression of hair loss is usually stopped. The bad news is, you can not "regrow" what has already been lost. There are however, several options depending upon the extent of the hair loss.

Scalp Advancement - This procedure is often performed at the same time as a hairline forehead lift for patients will some frontal hair loss. It is essentially a lowering of the hairline. In some instances, there is not enough elasticity in the scalp to provide adequate advancement, so we will place a tissue expander under the hair bearing scalp. The expander is then filled slowly, over time, to create the adequate of amount of scalp needed for proper placement of the hairline.

Fleming/Mayer Flap – For patients with more extensive frontal baldness, we can perform our renowned Fleming/Mayer Flap procedure to give the patient a full head of their own hair –with their own natural density A second flap may be needed to address more extensive baldness. In some cases, a Tissue Expander may also be required prior to the flap procedure. We also recommend that all of our flap patients undergo Micrografts (1-3 hair per transplant) to the hairline to soften the hairline for the most natural result possible.

Hair Transplants – Micrografts (hair transplants consisting of 1-3 hairs per graft) and Minigrafts (hair transplants consisting of 4-7 hairs per graft) are also used to treat male pattern baldness. These can be placed on any area of the scalp where hair loss is a problem. It usually requires several sessions for each area, and has less density than the flap procedure. However, some patients prefer this option.

The ultimate goal with hair replacement surgery is the same as with all of the other procedures we offer: a natural, more feminine look. We will review all of the options available to you and give our recommendations for the best possible solution to your individual hair loss concerns.

For a complimentary video on the Fleming/Mayer Flap procedure, and a complimentary copy of the Everyman’s Guide to Hair Replacement, please e-mail us at .

For more detailed information on the Fleming/Mayer Flap procedure, and other forms of hair replacement, please visit our main website at

Voice Modification Surgery

It has been more than fifteen years since that first transsexual patient asked me if there was not some operation I could do to modify her voice. Her body surgery had been successful, and I was about to perform both hair restoration surgery and nasal surgery to complete the physical transformation. Yet, she was still quite distraught about her voice.

She explained to me that it was quite embarrassing to speak to someone over the telephone and have them say, "Well, thank you for your help, Sir." Her voice was quite deep, and she was not able to place the pitch into the female range; this obviously presented serious problems in completing a successful transition for gender reassignment.

I explained to her that there was no surgery that I knew of for voice modification, but I would attempt a procedure which might work. I told her that there was no guarantee of success, but she said she was willing to take this chance, even though the procedure might fail, because of the problem that her voice presented. Well, not only was the experimental procedure successful, but it succeeded beyond my wildest dreams. The patient's voice was well within the female range and nobody referred to her as "Sir" after that! (All transsexual patients owe this person 'J' a great deal of gratitude, as she allowed me to develop this revolutionary procedure by her willingness to "take a chance.")

That was more than fifteen years ago, and since then several hundred patients have undergone similar surgery with a success rate of more than 95%. (The remainders do not achieve a significant change in voice pitch.) This voice modification surgery is unique, it was developed by me, and no other surgeon I am aware of uses this technique.

The voice modification surgery is performed as an outpatient procedure in our surgery suite under local anesthesia. There will be a small, fine, one-inch line in the neck crease after the procedure. If desired, the Adam's apple can be shaved during the same operation. There is very little discomfort afterwards, and the patient is able to fly home in 48 hours. Contact sports and extreme athletic endeavors are to be curtailed for several weeks after the procedure. The voice remains somewhat hoarse for a few weeks afterwards.

The goal of the surgery is to create a voice which sounds female on the telephone. The surgery is performed to the best of my ability. There can be no guarantee of the results, but there have been no serious complications or problems with this procedure to the present time. The cost of this surgery is $5750.00. (Click here for audio samples of voice modification patients)

Quite often other types of surgery are performed in conjunction with the voice modification procedure, such as our unique method of hair replacement for transsexual patients using the flap technique. Facial feminization procedures including; forehead and brow lifts with lowering of the hairline can also be done as well as contouring of the forehead-orbital bone. Nasal surgery to create a more feminine nose, without an artificial or overly scooped or pinched look, is often requested.

Our method of hair replacement depends upon the degree of hair loss already experienced by the patient. In some patients the hairline can be moved forward since there is no further hair loss once the patient is on estrogen. A simple advancement with or without tissue expansion is all that is necessary. Using a procedure which has been developed and perfected by Dr. Fleming and myself, hair will grow through the incision that is made at the frontal hairline so no scar will be detectable afterwards. Utilizing this same approach, excess bone over the ridges of the forehead can be smoothed to create a more feminine appearance as well.

For patients with more advanced hair loss, the Fleming/Mayer Flap procedure can be used to create a natural hairline, without "corn rows", hair texture change, and poor density associated with the hair transplant procedure. With the Flap procedure an entire section of hair is transferred at one time from the sides of the scalp to the front, resulting in a very natural and thick hairline. Dr. Fleming and I are recognized as authorities on hair flaps throughout the world, and we are the originators of this advanced development. We have performed more than two thousand hair flap procedures on patients from all over the world, including numerous entertainers, celebrities, athletes and professionals.

Toby G. Mayer, M.D., F.A.C.S. and Richard W. Fleming, M.D., F.A.C.S. are Medical Directors of the Beverly Hills Institute of Aesthetic and Reconstructive Surgery. They each have dual Board certifications, and are Fellows of both the AmericanAcademy of Facial Plastic and Reconstructive Surgery and the AmericanCollege of Surgeons. Dr. Fleming and Dr. Mayer are clinical professors and former co-chairmen of the Facial Plastic and Reconstructive Surgery Division of the University of Southern California. The doctors have been partners in private practice for over twenty years; their Beverly Hills office is designed for patient comfort and privacy with state-of-the-art surgical suites designed to accommodate the specific, delicate procedures they perform.

Highly regarded as world-renowned authorities on cosmetic and reconstructive surgery, Dr. Fleming and Dr. Mayer are frequently requested as speakers at medical conferences all over the world. As recognized leaders in hair replacement surgery they have co-directed the National Symposium on Hair Replacement Surgery for seven years. Dr. Fleming and Dr. Mayer have published numerous papers on their innovations to the revolutionary flap technique for permanent hair replacement, and both doctors have contributed to many leading textbooks on cosmetic and reconstructive surgery. Their medical reference textbook, Aesthetic and Reconstructive Surgery of the Scalp, made its debut in January 1992. A subsequent book entitled The Everyman's Guide to Hair Replacement Surgery was published in 1995, and is available by request.

For more information on any of the above procedures, Dr. Mayer can be contacted by calling (800) 854-8823 or by writing to him at:

The Beverly Hills Institute of Aesthetic & Reconstructive Surgery
416 North Bedford Drive, Suite 200
Beverly Hills, California 90210

E-mail :

Other Procedures

Liposuction:

Recontouring your body through the use of liposuction is a common procedure in the Feminization process. We use the Power Assisted Liposuction technique, which is the latest advancement in liposuction technology. This device gives us greater control during the procedure which results in better contouring and sculpting of the areas. The patient experiences less bruising and swelling, and therefore a faster recovery period. Unlike Ultrasonic liposuction, which can burn the skin, it is very safe for the patient.

Liposuction is commonly performed on the abdomen and flanks, but can be performed just about anywhere on the body that excess fat accumulates.

The procedure is performed through very tiny incisions which are placed in inconspicuous locations. A post-operative garment is worn for a minimum of one month after surgery, possibly longer, depending upon the areas treated and the doctor's recommendations.

Breast Augmentation

Enlarging the size of the breasts, to bring them into balance with the rest of the body, is very commonly associated with feminizing the body. We work very closely with colleagues who perform this surgery, and we can coordinate this procedure to occur at the same time as your other procedures.