In the rapidly evolving field of aesthetic medicine, the demand for procedures that promote holistic beautification and celebrate self-expression continue to expand. Yet, amidst this evolution, there remains a gap in medical literature regarding guidelines for aesthetic treatments with dermal fillers, neurotoxins, and thread
s in transgender and gender diverse (TGD) patients. This lack of information perpetuates stigma, discrimination and mistreatment in healthcare settings, exacerbating societal exclusion and its associated mental health challenges such as depression, anxiety and suicidal ideation.
In this edition of Talent & Techniques, I delve into the nuances of gender diversity within aesthetic medicine, offering practical guidelines for cultivating safe and inclusive spaces for all individuals. My journey as an LGBTQIANB+ specialist in minimally invasive aesthetic procedures has led me to question traditional notions of beauty standards and gender identity within the aesthetic and medical industry.
The Renaissance of Aesthetics and Medicine
As a practitioner, I have observed a pervasive emphasis on “gender affirming care” and “masculinization” or “feminization” procedures, which, paradoxically, seek to impose societal beauty standards on individuals, which conflicts with the ethos of anti-aging medicine and preventive aesthetic procedures. It is essential to challenge the notion that aesthetic treatments should dictate one’s gender identity or conform to rigid stereotypes.
I identify with the ethos of anti-aging medicine and preventive minimally invasive aesthetic procedures, which prioritize enhancing an individual’s quality of life and self-confidence without imposing external standards. As we navigate the complexities of gender diversity, it is crucial to recognize the diverse spectrum of identities beyond the binary framework.
Creating a Safe Space for All
Pre-Care: Establishing a foundation of respect and understanding begins with simple yet crucial steps. Introducing oneself first, affirm your patient´s pronouns, and invite them to share their aesthetic goals and concerns openly. By prioritizing open communication and mutual respect, we set the stage for a collaborative treatment journey.
Intra Care: Adopting gender-neutral language and treatment approaches is paramount in promoting inclusivity. Avoiding gendered terms and embracing patient-driven treatment plans empower individuals to articulate their unique aesthetic preferences and identities. Recommend using objective description words such as “more prominent, convex, wider, more projected, more angled, etc.”
Post-Care: Encouraging ongoing dialogue and feedback fosters a culture of continuous improvement and patient satisfaction. By prioritizing patients’ voices and experiences, we can refine our approach to meet their evolving needs effectively.
A Case Report
My patient, Noah Blanco, is a 29-year-old singer and music producer who identifies as a transmasculine individual.
Noah, whose sex was assigned female at birth, expresses a nonbinary gender identity, and prefers the use of masculine pronouns. During our consultation, Noah expressed a desire to enhance the contour of his jaw and chin (Figure 1), noting a common concern among transmasculine individuals regarding the accumulation of fat in specific areas, such as the nasolabial fold. He mentioned attempting muscle contraction exercises to define his jawline but expressed concerns about their efficacy and potential adverse effects on dental and muscle health.
After careful assessment and consultation, I recommended discontinuing the muscle contraction exercises due to their potential negative impact on Noah´s temporomandibular joints. Following a standardized protocol, I took a series of clinical photographs on Noah’s consultation day to establish a baseline for treatment planning. Noah’s skin type was assessed as Type III on the Fitzpatrick scale, with signs of moderate aging categorized as Type III on the Glogau scale.
Our tailored treatment plan aimed to address Noah’s concerns while ensuring natural-looking results and preserving facial harmony. We employed a combination approach, incorporating neurotoxin to target and prevent dynamic wrinkles in the forehead, glabellar lines and periorbital area. Additionally, strategic injections were administered to the mentalis muscles to achieve optimal results.
For volumizing and repositioning tissues, we utilized both cross-linked and non-cross-linked hyaluronic acid (HA) dermal fillers. Employing precise injection techniques, strategically following cranio-caudal, lateral to medial, and from deep supra-periosteal to superficial subdermal injections, we targeted key anatomical areas. These areas were the temporal fossa, zygomatic arch and eminence, mandibular angle, deep medial cheek fat pad, piriform fossa, superficial medial cheek fat pad, mandibular ramus, volume and contour, and the chin.
This comprehensive approach allowed for targeted enhancement while respecting Noah’s unique facial structure and aesthetic goals. The use of various injection methods and filler types ensured optimal tissue support and naturallooking results.
Throughout the treatment process, open communication and collaboration were prioritized, allowing Noah to actively participate in the decisionmaking process and express any concerns or preferences. As a result, we achieved a harmonious balance between aesthetic enhancement and individual expression, empowering Noah to embrace his authentic self with confidence.
By sharing Noah’s case, I aim to highlight the importance of personalized treatment approaches and inclusive care practices in aesthetic medicine. Through continued education and awareness, we can foster safe and affirming spaces for individuals of all gender identities, promoting holistic well-being and self-expression.
Clinical Data Support
While research specific to facial harmonization in transgender and gender diverse patients is limited, existing evidence underscores the transformative impact of aesthetic interventions on individuals’ well-being and self-affirmation. By advocating for comprehensive, patient-centered care, we can achieve natural and harmonious results through a preventive way of aging.
Conclusion
In embracing diversity and championing the principles of safety, dignity, and respect, we have an opportunity to redefine aesthetic medicine for the 21st century. By elevating the voices and experiences of gender diverse individuals, we honor their inherent dignity and reaffirm our commitment to compassionate, inclusive care.
In a constantly-evolving world, inclusion of diversity is imperative in all aspects of our lives, including aesthetic medicine. If you share my vision of promoting safe spaces for all people in the world, I invite you to join me in this important mission. If you are interested in exploring collaboration opportunities, do not hesitate to contact me.
Reference:
Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgender Health [Internet]. 2022;23(sup1):S1–259. Available from: https://doi.org/10.1080/26895269.2022.2100644
About the Author
Criss Andres Vargas, DDS
Dr. Criss is a dental surgeon based in Chile, specializing in Orofacial Aesthetics. As an LGBTQIANB+ advocate he is passionate about inclusive healthcare for all, and he is dedicated to fostering safe and affirming spaces within the aesthetic medicine community. Through research, education and advocacy efforts, he strives to empower individuals of all gender identities to embrace their unique beauty and reclaim agency over their aesthetic journey.
