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Coming & Going

By: Miles Graivier, MD


Facial Feminization Surgery

Unless you have been “Off the Grid” for the past year, it would be impossible to have missed the Caitlyn Jenner story documenting former Olympic Decathalon champion Bruce Jenner’s transition from male to female. From the cover of Vanity Fair in June (Caitlyn did look good), to her new reality show “I am Cait,” Jenner has helped Facial Feminization Surgery (FFS) become more mainstream and sought after.

FFS procedures involve soft tissue and bony surgery of the face and neck as well as thyroid cartilage (Adam’s apple) reduction. Facial hair removal as well as hair transplants and hairline changing surgery can also be part of FFS. These procedures can provide major or subtle changes to better emulate feminine facial features. These can include:

1) Hairline lowering if the hairline is too high and receding at temples; 2) Forehead contouring with removal of brow bossing and possible addition to central forehead area to make a more vertical, rounded forehead with a fairly flat front; 3) Eyebrow elevation with more arching and placement of brows ~ 1 cm above orbital rim as opposed to on the orbital rim; 4) Feminizing Rhinoplasty; 5) Cheek enhancement with fillers, fat, or implants to elevate, fill, and project more anteriorly; 6) Plump and sometimes shorten upper lip length with bullhorn type lip elevation, filler, fat, or implant to increase lip fullness and accentuate corner of lip elements and cupids bow; 7) Chin reduction if it is too wide, square, or long; 8) Angle of Jaw and masseter reduction can be achieved by burring of angle of mandible and by injection of neurotoxins if masseters too large; 9) Adam’s apple shaving or camouflage; 10) And, of course, blepharoplasty and facelift for that added “ Caitlyn” effect.

Any or all of these procedures may be requested, and with the popularity of Caitlyn Jenner, it’s fair to say that more FFS is on its way.


Armpit Sweat

More and more, people are looking for ways to eliminate or lessen underarm sweat and odor. The options for elimination of sweat and odor are improving. Injectable neurotoxins have been a mainstay in temporary reduction. A topical gel formulation of Botulinum toxin A, RT001 (Revance Therapeutics) is expected to start a Phase 2 FDA trial for moderate to severe axillary sweating in the second half of 2015.

Other methods gaining popularity are mechanically based technologies based on destruction of the axillary eccrine and apocrine sweat glands. These technologies include laser assisted destruction (Cynosure Precision), Radiofrequency (ThermiTight, Invasix BodyTyte), and microwave (miraDry). Most of these devices require one or two treatments done under local anesthesia and raise the temperature of the dermal-fat interface to 60-65° C to destroy these sweat glands. MiraDry may even yield some hair reduction.

Armpit sweat, odor, and maybe hair… Not bad things to see “going.”