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Playing The Gender Card

Top facial plastic surgeon reflects on role of gender in anti-aging surgery.
With Jeffrey Spiegel, MD


Boston facial plastic surgeon Jeffrey Spiegel, MD performed his first facial feminization surgery in 1995, and as his experience with this patient population grew, it changed the way he approached aging-face surgery in ways he could not have imagined. As women get older they look more masculine, so anti-aging facial surgery is really just another name for facial feminization. Today his approach with aging face patients is to identify and correct features that are not considered gender confirming or gender enhancing.

Dr. Spiegel, a Full Professor and the Chief of Facial Plastic and Reconstructive Surgery at the Boston University School of Medicine, sat down with Modern Aesthetics® to constructively dissect seven famous faces, and point out what is gender confirming, what isn’t, and why. (He has not treated any of these individuals.)

Lisa Rinna

Soap star-turned-reality-TV-housewife and entrepreneur

“For her, what’s feminine and stands out is her cheeks. She has a beautiful cheek that transitions from her lower eyelid. The right cheek comes out of her lower eyelashes. This is a very feminine feature. She is known for very full lips, but her upper lip is long and that is masculinizing. She could use a lip lift and to ease up on the lip fillers for a more feminine look. Her medial eyebrow is beginning to droop, possibly due to an over-aggressive use of neuromodulators, and this is a masculine trait.”

Renee Zellweger

Academy Award-winning actress

“She has very feminine full cheeks that come out anteriorly. She always had small eyes, which are technically a masculine feature, but for her, it is a trademark. A brow lift may have been better than a blepharoplasty as this would lift her eyebrow and arch it slightly, which may have preserved her trademark eyes in a less dramatic fashion.”

Madonna

Iconic singer

“Her eyebrow position is perfect, her forehead is nice and smooth, but her chin is very square, which is a bit of a masculine feature. We could do an intraoral mandible contouring procedure to reshape the bone and feminize her jaw. Her cheeks are full, which is very feminine, but she has a bit of a high hairline, which appears masculizing.”

Kenny Rogers

Country music icon (with wife)

“His cheeks were hollow and then they were filled in. This is good for aging but men must be very careful about how fillers are used. Overdoing it can make them appear feminine. His eyebrow is located beneath his glabella ridge and this is very masculine. He has a nice square jaw, but someone injected fillers into his pre-jowl sulcus, which has made his jaw too wide.”

Barry Manilow

Singer/Songwriter

“He has very feminine cheeks and a curiously hairless face. His upper lip is short and resembles that of an older woman. If you showed someone a photo of his mouth, they would likely think it belonged to a woman.”

Caitlyn Jenner

Olympic Athlete/Reality TV star formerly known as Bruce

“She has no visible Adam’s apple and a very feminine curve to her nose. What is masculine — her temporal hollowing is concave and needs filler or fat. All in all, her facial feminization surgery was extremely well done.”

Halle Berry

Academy Award-winning actress

“Her lower eyelid goes right into her cheeks, and her eyebrow has a nice arch. Her lips are possibly a little long, but her chin and jaw look nice. The peak of her cheeks is a little low. I’d like to see the highest point of her cheek be a little higher. Her skin is great.”