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Facial Feminization Surgery » Procedures

Lower Jaw Contouring

For many transgender women and nonbinary individuals, achieving a more feminine facial profile can be an essential part of gender affirmation. One of the most gender-signaling areas of the face is the lower jaw. Lower jaw contouring, also known as mandibular contouring or jaw recontouring, is a common and powerful procedure in Facial Feminization Surgery (FFS). It softens and narrows the masculine jawline to bring the lower third of the face into alignment with a traditionally feminine aesthetic.

A square, wide jaw with sharp angles is one of the hallmark features of a masculine face. In contrast, feminine faces tend to have a more delicate, tapered jawline with softer angles and a narrower chin. Lower jaw contouring reshapes this area by reducing bone bulk at the corners of the jaw (mandibular angles) and often reshaping the chin through a technique called sliding genioplasty.

For those whose jaw is dominated by bulky masseter muscles (the chewing muscles at the back of the jaw), additional contouring may involve masseter reduction, either through surgery or non-surgical treatments like Botox.

Dr. Thomas SatterwhiteSurgical Expertise: Dr. Thomas Satterwhite

This procedure requires extraordinary surgical precision, and few surgeons are as experienced in facial gender-affirming surgery as Dr. Thomas Satterwhite, co-author of the 2019 journal article on lower jaw contouring. Dr. Satterwhite has been a pioneering voice in the field, combining advanced craniofacial techniques with an affirming, patient-centered approach to gender care.

The Surgical Process: What to Expect

Preoperative Planning

  • A detailed facial evaluation, sometimes including X-rays or CT scans, is performed to assess bone structure and bite alignment. Many surgeons now use virtual surgical planning (VSP), a digital 3D modeling technique that allows the surgical team to simulate the procedure in advance. This technology helps determine the precise amount of bone to remove or reshape, visualize soft tissue outcomes, and ensure the final result is balanced and symmetrical. VSP is especially useful when combining jaw recontouring with other facial procedures.
  • A dental check-up is essential to ensure no infections or impacted teeth are present that could complicate healing.
  • Hormone therapy for at least a year to allow soft tissue changes that complement the surgery is suggested but not required.
  • Mental health support can help define realistic goals and expectations.

The Procedure

  • General anesthesia is used.
  • Incisions are made inside the mouth, along the lower gumline, to minimize visible scarring.
  • The surgeon carefully exposes the lower jawbone and uses specialized drills and saws to reshape the bone, curving it down from back to front to achieve a smoother, more rounded contour.
  • Surgical drains may be placed to minimize swelling and prevent fluid collection.
In this video, Dr. Jens Berli discusses lower jaw surgical techniques. Please note: The video contains graphic surgical content.

Healing and Recovery

  • You may stay in the hospital overnight for monitoring, especially if jaw contouring is part of a larger FFS package.
  • Swelling and bruising are expected, especially around the cheeks and lower face.
  • Numbness of the lower lip and chin is common due to nerve proximity but usually improves within weeks.
  • A soft diet is recommended for 4 weeks.
  • Antibiotics and antiseptic mouth rinses help prevent infection.
  • Most people return to daily activities within one to two weeks, though full healing takes several months.

Those aged 40 and over may notice looser skin around the jawline following surgery. This can sometimes be addressed with a lower face-lift or neck lift in a later procedure.

Risks to Consider

While serious complications are rare, it’s important to be informed of potential complications:

  • Nerve injury (mental or inferior alveolar) can cause temporary or permanent numbness.
  • Infection is uncommon but possible—especially if oral hygiene isn’t maintained.
  • Over-resection of bone or asymmetry can occur without careful preoperative planning.
  • Facial muscle or temporomandibular joint (TMJ) damage may affect mouth movement or jaw function.
  • Improper bone healing is rare but more likely in patients with poor dental health or those who smoke.

The use of intraoral incisions by experienced surgeons like Dr. Satterwhite minimizes many of these risks, especially injury to facial nerves.

Questions to Ask During Your Consultation

Bringing the right questions to your consultation can help you feel confident in your decision-making. Here are a few to consider:

  • How many jaw contouring procedures have you performed, and what are your complication rates?
  • How much jawbone will be reduced, and how will this affect my facial balance?
  • Will I need a sliding genioplasty or masseter muscle reduction as well?
  • Can I see before-and-after photos of patients with similar facial structures?
  • How do you minimize the risk of nerve damage or asymmetry?
  • What’s your protocol for managing swelling, drains, and infection prevention?
  • Will I need a follow-up procedure like a lower face-lift if I have loose skin post-op?
  • What outcomes do your patients typically report, especially in terms of confidence and gender congruence?

Lower jaw contouring can have a profound impact on how your face is perceived. It’s often done in combination with other FFS procedures for a fully harmonious result. Because the lower jaw is such a complex anatomical structure, it’s critical to work with a surgeon who has specialized craniofacial training and experience. This ensures not only aesthetic success, but also the preservation of important functions like bite alignment, nerve health, and muscle integrity.

 

Last updated: 06/17/25