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Sara's Solutions
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Introduction
As a pre-dental student (and TS) I thought I might be able to add my two cents to the internet resources on surgery for transsexual women.
The Problem
Males have wider mouths than females. Horizontally, the male mouth has about 10 to 15 mm more length from left to right. This is one of the greatest differences in the faces of the sexes. Most TS women have this larger mouth, even the most feminine-looking and even after hormones and FFS

The Reason
As anyone familiar with facial feminization surgery (FFS) is aware, the male jaws are wider and the chin blunter, but thats not the end of the story. The jaws' function is to support the teeth, which are also different in the male. The teeth are arranged like a horse shoe. As you would expect, the male horse shoe is wider (from a frontal view), just like the jaws. You can think of the female teeth as a 'U' shape, and the male's as a 'C'.
Here are two suggestions that might help -
The Solution
a. Makeup. Apply lipstick, not extended to the corners of your mouth. Try to leave off half a centimeter at each side, or as much as you can get away with. To go a step further, extend the color up past the lip line, to make the mouth appear smaller in relation to the lip size. To go even further, cover the corners of your mouth with foundation.

b. Tooth arch reduction. I NO LONGER RECOMMEND THIS PROCEDURE FOR ANY TS WHO IS OVER AGE 18 AND NO LONGER GROWING. I'm not sure that it actually shrinks mouth size - I now think it just takes away the necessity for the mouth to continue growing in patients who have not reached physical maturity.

Other related procedures I recommend are (in order of importance) jaw reduction, chin reduction, maxillary bone shortening (the bone holding your upper teeth). Aside from these, most transsexual women would also benefit from an alar base reduction of the nose, a rhinoplasty procedure in which the nose is made thinner, to simulate the thinner female nose. (This is just as important as the more typical TS rhinoplasty procedure, reduction of the profile - actually more important, but less well-known). The underlying bones can also be brought in and sutured together to make the nose thinner as well.

Background Info
A bit of background information - Premolar extraction began in the 1970s as a technique to make space in the mouth for the alignment of overcrowded teeth. But a few years later, the patient s faces were observed to have drastically changed: they had much smaller mouths and flatter oral profiles. The result was a feminine look in male patients and a "baby face" in female patients. This is bad news for those poor 70s children, but good news for the transsexual community! About half of orthodontists today refuse to have anything to do with premolar extraction, and there is still much controversy over the procedure.
Another thing they noticed was that less white showed in the patients' smiles, because their canines and molars had been moved inward. This problem should be solved by removing the SECOND premolars, instead of the first, as was done in the 70s.

Conclusion
If you want to solve a problem, the best approach is a scientific one. This is a solution based not on wives tales or fashion books, but on an observation of a male/female facial difference and a subsequent analysis of the human skull. This solution is not easy, but its easier than most TS procedures, and is nonetheless a legitimate one.
I ve searched the net for before and after pics of extractees, but alas have found only studies. If you would like to see or talk to someone who has done it, ask around in your community. Either they ll look at you like you re crazy or they ll say "you know, I think my cousin had hers taken out in the 70s". Its a long shot, but it s the only thing I can think of. On the other hand, to verify the difference in male/female mouth sizes, just start observing peoples mouths. And look at some TS and CD photos on the web. You ll see for yourself that mouth size is one feature making them stand out.
On one hand, its not for everyone, and it only makes a couple of centimeters difference, but on the other hand every little bit helps. Most people can't exactly say what differentiates male and female appearances but they know one when they see one. Its just one more subtle step towards an overall feminine appearance. Not a huge firecracker step like SRS. I have 19 pics under the "photo page" links to illustrate various ideas in this essay.
Email me if you have questions, feedback, or just to chat :)
By the way Im in Atlanta, if there are any other bored TSes around.
Sara Randall


the wonderful Ms. Carol Burnett (doesn't show her profile, but just to remind you who she is).
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