Where softness, harmony, and identity meet
The middle third of the face—your cheeks, nose, and upper lip—is where so much of facial “softness” lives. It’s also where proportion and balance can shift the entire feel of the face: the way light catches the cheekbones, the shape of the nose in profile, the distance between the nose and the upper lip, and the subtle contours that frame your smile.
At Evolve Your Life, we approach middle-third feminization with the same philosophy that guides everything we do: you deserve to feel good about how you look—and who you are. Led by Dr. Amir Dorafshar, a nationally recognized expert in craniofacial and gender-affirming surgery, our care combines deep anatomical expertise with artistry and empathy—so your results feel natural, authentic, and truly yours.
Middle third facial feminization includes surgical and non-surgical techniques to modify the bones and soft tissue of the midface—primarily the cheeks, nose, and upper lip. Depending on your needs, this may include cheek augmentation, rhinoplasty, lip enhancement, and/or fat grafting.
The goal isn’t to chase a trend or a “standard.” It’s to create contours that feel more aligned with your sense of self—while keeping your features balanced, expressive, and unmistakably you.
Middle third feminization is often part of a gender-affirming surgical plan for transgender feminine individuals who feel their midface carries more traditionally masculine characteristics and want their features to align with feminine contours. It can also support cisgender women who want refinement or rejuvenation of the midface.
If you’re unsure whether middle third procedures are “enough” on their own—or whether they should be combined with other areas—Dr. Dorafshar’s process is built around honesty, education, and a plan that makes sense for your face and your goals.
Dr. Dorafshar’s perspective is craniofacial at its core: the midface is structure + soft tissue + proportion. Understanding what creates width, projection, and transition is how we choose the right tools—without overdoing it.
Sits over the cheekbone and creates cheek fullness.
A deeper fat deposit in the lower cheek that can contribute to a fuller or heavier midface.
Contributes to the smile crease running from the side of the nose to the corner of the mouth.
There isn’t one “right” way to feminize the midface. Some patients want subtle softening. Others want more structural projection or a more lifted, youthful contour. Dr. Dorafshar helps you choose the approach that matches your anatomy and your comfort level—so your results stay natural over time.
Injectables (often called fillers) can replace or add volume to create cheek fullness and a more feminine midface contour. They may be performed with local anesthesia—or sometimes no anesthesia—depending on the area and the product.
Fillers can be placed in areas such as the cheeks, nose, nasolabial folds, lips, and temples, and they provide real-time feedback on the aesthetic outcome.
Considerations: fillers can carry risks such as asymmetry, nodularity, and swelling. The right injector and the right plan matter—especially when your goal is balanced feminization rather than “more volume.”
Malar augmentation focuses on increasing forward projection of the zygoma (cheekbone). This can create a more feminine and youthful midface by enhancing the convexity of the cheeks and improving the transition from under-eye to cheek.
Malar implants address a bony deficiency in cheek projection, creating the appearance of higher, fuller cheekbones.
Why some patients choose implants:
They do not change size or descend with weight fluctuations or aging in the same way soft tissue can.
Important considerations:
Silicone
Porous polyethylene (PPE)
PEEK (PolyEtherEtherKetone)
Intraoral approach (inside the mouth)
Advantage: no visible external scar
Considerations: infection risk (foreign body + intraoral environment), implant malposition, nerve injury, or an aesthetic outcome that doesn’t match goals
Transconjunctival approach (inside the lower eyelid)
Often considered when a patient is also undergoing lower eyelid surgery (e.g., blepharoplasty).
Advantage: lower risk of infection compared to intraoral placement (less intraoral contamination)
Considerations: conjunctival irritation/swelling or lower lid malposition (ectropion)
Fat grafting uses your own fat to enhance midface softness and projection. Fat may be harvested from areas such as the abdomen, thighs, flanks, and/or superior gluteal region, then transferred through a small incision to areas including:
Why patients like it: it can create a more convex, feminine midface appearance using your own tissue.
Considerations: some fat resorption is expected and may require staged/serial grafting; volume can fluctuate with weight changes.
Buccal fat reduction (buccal lipectomy) is performed through a small incision inside the mouth above the upper teeth. Dissection exposes the buccinator muscle, muscle fibers are separated, external pressure below the zygoma helps reveal the buccal fat, and the protruding portion is removed. The incision is closed with absorbable sutures.
Potential benefit: slimmer lower cheeks with more cheek definition.
Important considerations: over-resection can create a hollowed or prematurely aged look; there is also risk of injury to nearby structures such as the facial nerve or parotid duct.
This is one of those areas where restraint is a form of expertise—because “less” can be the most natural-looking feminization.
Zygoma repositioning/reduction is less common, but may be considered for patients with pronounced facial width.
A typical approach may involve:
Potential benefit: osteotomies are typically a more permanent solution with less likelihood of needing future revisions.
Considerations: contour irregularity, trismus (locked jaw), and a palpable step-off can occur.
Lip feminization—often called a lip lift—reduces the distance between the base of the nose and the upper lip to create a fuller, more feminine upper lip contour.
A classic technique uses a “bullhorn”-shaped incision at the base of the nose, removing approximately 5–7 mm of skin. The upper lip is then elevated and the incision is closed with absorbable sutures.
Why patients consider it:
Important considerations:
Feminization rhinoplasty reshapes the nose to create a softer, more traditionally feminine appearance—while still looking natural and proportional to your face. It can address concerns such as:
At Evolve Your Life, rhinoplasty is never about a “perfect nose” in isolation. It’s about harmony—a nose that fits your facial structure, supports confident self-recognition, and functions well for breathing.
You may consider feminization rhinoplasty if you want to:
A confident plan starts with understanding what the nose is made of—because rhinoplasty is both form and function.
The upper portion of the nose is bone. In masculine-pattern noses, these bones may be wider or create a noticeable dorsal hump. Feminization may involve reshaping to make the bridge narrower and smoother.
Below the bones, the nose is supported by cartilage (including the upper lateral cartilages), which also helps keep the airway open. Adjustments here can refine width and profile while preserving breathing.
The tip’s shape comes from the lower lateral cartilages and influences width, projection, and rotation. Masculine-pattern tips may appear broader or droop downward. Feminization often aims for a narrower, softer tip with gentle lift—without pushing it into an unnatural look.
The septum divides the nostrils and is made of cartilage in front and bone in back. A deviated septum can impact both appearance and breathing. Septoplasty can improve airflow and also provide cartilage that may be used to support the new shape.
The alar base frames the bottom of the nose. Wider, flared nostrils often read more masculine; narrowing can create a smaller, more balanced look relative to lips and cheeks.
Thinner skin shows definition more easily; thicker skin may hide subtle refinements. Soft tissue handling can help the underlying structure show through naturally.
Feminization rhinoplasty is about more than reshaping the nose—it’s about how the nose fits the face. Dr. Dorafshar evaluates proportions, angles, and balance so the result feels cohesive from every view.
The face is commonly divided into vertical thirds:
Masculine-pattern noses often have a straight or convex bridge with a dorsal hump. Feminine-pattern noses often have a smoother or slightly concave contour. Careful technique helps avoid an over-reduced “scooped” look.
A higher, more pronounced radix can make the nose look longer and stronger. A slightly lower, softer radix can create a gentler transition from forehead to nose.
This angle is measured where the underside of the nose meets the upper lip:
Masculine-pattern tips can look broader and less defined. Feminine tips are often narrower, more triangular, and lightly rotated upward. Cartilage strength and skin thickness help guide what’s achievable and stable over time.
Masculine-pattern noses may have a wider base with rounder nostrils. Feminine-pattern noses often have a narrower base and more oval nostril shape. Alar base reduction can refine width when appropriate.
From the front, these are the elegant lines running from the inner brows down the bridge to the tip. Feminine lines tend to be soft, smooth, slightly concave, and symmetric; masculine lines tend to look straighter and stronger.
A refined nose may appear too delicate if the chin or jawline is very strong. Some patients benefit from a combined plan for true facial harmony.
Feminization is never one-size-fits-all. Different ethnic backgrounds may naturally include a lower bridge, broader alae, or thicker skin. The goal is to enhance femininity while preserving identity—avoiding over-reduction and maintaining cultural authenticity.
A beautiful result should also breathe well. Evaluation may include septal deviation, valve collapse, or turbinate enlargement—issues that can often be addressed during surgery.
Every rhinoplasty plan is customized. Techniques may include:
Reshaping cartilage and bone to smooth or lower the bridge, creating a softer profile while preserving strength and avoiding an over-scooped look.
Controlled cuts in the nasal bones to narrow a wide bridge. Done precisely to avoid asymmetry or collapse.
Reshaping the lower lateral cartilages using sutures, trimming, or cartilage grafts to create a more delicate, defined tip—without over-narrowing that could affect breathing or look unnatural.
Adjusting the orientation of tip cartilages (sometimes using sutures or grafts) to lift a droopy tip and soften projection. Over-rotation is avoided.
Removing small wedges of tissue at the nostril edges/base to narrow flared nostrils, balanced carefully with lip and cheek proportions.
Straightening a deviated septum and reinforcing internal support structures (with grafts when needed) to improve airflow and reduce the risk of long-term collapse.
Cartilage may be used from the septum, ear, or rib to support structure and refinement, such as:
In thicker skin, conservative thinning/defatting under the tip may help refinements show more clearly—done carefully to avoid scarring or irregularities.
Middle third feminization is where artistry and anatomy have to meet—and where Dr. Dorafshar’s craniofacial background provides clear benefits. Whether we’re adjusting cheek projection, refining a lip contour, or rebuilding nasal structure for long-term stability, the goal is the same: natural results, honest planning and a face that feels like home.
A key part of our philosophy is respecting ethnic and individual identity. Not everyone wants the same changes—and we work to preserve the features that reflect your background and personality while enhancing femininity. Our focus is balance and harmony: results that look refined, breathe well, and blend seamlessly with the rest of your face.
Whether you’re considering cheek refinement, a lip lift, rhinoplasty, or a comprehensive plan, we’re here to listen and guide you with clarity, compassion, and craniofacial-level precision.
Dr. Amir Dorafshar is a board-certified plastic, aesthetic, and reconstructive surgeon, renowned worldwide for his pioneering work in aesthetic surgery, craniofacial and microsurgical reconstruction, facial gender-affirming surgeries, and computer-assisted surgical techniques.
With over three decades of professional experience, Dr. Dorafshar’s commitment to medical innovation and his passion for advancing surgical practices have established him as a leading expert, respected author, and authoritative figure in the field.
At Evolve Your Life, we’re committed to delivering a world-class experience through attentive, responsive, and compassionate care. How are we doing?
See what some of our patients have to say:
Kiersten Obermayer
Dr. Dorafshar is absolutely amazing. He truly cares about the results as well as the patient. He checked up on me multiple times through my recovery and my results are amazing already after 10 days! Can’t wait to see them when I’m fully healed!
Khyla Tatak
Talk about a great experience overall. Dr. Dorafshar made me feel at ease, answered all of my questions and set realistic expectations on recovery. Constantly checked in to make sure I was doing ok during the first week post surgery. His team set the bar high. I’m so incredibly happy with my results.
—Iliana Diana
At Evolve Your Life, we know how important it is to look in the mirror every day and see a reflection that feels like your own.
