American Association of Plastic Surgeons

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Defining Femininity: Crowdsourced Insights On Gendered Facial Features Across Ethnicities
Ishan Patel, BS1, Gabriella Glassman, MD2, Anjali Om, MD2, Daniel J. Gould, MD, PhD3, Daniel Cuzzone, MD2, Orr Shauly, MD2.
1Albany Medical College, Albany, NY, USA, 2Emory University, Atlanta, GA, USA, 3Private Practice, Los Angeles, CA, USA.

Purpose: Facial feminization surgery has become a key component of the male to female transition. This study aims to determine which facial features are viewed as most masculine or feminine across biological sex and ethnicity.
Methods: Four web-based survey instruments were used, displaying an image set of artificial intelligence-generated facial-photo of a cis-man and a cis-woman of varying ethnicities. Each survey evaluated the masculinity/femininity of specific facial components. Respondents voluntarily completed online consent forms and were randomly directed to one of the four survey instruments.
Results: A total of 2,566 respondents completed the survey instruments. There was no significant difference in the ethnicity, gender, or socioeconomic status of respondents across each of the surveys. Respondents identified the lips as the most feminine facial feature (7.98-9.41, p<0.0001). Female respondents found the lips to be the most feminine feature of all faces except those of the Black female and White male, where the eyes were rated as most feminine (8.09, 8.20, p<0.0001). Overall, the most masculine facial features were the mandibular angle (4.67), laryngeal prominence (4.81), chin (4.94), hairline (5.17), and forehead (5.35), while the most feminine features were the lips (8.50), eyes (7.84), orbits (6.74), cheeks (6.73), and nose (5.84), which were all statistically significant (p<0.05).
Conclusion: This study provides valuable insight into the public’s perception of inherently masculine and feminine facial features across ethnicity and gender. Surgeons can use these findings to enhance patient satisfaction and use a patient-centric approach in the deliberation of a surgical plan.
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