Plastic surgeon Dr. Jeffrey Spiegel has specialized in facial feminization for female transgender patients for approximately 15 years. Spiegel said he sees approximately 20 people a week for procedures to help them “pass” – he first started when a patient came in 15 years ago to ask him to help her look more feminine. We talked to Spiegel about what he procedures he thinks Bruce Jenner has gotten and the most common surgeries he performs on transgender patients. 

Bruce Jenner has made headlines lately since he announced that he is a transgender woman – there’s been a lot of speculation about the procedures he’s had. What do you think?

That’s a tough question because I haven’t seen any great photographs – a lot of them are grainy or taken from far away. By reports, the Adam’s apple has been changed, there’s been some anti-aging surgery and I think People Magazine said there may have been a forehead surgery done. That’s the most powerful surgery – I won an award for this technique five years ago. 

What’s the forehead procedure?

What’s the most important area of a person’s face that makes them feminine?

The jaw? 

It turns out it’s the eyebrows and the bone underneath the eyebrows. Jaw comes in second. Most men have a ridge of bone under their eyebrows on the lower half of their forehead that juts out. This is the area that our brains subconsciously look at to determine if we’re seeing a man and a woman. I reconstruct the skull to make the forehead look like a woman’s forehead and skull.

We can change that forehead bone and all of a sudden these patients become beautiful women. I also change the hairline from a man’s hairline to a woman’s hairline. Women’s hairlines tend to be lower, whereas men tend to lose their hair in the sides and corners of the forehead. That’s another procedure I do for women who say their hairline is too high. 

What are some other common procedures in the trans women’s community?

Adjusting the jaw and chin. That’s very popular in Korea and China and in Boston, I probably do that more than in any of those countries because I do it for trans and non-trans women. Narrowing and shaping the chin and jaw are considered very feminine and very attractive.

How many procedures does it typically take to achieve total facial feminization for most patients?

It depends on their age. The older you are, the more procedures you’re going to need. All people, men and women, look more masculine with time. The typical patient has her scalp adjusted, forehead bone contoured, brow lift, nose shaped, upper lip lifted, would have her chin and jaw shaped, Adam’s apple reduced in size and would have cheek implants. As people get older you might add to that to look younger, like an eyelid lift or facelift.

What’s the maintenance like for these procedures?

It is absolutely the same as for any other woman. All women start to look more masculine as time passes. Once I’ve done the surgery, you have the same woman’s face as any other woman. I’ve changed the structure from the bone, but time doesn’t stop, so you need to take care of yourself and stay out of the sun and fight wrinkles. It’s about taking care of dark patches and keeping your face fresh and young. If you want to continue to look young and your best, it’s a constant fight for your whole life.