Abstract
BACKGROUND: Facial feminization surgery has become a key component of the male-to-female transition. OBJECTIVES: The authors of this study aim 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 cis-male and cis-female facial photographs from the following ethnicities: Black, Asian, Oceanic, South Asian, and Caucasian. Faces were divided into 11 unique components and were thus rated on a scale from 1 (most masculine) to 11 (most feminine). RESULTS: A total of 2566 respondents completed the survey instruments. Respondents identified the lips as the most feminine facial feature (range, 7.98-9.41, P < .0001). Female respondents found the lips to be the most feminine feature of all faces except those of the Black female and Caucasian male, in which the eyes were rated as the most feminine (8.09, 8.20, P < .0001). The most masculine facial features were the mandibular angle (4.67), laryngeal prominence (4.81), chin (4.94), and hairline (5.17), whereas the most feminine features were the lips (8.50), eyes (7.84), orbits (6.74), and cheeks (6.73), which were all statistically significant (P < .05). CONCLUSIONS: The authors of this study provide valuable insight into the public's perception of inherently masculine and feminine facial features across ethnicity and gender.