Transforming Gender-Affirming Surgery: Dr. Okyay's Pioneering Approach to Upper Face Feminization at the 47th Turkish Congress
Dr. Mehmet Fatih Okyay’s insights on Upper Face Feminization highlight a breakthrough moment in gender-affirming care, offering patients more personalized and precise procedures.
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Nov 23, 2025
NATIONWIDE - NOVEMBER 2025 - (USAnews.com) In the heart of the 47th National Turkish Congress of Plastic Surgery, a groundbreaking shift in gender-affirming surgery (GAS) took place. The spotlight was on Dr. Mehmet Fatih Okyay, a renowned expert in transgender surgical care, whose comprehensive presentation on Upper Face Feminization (UFF) captivated an international audience of over 800 plastic surgeons. The detailed analysis Dr. Okyay presented underscored a critical evolution in the field, moving beyond broad, generalized surgical approaches to a more meticulous and personalized methodology aimed at achieving both anatomical and psychological congruence for transgender individuals.
With an audience representing the largest international turnout in the Congress’s history, Dr. Okyay’s talk marked a significant moment in the evolution of GAS, as it demonstrated how the field is moving toward achieving more natural, effective, and emotionally resonant surgical outcomes. His insights emphasized the role of highly specialized procedures in transforming not just appearance, but identity, a shift that elevates transgender healthcare to a new level of precision and compassion.
The Historical Landscape of Gender-Affirming Surgery
The evolution of gender-affirming surgery has been transformative, marked by distinct phases of medical progress and societal change. Early gender-affirming surgeries, primarily focused on genital reconstruction, aimed at providing functional alignment between the patient’s anatomy and gender identity. While these surgeries were revolutionary, they often lacked attention to the finer details that contribute to a person’s social perception and psychological well-being.
By the early 2000s, however, as societal awareness of gender identity expanded, so too did the understanding of gender dysphoria, particularly the profound impact of facial appearance. Research revealed that the face is the most significant element in gender perception, and misalignment between one’s gender identity and facial features was often a significant source of distress. This understanding sparked the development of Facial Feminization Surgery (FFS), a multidisciplinary approach that includes a range of procedures aimed at feminizing facial features to better align with the patient’s gender identity.
Dr. Okyay’s role in this evolution cannot be understated. Having previously contributed to the broader conversation at the 46th National Congress in 2024, where he spoke about “International Transgender Patient Management,” Dr. Okyay has continuously paved the way for more nuanced and compassionate transgender healthcare. His return to the Congress in 2025, with a deeper dive into Upper Face Feminization, signals not only an evolution in the medical community’s approach to transgender care but also a reflection of a broader, more inclusive shift toward advanced, individualized surgical care.
Upper Face Feminization: A Comprehensive Approach to Transformation
Dr. Okyay’s presentation focused on Upper Face Feminization (UFF), a crucial subset of FFS that targets the upper third of the face. This area, as Dr. Okyay highlighted, is disproportionately responsible for shaping gender perception. With an ever-growing demand for more individualized and detailed gender-affirming procedures, UFF has become a critical component in achieving profound gender congruence for transgender patients.
A. Forehead and Brow Bone Reduction: Shaping the Foundation
The first area of focus in UFF is often the forehead and brow, as the brow bossing (or supraorbital ridge) is one of the most visible indicators of gender. Dr. Okyay described the various surgical techniques for brow bone reduction, noting that the Type III Cranioplasty (Forehead Reconstruction) is the most commonly used method for achieving the desired feminization effect.
This procedure involves cutting and remodeling the frontal sinus’s anterior wall to reduce the prominence of the brow ridge and create a smoother, more rounded forehead contour. According to Dr. Okyay, Type III Cranioplasty is required in over 75% of cases for patients seeking maximal feminization results. He stressed that successful outcomes depend on precision, making sure that osteotomy cuts are performed with care to maintain sinus integrity while achieving the desired aesthetic transformation.
B. Hairline Advancement and Temporal Management: Framing the Feminine Face
Hairline position is another critical element in UFF, with a typical male receding or M-shaped hairline being a key factor in a masculine appearance. Dr. Okyay discussed Hairline Advancement as an essential technique in UFF, explaining that advancing the hairline by 1.5 to 3 centimeters significantly shortens the vertical height of the forehead and is a crucial step in creating a more feminine face.
In addition to hairline advancement, Dr. Okyay addressed the importance of Temporal Bossing Reduction. This technique focuses on the lateral prominence of the temporal bones and ensures that the transition between the forehead and the rest of the cranium remains smooth and harmonious. Without this step, the face may appear overly narrow or "pinched." The balance of bone reduction and soft tissue redraping is essential to ensure natural, feminine contours.
C. Soft Tissue Dynamics: Brow Lift and Orbital Hooding
The final stage of UFF involves managing the soft tissue of the face to complement the bone structure. Dr. Okyay highlighted the importance of eyebrow positioning in gender perception. Male eyebrows typically rest lower and are less arched than female eyebrows, so elevating and reshaping the brow is a crucial step in feminizing the face.
Dr. Okyay’s approach to brow lift surgery involves using an Endoscopic Brow Lift technique, which minimizes scarring and allows for precise repositioning of the brow. He also discussed Orbital Hooding, the condition where excess skin or fat appears above the eyes, which can persist even after successful brow bone reduction. Combining bone surgery with soft tissue elevation ensures that the final result is both aesthetically pleasing and congruent with the patient’s gender identity.
The Evolving Landscape of Gender-Affirming Surgery
The discussions at the 47th National Turkish Congress and Dr. Okyay’s presentation reflect a broader shift in the approach to gender-affirming surgery. This transition from generalized procedures to highly personalized and precise surgeries marks a new chapter in the field of transgender healthcare. As the techniques become more sophisticated, patients can expect results that align more closely with their gender identity and self-perception.
Future Implications for Gender-Affirming Surgery
Looking ahead, the integration of technology into gender-affirming procedures will continue to drive innovation. The use of 3D imaging, AI-driven surgical planning, and predictive modeling will allow surgeons to create highly individualized plans for each patient, optimizing both aesthetic and functional outcomes. As these technologies become more widely adopted, the accessibility and affordability of procedures like Upper Face Feminization are expected to improve, making them available to more individuals who seek them.
Furthermore, as the field becomes more specialized, the importance of a holistic, interdisciplinary approach to gender-affirming care will become clearer. The need for collaboration between plastic surgeons, radiologists, and mental health professionals will ensure that patients receive not only the best possible surgical care but also the emotional and psychological support they need throughout their gender-affirming journey.
This momentous shift reflects not only technical advancements but also a more profound understanding of gender, identity, and self-expression. Through detailed, compassionate surgical care, the field is moving toward a future where transgender individuals can experience true anatomical congruence and emotional validation.
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