There are significant differences in facial bone structure between males and females. That is why it takes a group of procedures to “feminize” a face for a transgender women. After thorough discussion with the patient, we decided to start with areas of most masculine and concerned including the hairline, forehead, cheek bones, lower jaw and the chin, leaving the Adam’s apple reduction and rhinoplasty to the next stage. For the forehead, we changed the M-shaped hairline to an oval pattern, contoured and reduced the prominent supra-orbital ridge, augment the sloped forehead into round and convex one with custom-made implant. For the cheek bones, the goal was to create a more  slender and smooth midface contour which is considered attractive and feminine. For the lower jaw, it is usually beneficial to alter the masculine square, sharp and prominent lower jaw angle into a more oval, soft and less prominent jaw line. In our team, the osteotomy (bone cutting) had been routinely performed using 3-D printed surgical guides with optimal accuracy and safety.