When Caitlyn Jenner shared her story of transition from male to female she put the transgender community in the spotlight. She also focused attention on a specific surgery, known as facial feminization.

Have you ever thought about what makes a face feminine? I’m not talking lipstick here, but something deeper.

According to one of the surgeons who pioneered facial feminization surgery, what makes a face feminine and beautiful is easy to generalize, much harder to pin down.

Sixteen years ago a transgender woman came to Dr. Jeffrey Spiegel and asked for help. She wanted to look more feminine.

“I went to the medical literature and looked up what procedures exist to do this,” he says, “And there was nothing.”

So, Spiegel improvised, and the woman liked it.

“I was happy that she was happy and I thought that was the end, but then she told someone and she told someone and she told someone, and pretty soon it became a very busy part of my practice.”

In a one-week period in September, Spiegel operated on people from four states and three countries. Their pilgrimage to his Boston office is noteworthy because what they’re seeking – some piece of femininity – is a bit elusive. Spiegel says what makes a face feminine and beautiful is easy to generalize, hard to pin down.

“It ends up being very deep things,” he says. “It ends up being the bones. We hear beauty is only skin deep, it’s not. It has to do a lot with the bones. When we change the face, I need to change the bones. And then the skin is almost like clothing. If a woman puts on a man’s shirt it still looks like a woman, similarly if a man puts on women’s clothing it looks like a man in woman’s clothing. So the skin if it sits on the right way on the facial structures we start to get the right cues.”

Renee Baker

A photo of Renee Baker before facial feminization surgery in 2006.

Almost a decade ago, Renee Baker flew from Dallas to Boston to have Spiegel, as she puts it, take the masculine edge off her face. Baker, a licensed counselor who primarily works with gender and sexuality issues used savings from her former job as an engineer and pulled together $18,000 dollars.

“I guess my cheeks are just fuller, my face is rounder, the distance between my eyebrows and my hairline is about a half inch shorter cause they raise your brows and all that, so my eyes are a lot more open, and visible, I kind of like that part,” Baker says.

Her bright blue eyes are the same, but, everything else seems softer. Dr. Spiegel says there is no formula to sculpt a “feminine” nose or eye. You can’t just focus on one feature, you have to take into account the entire face. This is a technique the best artists and architects use. For example, the columns on the Parthenon in Greece aren’t actually perpendicular. But they appear to be because of optical illusions. Plastic surgeons too are creating illusions with light to make faces appear more feminine.

Renee Baker

A photo of Renee Baker after facial feminization surgery.

“One of the key differences between men’s and women’s faces and less attractive and more attractive faces is how light reflects off the face,” Spiegel says.

Our brains, he says, are processing shadows and reflections and that’s what we’re using to gauge femininity and attractiveness. He says women’s faces have a lot of light that bounces off the eyes and the mouth. Why?

“Women have larger cheekbones,” he says, “which acts like a solar reflector it bounces light into the eyes. They have small brows, which means there’s no visor shading the eyes. And, an import one is women have shorter upper lips, the upper part of the lip is longer in a man, therefore you get less light bouncing off your teeth.”

Spiegel says more surgeons are learning the tricks used in facial feminization surgery.

Not everyone can afford this type of surgery, and, not Renee Baker says, not every transgender woman wants it.

“The majority of my clients just want to have their hormones adjusted. It’s about getting the hormones right and getting their gender expression to line up with who they feel like their gender identities are.”

For her, facial feminization was part of a larger journey. One that involved soul searching, hormones, and a scalpel.