In this review article the author outlines the various elements of this subspecialty, with reference to published literature and his own clinical experience in the field. The article does not present new data, and lacks the detail necessary to appeal to those already practising in this area, or even for trainees wishing to enter the field. It does, however, provide a summary overview for those with a more general practice. The article reviews the origins of gender affirmation surgery in interwar Germany, and the development of the facial subspecialty by Ousterhout, with whom the author trained. There follow subsections on the hairline, forehead, rhinoplasty, upper lip, jaw and thyroid cartilage. Generalisations are drawn regarding gender-specific facial characteristics, based on clinical practice, but also study of the extensive collection of the Atkinson Skull Library of San Francisco. In their practice of forehead procedures, the majority of trans female patients require the frontal sinus to be addressed, and only in a small proportion is supra-brow augmentation or simple burring an option. The authors give their four point classification to guide preoperative planning. The remaining sections are tantalisingly brief (lip), lacking in detail (thyroid) or sketches (rhinoplasty / chin) based on the more familiar principles of plastic / maxillofacial surgery. Overall, this is interesting background reading for the generalist but a bit thin on detail.