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The apple of the cheeks (fleshy part) tends to be fuller and rounder in females than males because it contains more fat – masculine cheeks are often quite hollow. Hormones will add fat to the apple and in many cases trans women who are on hormones don’t need any additional help here.

The cheek bones themselves tend to be a somewhat heavier in males, but this is not really visible from the outside so it’s not a significant gender sign.

The width of the cheeks is also about the same in men and women when compared to the distance between the eyes.

Surgical Options:

1. Fat Transfer:
If the apple of the cheeks needs to be fuller and more rounded you can have fat from another part of the body injected into the area. This is called a “fat transfer” or sometimes a “fat graft”. Using your own fat means that there is no risk of rejection or allergic reaction. However, there is some unpredictability involved with fat transfers because some of the fat is reabsorbed by the body. The amount that remains varies from person to person and is quite unpredictable – it can be anywhere from about 30% to about 80%. So the surgeon will usually put in a little more than you need at first and will then top up as necessary a few months later. That way, you gradually build up the permanent layer until what remains is the amount you need.

2. Solid Implants:
Solid implants are used to enhance the cheekbone, or to add fullness to the cheeks. They are available in several shapes and can be placed over or under the cheekbone or lower down near the sides of the nose according to the needs of the patient. However, they can look unnatural if the implants are too big, and it is sometimes possible to see the outline of them under the skin if you don’t have enough fat in your cheeks to hide the outline of the implants. This can look unnatural and quite strange. The incisions for cheek implants are made inside the mouth.