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Non-Binary Body Contouring

A gender-affirming body contouring procedure is the surgical process of removing or re-contouring body fat to alleviate feelings of gender dysphoria or discomfort between a person’s assigned gender and the gender with which they identify. These procedures hopefully reduce how often a non-binary person will be misgendered. Much like non-binary top surgery, body contouring specific to non-binary appearing results is seldom discussed but is a viable option for those who are interested in obtaining a gender-neutral appearing body.

It’s important to note that when someone is non-binary, genderqueer, or gender-expansive, their body is by definition also non-binary (with or without medical intervention such as hormones or surgery). For folks who feel that their body shape doesn’t align or reflect their non-binary gender identity, this content will be helpful in determining what your options are.

Content note, body shapes: Although the following images and descriptions attempt to describe average or typical body shapes, the human body has many variations that extend beyond this set of parameters. This information is intended to shed light on how people assign gender to others based on body shapes. It is likely that someone’s body shape might look different than these images based on what type of puberty they went through, among a variety of other factors. 

To understand what could be viewed as a “gender-neutral body shape” (appearing neither exclusively masculine nor exclusively feminine) we’ll first define:

• What is traditionally considered a binary appearing female body and male body
• The pubertal period the body undergoes that determines those ‘male’ and ‘female’ characteristics
• What a masculinizing body contouring procedure is & how that could be different from a gender-neutral/non-binary procedure 

Puberty-Determined-Fat Distribution

• If you were assigned female at birth and went through a full estrogenic pubertal period uninhibited by hormone blockers or hormone replacement therapy, your body is likely accustomed to storing fat around the hips, buttocks, and thighs due to your estrogen levels (see figure A and D compared to B and E). This type of fat storage is what can make a body look or feel curvier, which could cause discomfort for someone who identifies as non-binary or trans masculine.
• Since hormone levels affect how fat is metabolized and carried, testosterone can help redistribute fat from the hips, buttocks, and thighs more towards the abdomen and flanks, resulting in a less feminine appearance.
• Although the redistribution of fat can occur while on hormone replacement therapy, its effects are limited and generally don’t result in a drastic change in body shape.

Puberty-Bone Development/Structure

• The pubertal development you undergo (whether estrogenic or androgenic) determines the bone structure you’ll have as an adult. For folks who underwent estrogenic puberty, they will have wider hips (figure A) compared to those who had an androgenic development (figure B).
• When body contouring is performed the surgeon can’t alter the bony framework of your body, but can alter subcutaneous fat over the bony structure of your body.
• In order to optimize the effectiveness of the body contouring procedure it’s recommended (but not required) that a patient is on hormones for at least 1 year so some natural fat distribution can occur first.

Waist-To-Hip-Ratio

Waist-To-Hip-Ratio (WHR) is the dimensionless ratio of the circumference of the waist to that of the hips. This is calculated as waist measurement divided by hip measurement (W ÷ H) and it can tell you your fat deposition. The WHR for those who went through estrogenic puberty is usually between 0.65-0.80, whereas those who went through an androgenic development are usually 0.85-0.95. Depending on the amount of time since puberty and the amount of fat they deposited, the amount that soft tissue characteristics can be changed varies. You can learn more about Wait-to-Hip Ratios here.

• If someone wants a masculine appearing body the surgeon would aim for a WHR of 0.85-0.95.
• If someone wants a feminine appearing body the surgeon aims for a WHR of 0.70.
• If someone wants a gender-neutral appearing body the surgeon aims for a WHR of 0.70 to 0.85. 

Traditionally Masculine Bodies 

Since the patients Dr. Mosser has treated for gender-affirming non-binary body contouring procedure mostly identify on the transmasculine spectrum we’ll cover traditional ‘masculine’ forms, and then move onto what could be considered more gender-neutral appearing and find a balance between the two.

Someone who underwent a full androgenic pubertal period (assigned male at birth) will usually have the following characteristics that result in masculine body shape and are distinctly different than those who went through an estrogenic pubertal period.

• 10% less body fat with fat deposition along the abdomen and flanks
• Narrow pelvic brims
• Gluteal form has a flatness/concavity

A masculinizing body contouring procedure aims to remove some of the more ‘feminine’ appearing characteristics by:

• Altering the waistline through liposuction, which can have a significant positive improvement in the fit of masculine clothing.
• Removing the fullness of the gluteal region to give the traditional concavity or ‘flat’ appearing gluteal form.
• Obtaining a WHR of 0.85-0.95.

Non-Binary Body Shape

When thinking about manipulating the aesthetics of gender, there are a few areas in which body fat will be removed or reduced in the following areas that can create a more non-binary appearance:

• Thighs (inner and outer)
• Hips/flanks
• Abdomen

In addition, when thinking about non-binary body contouring, special attention must be paid to the buttocks region. In the image below, we see the body of a person who underwent estrogenic puberty on the left, and an androgenic puberty on the right.
If a non-binary person desires a more feminine body shape, we can do fat grafting and liposuction to create more of the “S-curve” shape that we see on the left. Conversely, if the patient desires a more masculine body shape, we can work to create a more boxy body silhouette that looks more like the image on the right. Because the skeletal structures are limiting to this procedure, when doing non-binary gender-affirming body contouring, we work with every individual to design a plan that works for them. We also take into account the extent to which the patient’s final gender form will be expressed, meaning we will discuss the ideals and expectations of non-binary body contouring at length.

Overall, when thinking about non-binary body contouring, our goal is to work towards eliminating characteristics that are overly masculine or overly feminine, depending on the goals of the patient. 

In Summary

• Non-binary body contouring can be a helpful procedure for folks who desire a more gender-neutral body shape. 
• There is a natural and wide variety of body shapes that exist, and non-binary body contouring seeks to get rid of overly masculine or overly feminine characteristics.
• While skeletal structures are a limiting factor, body fat can be removed or shifted via liposuction to create a body shape that affirms your unique gender goals.
• Because everyone’s body is different and every one has distinctive goals, we recommend consulting with our staff to discuss which procedures are right for you.