• Home
• Body Contouring
• Non-Binary Body Contouring

Non-binary Gender-Affirming Body Contouring

Medically reviewed by Jennifer Richman on February 22, 2024.

This article is an introduction to the options for gender-affirming body contouring, also called transgender body sculpting, that have been commonly solicited by non-binary and gender expansive patients. We start with a discussion of conventionally “masculine” and “feminine” body shapes to address how liposuction and fat grafting in our state-of-the-art San Francisco facilities–whether trunk liposuction, a BBL, hip dip fat transfer or more–can be used to meet your specific body goals. By strategically using the techniques of “body masculinization surgery” and “body feminization surgery”, we hope to provide models for patients who wish to create more androgynous or gender fluid body shapes through surgery.

A gender-focused  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 are meant to  improve the comfort a patient  feels in their body. Much like top surgery for non-binary patients, body contouring beyond the gender binary is seldom discussed but is a viable option for those who are interested in obtaining what is conventionally seen as a gender-neutral appearing body or a body with which it feels easier to fluidly express gender–depending on your unique goals. This content is geared primarily towards nonbinary people who underwent an estrogenic (estrogen-dominant) first puberty. For more expansive content that also speaks to procedures for people who went through an androgenic (testosterone-dominant) puberty, as well as summarizing the information on this page, see our printable PDF.

It’s important to note that when someone is nonbinary, genderqueer, or gender-expansive, their body is by definition also nonbinary (with or without medical intervention such as hormones or surgery), regardless of what others may believe their gender expression to be due to their body shape. For folks who feel that their body shape doesn’t align or reflect their nonbinary gender, this content will be helpful in determining what options there are.

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 or fluid body shape” (appearing what is conventionally considered to be neither exclusively masculine nor exclusively feminine) we’ll first define:

• What is conventionally considered a 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 went through a full estrogenic pubertal period without the use of 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 feels gender dysphoria or incongruence with these parts of their body. 
• 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.
• 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 below) compared to those who had an androgenic development (figure B below).
• 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. Bones that cannot be safely changed by surgery include the bones inside your hips and shoulders.
• 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 conventionally “masculine” body the surgeon would aim for a WHR of 0.85-0.95.
• If someone wants a conventionally “feminine” body the surgeon aims for a WHR of 0.70.
• If someone wants a conventionally “gender-neutral” body the surgeon can aim for a WHR of 0.70 to 0.85.

Conventionally  “Masculine” Bodies 

Since the patients of our surgeons who have sought out a  nonbinary gender affirming body contouring procedure generally desire a more conventionally “masculine” body type to “defeminize” the curvature of their bodies, this is the information we will focus on. From there we will move onto what could be considered more gender-neutral or androgynous appearing body shape and find a balance between the two.

Someone who underwent a full androgenic pubertal period will usually have the following characteristics that result in a “masculine” body shape and are distinct from  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” or “defeminizing” body contouring procedure aims to do the following: :

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

Nonbinary 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 alter gendered aspects of the body:

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

In addition, when thinking about non-binary body contouring, special attention must be paid to the buttocks and hip 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 nonbinary 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. That said when doing nonbinary gender-affirming body contouring, we work with every individual to design a unique, individualized 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 nonbinary body contouring at length.

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

In Summary

• Nonbinary gender-focused body contouring can be a helpful procedure for folks who desire a different  body shape or to change gendered aspects of their body shape. 
• There is a natural and wide variety of body shapes that exist, and how one views gendered parts of a body are individually-, culturally-, and societally-based. 
• While skeletal structures are a limiting factor, body fat can be removed or shifted via liposuction to create a body shape that affirms your  gender.
• 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.

For Patients with Insurance Coverage:

If you have insurance coverage and we are a contracted provider, we are unable to offer you an out-of-pocket price. This is due to the service being reimbursed at a drastically reduced amount, limiting our ability to provide this service at a reasonable reimbursable rate.

Managed Medi-Cal plans, such as San Francisco Health Plan (SFHP), coverage has not changed for Liposuction, ensuring flexibility in Liposuction units.

Background Information:

In the past, GCC billed for multiple units, each representing different areas on the body, and the procedure was reimbursed based on the number of units. However, insurance companies are now reimbursing for only one (1) unit, regardless of the number billed.

Impact on GCC:

Since May 2023, GCC has experienced significant impacts due to reduced reimbursement for Liposuction.

Self-Pay Patients (Cash Patients):

All self-pay patients (cash patients) can still undergo the procedure in the same manner as before.

Message to Patients with Insurance Scheduled for Liposuction:

Unfortunately, currently insurance companies have decreased the reimbursement for liposuction, and starting from 1/1/2024, GCC cannot proceed with insurance-based liposuction procedures. We regret any inconvenience this may cause.

For comprehensive details on our fees and available patient financing resources — including reputable credit providers and scholarships for gender-affirming surgeries — please refer to this page: https://www.genderconfirmation.com/about-us/fees-and-financing/.