It’s difficult to glance at a magazine rack, scan your favorite blog, or catch up on the headlines without hearing the “news” that famed Olympic athlete and reality television personality Bruce Jenner is transitioning into a woman. Jenner has not yet made this announcement directly—though his mother has acknowledged it—but people are already struggling to understand what such a transition means and why Mr. Jenner is starting to look more feminine. (Because Mr. Jenner has not yet openly identified as a woman I am using masculine pronouns. After such an announcement, of course, feminine terms are appropriate.)

Several months ago it was reported that Bruce had undergone surgery to reduce his Adam’s apple. He may have had a facelift and had his nose changed. Why?

It’s part of a process called facial feminization. When you look at a face, you instantly learn many things about the person you are seeing. You know their approximate age. You can often tell something about their ethnicity and health, and you can easily determine their mood (Happy? Angry?). You know if you recognize them or if they are a stranger, and you quickly determine if they are attractive or not. And, of course, you can tell if they are a man or a woman.

But, how do we do these things? How do we know if we are seeing a man or a woman? If a woman shaves her head we don’t mistake her for a man, and if a man has long hair and is wearing lipstick we don’t mistake him for a woman.

There are a number of facial features that our brains use to determine someone’s gender and they aren’t all obvious. Among these are facial shape and bone structure, eyebrow position, brightness around the eyes and mouth, nose shape, skin quality, hair patterns, and more.

Over more than a decade I’ve been studying how we determine gender and what makes a person beautiful. From my research and experience with well over a thousand transgendered women and thousands of non-transgendered women I’ve learned a number of things.

For starters, beauty isn’t only skin deep. It turns out that an attractive feminine face has certain bony characteristics. And, the most important of these is the shape of the brow bone.

The brow bone is the ridge of bone just over the eyes and under the eyebrows. Attractive women tend to have a fairly flat and vertical forehead with a relatively short distance between the eyebrows and the front of the hairline. The eyebrows have a delicate curve and rise above the top of the eye sockets. Masculine faces have a prominent brow ridge with more deeply set eyes framed by flatter and lower eyebrows.

Attractive women have full cheeks, which extend to the sides of and to the front of the lower rim of the eye socket. Why are these two features important? Women have brighter eyes then men. This is because they have cheeks that bounce light towards the eye and lack a strong bony visor of bone above their eyes that would shadow the eyes. Men have both this brow ridge shading the bone and a lack of full cheeks to bounce light towards the eyes. These bright eyes are such an important feature of an attractive feminine face that countless articles are written each year explaining how to use cosmetics to create bright, sparkling, sexy eyes.

We already know that women have a smaller Adam’s apple than men and that surgery exists to reduce the size of the Adam’s apple. (This has to be done very carefully to protect the person’s voice. I’ve written an article explaining to other facial plastic surgeon’s how to do this safely.) But how do we change the brow ridge and send light to the eyes?

There’s a procedure for that, too. It’s called a frontal cranioplasty and includes three parts. First, I reduce the size of the male forehead to create an attractive female shape to the forehead. This involves more than just removing excess bone, as we need to adjust the size of some of the sinuses and open up the eye sockets. As part of this procedure I bring the hairline forehead and round it to reduce the signs of male-pattern-baldness and I lift and shape the eyebrows. This procedure takes less than two hours and is safer than getting your tonsils removed. And, of all the facial procedures this tends to be the single most effective at feminizing and beautifying the face. If Bruce Jenner is serious about transitioning and presenting as an attractive woman, this procedure is a logical consideration.

What else needs to change? Men tend to have wider and heavier looking jaws and chins than women. This bone is also shaped to a more narrow and gentle appearance. To do this I access the bone through the inside of the mouth and make the necessary changes. This procedure is also very popular amongst Asian women as people in Korea and China, for example, are very aware of the attractive results obtained. I regularly have women come from the Far East for this procedure, and it is increasingly popular amongst people in the U.S. as well.

Looking feminine also involves looking young. A facelift may be part of that as well as an eyelift. You also need to have healthy looking and unblemished skin. Hormones can help but often chemical peels, laser treatments, and the most advanced skin creams also play a role.

One more important consideration is the lip. We all know that some people get their lips injected to appear larger, and if you watch the various Housewives shows you may see some who seem to have overdone this in their quest for beauty.

Full lips are attractive and feminine, but the real key is to have a short upper lip. That’s right – a short lip. Men, and older women, have lips that cover all or most of the upper teeth when they are at rest. Younger attractive women have a short lip with several visible bright teeth. (Look at photos of models in your favorite fashion magazine.)

One of the best ways to have a feminine attractive mouth is to have a “lip lift”. This quick office procedure shortens and reshapes the upper lip to a fuller and more attractive position. Many women, transgendered and not, find this greatly improves their femininity and beauty.

There’s more but this is a good start to understanding what goes into looking attractive and feminine. It’s not an issue of preference or fashion. Our brains have evolved to recognize these features as beautiful and it’s universal.

One of the most interesting things to realize is that these same facial feminization procedures that could help someone like Bruce Jenner to look more feminine if he chose to have them can also greatly improve the appearance of any woman.

After helping so many transgendered women to look like the beautiful women they know themselves to be, I’ve had so many non-transgendered women come see me to look their best. It’s nice to know that all women can benefit from the same approach of considering femininity in the analysis of beauty.

One last point: I don’t know if Bruce Jenner is in fact going to come out and say he is a transgender woman, but if he is transitioning I appreciate his courage and the courage all transgender women have who recognize who they are and don’t try to keep it hidden. Facial feminization is only one part of their journey, but when done correctly can help these women achieve their goal of womanhood.

Jeffrey H. Spiegel, MDAdvanced Facial Aesthetics www.DrSpiegel.com