Dr. Paul Mittermiller
Specialist in Gender-Affirming Facial Masculinization Surgery – Los Angeles
Dr. Paul Mittermiller, MD, is a board-certified plastic and craniofacial surgeon based in Santa Monica, California. With advanced fellowship training and a dedicated focus on gender-affirming facial procedures, he offers a refined, individualized approach to patients seeking facial masculinization surgery (FMS). His practice at Align Surgical Associates emphasizes not only technical precision but also a deep understanding of how facial structures relate to gender identity. Dr. Mittermiller is one of the few surgeons in the country with formal training in both craniofacial and gender-affirming surgery, making him uniquely equipped to deliver safe and effective results.
Education and Training
- B.S. in Biomedical Engineering from Yale University
- Surgical robotics research internship in Germany
- M.D. from University of California, San Francisco (UCSF)
- Plastic and Reconstructive Surgery Residency at Stanford University
- Craniofacial Surgery Fellowship at New York University (NYU) under Dr. Eduardo Rodriguez
- Participated in groundbreaking cases such as the world’s first successful face and double hand transplant
- Received specialized training in gender-affirming facial surgery
- Returned to Los Angeles to train and collaborate with FFS and FMS expert Dr. Kyle Keojampa
Professional Memberships
- World Professional Association for Transgender Health (WPATH)
- American Society of Maxillofacial Surgeons
- California Society of Plastic Surgeons
- American Society of Plastic Surgeons
- AO – Craniomaxillofacial
- The Rhinoplasty Society
Facial Masculinization Surgery (FMS)
Facial Masculinization Surgery is a set of procedures that reshape facial features to reflect a more traditionally masculine appearance. These surgeries are especially affirming for transgender men, nonbinary individuals, and others seeking a stronger, more angular facial profile. Dr. Mittermiller approaches FMS with a high level of personalization, aiming to harmonize facial structures with each patient’s gender identity and personal aesthetic.
Common FMS procedures include:
- Jaw and Chin Augmentation: A strong jawline and square chin are hallmark features of a masculine face. Dr. Mittermiller uses techniques such as implants or bone reshaping to achieve a sharper, more defined lower face.
- Forehead and Brow Enhancement: Masculine brows tend to be more prominent and lower-set. Forehead augmentation or brow bone implants can add structure and create a flatter upper face contour.
- Rhinoplasty: A straighter, broader nasal bridge and a less upturned nasal tip are often targeted through masculinizing rhinoplasty.
- Cheek Reduction: Softer, rounder cheeks may be modified to reduce volume or enhance angularity through fat sculpting or bone contouring.
- Facial Hair Restoration: While not always part of surgical care, some patients pursue facial hair transplants to complete their masculine aesthetic.
Each procedure is tailored to the patient’s existing anatomy and long-term goals. Dr. Mittermiller also utilizes virtual surgical planning (VSP) to simulate and customize surgeries before the operating room, improving both outcomes and communication with patients.
Surgery Requirements
Dr. Mittermiller follows the WPATH Standards of Care for gender-affirming facial surgeries. Candidates for FMS must meet the following:
- Be at least 19 years old
- Have a documented diagnosis of gender dysphoria from a qualified mental health provider
- Submit one or two letters of medical necessity, depending on insurance guidelines
- Undergo hormone therapy for a minimum of one year, unless there are valid medical reasons not to
Insurance & Medi-Cal Coverage
Dr. Mittermiller accepts various private health insurance plans and some managed Medi-Cal programs. Managed Medi-Cal plans are state-funded, privately administered insurance plans in California that often require prior authorization, referrals, or the use of in-network providers for specialty care like facial surgery.
It’s important to note that while gender-affirming care is increasingly recognized as medically necessary, facial masculinization procedures are still sometimes classified as cosmetic by insurers. To find out if you have coverage under your plan, call your insurer’s member services line and ask directly about coverage for “gender-affirming facial surgery.” Request written documentation of their policy’s stance on these procedures and ask about preauthorization or mental health documentation requirements.
Booking a Consultation
Facial masculinization surgery is highly customized, and a comprehensive consultation is essential for building a surgical plan that suits both the patient’s facial structure and personal goals. Dr. Mittermiller offers phone and virtual consultations, giving patients the opportunity to ask questions, explore their options, and visualize their potential outcomes using digital tools. To begin your FMS journey, reach out to Align Surgical Associates to schedule a consultation with Dr. Mittermiller.
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