Facial gender affirmation integrates anthropometry-driven diagnosis with surgical and minimally invasive interventions to align visible traits with gender identity. This chapter consolidates sex-dimorphic benchmarks across the upper, middle, and lower face—forehead convexity and hairline design; brow position; nasal profile (nasofrontal and nasolabial angles); malar projection; lip–smile dynamics; jawline and chin proportions—into region-specific planning algorithms for feminization, masculinization, and nonbinary goals. Ratio-based targets and practical levers are detailed, including neuromodulators, soft-tissue fillers, energy-based devices, hair reduction/transplantation, rhinoplasty, zygomatic and mandibular osteotomies, genioplasty, and implants, with guidance on sequencing alongside hormone therapy and digital planning. Patient-centered care emphasizes inclusive communication, realistic staging around access and cost, and rigorous risk reduction for injectables and airway-preserving nasal surgery. Ethnic variation and aging are incorporated to individualize endpoints while preserving function. The framework translates high-weight perceptual cues—softness versus angularity, convexity versus flatness, and frame taper—into measurable objectives and stepwise treatments, offering clinicians a coherent, safety-focused pathway to optimize aesthetic harmony and psychosocial outcomes.