While aesthetic facial surgery performed for reasons of undesired facial masculinity or femininity has had some attention in the literature, there is a lack of information on gender-confirming facial surgery as part of an overall surgical sex reassignment program. In this paper we try to capture some of the sex differences, respectively, of skeleton, musculature and other subcutaneous soft tissues, integument and frame of the face. From this, we come to a description of some general differences of facial appearance between the sexes. In restructuring the skeletal architecture and facial proportions to match the desired gender, these factors should be taken into account.