San Francisco
2299 Post St. Suite 207
San Francisco, CA 94115
(415) 530-5335
Los Angeles
1317 5th St #300
Santa Monica, CA 90401
(310) 751-5886
Paul Mittermiller, MD, is a board-certified plastic surgeon at Align Surgical Associates in Los Angeles, where he specializes in gender-affirming facial surgery for transgender, nonbinary, and gender-diverse patients.
Dr. Mittermiller’s approach combines a craniofacial surgeon’s understanding of facial structure with a measured aesthetic. He focuses on thoughtful, natural-looking changes that support facial balance without erasing what makes the face feel familiar.
Explore Surgical Options with Dr. Mittermiller
Credentials At A Glance
Education & Training
- Fellowship – Craniofacial Surgery, New York University
- Residency — Plastic and Reconstructive Surgery, Stanford University
- Doctor of Medicine (MD) — UCSF School of Medicine
- Undergraduate — Yale University
Professional Affiliations
- The Rhinoplasty Society
- Society of Gender Surgeons
- World Professional Association for Transgender Health
- United States Professional Association for Transgender Health
- American Society of Maxillofacial Surgeons
- California Society of Plastic Surgeons
- American Society of Plastic Surgeons
- AO Craniomaxillofacial Surgery
Credentials
- Board Certification – American Board of Plastic Surgery
- Licensure — Physician’s and Surgeon’s License, Medical Board of California
Advanced Craniofacial Training for Gender-Affirming Facial Surgery
Dr. Mittermiller’s path to gender-affirming facial surgery began with a foundation in structure, planning, and problem-solving. He studied biomedical engineering at Yale University, graduating cum laude, before earning his medical degree with distinction from UCSF School of Medicine.
He completed his plastic and reconstructive surgery residency at Stanford University before undertaking a craniofacial surgery fellowship at NYU, which included uncommon training in facial feminization surgery.
His training and professional experience also exposed him to some of the most complex work in facial surgery, including face transplantation, complex craniofacial reconstruction, and contemporary gender-affirming surgery techniques. This background continues to inform the detailed, structure-focused approach he brings to his work at Align today.
A Practice Focused on Facial Feminization Surgery
Facial feminization surgery makes up about 95% of Dr. Mittermiller’s practice. This specialization can be felt not just in the natural-looking results he is known for, but in the very first conversation with his patients.
During his patient consultations, Dr. Mittermiller uses digital simulations and the patient’s own photographs to create a shared visual language for their surgical plan. Patients can see why one procedure may belong, why another may not, and how the overall result is intended to fit their own features.
Restraint is an essential part of Dr. Mittermiller’s philosophy. Rather than pursuing the most dramatic possible transformation, he encourages patients to consider which changes will best serve their facial structure and embodiment goals.
Special Clinical Interests
Dr. Mittermiller’s clinical interests focus on how different areas of the face work together and how each surgical decision contributes to a balanced, natural-looking result.
Brow Bone Reduction (Forehead Contouring)
For Dr. Mittermiller, brow bone reduction and forehead contouring require a careful sense of how far to go to achieve the best outcomes. Too little change may leave the upper face under-refined; too much can make the result look overly altered or out of balance with the rest of the face.
Dr. Mittermiller’s craniofacial training is critical to this judgment. During the consultation, he carefully evaluates the brow bone, orbital rims, forehead contour, hairline, and profile together, then plans the amount of reduction needed to soften the upper face while preserving a natural relationship between the features.
Rhinoplasty
In gender-affirming rhinoplasty, the nose cannot be planned by profile alone. A change that looks right from the side still has to support the patient’s embodiment goals, relate naturally to their surrounding features, and make sense with the way their face moves in real life.
Dr. Mittermiller’s rhinoplasty work sits at this intersection of form and function. His craniofacial training and functional rhinoplasty experience help him plan changes that fit the overall facial structure while preserving nasal support and breathing.
In addition, his membership in The Rhinoplasty Society reflects a serious commitment to the nuances and ongoing refinement of rhinoplasty as a surgical discipline.
Chin and Jaw Contouring
Chin augmentation and jaw contouring require careful judgment about strength, softness, and proportion in the lower face. For Dr. Mittermiller, the question is not simply how much to reduce, augment, or reshape, but how those changes will affect the way the full face comes together.
Depending on the patient’s goals, the lower face may need to be softened, strengthened, narrowed, or given more definition. Dr. Mittermiller carefully considers these choices because even small differences in chin projection or jawline width can change the character of the lower face.
Lip Lift
A lip lift can meaningfully affect expression, balance, and the way the lower face is framed. Dr. Mittermiller evaluates whether increasing upper lip visibility will improve the relationship between the lips, nose, chin, and lower face before deciding whether to recommend it or suggest an alternative.
Tracheal Shave
Tracheal shave surgery, also known as chondrolaryngoplasty, requires a fine balance: reducing visible prominence while protecting the delicate anatomy of the voice box. Dr. Mittermiller plans this procedure meticulously, aiming for a smoother neck profile that looks natural and preserves vocal function.
Facial Masculinization Surgery
Dr. Mittermiller also performs facial masculinization surgery for patients who want stronger definition or more traditionally masculine facial proportions. Masculinizing facial surgery is not simply the reverse of feminizing surgery; it requires its own judgment around structure, contour, and degree of change.
These procedures may build definition in the chin or jaw, adjust contour, or refine soft tissue features. Dr. Mittermiller focuses on strengthening the facial structure without making it look heavy, exaggerated, or out of proportion.
Highly Personalized Care for Highly Visible Surgery
Because gender-affirming facial surgery is so visible, Dr. Mittermiller prioritizes clear, honest communication before surgery. He would rather slow the process down, clarify expectations, and pull back on a plan when needed than let a patient move forward with an unclear or unrealistic idea of the result.
Some patients spend close to an hour with him reviewing photographs, possible changes, expected outcomes, and anatomical limits. Dr. Mittermiller is fully transparent about what a procedure can do and whether it “earns” its place in a patient’s treatment plan.
This individualized care gives patients more than a rote procedure list. It gives them time to ask better questions, weigh recommendations, and explore their unique embodiment goals in a safe, supportive environment.
Professional Involvement in Facial and Gender-Affirming Surgery
Gender-affirming facial surgery draws from several overlapping surgical fields, including craniofacial surgery, rhinoplasty, maxillofacial surgery, plastic surgery, and broader gender-affirming care. Dr. Mittermiller’s professional involvement keeps him connected to the communities advancing those areas of practice, including:
- The Rhinoplasty Society
- Society of Gender Surgeons
- American Society of Plastic Surgeons
- American Society of Maxillofacial Surgeons
- California Society of Plastic Surgeons
- AO Craniomaxillofacial Surgery
- World Professional Association for Transgender Health
- United States Professional Association for Transgender Health
Dr. Mittermiller also serves as a peer reviewer for surgical journals, including Plastic and Reconstructive Surgery Global Open, Annals of Plastic Surgery, and The Cleft Palate-Craniofacial Journal. Not only is he actively engaged with current surgical literature and evolving standards, but he also helps evaluate the research that other surgeons learn from.
Selected Honors and Recognition
These honors recognize Dr. Mittermiller’s contributions to craniofacial research, surgical peer review, and international surgical education. Highlights include:
- Best Pediatric/Craniofacial Paper of 2018 in Plastic and Reconstructive Surgery — Recognition for his article on anatomic nasal lining flaps in cleft lip repair.
- PRS Global Open Award for Exemplary Peer Review of Manuscripts — Recognition of his contribution to surgical peer review.
- Minami Travel Funds — Awarded to learn and teach cosmetic surgery in Vietnam.
- Laub Fellowship Award — Awarded to learn and teach reconstructive plastic surgery in Zimbabwe.
- Zedplast Travel Scholarship — Awarded to observe polyethylene ear reconstruction.
Featured Publications
Across his publications, Dr. Mittermiller examines how facial structure can be repaired, planned, measured, and refined through complex reconstructive surgery.
- Primary Surgical Repair for Unilateral Cleft Lip — chapter in Cleft and Craniofacial Orthodontics, 2023
- Reconstructive Approaches Following Sphenoorbital Meningioma Resection — The Journal of Craniofacial Surgery, 2022
- Clinical Outcomes in Orthognathic Surgery for Craniofacial Microsomia Following Mandibular Distraction Using CBCT Analysis — The Cleft Palate-Craniofacial Journal, 2022
- Craniosynostosis: Le Fort III Distraction Osteogenesis — Clinics in Plastic Surgery, 2021
- Body Image Disturbance and OCD Symptoms Improve After Orthognathic Surgery — Journal of Oral and Maxillofacial Surgery, 2020
- Improvements in Aesthetic Outcomes of Cleft Lip Repair With the Anatomic Subunit Repair in Comparison to the Rotation-Advancement Repair — Plastic and Reconstructive Surgery Global Open, 2020
- Anatomic Nasal Lining Flaps for Closure of the Nasal Floor in Unilateral and Bilateral Cleft Lip Repairs Reduce Fistulas at the Alveolus — Plastic and Reconstructive Surgery, 2018
- Efficacy and Safety of Titanium Miniplates for Patients Undergoing Septorhinoplasty — JAMA Facial Plastic Surgery, 2018
Explore more of Dr. Mittermiller’s research contributions and related publications on our Research page.
Beyond the Operating Room
Outside the operating room, Dr. Mittermiller is an avid bonsai collector and cultivator. He also enjoys running and cycling around Los Angeles and cooking with his wife.
Request a Consultation
With Dr. Mittermiller
To meet with Dr. Mittermiller, request an in-person or virtual consultation using the online form or call Align Surgical Associates at (415) 530-5335. Dr. Mittermiller offers gender-affirming facial surgery, including facial feminization surgery, as well as select chest and body procedures for patients at our Los Angeles office.