Purpose of Review <p>Facial gender affirmation surgery has become well established with many centers and surgeons offering comprehensive care. Feminization of the neck however, is somewhat nascent. Understanding of the gender dimorphic differences, strategies to improve contour and neck size, as well as maneuvers to rejuvenate and tighten the neck will all receive focus in this review.</p> Recent Findings <p>Transoral chondrolaryngoplasty performed with either endoscopic or open exposure enables some patients to avoid potential misgendering caused by the traditional transcervical approach. Face/neck lifting improves the appearance of femininity by both smoothing contours as well as by making the neck look more youthful. Nonsurgical approaches offer the potential to improve skin thickness, hair density, and muscle mass. Selective sternocleidomastoid muscle denervation offers the potential for myoreduction, thereby reducing neck circumference.</p> Summary <p>Many modifications of traditional surgical approaches have recently emerged, which offer the potential to feminize the neck with minimal or absent scarring.</p>