He simply doesn't look like a girl, and I doubt cosmetic surgery is ever likely to change this.
This is half the problem. People should be able to wear whatever they like, whether it's a male wearing stereotypically female clothing or vice versa. We shouldn't judge them for not passing as looking like a woman, because performing femininity no more makes you a woman than not performing it does. A man in a dress is no less a man than any other man, regardless of how stereotypically feminine he looks.
The end point of this thinking is pressure on youngsters who do not meet society's standards of conformity to question whether they are really a boy because they like pink and dolls, or really a girl because they don't like dresses and make up.
When you read the accounts of detransitioners, especially young women, a common theme is that they were gender non conforming, same sex attracted kids. Somehow they fell down the rabbit hole of thinking that this meant they couldn't be all that and still be women.
