Facial Feminization Surgery

Why is facial feminization surgery done?

You may choose FFS if you:

• Are a transgender woman (transitioning from male to female).
• Are a cisgender woman (your gender identity matches the gender assigned at birth) who wants to feminize her face.
• Have a diagnosis of gender dysphoria (psychological distress due to conflict with the gender assigned at birth).

Who shouldn’t have facial feminization surgery?

You may not be a good candidate for FFS if you:

• Are under the age of 18.
• Don’t have realistic expectations about the results.
• Have a health condition that makes surgery dangerous.
• Have a mental health disorder that impairs your ability to make appropriate personal decisions.

Who performs facial feminization surgery?

A plastic surgeon specializing in surgery of the face, head and neck performs facial feminization surgery. This type of healthcare provider specializes in surgery to change or enhance your physical appearance.

PROCEDURE DETAILS

How do I prepare for facial feminization surgery?

Before facial feminization surgery, your healthcare provider will perform a thorough personal assessment. They will ask you about your goals for surgery and explain what you can expect during your recovery after the procedure. It’s important that you and your surgeon have goals that are aligned and realistic.

Your provider also makes sure you’re in good physical health by:

• Assessing your lifestyle, including smoking or drinking habits.
• Doing a physical exam, including lab tests.
• Identifying risks for potential complications.
• Reviewing your current medications and any allergies you may have.

You might also have imaging scans before facial feminization surgery. X-rays or CT scans take pictures of the bones and soft tissues of your face and skull. Your surgeon may also measure your face, take photographs and assess your skin quality. All of this information helps your surgeon plan your treatment.

What happens during facial feminization surgery?

Facial feminization surgery is different for everyone. The process depends on the facial features you choose to change. You might have one surgery or several, including:

• Hairline lowering: Men are more likely than women to have receding hairlines. Your surgeon may make an incision along the length of your hairline and bring your skin forward over your forehead, preserving the healthy hair follicles, so your hair continues to grow. Hair transplantation is also an option for male-pattern baldness.
• Forehead contouring: Men may have frontal bossing, which is a pronounced bone just above the eyebrow ridge. Your surgeon may surgically remove part of this bone and reshape it to give a smoother appearance.
• Cheek augmentation: Women have higher cheekbones and more fat in their cheeks. Your surgeon may do a cheek augmentation with silicone implants or fat injections. They may take fat from another area of your body such as your thighs.
• Rhinoplasty (nose reshaping): Your surgeon can reduce the width of your nose by removing and reshaping the bone. They may also reshape the bridge and tip of your nose during rhinoplasty so it has smooth contours and a refined, feminine tip.
• Lip lift and augmentation: Women’s top lips tend to be larger and closer to their nose than men’s. Your surgeon can raise the height of your top lip through a small incision under your nostrils. They may also make your lips fuller with fat injections or fillers.
• Chin reduction: Men tend to have larger, square chins. Your surgeon may reduce the size of your chin and reshape it for a more pointed or oval shape. Chin reshaping is also called genioplasty.
• Jaw shave (reduction): Like the chin, men also have wide, square jaws. Through an incision inside your mouth, your surgeon can shave away layers of bone to reduce the size and sharp angles of your jaw. This type of incision means you won’t have a visible scar.
• Tracheal shave: Men tend to have larger Adam’s apples, which is when the cartilage of the trachea (windpipe) protrudes at the front of your throat. During a tracheal shave, a surgeon makes an incision under your chin and shaves away some of the cartilage.

How long does facial feminization surgery last?

If you get a comprehensive FFS as a single surgery, it can take eight to nine hours. Some surgeons recommend splitting the procedures into two surgeries, separated by seven to 10 days or longer. Doing two surgeries gives your face more time to heal between surgeries and allows more flexibility for patients.

What happens after facial feminization surgery?

You’ll have gauze or bandages over your incisions for several days. You might wear compression wraps around your forehead or jaw to reduce inflammation.

You may go home with a surgical drain. A drain is a thin, plastic tube that the surgeon places under your skin. It helps drain blood and fluid to prevent swelling.

Your healthcare provider will probably take out the nonabsorbable stitches a week after your surgery, or they may place absorbable stitches that don’t need to be removed. However, after the sutures are removed, you face will still need weeks to continue to healing process until the final result is fully visible.