Feminization Surgery
Facial feminization surgery (FFS) is a set of plastic surgery procedures that help your face appear more feminine. FFS can include various different bone remodeling and soft tissue procedures, such as rhinoplasty (nose job) to feminize a male nose, jaw contouring, lowering of the hairline, cheek implants, tracheal shave, facelift, neck lift, brow lift, eyelid surgery, and other facial plastic surgery. (A different set of procedures can be performed for facial masculinization surgery).
Plastic surgeons offer FFS to transgender women as part of their male-to-female transition. FFS helps to address gender dysphoria (distress experienced due to a difference between the gender assigned at birth and a person's expressed gender). In other words, facial feminization surgery helps transgender women physically transition to their self-identified gender. In addition to being a facial gender confirmation surgery, FFS is also offered to cisgender women with masculine facial features who wish to have a more feminine appearance.
Please continue reading to learn more about FFS gender confirmation surgery, including the surgical techniques employed to transform the facial skeleton and give a person a more female face, the preparation, surgery, and recovery process, risks, costs, and more.
What is facial feminization surgery FFS?
Facial features such as the eyebrows, eyes, nose, chin, and jaw are strongly reflective of gender differences. While many parts of the body remain hidden, a person's face is readily visible. In transgender people, altering the facial features is an essential part of their transition. Being seen as women is also critical for transgender health and helps to avoid discrimination and harassment.
Essentially, facial feminization surgery (FFS) is any procedure or set of procedures that make a person's face appear more feminine and less masculine. This type of craniofacial surgery can involve reshaping bone, cartilage, and soft tissues. The goal is to reduce masculine facial proportions such as square and sharp features and create a softer, more oval-shaped female face. Sometimes, skin resurfacing and tightening of sagging skin may be included in FFS to give the person a more youthful appearance.
Why is it done?
Facial feminization surgery is done to help a transgender woman transition from male to female. It is also done to help a cisgender woman with a masculine-looking face to achieve a more feminine appearance.
Which surgical procedures are performed during facial features feminization?
A facial feminization surgery is a highly customized treatment. The surgical procedures included in FFS will depend on a patient's existing facial features and the areas of the face that the patient considers masculine and wants to address. A highly skilled surgeon will see each patient in consultation and recommend one or more plastic and craniofacial procedures to make the face look more feminine.
Some of the most common procedures offered to transgender patients as part of FFS include scalp advancement for a more feminine hairline, forehead reduction with forehead bone remodeling, forehead contouring, brow lift or temple lift, blepharoplasty (eyelid surgery), brow bone remodeling, rhinoplasty (nose reshaping), cheek augmentation with silicone implants or fat grafting (transfer of body fat), lip reshaping, upper lip lift, corners of mouth lift, jaw reduction, jaw contouring, chin contouring (genioplasty), chin implants, chin bone reshaping, V-line surgery, tracheal shave, reduction of Adam's apple, thyroid cartilage reduction, and hair transplantation (transplantation of hair follicles to address male pattern baldness, for example).
If you wish to undergo gender confirmation surgery with facial feminization surgery, you will need to work with a plastic surgeon to decide which craniofacial surgical procedures will help you tone down masculine facial features and achieve a more feminine look.
Who is a good candidate for facial feminization?
You may be a good candidate for facial feminization surgery if you are over the age of 18, have realistic expectations, and want to correct what you feel is an undesirable "male face." Some of the common complaints you hear when this is the case include - My jaw is too square, my forehead is too high, my brows appear heavy, I don't like my upper lip, or my eyes are too deeply set.
Facial feminization surgery is not right for every cisgender woman with masculine features or every transgender woman transitioning from male to female. These procedures are not recommended if you have untreated mental illness or significant physical health conditions. They are also not suitable for anyone under the age of 18.
How do you prepare for FFS?
Consultation
Facial feminizing surgeries are not performed in children or teenagers - you will be asked to wait until you are an adult. Before the surgery, you will meet with one or more plastic surgeons for an in-depth consultation. At this time, your doctors will understand what bothers you about your face. They will then recommend a surgical procedure or a set of procedures that can contribute towards making your face appear more feminine.
Physical Examination
At the consultation, the plastic surgeons will obtain a complete medical history and perform a thorough physical examination. They may order some lab tests to assess your readiness for surgery. As part of the surgical planning, your doctors may take photographs from several angles and obtain imaging with a CT scan.
Pre and Post-Surgical Instructions
Your plastic surgeon will discuss anesthesia and give you instructions for before and after the facial feminization surgery. Following these instructions carefully can help ensure optimum results and an uneventful recovery.
Mental Health Evaluation
A mental health evaluation by an expert in transgender health is required by most insurance companies and plastic surgeons. This evaluation assesses your gender dysphoria, self-affirmed gender identity, the impact of your gender identity on your life including discrimination, mental health concerns, and sexual health. At this evaluation, the transgender mental health expert will also discuss the risks of using unapproved treatments such as hormones and non-medical-grade silicone injections.
What happens during facial feminization surgery?
The duration of your facial feminization surgery will depend on what surgical procedure you are having. For example, a single procedure such a a lip lift, cheek augmentation, or nasal surgery can usually be done in 1-2 hours.
A more comprehensive FFS with multiple procedures can take 8-10 hours. Sometimes, your surgeries may need to be done on two separate days spaced 7-10 days or more apart. The long-format surgery with multiple facial features addressed at the same time can be done using general anesthesia, which reduces the need for repeat anesthesia exposure. It also saves on downtime, makes recovery easier, and brings down the cost.
How long is the recovery period?
You might need to spend a night in the hospital. You will go home the day after facial feminization procedures with bandages that will stay in place for several days. You may also have surgical drains in place. Your plastic surgeons might ask you to wear a support strap or compression wrap to reduce swelling. If your surgeon used non-absorbable stitches, they will come out about a week after your FFS.
The recovery process can take several weeks. It is not uncommon to experience facial swelling, redness, and mild discomfort during the first 3-4 weeks. This can usually be managed with pain medicine. You can resume normal activities and wear makeup after about 4 weeks. You will need to avoid strenuous exercise for 3-6 months.
What kind of results should you expect?
The final results of your facial feminization surgery may not be visible until one year after the procedures. This is because it takes time for for the facial tissues and facial structure to settle into their new positions and the facial swelling to resolve. Optimum results are seen between 6-12 months. When your FFS is performed by a highly skilled surgeon, you can expect to look more feminine but still "you."
Is FFS permanent?
While it will depend on the type of procedures you have, for the most part, the changes achieved with facial feminization surgery are permanent.
Is there any scarring after facial feminization?
There is minimal scarring with facial feminization procedures. A skilled board-certified surgeon can ensure that all incisions are carefully concealed in natural skin creases, in the hairline, inside mouth or nose, or behind the ears.
What are the risks of facial feminization surgery?
FFS carries surgical risks like any other major surgery, including bleeding, infection, reactions to anesthesia, seroma (fluid accumulation), hematoma (blood accumulation), damage to nerves or blood vessels, visible scarring, facial asymmetry, and dissatisfaction with the results. Sometimes, additional surgery may be necessary to correct asymmetry or improve the final outcome.
How much does facial feminization surgery cost?
The cost of facial feminization can vary greatly depending on the degree of masculinity that needs to be addressed, the number of procedures being performed, the skill of your plastic surgeons, and more. Because these factors vary so widely from patient to patient, it is not possible to predict the cost of FFS until after the consultation.
Choosing a plastic surgeon for facial feminization surgery
If you would like to learn more about facial feminization procedures, the MeTime app makes it easy. You can connect with top-rated facial plastic surgeons in your area, send photos across, ask questions, do a video consult, and book an office consultation when you're ready. Download the MeTime app today and learn more about facial feminization surgery FFS and facial gender confirmation surgery.
