Comprehensive Guide to Facial Feminization Surgery: How FFS Transforms Lives

Facial feminization surgery (FFS) is a set of cosmetic procedures designed to give the face a more feminine appearance. FFS can transform how you see yourself and how the world sees you. It's a game-changer for transgender women, nonbinary people, and cis women who want to bring their appearance in line with their true identity. The Bookimed team has gathered insights from leading clinics to guide you through the essentials of FFS, ease your concerns, and provide a roadmap for what lies ahead.

 

What is Facial Feminization Surgery (FFS)?

Facial feminization surgery (FFS), or facial gender confirmation surgery, is a collection of surgical procedures designed to make facial features more typically feminine. It helps patients, primarily transgender women, align their physical appearance with their gender identity. FFS often involves altering the forehead, jawline, cheeks, nose, and other facial areas to achieve softer contours.

What are the benefits of facial feminization surgery?

The benefits of FFS go beyond aesthetics. It can boost self-confidence and ease gender dysphoria, allowing people to live more authentically.

1. Improved quality of life

Research shows that FFS has a positive impact on the quality of life for transgender people. As documented in one study, on a 100-scale, patients' satisfaction with their facial appearance increased from 47.2 before surgery to 80.6 after.

2. Psychological benefits

According to another recent study, transgender individuals who undergo FFS often experience:

• reduced anxiety, depression, and social isolation;
• a greater sense of femininity and self-confidence.

3. Social and professional impact

FFS also opens doors for individuals in social and professional contexts. After surgery, patients report:

• increased public perception of the patient’s femininity;
• fewer limitations in social and professional activities.

Who is a Good Candidate for Facial Feminization Surgery?

Many facial features, such as the jawline, brow, and chin, differ between sexes. Unlike other body parts that can be covered with clothing, the face is always visible. Altering these features is an important step toward gender affirmation for people whose gender identity differs from the sex they were assigned at birth.

If you're considering FFS, here are some factors that suggest you're a good candidate:

• You have a diagnosis of gender dysphoria, indicating discomfort with your assigned sex.
• You have experienced living as a member of your desired gender.
• You are of legal age and can give informed consent.
• You have a constructive mindset and realistic expectations about the outcomes.
• Any significant medical or mental health issues are well-controlled.

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Overview of FFS Procedures

Feminizing facial surgery is a subset of facial plastic surgery that encompasses a wide range of procedures that address various elements of the face. From the forehead to the chin, each procedure plays a unique role in crafting a visage that reflects your feminine identity. We'll examine each procedure's role in achieving a feminine aesthetic.

Forehead reconstruction

The forehead and brows are significant in facial feminization as they largely determine the difference in male and female faces. Cisgender men tend to have more pronounced brow bones and lower, angular foreheads. Cisgender women generally have higher, smoother, and more rounded foreheads. Forehead contouring helps to achieve a more feminine or nonbinary look by addressing these differences.

💉How It's Done:

• Shaving or grinding. If the brow bone protrusion is small, surgeons can simply shave or grind it down to reduce hard angles.
• Osteotomy and bone grafting. For more pronounced protrusions, the surgeon may cut a section of the existing bone (osteotomy) and reshape it. The reshaped bone can then be replaced or grafted with a smoother surface to create a more feminine contour.
• Brow lift. Sometimes, the surgeon may raise the brow to give the eyes a more feminine appearance.

Hairline lowering (scalp advancement)

Hairline lowering is often combined with forehead recontouring in facial feminization surgery (FFS) to address receding hairlines or male pattern baldness.

💉How It's Done: The surgeon makes a cut along the hairline's edge. The surgeon then moves the scalp forward and attaches it to the forehead bone at a lower point, removing the excess forehead skin.

Nose reshaping (rhinoplasty)

Rhinoplasty, or nose reshaping, plays a pivotal role in FFS. Considering that male noses are generally larger, longer, and wider than female noses, these modifications can significantly contribute to a more feminine facial appearance.

💉How It's Done: In transgender rhinoplasty, the approach doesn't differ significantly from a standard cosmetic "nose job." However, surgeons with FFS experience often achieve better results, especially when other facial features are also being altered.

Rhinoplasty in FFS can involve:

• reducing the width of the nose;
• reshaping the bridge and tip to create a more delicate look;
• cutting or reshaping the nasal bones and cartilage to achieve a narrower or softer profile.

Cheek augmentation

Cheek augmentation gives a more rounded and feminine appearance to the cheeks, often a characteristic of cisgender women. This procedure is less common in facial feminization surgery (FFS) because hormone therapy can naturally increase cheek fullness.

💉How It's Done:

• Cheek implants. Solid materials are placed in the cheeks to add volume and create a fuller look. This is a more permanent solution.
• Fat grafting. Fat is taken from another body part, such as the belly or thighs, and transferred to the cheeks for a more natural appearance.
• Cheekbone adjustment. In some cases, surgeons may reposition the cheekbones to create a different contour and enhance the feminization effect.

Lip procedures

Lip changes can play a significant role in facial feminization. Cisgender women typically have a shorter distance between the base of the nose and the upper lip, while cisgender men often have longer upper lips.

💉How It's Done:

• Lip lift. This procedure shortens the distance between the upper lip and nose, creating a shorter, more curled lip. It involves removing a small strip of skin below the base of the nose and lifting the upper lip.
• Lip Augmentation: Lips can be made fuller with implants or injectable fillers. Fat grafting is another option, where fat from other body areas is transferred to the lips to increase their size and create a plumper appearance.

Genioplasty (chin contouring)

Genioplasty focuses on modifying the chin.

💉How It's Done: Surgeons typically approach the chin through incisions inside the mouth, along the gum line, to avoid visible scarring.

• Chin reduction. This procedure involves shaving down the chin bone to reduce its size and smooth out protrusions. It's commonly recommended for those with a pronounced or angular chin.
• Chin augmentation. In this approach, surgeons cut the bottom part of the chin bone into a wedge shape, then slide it forward and reattach it in a new, advanced position. An alternative is using a chin implant to achieve the desired shape and projection.

Jaw contouring

Jaw surgery aims to reshape the back corners of the jaw, where the bone curves upward toward the ears. This area tends to be more prominent in cisgender men, giving the jawline a square look.

💉How It's Done: Surgeons can smooth strong protrusions by shaving the bone. This helps soften the jawline and create a more rounded, feminine shape. However, this operation has limits due to the presence of a crucial nerve. Excessive jaw reduction risks exposing or damaging this nerve, which can cause complications.

Adam's apple reduction (tracheal shave)

A tracheal shave, also known as thyroid cartilage reduction, is a surgical procedure that reduces the prominence of the Adam's apple. The Adam's apple is a cartilage structure around the larynx (voice box) that is typically larger in people assigned male at birth. Reducing its size can help create a smoother neck profile, an important aspect of facial feminization surgery.

💉How It's Done: The tracheal shave involves a small incision in the neck to access the thyroid cartilage. The surgeon shaves away some of the cartilage from the front of the larynx and closes the incision with stitches.

Soft tissue procedures

Although facial feminization surgery (FFS) typically focuses on reshaping facial bones and altering the nose, soft tissue work can also help achieve a more youthful or refined appearance. While these procedures aren't usually essential for gender perception, they can enhance the results of core FFS procedures.

FFS procedures that focus on soft tissues such as skin, muscles, and fat include:

• lip injections;
• eye lift;
• face lift;
• neck lift;
• brow lift.

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How to Find the Best Facial Feminization Surgeon

Choosing the right surgeon is one of the most crucial decisions in your facial feminization journey. To ensure the best possible outcome, you need a plastic surgeon with specific skills, experience, and credentials.

1. Choose board-certified surgeons. Certification guarantees that the surgeon has met rigorous education and ethical standards and commits to ongoing research and best practices in plastic surgery.
2. Look for training in craniomaxillofacial surgery. Bone work on the facial skeleton requires advanced skills and experience.
3. Seek aesthetic expertise. The best surgeons have extensive experience with feminizing procedures and a keen understanding of facial aesthetic harmony. Look for surgeons who specialize in FFS and can demonstrate a portfolio of successful outcomes.
4. Check membership in professional organizations. For example, membership in the American Society of Plastic Surgeons ensures adherence to strict standards and continuous training. Affiliation with the World Professional Association for Transgender Health (WPATH) indicates expertise in transgender medicine and a sensitive approach to transgender patient care.
5. Read patient reviews. Look for feedback from previous patients to gauge the surgeon's reputation and patient satisfaction.

💚Bookimed partners with over 50 global FFS specialists. Here are some of the best surgeons offering feminizing facial surgery:

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Financing Your Transformation: Facial Feminization Surgery Cost

Out-of-pocket costs for FFS range from $20,000 to over $50,000, depending on the number and complexity of procedures, the surgeon's experience, and the country.

Here's a snapshot of average FFS surgery costs in different countries:

Country	Average FFS Cost
US	$36,600
UK	$36,700
Thailand	$21,400
Turkey	$10,800

These costs vary due to differences in healthcare systems and surgeon fees. When considering FFS, focus on both the price and the surgeon's expertise for the best results.

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💰Discover the best ways to finance your sex reassignment surgery here.

Preparing for Facial Feminization Surgery

The FFS journey extends beyond merely the surgical operations. It’s a step-by-step process that requires careful planning and preparation. FFS typically involves a series of procedures planned based on the patient’s priorities, not a single operation.

Consultations

The process begins with a surgical consultation, covering diverse topics, including:

• medical conditions;
• aesthetic goals;
• recovery expectations;
• cost.

Patients often use inspiration photos or a ‘wishlist’ collage during the consultation to clarify their desired outcomes with the surgeon.

Preparation

Before surgery, FFS patients may be asked to:

• undergo comprehensive imaging, such as photographs, X-rays, and 3D CT scans, to help doctors understand their specific facial structure;
• pause hormone replacement therapy (HRT) two weeks before surgery and adjust other medications;
• provide informed consent, confirming you understand the benefits, risks, and effects of surgery;
• undergo a behavioral health evaluation with a professional specializing in transgender health;
• stop smoking to reduce surgical risks;
• avoid aspirin, anti-inflammatory drugs, and herbal supplements, as they can increase bleeding.

FFS Process Timeline

📆Surgery duration: The duration of your surgery depends on the complexity of the procedures. Cosmetic fillers require an hour or less. On the other hand, intricate procedures like forehead recontouring, rhinoplasty, or jaw reshaping may take several hours. If you opt for comprehensive facial feminization in one go, be prepared to spend up to 8-9 hours in the operating room.

📆Hospital stay: After most facial feminization surgeries, patients typically spend at least 1 day in the hospital for observation.

📆First follow-up: This usually occurs within 5 days of surgery. This visit allows your surgeon to check on your healing progress, remove sutures, and address any concerns you might have.

Facial Feminization Surgery Risks

Facial feminization surgery is a low-risk procedure, and a skilled surgeon can manage any complications that may arise. However, like any surgical procedure, FFS still carries some potential risks. These can include:

• bleeding;
• infection;
• poor reaction to general anesthesia;
• poor incision healing;
• bruising;
• failure of the bone to heal properly;
• prolonged swelling after surgery;
• facial nerve damage;
• implant migration;
• hair loss along the incision line.

A tracheal shave can cause temporary side effects like painful swallowing, muscle spasms, and hoarseness, usually resolving within a week. Risks include voice changes and vocal cord damage. Scarring is another potential complication that surgeons try to minimize through careful incision placement.

Facial Feminization Surgery Recovery and Aftercare

FFS recovery timelines

🗓️1 Week: Expect bruising, swelling, and some discomfort. Nonabsorbable stitches are usually removed within a week, while absorbable stitches dissolve on their own. Avoid removing bandages, gauze, drains, splints, or compression dressings. Your doctor will remove them at your first post-surgery appointment.

🗓️2-6 Weeks: Most FFS patients experience initial healing during this period. Swelling and bruising should subside significantly. Avoid heavy lifting or vigorous exercise.

🗓️1 Year: It may take up to a year to experience full healing and witness final results. Gradually ease back into regular activities, following your surgeon's guidance.

Aftercare tips

• Follow your doctor's instructions for managing discomfort.
• Use unscented soap for sponge baths. Avoid showering until your doctor allows it.
• Doctors recommend a liquid diet or soft foods when patients experience difficulty chewing or swallowing due to swelling.
• Consider talking to a mental health professional specializing in gender-affirming care to support your recovery journey.

• Establishing a support system to help you through the recovery period.

FFS Results: What to Expect

High success rates

The results of FFS can have a profound, transformative impact. The success of FFS is evident, with patients more likely to be identified as female both by artificial and human intelligence. According to one study, before FFS, only 54.5% of patients were identified as female by AI, whereas after FFS, this increased to 93.7%. Human recognition followed a similar trend: people recognized preoperative patients as female only 57.3% of the time, but after surgery, the number rose to 94.3%. These results reflect the potential of FFS to enhance social acceptance and reduce gender dysphoria.

Long-lasting changes

FFS results are generally permanent. Once the healing is complete, the changes should last a lifetime. The only exception is injectable treatments like dermal fillers, which may require periodic retreatment. Depending on the type of filler, these can last from a few months to up to 5 years.

Revision surgery

If you're not entirely satisfied with the results, or if your facial features seem out of balance after you've healed, you may need revision surgery. This is to make additional adjustments or correct any issues arising from the initial procedure. Discuss your concerns with your surgeon to determine the best course of action.

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Takeaways

• Facial feminization surgery aims to soften facial features and make them more typically feminine.
• Procedures include forehead contouring, rhinoplasty, cheek augmentation, lip lift, jaw reshaping, and tracheal shave.
• FFS can reduce gender dysphoria, improve self-confidence, enhance quality of life, and increase societal acceptance.
• Out-of-pocket costs of FFS range from $20,000 to over $50,000.
• Although FFS is a low-risk procedure, complications can include infection, bleeding, bruising, implant migration, hair loss, or facial nerve damage.
• Initial healing takes 2-6 weeks, with full recovery and final results taking up to a year. Follow post-surgery care instructions to ensure a smooth recovery.

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