Facial Feminization Procedures Explained

Facial Feminization Surgery (FFS) is a subspecialty of transgender surgery that draws from cosmetic and reconstructive oral, dental, maxillofacial and otolaryngological (ENT) surgical fields. Many Facial Feminization Surgery procedures are also commonly part of routine cosmetic surgery (e.g. face lift, neck lift), while some are specific to feminization (mandibular angle shaving, brow bossing reduction). FFS can include transforming the eye lids, nose, mouth, cheeks, forehead, jaw, chin, scalp and Adam's apple. Normally, a FFS surgeon will perform multiple procedures in one surgery. As a result, FFS can mean up to 12 hours in the operating room.

FFS is a medically necessary treatment for gender dysphoria in many transgender women. In fact, Facial Feminization Surgery can be more important than genital surgery to allow for societal integration. Studies have shown that mental health quality of life for transgender women who have had FFS is significantly higher than for transgender women who have not had FFS versus those who had not. FFS continues to evolve in the type of procedures and the way they are performed to change male dominant facial characteristics to a more feminine facial structure.

FFS can involve one or more procedures, such as forehead sculpting and contouring, mandible contouring, tracheal shaving, jaw and chin shaving, chin implants, rhinoplasty and cheek augmentation. You can choose procedures based on your personal goals and your Surgeon's recommendations.

Looking for a FFS Surgeon? Find one here.

Hairline Correction

In males, the hairline tends to be higher on the face and imparts the forehead with a box shape; in females, the hairline tends to be lower on the face and imparts the forehead with a semicircular shape.

This procedure is relatively straightforward. An incision is made along the hairline. A section of skin is removed from the forehead, and the scalp is literally pulled down to its new position and stapled to the rest of the forehead. At the same time, the brows can be elevated to a higher position. Often done in conjunction with Forehead Recontouring and/or Rhinoplasty. Learn more »

Forehead Recontouring

The male forehead, in addition to being overall larger, has thick bony ridges over the eyes known as "brow bossing" (more prominent orbital rims) and may slope forward; the female forehead is flatter and convex in all planes.

Using either a separate incision, or the incision made for a scalp advance, the skin from the forehead can be turned downward to reveal the bones underneath. For some patients, it may be adequate to shave down the orbital rims to a flat, smooth contour. Other patients may require forehead reconstruction for optimal results. In this case, the bones overlying the frontal sinuses are removed, reshaped, and replaced using surgical-grade screws. Often done in conjunction with Rhinoplasty and/or Hairline Correction. Learn more »

Brow Lift

Brow Lift refers to a surgical procedure that repositions the eyebrows higher, resulting in a more feminine appearance. This is considered one of the most effective procedures to feminize the upper face.

Many FFS Surgeons will also perform Forehead Recontouring and Hairline Correction along with a Brow Lift as this typically produces better results and all three procedures use use the same incision.

The eyebrows can also be lifted by tightening the muscles attached to the outer third of the eyebrow. One incision is made during scalp advance or brow-bossing reduction, or two very small incisions are made in the scalp. Learn more »

Cheek Augmentation & Implants

Females more often have full, round cheeks. Cheek implants or bone filler can be used to give the cheeks the desirable full, round appearance. Solid implants are available in several shapes and can be placed over or under the cheekbone or closer to the nose. Bone-filler can be molded to its desired shape. The patient is sedated and the implants are placed through a tunnel, into a pocket under soft tissue over the cheekbones. Certain bone cuts and bone segment repositioning is useful for this Facial Feminization procedure. Pain, swelling, stiffness and temporary numbness may occur. Tenderness in the teeth may also occur and smiling and chewing might be affected.

Rhinoplasty

The male nose tends to longer and wider, consistent with its overall larger size. The nose is more likely to be angled downwards. A female nose tends to be narrower, shorter, directed upwards, and slightly concave.

Standard rhinoplasty techniques can be used and involves changing the nose's contour to make it appear more feminine. The shape of the nose is altered by changing the underlying bone and cartilage. Lateral and medial tissue can be removed from inside the nose to make it narrower. A bump can be smoothed out if desired. Also, the tip of the nose can be raised and reduced. Nasal surgery is usually completed under general anesthesia, and rarely requires a night in the hospital. Complete recovery takes ten to twelve days.

Rhinoplasty is often done in conjunction with forehead recontouring.

Lip Lift and Reshaping

To feminize the lips, an incision is made under the nose and part of the skin is removed; the remaining skin is resutured to the base of the nose, pulling the top lip up and shortening the distance between the top lip and nose.

Lips can also be made to look more full. During a lip lift, the lip can be rolled outwards making it fuller, and an entire section of skin from lip to nose can be angled back slightly if necessary. Natural or synthetic and solid or injected implants can also make the lips fuller. Alternatively, an incision can be made at the Vermilion Border (the edge between the red and white parts of the lip).

Chin Recontouring

The male chin tends to be wide, flat and square. The distance between the end of the chin and the lower lip is increased. Females have smaller chins that project forward slightly.

An incision is made through the chin to make a wedge of bone. This wedge can be advanced or retracted, or removed, to change the shape of the chin. Also, a chin implant may be used to give the desired forward projection of the chin. Learn more »

Jaw Recontouring

The male jaw tends to be wider and larger, as does the overlying masseter muscle. The angle of the mandible forms a right angle, whereas in females the angle curves much more gently, approaching a straight line.

The angle of the jaw is cut or filed down to achieve a feminine contour and the jaw may be narrowed as well. Learn more »

Tracheal Shave

Males have more prominent thyroid cartilage. In a Tracheal Shave, the thyroid cartilage ("Adam's apple") is shaved down to a more feminine size. The procedure is typically done on an outpatient basis with local anesthetic. Risks include removing too much cartilage and affecting the vocal chords, which may permanently affect the voice. Learn more »

"I certainly have some patients come in and say, 'I want everything done,'" explains Dr. Thomas Satterwhite. "And I have other patients who are more concerned with certain aspects of their face. I recall one patient who said, 'You can do whatever you want, but don't touch my nose, because my nose is a part of me, it's part of my family, it's part of my heritage.' It's what's important to you and what your particular goals and wishes are that are of utmost importance."

Additional FFS Procedures

• Blepharoplasty: "Eyelid Lift"
• Otoplasty: Reshaping of the ear
• Rhytidectomy: "Face Lift"
• Temporal fossa augmentation: Filling in the temples; improves facial contour.
• Frontal bossing reduction osteotomy
• Reduction osteotomy of the supra-orbital rims
• Osteotomy of the bony pyramid
• Dorsum reduction
• Zygoma augmentation
• Submalar augmentation
• Lateral lower mandibular shave
• Mandibular angle shave
• Submandibular liposuction
• Neck lift
• Platysma banding elimination

 

Last updated: 02/23/22