Facial Feminization Surgery (FFS) refers to a set of procedures that help align one’s inward identity with that of their outward identity. It encompasses a wide range of treatments that aim to make male facial features appear more feminine in terms of contour and size. Since your facial appearance is what people most often first notice about you, these procedures guarantee that you will be recognized as female by everyone else, including yourself, thereby signifying the completion of transition.
In order for this to be successful, it is important that you first and foremost choose a cosmetic surgeon who is well-experienced in performing facial feminization surgery. Inexperienced surgeons may not be well-versed in knowing what ‘truly feminine’ features actually look like and may give you results that vary greatly from what you expected in the first place.
The main goal of facial feminization surgery is to feminize typically masculine facial features and is often composed of one or more multi-step procedures. It involves the alteration of bone tissue as well as soft facial tissues through surgical means in order to achieve a more feminine appearance.
$1,600 to $6,300
Facial feminization surgery is composed of many procedures. The most relevant treatments for your situation will be determined via an in-depth discussion between you and your surgeon.
· Forehead Lift
Sometimes called a brow lift or browplasty, a forehead lift works to not only feminize but also rejuvenate your forehead area. Eyebrows are an important facial feature that enables one to outwardly express their emotions and feelings; they also play a vital role in determining how feminine or masculine your eyes look.
Contour and thickness generally differentiate female eyebrows from male eyebrows, with the former being a lot curved and higher than the latter. A brow lift works to enhance the definition of eyebrows by making them more curved and higher-positioned in order to achieve a more feminine appearance. Surgeons may sometimes perform frontal bone reshaping prior to a brow lift as the frontal bone directly determines how arched and high-set your eyebrows are.
· Midface Lift
If you had saggy skin in the cheek area before undergoing facial skeleton feminization, you may need to have a midface lift (also known as a cheek lift or rhytidoplasty) performed as well. This is usually the final step in the process of facial feminization.
Feminizing the facial skeleton causes it to reduce in size, thereby enveloping it with more layers of skin and soft tissue which may start to droop. If the patient is quite young, it is very likely for the skin tissue to readjust according to the reshaped facial bone, thus preventing the appearance of saggy cheeks. This tissue readjustment may not occur if the patient is slightly older, therefore a midface lift would have to be performed in order to enhance chin and jawbone contour. How pronounced the final results will be depends on how extensive the signs of aging were at the time rhytidoplasty was performed, and how much bone was removed during facial skeleton feminization.
· Neck Lift
One of the first signs of aging is loose, saggy neck skin as a result of gravity causing the tissues to stretch over time. Neck lifts are the only go-to solution for such situations and are sometimes performed in conjunction with a facelift for better results. A neck lift is also often performed after facial skeleton feminization in order to adjust the skin and soft tissues against the reshaped facial skeleton, thereby tightening skin that has lost elasticity due to genetics or aging.
Blepharoplasty is sometimes performed as a form of facial rejuvenation during feminization surgery since a youthful appearance tends to come off as more feminine than an older countenance. There are two kinds of blepharoplasty:
o Upper blepharoplasty involves the removal of loose skin or fat on the upper eyelids to make them more noticeable
o Lower blepharoplasty involves the removal of excess skin and fat responsible for under-eye bags
· Rhinoplasty/Nose Reshaping
Rhinoplasty as part of facial feminization surgery aims to alter the overall profile of the nose by making it smaller in appearance and enhancing its contour. This is usually done via internal changes that involve narrowing the nasal bridge, or remodeling and repositioning the nasal cartilage. The male nose and nasal bridge are often broader and sharper in appearance, with pointed nasal tips being more common in females than men. The only challenge with this procedure is ensuring your nose is well-balanced against your other facial features.
· Tip Plasty
This procedure involves remodeling the nasal tip to achieve symmetrical yet elegant proportions, contour, and function. As the nasal tip is a part of the nose that is often noticed first, it is important for it to be aesthetically pleasing in appearance and shape while still looking feminine.
Alarplasty is a quick surgical procedure that involves the removal of excess nasal tissue to narrow the nostrils and reduce the width of the ala (nasal wings). In many cases, it is performed in conjunction with rhinoplasty to achieve an overall enhanced aesthetic appearance; however, the main aim of alarplasty is to make the nose appear more feminine while remaining well-balanced against other facial features.
· Brow Reduction
As mentioned previously, the eyebrows are one of the main facial features that influence how feminine or masculine your eyes appear to be. The brow ridge is the covered bony area on top of which the eyebrows are located and is most noticeable when the forehead is viewed from the side. The lower part of the brow ridge curves inward to form the eye sockets, while the upper part comprises a portion of the forehead formed by merging with the frontal bone.
The shape of the brow ridge is typically dependent on genetics, but it can be affected by conditions such as endocrine disease or trauma which can cause it to thicken. Prominent brow ridges are known to be more common amongst males, which is why brow reduction is a procedure often considered by individuals who are transitioning in order to significantly lessen ridge protrusion for softer-looking eyebrows and a more feminine forehead.
· Cheek Implants
Unlike males, females are known to have slightly more defined, protruding cheeks that tend to occupy more facial surface area. It has become a lot easier to increase the size of cheeks nowadays owing to the introduction of synthetic implants (commonly made of flexible solid silicone) that offer permanent results. The procedure involves the creation of incisions along the upper gums to form pockets behind the cheek muscles through which the implant is inserted.
· Cheek Augmentation & Cheek Reduction
The process of cheek feminization typically involves one of the following treatments:
o Cheek augmentation: This procedure adds definition to the cheeks through fat autografts (lipofilling) or via implants which are placed directly on the cheekbone underneath the skin to make the cheeks appear more prominent and fuller and less sunken/hollow. Cheek augmentation helps you acquire softer facial features for a more elegant, feminine appearance while also enhancing contour and restoring youth to the midface region.
o Cheek reduction: This procedure, in contrast, works to reduce the size of the cheeks and make them less prominent. Reduction is most beneficial for individuals with excessively wide cheeks to help them achieve a more balanced and symmetrical facial appearance.
· Mandible Angle Reduction
Males are known to have wider, heavier-set jaws with sharp angles and a flat base, giving rise to a square-shaped jawline. Females, on the other hand, have rounder-shaped jaws that are often tapered and pointed — such is the same even when the jawline appears square-shaped. Mandible angle reduction works to feminize male jawlines by reshaping the back corners to seem much rounder and smoother in appearance. To further narrow the jawline, bone along the lower edge of the jaw may also be shaved off.
· Chin Reshaping & Chin Implant
Chin appearance and contour also happen to be important factors when identifying gender. Males are known to have wider, sharper and longer chins with a square-shaped appearance and a flat base, unlike females whose chins typically appear softer, smoother, and rounder.
Chin reshaping is a procedure performed to feminize the chin by making it smaller, less sharp, and smoother in appearance while remaining well-balanced against the rest of the facial features. Receding/weak chins can be corrected with chin implants to add more definition to the chin area while also improving facial balance.
· Adam’s Apple Shaving
One distinctive feature of adult males is the Adam’s apple. A noticeable Adam’s apple can be made less conspicuous by performing an Adam’s apple shaving or thyroid cartilage reduction. These procedures involve shaving off some of the cartilage to ensure the Adam’s apple no longer protrudes, thus giving a smoother-looking, feminine neck.
Surgeries for facial feminization are usually kept on hold until adulthood is reached. Before undergoing surgery, you will have an in-depth discussion about your treatment process during a consultation with your surgeon. It is important that you choose a board-certified surgeon who is well-experienced in the procedure you are going for. Since every individual’s facial structure is very distinct, your surgeon will ask you about your desired expectations and, based on this, will recommend the best procedures that most benefit your situation. They will also give an idea of the results you can expect to achieve.
For your surgeon to lay out a detailed surgery plan, you may be asked to undergo a CT scan in order to obtain comprehensive anatomical information that specifically pertains to you. Photographs of your face will also be taken before and after your surgery at different points in time to assess your results.
Depending on the procedure being performed, you may need to have anesthesia administered prior to surgery. Before doing so, your surgeon will discuss with you about any known allergies you may have so that any potential adverse reactions to anesthesia can be avoided.
It is imperative for all pre-treatment instructions to be meticulously followed as provided. These instructions may address certain aspects such as whether you should quit smoking for a certain period of time, if there are any adjustments you may need to make to the medications you are currently taking, and if there are any restrictions to eating/drinking prior to surgery. In addition, you will be given relevant guidelines after surgery to ensure you maintain your results. Please also take note that you will need to satisfy specific requirements in order to have certain procedures performed.
Most importantly, your surgeon will carry out a proper evaluation of your health status to ensure that you do not have any underlying medical conditions which may negatively affect treatment progress.
The following may be included as part of your medical evaluation:
Even though it is standard protocol to give your consent to perform a procedure after being informed of all potential risks and benefits, an evaluation by a mental health provider with transgender health expertise may still be requested by your surgeon or insurance companies. This evaluation might assess:
We understand you may want to change your plans due to the coronavirus (COVID-19) and its health implications.
As with all surgical procedures, feminization surgery can present risks such as bleeding, infection, undesirable reactions to anesthesia, structural tissue damage, and facial imbalance.
Possible complications can include:
What kinds of facial feminization procedures are available for me?
Since no facial structure is exactly the same, the procedures that would most benefit an individual’s unique situation will vary. The photos that you submit via your free virtual consultation will be thoroughly assessed by a surgeon. You will then be sent an email from one of our virtual consultants which details the exact procedures that would be most beneficial to you in terms of facial feminization.
The following procedures are involved as part of facial feminization surgery:
- Forehead lift
- Midface lift
- Neck lift
- Upper and lower blepharoplasty for the eyes
- Rhinoplasty, tip plasty, and alarplasty for the nose
- Various other procedures, such as:
o Brow reduction
o Cheek implants
o Cheek augmentation (lipofilling)
o Cheek reduction
o Mandible angle reduction
o Chin reshaping
o Chin implants
o Adam’s apple shaving
How much time do I need to get back to my normal daily activities?
It is a requirement to have at least seven days off work or studies in order to give yourself enough time to prepare for your surgery and have it performed, as well as attend any post-treatment follow-up sessions. Swelling is expected to gradually reduce over a week, with bruises becoming less visible two weeks after surgery but they can of course be concealed with makeup.
If you are working from home, you can resume work a couple of days after the procedure has been performed. However, individuals who would like to wait until they completely recover before returning to work or studies would need a comprehensive resting plan that should span at least two to three weeks.
Can any face be feminized?
All individuals are able to undergo facial feminization surgery, especially those who are deemed to be in good health. Nonetheless, your candidacy for a certain procedure will be determined by your surgeon.
Does facial feminization surgery hurt?
Fear of pain or discomfort that may be experienced post-surgery is a very common cause of anxiety for patients before actually getting the procedure done. However, you will be pleased to know that the discomfort you may experience is often well-controlled, depending on the procedure that is being performed as well as the quality of post-surgery aftercare. So long as you choose a well-experienced and highly-qualified surgeon, you can typically expect tolerable pain of very low intensity after surgery. Reading through the post-treatment section on this page should give you some idea of how to effectively manage pain after undergoing facial feminization surgery.