Facial Feminization Surgery, or FFS, is an umbrella term encompassing a variety of facial plastic surgery techniques. FFS seeks to help an individual realize a more feminine appearance on their face, softening and de-masculinizing features, and is often sought by women who were assigned male at birth. Another commonly used term, Gender Confirming Facial Surgery (GCFS), includes both FFS and FMS (Facial Masculinization Surgery).
Facial Feminization Surgery (FFS) Explained
Testosterone produces characteristic changes in the face that are commonly used in society to assign a male gender label. These changes are typically only a few millimeters in any dimension, but quite powerful. Nearly every culture has widely accepted cues that an individual can adopt to augment or decrease this affect using clothing, hairstyle, or other adornments, but even without these cues, our brains are very attuned to the subtle changes caused by testosterone. These changes include alterations in hair distribution, facial bone structure, and the thickness and location of soft tissue. Some of these masculine features can be at least partially addressed with non-surgical procedures like hormone therapy, hair transplantation, and hair removal. Other features, though, like a strong brow bone, masculine nose, flat cheeks, a long upper lip, a strong jaw, or a visible Adam’s apple are often best addressed with a surgical procedure. These procedures, when used to create a more feminine face, are blanketly called FFS.
For most patients with features that are in a characteristically masculine range, FFS can bring those features well into the feminine range. FFS has been shown to reduce gender dysphoria in transgender women, and can be a lifesaving procedure for patients at risk of trans violence.
Who is a Good Candidate for Facial Feminization Surgery?
If you have been considering FFS, you may be wondering if you are a good candidate.
The most common FFS patient identifies as a transgender woman and has masculine facial features that are either a source of dysphoria or lead others to assign her a male gender. The procedures included in this category can be of benefit to patients who identify in a variety of other ways. Transfeminine, gender queer or non-binary individuals, as well as cis women with strong masculine features, may be great candidates for FFS. Cis men with overly masculine features, like a “caveman” forehead or jaw, may undergo FFS to bring those features into a more typical masculine range. FFS can help to create more symmetry in a very asymmetric face. In general, no matter how we identify, we all look more masculine as we age. Many of the procedures used for FFS can help restore a more youthful facial shape and balance. The first requirement in a patient seeking FFS is just that they want a more feminine face.
Those features could include several things, such as the size and shape of:
- Jaw and/or chin
- Brow bone
Just as every person’s face is different and everyone has varied ideas regarding what they believe is beautiful, it is important to consult with a plastic surgeon who specializes in FFS, such as the doctors at Omni Cosmetic in Minneapolis and Saint Paul.
During a consultation, you and your surgeon will discuss whether you are a good candidate as well as your targeted outcomes. Additionally, your surgeon will want to learn about your overall health, perform a detailed physical of the face, learn about your motivations, and take photos of your face.
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Procedures Included in a Facial Feminization Surgery
While each patient has unique desires as it relates to FFS, there are some typical procedures. These procedures all seek to give your face a softer, more traditionally feminine appearance and could potentially involve both soft and bony tissue surgeries on and around the face, neck, and thyroid cartilage.
Adam’s Apple Reduction
Also known as a Tracheal Shave, Thyroplasty, or Thyroid Cartilage Reduction, this is a common procedure and involves reducing the size of the Adam’s Apple while protecting the vocal cords and structural support of the neck.
Learn more about adam’s apple reduction.
Brow Bone Reduction
In this procedure, the forehead and area around the eyes are reshaped to open the eyes and create a more feminine brow shape. Most patients require a type 3 brow bone reduction where the thin bone over the frontal sinus is carefully removed, the forehead and orbital rims are reshaped, and the brow bone is reattached with tiny plates and screws. Brow reduction is one of the most common and powerfully feminizing steps in FFS.
Learn more about type 3 brow reduction.
This procedure brings the hair-bearing tissue of the scalp forward to lower and round the hairline. This creates not only a more feminine hairline, but also a more feminine facial shape and more feminine facial proportions are achieved. This procedure is often performed in combination with a brow bone reduction and brow lift.
Learn more about hair advancement.
Creating fuller and feminine-looking cheeks can be accomplished with cheek implants, a fat graft from somewhere else on your body, or injectable fillers. Augmentation with implants is completed through a small incision in the mouth, and is a great way to permanently achieve a fuller, more feminine cheek. Fat grafting can achieve similar results that last decades and can also be used in other areas of the face, like lips. Even the longest-lasting injectable dermal fillers will be gone in two years, but they may have a role in patients who cannot have surgery or who may want to see the changes before committing to a permanent change.
Cheek augmentation procedure options:
Learn more about cheek implants
Learn more about facial fat grafting
Learn more about dermal fillers
Feminine noses tend to be proportionally smaller, more upturned, and typically have a straight to gently concave line along the bridge in profile. The goal of a feminizing rhinoplasty is to make a feminine nose, not a nose that looks like it had surgery to look more feminine. To avoid the latter appearance, we focus on creating a symmetric nose with soft, smooth features and naturally feminine dimensions. The perfect nose on one face will often look quite out of place on another, so taking into account each individual’s facial features and initial nasal structure is critical to a natural outcome.
Learn more about feminizing rhinoplasty.
The distance from the bottom of the nose to the upper border of the red part of the lip is typically shorter in a feminine face. Even more importantly, a feminine face will often have several upper teeth visible in a resting facial position. To perform a lip lift, a small strip of tissue is removed from right under the nose. This shortens the distance from the nose to the lip, rolls the lip out and makes it appear fuller, and can be used to enhance the cupid’s bow shape of the lip. This procedure is often combined with augmentation to make the upper and/or lower lip fuller.
Chin and Jaw Reduction
A feminine jaw has a higher, more narrow and softer angle, and it tapers in a “V” toward the chin. A feminine chin is narrower and not as tall as a masculine chin. Achieving the ideal feminine jaw and chin shape takes a slightly different procedure for every single patient. Bone is removed from different areas in different proportions to maximize the feminine change, jawline definition, and symmetry. In addition to bone removal, or contouring, this will often involve a sliding genioplasty.
Learn more about jaw reduction or jaw contouring
Facelift or Neck Lift
As we age, our soft tissues descend, and our jawline becomes more square shape and masculine. Loss of volume from significant weight loss or a significant jaw bone reduction can accelerate this process. Many young, healthy FFS patients will see little benefit from a face or neck lift even with a mandible reduction, but “more experienced” patients or those with a history of significant weight loss may not get the full benefit of the mandible reduction without a lift.
Learn more about face and neck lifts
Laser Skin Resurfacing
Feminine skin is smooth, healthy, and bright. Sun damage, facial hair, and contour irregularities caused by wrinkles or scarring from acne or electrolysis reduce the amount of light reflected and make skin more masculine. Fractional laser skin resurfacing can make skin smoother, healthier, and more reflective.
What is the Cost of Facial Feminization Surgery?
When considering Facial Feminization Surgery, it is necessary to understand that there are many factors that can go into determining the costs associated with the entire process. Every FFS is uniquely tailored to each patient; therefore, a consultation is necessary to determine exact costs.
The factors that are involved in determining the final cost include:
- Where the procedure is performed and if there is a hospital stay.
- Hardware used, including implants or inserts.
- Anesthesia and operating room fees.
- The number and type of procedures that will be performed
Typical costs for FFS could range from $20K to over $50K. Contact us at Omni Cosmetic to schedule a consultation and learn more.
What Are the Risks of Facial Feminization Surgery?
As with any surgical procedure, there are risks associated with FFS. It is important to be aware of the side effects that will certainly occur, like swelling, bruising, and incisional scars. These issues will remedy themselves as you heal, but will often require several weeks to completely resolve.
Patients should also be aware of other rare but more significant risks associated with FFS, including postoperative bleeding and the potential of local infection. Your surgeon will carefully review all of the risks associated with your specific surgery, what is normal, and what should prompt you to contact our office. As always, our team is available around the clock to answer any questions you may have through your recovery.
Do you want smoother, more feminine facial features?
Facial feminization surgery can help correct common masculinizing features such as a square jaw and pronounced brows. If you are undergoing a gender transformation, it can also help reduce your Adam’s apple or soften your nose shape.
What to Expect During the Facial Feminization Surgery Recovery Process?
It is common for swelling and bruising to be experienced during the recovery process. As such, your final results will not be immediately visible. While this varies from patient to patient, the most significant swelling typically will subside within the first month post-surgery. Some less significant but more persistent swelling, especially in the nose and jaw, can take several months to resolve.
Depending on your surgery, it is likely that you will have some restrictions on your activity after it is completed—at least for 4-6 weeks. This is to avoid injuries occurring to bones and tissues as they heal.
Incisions within your mouth may make rough, firm, or sharp food uncomfortable for 1-2 weeks.
Most patients return to work after 2-4 weeks; however, this will vary from patient to patient based on the course of your recovery and the requirements of your position.
What Results Can I Expect from Facial Feminization Surgery?
One of the main goals of the consultation process is to set expectations. We want every patient to know what they can expect; from the day of surgery, through recovery, and as a final result. We will use several tools like demonstrations, diagrams and before and after photos to help you best understand what to expect through the whole process.
The short and long-term changes after surgery will depend on where you start from and what procedures you undergo. Most patients will see a few hints of the changes they were hoping for right away, but the full picture will take months to see. The first days of recovery are the most uncomfortable, but this waiting period can be just as challenging in its own way. Our surgeons and staff will do everything we can to support you through the entire process, but a strong network of family, friends and medical and mental health professionals will help make recovery as smooth as possible.
Meet Our Surgeons
As you consider pursuing FFS, realize that the plastic surgery practice you decide to partner with can make all the difference. At Omni Cosmetic, we are passionate about helping our patients as they journey on their path to self-improvement, and we want you to feel confident and secure in the appearance that you project to the world.