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What to Know About Facial Feminization Surgery

Reviewed by Dan Brennan, MD on April 15, 2021

At birth, a doctor and a person’s parents typically assign their gender. This is typically based on physical characteristics, like the presence of a penis or vagina.

A transgender woman is typically assigned male at birth (AMAB). This means the doctor and their parents assumed they were a boy due to physical characteristics – like a penis.

Regardless of their assigned sex at birth, a person may feel their gender identity is different. They may have gender dysphoria, where their internal gender does not match the gender they were assigned at birth due to the presence of sex organs and other physical characteristics.

This condition can be emotionally distressing and cause feelings of depression, anxiety, and other mental health struggles. A diagnosis of gender dysphoria can be helpful as this helps the person with this condition access resources and professional help so they feel more comfortable.

To feel comfortable in their bodies, many people choose to transition to the gender they feel they are inside. This process is called “transitioning.” Transgender women typically transition from male to female.

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Trans women may do a number of things to make them feel more comfortable in their own bodies when transitioning. They may

  • wear more feminine clothes
  • grow their hair longer
  • take estrogen, progesterone, and testosterone blockers
  • get gender-affirming surgeries

Facial feminization surgery, or FFS, is a gender-affirming surgery a trans woman may choose to have.

Other gender-affirming surgeries for trans women include the following:

What Is Facial Feminization Surgery?

FFS procedures include any facial cosmetic surgeries that a person gets to make their face appear more feminine. It may include the following procedures.

Hairline advancement. In this surgery, doctors move the hairline forward and remove the characteristically male "peaks" from the hairline.

Brow lift. Raising the eyebrows can sometimes give the face a more feminine look.

Chin and/or jaw shaping. Male jawbones often have more bone in them. This makes the jaw appear more square. Doctors can shave this bone to give the jaw a more pointed, feminine appearance.

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Rhinoplasty. Otherwise known as a " nose job," doctors do this surgery to create a smaller, more feminine nose.

Tracheal shave. People who were AMAB have a prominent Adam’s apple. Doctors can reduce the size, making the neck more feminine.

‌Forehead and orbital rim contouring. A protruding or overhanging brow is typically seen in those AMAB. Surgery can be used to reduce it.

Cheek augmentation. Many women have high cheekbones. Cheek implants can be inserted to give a more feminine appearance.

Each FFS procedure is unique to the individual. When you first visit your doctor, they will offer you all the options available. They will work with you to choose the procedures you want to have.

FFS may be a multistage procedure, with one or more surgeries, depending on your choices.

Who Can Get Facial Feminization Surgery?

You may be a good candidate for facial feminization surgery if you:

  • Are generally in good health
  • Have a diagnosis of gender dysphoria
  • Have been living as your desired gender
  • You have any significant mental health concerns under control with the help of professionals
  • You are aged 18 or older
  • You understand the limitations of cosmetic surgery

What Are the Risks of Facial Feminization Surgery?

FFS comes with the risks of any major surgery; these include the following:

  • Excessive bleeding
  • Infection
  • Unintended reaction to anesthesia
  • Damage to other structures of the face

Risks specific to many FFS procedures include the following:

  • Facial asymmetry
  • Scarring
  • Injury of facial nerves
  • Feeling dissatisfied with how you look after the surgery

What Should You Expect for Recovery After a Facial Feminization Surgery?

The details of recovery from facial feminization surgery depend on which procedures you choose to have. 

In general, swelling, pain, and redness will be present after surgery. For most FFS procedures, you should avoid any strenuous activities or exercise for about 4 weeks. 

Depending on which procedures you have had, you may have a tube placed to drain extra fluid that collects after surgery. You may have a gauze, a facial compression garment, or bandages placed on you. Your doctor will tell you how to care for your incisions and drains and when to change your bandages. They will also tell you about specific things to look for in the healing process.

What Do the Results of FFS Look Like?

It can take up to one year to see the full results from your FFS. As you heal, your doctors will work with you to help you get the results you want. 

You may have lasting scars, especially along the hairline. Following your doctor's instructions after the surgery increases the chances of positive results. 

FFS is a recognized treatment for gender dysphoria. Studies prove that it both gives faces a more feminine appearance and improves the quality of life for transgender women.

WebMD Medical Reference

Sources

SOURCES:

Alberta: "Learning About Gender-Affirming Surgeries for Transgender Women."

American Society of Plastic Surgery: "What is facial feminization surgery?," "Who is a good candidate for facial feminization surgery?," "What should I expect during my recovery after facial feminization surgery?," "New Study Evaluates Facial Feminization Outcomes, Benefits for Transgender Women," "What results should I expect after facial feminization surgery?"

Mayo Clinic: "Gender dysphoria," "Facial feminization surgery."

Montclair State University: “Terminology.”

UCSF Facial Plastic Surgery: "Facial Feminization Surgery (FFS)."

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