Facial Feminization Surgery

Overview

Facial feminization surgery (FFS) is a type of plastic surgery that makes facial features appear more feminine. FFS can involve one or more surgical procedures, depending on the person’s goals. Sometimes, nonsurgical treatments support these changes.

Common changes include:

Smoothing the brow or reshaping the forehead
Adjusting the cheekbones for a softer look
Altering the shape of the jaw and chin
Changing the size or shape of the lips
Moving the hairline or using hair transplants

Some people also consider skin-tightening procedures, such as a face-lift, as part of their plan. These procedures help create facial features that align more closely with a feminine appearance.lp people’s faces match how they feel inside and address gender dysphoria.

Reasons for Undergoing This Procedure

Transgender women and trans women may experience gender dysphoria due to visible facial features that differ from their gender identity. Facial changes help people feel more comfortable in their appearance and support gender-affirming care. Common areas changed:

Brow
Jaw
Chin

This aligns how they look with how they identify, following guidelines from professional groups like the World Professional Association for Transgender Health (WPATH). These changes can have a strong impact on a person’s confidence and sense of self.

Possible Dangers

Facial feminization surgery carries certain risks, similar to other major operations. Common issues include:

Bleeding
Infection
Damage to tissues near the surgical site
Bad reactions to anesthesia

More specific risks to this type of surgery include:

Risk Type	Description
Scarring	Visible marks on the face after healing.
Facial nerve damage	Loss of feeling or movement in some areas.
Incision opening	Wounds may come apart after surgery.
Seroma	Build-up of clear fluid under the skin.
Hematoma	Collection of clotted blood in tissue.

Doctors say serious problems rarely occur, but every surgery has risks.

Getting Ready for Surgery

Providing Agreement for Surgery

Before moving forward, each person must clearly agree to the procedure. The patient and their surgical team discuss the benefits and risks involved, making sure there is a clear understanding of what to expect. These talks include:

The permanent nature of some changes after surgery.
Potential complications or health issues that might happen.
The cost and possible insurance coverage.
Other treatment options which could be considered instead of surgery.
Whether more surgery might be needed in the future.
The social and legal impacts, such as documents or name changes.

This process ensures the person feels comfortable with their decision and understands how surgery could affect many areas of their life.

Health and Readiness Check

Before the procedure, a healthcare professional checks general health and assesses if the person is physically ready for surgery. These checks often include:

Medical Evaluation: A thorough review for any health problems that might affect surgery or recovery.
Behavioral Health: An expert in transgender health may talk with the person to offer support, especially for emotional wellness during and after recovery.
Imaging and Documentation: CT scans or x-rays may be needed to get detailed information about the bone structure. Recent photos are usually taken for planning.
Medication review: The surgical team checks all medications, including hormone therapy, and may recommend stopping or changing some drugs before surgery.
Substance Use: Stopping use of nicotine products, alcohol, and some drugs is usually needed.
Surgical Plan: Together with the surgeon, the person will create a treatment plan matched to their goals, expectations, and medical condition.

Area Reviewed	Details
General health	Medical conditions, allergies, etc.
Mental health	Emotional readiness, support systems
Current medications	Including hormones and other medicines
Imaging	CT scans, x-rays for planning
Treatment goals	Personal expectations and desired results

More Things to Keep in Mind

Insurance coverage is important to check early. Surgery costs can vary, and what is covered by insurance is different for each person. Connecting with support groups or others who have gone through facial feminization can provide helpful insights.

Having good follow-up care, help at home after surgery, and clear communication with the healthcare team creates a smoother recovery process. These practical steps can lower stress and help set clear expectations.

What You Might Experience

While the Surgery Is Happening

Facial feminization procedures include a range of surgeries. Forehead reshaping often comes first. Here, the surgeon removes and shapes bone around the upper face, making it smoother and less prominent. Sometimes, the surgeon takes out the bone, carefully reshapes it, and places it back for a more rounded result.

For the eyes and eyelids, the surgeon removes extra tissue to give the eyes a bigger, softer look, using a method called blepharoplasty. Eyebrow lifts and other techniques also help make the area above the eyes higher and more arched. Surgeons can make cheeks rounder or fuller through cheek implants or fat grafting.

They may take fat from the stomach or hips and put it into the cheeks for a natural look. In some cases, the surgeon moves the cheekbones for better symmetry. Rhinoplasty, or nose reshaping, changes the size, angle, and shape of the nose to fit more feminine features. Surgeons often make the nose narrower and smaller.

Lip lifts shorten the space from the nose to the top lip, creating a youthful, upward curl. For fuller lips, surgeons use implants, fat transfer, or fillers. To soften and narrow the jaw, jaw contouring and jaw reduction remove some outer bone. The surgeon may also work on the chin with techniques like chin reduction, sliding genioplasty, or even chin implants to make it smaller or change its shape.

Surgeons reduce the size of the Adam’s apple, called a tracheal shave or chondrolaryngoplasty, through a cut under the chin for a less noticeable mark. They remove and shape some cartilage for a flatter look. Surgeons may perform hair transplantation by moving hair follicles from fuller areas to the hairline or temple regions.

A hairline-lowering or scalp advancement surgery moves the scalp forward and removes excess forehead skin, bringing the hairline lower. Neck lifts, liposuction, and face-lifts can be combined with these procedures to tighten skin or reduce fat for a smoother look. These treatments create more youthful, defined facial features. Below is a summary table showing common procedures and what they address:

Procedure	Purpose
Forehead Contouring	Smooths, rounds, and feminizes forehead.
Blepharoplasty	Softens and opens the eye area.
Cheek Augmentation	Adds fullness, creates rounder cheeks.
Rhinoplasty	Reshapes and smooths the nose.
Lip Lift/Augmentation	Shortens upper lip and plumps lips.
Jaw Reduction/Contouring	Narrows and softens jawline.
Chin Reduction/Genioplasty	Shapes and reduces chin size.
Tracheal Shave	Reduces Adam’s apple.
Hair Transplant/Lowering	Lowers hairline and restores hair.
Face-lift/Neck-lift	Tightens and smooths skin.
Liposuction	Removes excess fat.

What Happens Once Surgery Ends

Right after surgery, swelling, redness, and pain often affect the face, especially around the eyes, nose, jaw, and chin. Bruising and mild bleeding may occur in the first days. Your care team gives you a list of things to do and avoid.

Recovery usually means resting at home for several weeks, often around one month. After this, many people return to their regular daily activities, depending on how they heal. Always check with a medical professional before getting active again. Eating might be hard at first.

Chewing and swallowing could be uncomfortable due to stitches and swelling, especially after jaw work, chin surgery, or lip changes. A dietitian can help you choose foods that are easy to eat but still high in nutrients. Staying healthy while recovering is important for faster healing. A typical recovery process involves these steps:

First Few Days: Swelling, redness, and discomfort are most noticeable.
First 1-2 Weeks: Stitches may come out after about a week; bruises and swelling start to get better.
3-4 Weeks: Most swelling and bruising will improve. Many normal activities can be started again, but strenuous activity should still be avoided.
Several Months: Full healing, including final results, can take a few months. Numbness or changes in feeling are possible and usually get better with time.

Some people find it helpful to talk with a mental health professional during recovery. Adjusting to changes in appearance or dealing with emotions after surgery is normal. Support from experts in gender-affirming care can make recovery less stressful.

Pain medicine, cold packs, and keeping the head raised help reduce swelling and discomfort. Gentle face washes, as instructed by the care team, keep incisions clean and help avoid infection. You will have follow-up visits with the surgical team to check healing and remove stitches.

If you notice high fevers, worsening pain, or increased redness, call your doctor. Most people see improvements in their facial features within the first month, but some subtle changes can continue over several months as the body fully heals. Each person’s process is unique but following instructions from the care team supports the best results.

Surgery Outcomes

People usually notice the complete changes in their facial structure, including the brow ridge and lower face, after about a year. Regular follow-up visits help track progress and address any concerns. Some may consider additional procedures if facial features look uneven or if the first surgery did not create the desired feminine appearance.

Common Observations

Smoother brow ridge
Softer, more feminine face shape
Reduction of masculine features

Feature	Typical Change
Brow Ridge	Less pronounced
Lower Face	More refined contour
Facial Structure	Feminine balance