Craniofacial FAQs

The answer is a little bit complex; however, craniofacial surgeons are trained, generally speaking, in the United States as medical doctors who have completed a general surgery and plastic surgery residency and then have gone on to do craniofacial surgery training. These physicians generally are skilled in skull bone reshaping and in orbital surgery. They are also highly trained in cleft lip and cleft palate. Generally speaking, most craniofacial surgeons in the United States are not as well trained in orthognathic surgery, which tends to be the purview of maxillofacial surgeons in the United States. The European system is slightly different from us. Maxillofacial surgeons in the United States more often than not tend to be dentists. They have often gone on to do a residency in oral and maxillofacial surgery, often otherwise known as OMFS. The purview often includes as part of that orthognathic surgery, but more often than not, the vast majority of that field is doing bony tumors, dental implants, and complicated and/or impacted tooth extractions.

The answer, again, is slightly complex. I would say that most patients look like they are able to go out in public without attracting too much attention in 2-3 weeks after the initial operation. This does not mean to say that you are completely healed. It takes six weeks for the bones to completely fuse and to achieve essentially stability there where essentially rolling over on your pillow or some other type activity would not displace and/or harm the result that we have done. Now with that being said, I would say that approximately 60% of the swelling is gone after about three months; however, the remaining 40% of swelling can often take somewhere up to one year to fully resolve, or longer. Therefore, I do not tell any patients that complete healing has occurred until the patient is about one and a half to two years out from surgery. However, in terms of when a patient might be able to attend a social event where looking their best is important, I generally will say 2-3 months is the minimum in that regard.

The answer is sort of. The size and shape of the skull in general does not generally change after approximately the age of 7 or 8, at least not appreciably. However, there can be some changes in the shape of the orbits. These are pretty subtle changes that are generally studied by patients who do longitudinal studies on skull shape and, generally speaking, when it comes to aging, and therefore you can ascertain some differences in the shape of a facial skeleton around the eye socket, which will slightly change in shape, as well as the piriform aperture which is otherwise known as the central hole that you breathe through upon which your nose sits.

: Ha-ha. Well, of course, me! (Kidding.) I think that the best facial feminization surgeon is somebody who is trained in the rigorous facets of not only plastic surgery, but craniofacial surgery and maxillofacial surgery. In addition, I think somebody needs a significant amount of experience with somebody who essentially does facial feminization surgery. My mentor, Doug Ousterhout, felt like that took at a minimum of 2-3 years before anybody would be ready to perform the myriad of operations in a reasonable amount of time and with a reasonable result.

The answer is any time after one is skeletally mature and psychologically prepared to undergo a large operation.

The answer is complex. Everybody’s insurance plan has different provisions. Many insurance plans consider any facial surgery to be cosmetic and specifically excludes them. Other insurance plans have a looser generalization regarding what they will cover and not cover. It also depends what you mean by “covered.” Oftentimes, insurance companies will cover a portion but not all of your case, and this is very specific to your particular insurance plan, what the deductibility of your insurance plan is, and what doctors they are contracted with and at what rates. So the answer is a little bit complicated. I can say that various employer-sponsored health plans more often than not with large technologies companies, and in addition to Starbuck’s and Amazon, will often make agreements with our practice in order to completely cover the cost of facial feminization surgery.

Facial feminization surgery, when I first started doing it, routinely took 10-12 hours. This was doing the surgery with Douglas Ousterhout, the pioneer and founder of facial feminization surgery. Upon the doctor’s retirement, we made a number of changes and improvements in not only efficiency, but technique which allowed us to reduce the operating times, and now our surgeries rarely take beyond six hours and sometimes between four and a half to five and a half, depending on the scope and extent of surgery. This provides for a lower dose of anesthesia, less time while you are under/asleep, less swelling, and a faster recovery period in our experience.

Definition of a jawline is essentially based on two issues. One is how slender a patient is renders a thinner covering over the bones, and then essentially when it comes to a jawline, definition is often associated with the wider the jaw and the skinnier the neck, the more defined the jawline will be. Therefore, you can add definition to a jawline essentially by placing implants at the risk of potentially masculinizing a jaw. Additionally, you can add definition by having the patient lose weight. Sometimes you can add definition to a jawline by advancing the chin if the patient has what is called microgenia, or a weak chin, as this will often tighten up the neck and the submental region of the neck and improve the definition along a jawline.

Yes, cisgender females may also get facial feminization surgery. Cisgender females tend to not like particularly masculine features if they have them any more than transfeminine individuals do. Therefore, a small but not insignificant number of patients that we see yearly are cisgender females who may have some slightly masculine traits, whether it be a tall chin, whether it be a square jawline, or whether it be an unsightly amount of brow bossing that they consider to be masculine in nature. So, yes, you can feminize a cisgender female patient.

Very little difference. They are one in the same within the United States’ medical training system.

The answer is facial feminization surgery tends to not be particularly painful. Facial feminization surgery, however, would not otherwise be described as comfortable. Most of our patients report very little pain after surgery and tend to look fairly at ease after surgery; however, that is not the same thing as saying that the patients are otherwise comfortable. For instance, after a rhinoplasty you will have splints in your nose which impedes breathing. This causes people to have a stuffy nose, which is uncomfortable by definition. This causes the patients to mouth breathe, they often have dry lips and dry mouth because of that which can lead to chapped lips and discomfort in that regard. Additionally, patients after facial feminization surgery will take a few days to shake off some of the “hangover” from the anesthetic drugs that are sometimes used, and this can therefore also lead to a different kind of sensation that is not exactly described as pain, but would otherwise be described as uncomfortable.

The answer to this is too complex to be answered by anyone. Numerous types of studies have tried to ascertain the difference between beautiful and otherwise unconventionally not beautiful faces and no correlation with any particular facial measurements, feature, or particular shape has actually been reliable drawn on most given studies. Beauty is too complex to be able to quantify in that way and there is no answer to this question.