Facial Feminization Surgery

Facial Feminization Surgery
 Female face skull. Image credit: Chris Gralapp
Female face skull. Image credit: Chris Gralapp
Male face and skeleton. Image credit: Chris Gralapp
Male face and skeleton. Image credit: Chris Gralapp

Facial Feminization Surgery: Feminizing the Male Face

Often transgender individuals feel unhappy with how they appear to the world because their outside appearance is out-of-sync with how they feel inside. How we feel about our appearance in the world is critically important, not only in our daily lives and in our relationships, but also in how we feel about our own bodies, our feeling of self- worth, and inner sense of wellbeing. Facial gender confirmation surgery aligns the person “inside” with who we are “outside”, and includes a wide range of reconstructive and aesthetic surgical procedures that work to reshape masculine facial features to make them appear more feminine:

Why choose a plastic surgeon with craniomaxillofacial training for your FFS?

Most plastic surgeons are capable of performing soft tissue procedures, however, for a successful and long-lasting facial gender confirmation surgery result, bone work on the facial skeleton needs to be performed by a highly skilled surgeon with craniofacial training. We believe that only surgeons cross-trained in both general plastic surgery AND craniofacial and orthognathic (jaw) surgery should perform FFS. Needless to say, your surgeon must also have the keen eye of an artist and a deep appreciation of facial aesthetic harmony.

Have you had FFS surgery before but are less than happy with the results?

Unfortunately, one of the most common types of facial gender confirmation procedures we perform is to correct a previous surgeon’s work. This is often because while a surgeon may know technically what is required for facial feminization, they may not understand the subtle qualities of what truly makes a face “feminine” versus what makes a face simply beautiful. To capture authentic feminine gender expression, your surgeon needs to fully comprehend the science and structural proportions behind male vs. female faces, and also have a deep awareness of the more subtle aesthetic qualities of what constitutes gender.

Read more about the characteristics of facial femininity here.

Can I have a facelift at the same time as my facial gender confirmation surgery?

Dr. Deschamps-Braly recommends waiting at least six (6) months after your surgical procedure before pursuing a facelift or any other facial rejuvenation procedure. This is because feminine facial features are generally more petite than male features, so the facial gender confirmation surgery may leave some individuals with excess laxity of the skin. Depending on your age and skin condition, this excess laxity may resolve on its own, or it may need a facelift in order to remove it.

Read more about face and neck lifts here.

Can I do my FFS in different phases? Or should it happen all at once?

While we recommend that facial gender confirmation is completed in a single stage, the procedure may be broken up into phases—typically an “upper face” and ‘”lower face” phase. Each phase would encompass a cluster of surgical procedures that are closely related to each other to ensure a harmonious balance to the face (i.e. forehead and nose or chin and jaw). The two phases can be performed as close as two days, or as long as several years apart. And of course, a single, comprehensive facial gender confirmation surgical procedure can also be performed and is preferable in most cases to save on downtime and of course, expense.

How long will the surgery take? How safe is long-format surgery?

A set of facial gender confirmation procedures most often takes anywhere from 6 to 10 hours depending on the exact set of plastic and craniofacial surgical procedures that are required. Undertaking multiple surgeries at the one time is very common and usually quite safe if you are in reasonable health. Your surgeon will help you to decide if the specific procedures you require are safe to do in the one session.

How long will it take to recover from facial gender confirmation surgery?

Typically you will stay the night in hospital immediately after your surgery. Your surgeon will visit with you in the morning on the day after your surgery to check in with you. The first few days you will experience facial swelling and also feel mild discomfort. However, because we will have taken steps to reduce your pain and swelling before you were operated on, this will subside rapidly. Read more about our pre-op pain relief strategies here. Within about 7 days after your surgery, most of the swelling and bruising will resolve. After about 3 to 4 weeks you should have a full recovery and be able to resume your usual activities and wear makeup. However, your results will continue to improve over the next few months, with the final result being evident at six to twelve months.

Facial Feminization Surgical Procedures:

Facial feminization surgery includes a wide range of reconstructive and aesthetic surgical procedures that work to reshape facial features to make them appear more feminine.

Depending on your current features and expectations you may need one, or a few of the following procedures to obtain the results you’re seeking:

Hairline Lowering / Scalp Advancement Surgery

The male hairline is often higher on the forehead and may recede with age. To make the hairline more feminine, it is lowered through feminizing hairline lowering and scalp advancement surgery (also known as a hairline correction). Hairline lowering is almost always recommended in Facial Feminization Surgery because most male-to-female (MTF) patients seek to lower the height of the forehead and improve temporal hair loss (male-pattern balding).

Read more about hairline lowering surgery.

Forehead Reduction and Contouring Surgery

Forehead contouring and reduction is one of the most common surgeries included in Facial Feminization Surgery and results in a significant feminization of the face whilst keeping the features looking natural and in proportion. Dr. Deschamps-Braly was personally trained in the art of forehead contouring by Dr. Ousterhout – the pioneer of this procedure. As a result, this procedure is not performed anywhere else in the same meticulous manner as we do here in San Francisco.

Read more about forehead reduction and contouring.

Brow Lift (Browplasty)

Within the context of facial feminization, a brow lift procedure raises the eyebrows into a higher, more feminine position on the face. A brow lift also works to eliminate common telltale signs of aging such as wrinkles on the forehead, crow’s feet, horizontal or vertical lines such as frown lines and furrows between the eyebrows and around the eye.

Read more about brow lifts for feminization here.

Feminizing Rhinoplasty (Nose Surgery)

Feminizing rhinoplasty, or nose surgery, is another common procedure used in facial feminization. Male noses are usually wider and larger and need to be reshaped and refined to appear more feminine. The rhinoplasty procedure reduces the size of the nose by narrowing and/or altering the nose internally, and/or reshaping and moving the nose cartilage. The art of feminizing rhinoplasty is a delicate one. Along with precise surgical skills, your surgeon must also possess a keen artistic eye to be able to visualize how your reshaped nose will appear in harmony with your other facial features.

Read more about rhinoplasty for feminization here.

Cheek Enhancement: Augmentation & Reduction

Feminizing cheek enhancement gives the cheeks a rounder and smoother feminine appearance. Depending on your existing features and the desired effect, the procedure includes either cheek augmentation or cheek reduction.

Cheek augmentation most often includes inserting implants under the skin to create a fuller more feminine cheek shape. Another way to augment the cheek is via volume enhancement with fat injections (with fat taken from other parts of your body). In comparison, cheek reduction reduces the width and outward prominence of the cheeks allowing for more slender and streamlined facial features.

Read more about cheek augmentation and reduction surgery here.

Lip Reshaping: Upper Lip Lift, Lip Augmentation, Corners of the Mouth Lift

Feminizing the lips involves either a lip lift (upper lift reduction), lip augmentation (lip filling), or you may even chose a corners of the mouth lift. You may need one or all procedures depending on your desired result and existing facial features.

  1. An upper lip lift shortens the upper lip and improves the visibility of upper teeth, creating a more feminine and youthful appearance.
  2. A lip augmentation fills or plumps the lips so that they appear fuller, younger and more feminine.
  3. A corners-of-the-mouth lift focuses exclusively on lifting the corners of your mouth and does not affect lip movement, which is necessary for expressing a full range of emotions.

Read more about feminizing lip enhancement procedures here.

Chin Recontouring (Genioplasty / Mentoplasty)

Feminizing chin re-contouring (genioplasty) alters the shape of the male chin by reducing, reshaping, or augmenting (making the chin larger). Most often the male chin is reduced in size and reshaped to be less angular, creating a smoother and more feminine aesthetic. Chin surgery may also involve the elimination of asymmetries – making your features more symmetrical and aesthetically in harmony. Contrary to popular belief, no chin implants are used in chin recontouring other than small screws to hold the bones in their proper position.

Read more about feminizing chin surgery here.

Jaw Contouring (Reshaping or Tapering)

The male jaw is usually wider and more angular than the female jaw. Men tend also to have a sharp back “corner” to the jaw, which can be made to appear rounder and smoother through jaw contouring resulting in a more feminine look. The bone of the jaw can also be shaved along its lower edge and chewing muscles reduced to make the jaw more slender. Jaw contouring also helps patients who may have a lopsided face and wish to have their features appear more symmetrical.

Read more about feminizing jaw contouring here.

Feminizing Ear Lobe Reduction Surgery

Feminizing Earlobe Reduction Surgery is a plastic surgery procedure that can be undertaken independently, or as part of more extensive facial feminization surgery (FFS). The procedure aesthetically enhances the appearance of the earlobes and cartilage, with the goal of creating an external ear that is naturally feminine-looking in proportions, contour, and appearance.

Read more about Earlobe Reduction here.

Adam’s Apple Reduction (Tracheal Shave)

The Adam’s apple is one of the most recognizable male physical characteristics and as such, reducing its size with a tracheal shave is often one of the most common feminization procedures. The tracheal shave reduces the outward prominence of the thyroid cartilage and gives the throat a more feminine appearance. It is critical that the surgery is done correctly because occasionally the cartilage may grow back. We use special surgical techniques to greatly reduce that possibility.

Read more about Adam’s apple reduction (trachael shave) here.