Most Frequently Revised Facial Feminization Surgeries

Redoing Facial Feminization – the Four Most Frequently Revised Surgeries

Redoing Facial Feminization: Why is it sometimes necessary?

Facial feminization surgery is a highly complicated cluster of procedures that involve a lot of “moving parts”. And, like any plastic or craniofacial surgery that is performed for aesthetic purposes, sometimes the results fall short of patient expectations. In fact, 15% of all facial feminization surgery that we perform is to improve upon another surgeon’s work.

The main reason for this high frequency of FFS revision surgeries is to do with the difference between artistry and technical expertise. For example, your chosen surgeon may have the technical skills to perform feminization, but they may lack an in-depth understanding of the subtle aesthetic qualities that make a face “feminine” versus what makes a face merely ‘attractive.’

The most common complaint that we hear from new patients seeking FFS revision is that their facial features have not been successfully ‘captured’ or represented as their preferred gender by their previous surgeon. On the first impression, the patient may appear beautiful, but not as feminine as they desired. In such cases, revision feminization surgery is highly recommended.

The 4 Most Frequently Revised FFS Surgeries are…

1. Jaw Tapering and Chin Recontouring

At our clinic, the most frequently requested FFS revision procedures include both jaw tapering and chin recontouring.

The chin and jaw compromise a significant portion of the lower face, and if not performed correctly, their shape will affect all other facial features. The reason these procedures are the most often revised is that the techniques are somewhat esoteric and not generally taught at academic centers during most surgeons’ training, therefore, most lack any experience with them. Most often these two procedures are performed during the same surgical session so it makes sense to also revise both at the same time if needed.

  • Chin recontouring works to reduce the angular shape of the male chin to be smaller, less angular, with a smoother and more feminine aesthetic. Sometimes less-skilled or poorly trained surgeons will use a chin implant to feminize the face but it is impossible to feminize a face with a chin implant and we strongly recommend avoiding chin implants for facial feminization.
    Read more about chin recontouring.
  • Jaw tapering (AKA jaw reduction) works to smoothen and soften the jaw to make the jawline appear narrower and more feminine. Sometimes the surgeon may lack the aesthetic eye to create a jawline that enhances the patient’s other facial features, resulting in a need for a do-over jaw surgery.
    Read more about jaw tapering.

2. Forehead Reduction and Contouring

Forehead reduction is one of the most critical procedures included in facial feminization because the forehead makes up almost 30-40% of the entire facial surface. The forehead also essentially ‘frames’ all other facial features; therefore it is one of the most significant surgical procedures included in facial feminization.

Many of our feminization revision patients report that they are unsatisfied with the shape of their newly reduced forehead. The most common complaint is either that the forehead has been “ground down” (instead of contoured or reshaped) without sufficient improvement in the result. Usually, in this scenario, the depth of the eyes will remain unchanged. Also, the shape of their new forehead does not ‘sit’ in aesthetic harmony with other facial features.

The solution is a do-over ensuring that the result of the procedure enhances and contributes to the overall ‘feminine’ appearance of the face.
Read more about forehead reduction here.

3. Tracheal Shave – Adam’s Apple Reduction

The Adam’s apple is one of the most apparent ‘masculine’ characteristics, and as such, it’s reduction is frequently included in the cluster of surgeries that make up facial feminization. The ‘apple’ is minimized via a tracheal shave, otherwise known as an Adam’s apple reduction.

Even though this procedure seems quite straightforward, it is critical that an Adam’s apple reduction is performed by a qualified and experienced plastic and craniofacial surgeon with extensive experience in gender confirmation surgery. If not executed correctly, the thyroid cartilage may grow back necessitating a do-over, or even worse the voice may be damaged which often is difficult to correct. At the Dr. Deschamps-Braly Clinic of Plastic and Craniofacial Surgery, we use advanced surgical techniques to significantly minimize the risk of voice injury or regrowth of the cartilage.

A word of caution: if you choose an unskilled or unqualified surgeon for your Adam’s apple reduction, you run the risk of a voice injury if your surgeon is not skilled at identifying the positioning of the vocal cords and protecting them during surgery.
Read more about Adam’s apple reduction here.

4. Rhinoplasty (nasal surgery AKA “nose job”)

Another frequently requested FFS revision surgery is rhinoplasty or a ‘nose job’, this is because the procedure–in and of itself–is quite complicated, regardless of gender. And also, the main reason being is that the previous surgeon lacked the keen artistic “eye” that is necessary to produce a beautiful and truly feminine result. The surgeon had the technical skills to perform a rhinoplasty, but not the aesthetic appreciation of what constitutes a truly feminine nose. Often unskilled or inexperienced surgeons will “make the same nose” that they believe will work on everyone–a recipe for an unsatisfactory result.
Read more about revision rhinoplasty here.

How can you avoid the need for a feminization “do over”?

Facial feminization surgery is a big undertaking, and most people want to ensure that their surgeon gets it right the first time. The best way to ensure that your facial feminization surgery will be less likely to need a revision is to make sure that you choose a surgeon who has…

Additionally, it is critical that your surgeon shows evidence of having a keen artistic eye along with a deep understanding of what constitutes ‘femininity’, not only as it is expressed in the soft tissues of the face but also the underlying skeletal structure. An intimate and in-depth understanding of the structural characteristics of the female vs. male craniofacial skeleton is essential for a successful result.

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Dr. Deschamps-Braly is a board-certified plastic and craniofacial surgeon specializing in facial plastic surgery, orthognathic (jaw) surgery, and craniofacial surgery for adults and children. He is also one of the world’s foremost leaders and innovators in facial gender confirmation surgery.