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Facial Feminization Surgery (FFS)

FFS Overview

Facial Feminization Surgery consists of a group of surgical procedures that transform the features of a face from male to female. Facial feminization includes surgical manipulation of the hairline, brow, nose, and chin.

The characteristics of a person’s face are often the first aspect we notice when approaching someone. The face is our portal to interact with the outside world. Many of our patients regard this as an essential process in gender confirmation to gain full social acceptance.

Male and female faces have very distinguishing features. In general, a woman’s face will have softer, smaller, more delicate, and rounder features with an oval-shaped face, compared to the larger, more square-shaped face of a man.

Women have shorter, flatter foreheads with a rounded hairline. The eyebrows are typically higher and more arched. Men have a square or rectangular hairline, a heavier brow, and lower, flatter eyebrows. The bridge of the female nose is straight to mildly concave, with a slightly upturned and smaller tip. A male nose is broader with a wider tip. The female chin is smaller and less prominent than the male chin, as is the Adam’s Apple.

Although these are aesthetic guidelines, every patient is different. Our physicians understands that an individualized plan addressing each patient’s cosmetic concerns is the best way to optimize results with facial feminization surgery*. There is no “one-size-fits-all” approach to facial surgery. Not every patient will require “full” facial feminization. The procedures performed will be determined after detailed discussions and analysis, upon which you and the surgeon determine a very specific, personalized plan.

Facial Feminization Surgery Procedures

Forehead Contouring
This involves a series of steps to shape the forehead to match female aesthetics. Through a hairline incision, the brow is approached. In most patients, excess bone over the brow (overlying the frontal sinus) is cut away, and then repositioned to a less prominent position. Additional contouring of the brow and orbits is performed, creating a more open appearance of the eyes. The eyebrows are elevated to create a more feminine arch. Scalp advancement will shorten the forehead and round out the hairline.

Cheek Augmentation
Male cheeks tend to be broad and flat, while those of females tend to appear more prominent and refined. Surgical options include fat grafting, bone grafting, and the use of synthetic implants. For these procedures, incisions are generally made inside the mouth. Non-surgical options involve the use of cosmetic injections.

Operating on the nose requires a very individualized approach. In general, an incision is made along the base of the nose (along the columella) to allow surgical access. Hump reduction is performed, and a series of controlled fractures (osteotomies) are used to narrow the bridge. The tip of the nose is narrowed and refined. Asymmetries in the nose and septum (inside your nose) may also be addressed.

Male vs. Female

Male vs. Female

Lip Augmentation
Female lips tend to be fuller, especially the upper lip. In aesthetically-pleasing female lips, the upper lip projects slightly over the lower lip. Achieving pouty lips can be accomplished through several means: injecting fat, surgically inserting a dermal graft (using a piece of your own skin), or by using temporary biologic injectable materials (such as hyaluronic acid). Women tend to have a shorter distance between the base of the nose and the vermilion (the red part of the lip), and they also have more tooth (“incisor”) show when lips are relaxed. A “lip lift” can be performed to create these feminine qualities.

Mandible Reduction/Contouring
Hallmark features of a male face include a broad, tall, heavy jaw that flares out and has a more prominent angle (gonial angle) in the back. Through an incision inside the mouth, the jaw can be contoured to make it more feminine. This involves cutting away the excessive bony angle and rounding out the back part of the jaw. Burring along the sides further tapers the jawline

Chin Surgery
Through an incision inside the mouth, a sliding genioplasty is performed to decrease the height and width of the chin. Based on pre-operative assessment, a sliver of bone is removed to decrease the size. After cutting and resizing the bone of the chin, it is then held into place with small plates.

Thyroid Cartilage Reduction (“Tracheal Shave”)
Through a small, well-concealed neck incision, the Adam’s apple is accessed. The upper portion of the thyroid cartilage is sharply reduced to create a more feminine neckline. It is important to note that temporary speech changes may occur after the operation.

Additional Cosmetic Procedures

Facial rejuvenation surgery involves cosmetic treatments to help “freshen” the face with the goal of creating a more youthful image. We offer the following:

Through well-concealed incisions around the ears and hairline, the skin and underlying facial tissues are tightened and re-shaped, obliterating deep wrinkles, softening the nasolabial folds, providing fuller cheeks, removing jowls, and tightening the neckline.

This involves the removal of excess skin and fat around the eyes, with careful re-draping of soft tissue. Removal of bags, wrinkles, and prominent folds can dramatically freshen the face, and make you look “less tired.”

Particularly under the neck (submental), removing fat creates a sharper, more well-defined neck line.

Fat Grafting
The face deflates and loses volume with aging. To combat these effects, fat is taken from other parts of your body (usually during liposuction performed at the same time) and injected into areas of your face (such as the cheeks and lips) to add youthful volume and fullness.

Injectables and Non-Surgical Treatments
Botulinim toxin (Botox and Dysport) are particularly effective in reducing wrinkles and signs of aging in the forehead, glabellar region (frown lines) and around the eyes (crow’s feet). Hyaluronic acid fillers (Juvederm, Restylane, Perlane) provide temporary volume to the cheeks and lips, and are effective in reducing fine wrinkles and blunting the nasolabial folds. Additional skin treatments are available such chemical peels, laser treatment, and dermabrasion to help correct dyschromia (discoloration) and to address fine wrinkles.

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