Understanding Facial Feminization Surgery

Gendered terms are used here to talk about anatomy and health risk. Please use this information in a way that works best for you and your provider as you talk about your care.

Facial feminization surgery (FFS) is a group of plastic and craniofacial surgeries that are done to soften male facial features. The goal is to reshape certain parts of the face to create a more feminine appearance. FFS is often done for people who are transitioning from male to female (transgender women) or for nonbinary trans people who are assigned male at birth (AMAB). It can include procedures to reshape these face and neck areas:

• Forehead

• Cheeks

• Nose

• Eyes

• Lips

• Jaw

• Chin

• Adam’s apple

Depending on the person and their needs, some or all of these features may be reshaped and softened. FFS aims to create a more feminine look that reflects how the person sees themselves and how they want to be seen by others.

Why facial feminization surgery is done

There are many aspects of a person’s face that can signal gender identity—from the size of the forehead and the shape of the nose and lips, to the width of the jaw.

Female feminization surgery changes male facial features. It’s often done for transgender women or nonbinary trans who want to identify more easily and clearly as female. FFS can be a key part of someone’s physical transition to becoming a woman.

By aligning the person’s outside appearance with their gender identity, FFS also serves an important emotional and psychological role. It can greatly decrease the feeling of anxiety (called gender dysphoria or gender incongruence) that occurs when someone’s gender identity doesn’t match their sex assigned at birth.

Several studies have shown that FFS can improve a transgender woman’s confidence level and quality of life. It can improve how well they are accepted by others, and how they interact with other people.

But it’s important to note that the decision to have facial feminization surgery is a very personal one. Not all transgender women want, need, or are able to have FFS. Talk with your healthcare provider about your own personal situation and needs.

How facial feminization surgery is done

FFS is done by a plastic surgeon. Be sure to choose a board-certified plastic surgeon who is experienced in FFS procedures. As you plan your surgery, you will meet with the surgeon. You will have facial photos taken and images taken of your skull. Together you will discuss your goals for the surgery, what options are best for you, and what results you can expect. You will create a plan for the surgery. It’s advised to wait to have FFS until you are older than 18 (in some cases until 21) and your facial bones have stopped growing.

FFS may be done as one overall surgery or as several separate procedures. Depending on your personal situation, some or all of these procedures may be done. FFS includes the following procedures:

• Forehead reduction and hairline lowering. The forehead is reshaped and made smaller. The hairline is moved forward and given a more rounded shape.

• Brow lift (browplasty). The eyebrows are lifted or reshaped.

• Eyelid modification (blepharoplasty). Small incisions are made into the eyelids to remove excess fat or skin.

• Cheek augmentation. The cheeks are made rounder using implants or by taking fat from another part of the body (fat grafting).

• Nose reshaping (rhinoplasty). Also known as a nose job, this procedure makes the nose smaller and narrower.

• Lip lift and reshaping. The upper lip or the corners of the mouth may be lifted. The lips may be made fuller.

• Jaw shaping or reduction. Bone is removed to reshape the jaw so that it’s narrower and not as square.

• Chin width reduction (genioplasty). A wide and square-looking chin is reshaped to be shorter and narrower.

• Adam’s apple reduction (thyroid cartilage reduction). The Adam’s apple is made smaller by shaving the thyroid cartilage in the neck. This is sometimes called a tracheal shave.

A facelift or other procedure to help tighten the skin may also be done.

Risks and possible complications

All surgeries have risks. Possible complications of FFS include:

• Infection

• Bleeding

• The incisions don’t heal

• The bone doesn’t heal

• Risks from anesthesia medicine

• Scarring

• Hair loss along the incision line

• You’re not happy with the surgery results

Questions for your healthcare provider

If you’re thinking about having FFS, here are some questions to ask your provider:

• Is FFS covered by my insurance? Do you have an advocate to help coordinate with my insurance company?

• Where will the surgery be done and will I need to stay in the hospital?

• Will I have dressings, bandages, or drains after my surgery? If so, when will they be removed?

• What are my activity restrictions after surgery? When can I go back to my normal activities like work?

• When can I drive after surgery?

• When can I shower or bathe?

• How will I be kept comfortable after surgery?

• How long will healing take?