Facial Feminization Surgery (FFS)
Facial Gender Confirmation Surgery or Facial Feminization Surgery (FFS) is a technique utilized to change masculine facial features into softer feminine ones. This is highly considered one of the most “life-altering” surgeries for a transgender patient because the impact is visible right away.
For trans women, altering certain characteristics can be essential in their transition and in their fight against gender dysphoria. It can also give their self-esteem a boost, which helps promote mental well-being.
Facial Feminization Procedure is a delicate and challenging technique under sex reassignment surgery as women's facial features possess unique subtleties. This surgical procedure requires a surgeon with an expert touch and creative artistic vision to be able to change a masculine face into a more feminine face while keeping it looking as natural and beautiful as possible. This skill is something that is mastered over time and perfected with experience.
The Aim of FFS
Facial Feminization Surgery aims to transform the more masculine face into a more feminine one. The guiding principles of the procedure are based on the following aesthetic fundamentals:
- To try to balance a patient’s facial proportions as best as possible. To do this a surgeon will focus on the ratio of the upper, middle, and lower face divided into five different parts from left to right.
- A surgeon also needs to balance the facial components as they relate to a patient’s existing eyebrows, eyes, nose, cheeks, and lips. The perfect balance is required to make the face softer and more feminine.
- A surgeon must also balance the facial frame. This includes the hairline, jaws, side cheeks, and chin. More angular male facial frames will be adjusted to create softer feminine ones.
- The procedure also looks at the balance of facial bones and soft tissue.
- The last step is the final full facial rejuvenation.
The Distinct Features of a Feminine Face
All faces are different and unique in their own way. However, there are certain recognizable feminine features that surgeons will consider to get the best possible results for each patient, that are:
- Upper Part: Forehead and eyebrows
- Middle Part: Nose, eyes, and cheekbones
- Lower Part: Lips, chin, jaw, and trachea
The forehead is the biggest part of the upper face. It's often the first thing people notice. It’s important to have the right kind of forehead to appear more feminine.
Men tend to have broader and higher foreheads with a bony ridge above the eyes sloping backward. Women, on the other hand, have smoother and flatter round foreheads.
There are several surgical procedures for forehead feminization including:
- Forehead Shaving and Brow Bossing Surgery
- Forehead Augmentation
- Forehead Reduction (forehead compression)
- Hair Transplant (to achieve a more feminine hairline)
There are three available procedures for forehead contouring:
Forehead Bone Shaving
Forehead Bone Shaving plus Augmentation
Frontal sinus osteotomy anterior wall set back
Forehead augmentation procedures utilize three types of materials:
- ePTFE sheets
- Fat transfers
- Implants (silicone)
Brow Bone Reduction, Brow Lift or Brow Augmentation
There are significant differences between male and female eyebrows. The main ones include that male eyebrows are thicker and straighter while female eyebrows are thinner and arched. Secondly, male eyebrows tend to be found closer to the orbital eye rim and female eyebrows are often found higher.
Several surgeries can address eyebrow feminization including brow lift, eyebrow lift, or even forehead lift. These can be done in tandem with other forehead manipulations.
Nose Reshaping or Nose Job
The nose plays a big part in giving the face either a masculine or feminine look. It is in the middle of the face and its shape and size is an easy gender identifier. There are roughly two differences between the male and the female nose that stand out.
The male nose tends to be broader and extends outward while females tend to have shorter narrower noses. Additionally, male noses tend to have straight or arched nose bridges while female nose bridges are more curved.
There are three procedures available for rhinoplasty feminization:
- Rhinoplasty: Reduction – Usually recommended for Caucasian patients. This surgery helps to reduce the hump, the nasal tip, and side bumps.
- Rhinoplasty: Augmentation – In this procedure, the nasal bridge and the tip are augmented usually with silicone implants, ePTFE, or cartilage from the ear or rib. This is usually recommended for Asian patients.
- Combination Rhinoplasty – Some patients may need a little bit of both – ridge reduction coupled with nasal tip augmentation to get the best possible result.
Cheek Augmentation, Cheek Enhancement, or Cheek Implants
There are striking differences in the cheekbones of males and females. Female cheekbones are more curved and rest higher on the face making the face look fuller. In males, the cheekbones are usually flatter and lower.
To achieve beautiful feminine cheeks, there are two possible procedures:
- Cheekbone Augmentation
- Cheekbone Reduction or Zygoma Reduction
Eye Feminization, Eyelid Surgery, or Upper Blepharoplasty
Eyes are often considered the soul’s windows and are a very striking facial feature. Men’s eyes are often deeper set and narrower while females have larger and wider eyes.
To achieve more feminine eyes, patients can explore the Cat-eye (almond-eye) surgery. This procedure widens the eyes and opens up the eyelids by lifting the outer edge upward. Eyebrows may also be lifted to create a bigger distance with the eyes.
This procedure usually takes roughly 2 hours to complete. Stitches are removed five days post-surgery and patients can open their eyes normally after the procedure. Light activity can resume within a week after the surgery.
Lips are a highlight of feminine beauty. Females are known to have full and plump lips while men have straight narrower lips.
To get lips closer to a patient's chosen gender, one of three procedures may be utilized:
- Feminine Lip Lift
- Lip Enhancement
- Lip Contouring and Reduction
Adam's Apple Reduction, Adam's Apple Shaving or Tracheal Shave
The Adam’s apple is a unique feature to men and is often used as a clear marker between genders. Adam’s apple removal is therefore essential in creating a more feminine appearance.
There are two available procedures to remove the Adam’s apple:
- Supra Thyroid incision technique or the open technique
- Intra Oral incision or the endoscopic technique (less visible scarring)
Chin Augmentation and Jaw Reduction
The size of the chin and jaw also contributes to creating a feminine face. It’s important to consider shaping this part of the face to complete a more feminine look. Men tend to have wider jaws and more protruding and pronounced chins. Women, on the other hand, have more slender jaws and smaller pointed chins.
Patients may opt between jaw and chin implant depending on their current features.
Other Facial Feminization Surgery (FFS) procedures
- Neck Lift
- Scalp Advancement
- Maxillofacial Surgery
- Chin Recontouring
- Jaw Surgery
- Facial Bone Surgery
- Hairline Lowering
Facial Feminization Surgery (FFS) Duration
Every type of facial feminization surgery has a corresponding timeline, but as these procedures differ depending on the patient's face and existing features, the timeline depends on the surgeries being done. Most FFS surgeries take around 2-6 hours on average.
After each surgery, patients will spend a few hours in the recovery room and then be taken to their private rooms as they wake up and after the anesthesiologist has checked all the vital parameters. Pain is tolerable and managed with the use of painkillers in the immediate aftermath of the surgery. Patients stay in their private hospital’s rooms for the whole period of their hospitalization that can vary between 1 to 3 nights. When the hospitalization ends, they are moved to other rooms where they can continue their recovery until the doctors allow them to return safely to their countries.
Preparing for Facial Feminization Surgery (FFS) Procedures
These are the steps you will need to take before FFS surgeries:
- Consultation with the plastic surgeon to assess your face, discuss your goals, medical history, any ongoing treatments, and more.
- There will be a compulsory physical examination including X-rays, blood tests, CT scans, HIV tests, or more depending on the physical condition of the patient.
- Smoking and drinking need to be stopped at least 7 days before the surgery.
- All blood-thinning medications like Aspirin, Ibuprofen, hormones, and some supplements must be stopped a minimum of two weeks before the surgery.
Facial Feminization Surgery (FFS) Recovery Timeline
Facial feminization surgery recovery depends on the procedures done and the overall pain threshold of the patients. Surgeons usually map out the recovery timeline and plan before the surgery so that the patients have a clear understanding of all important recovery factors.
Usually, different procedures under facial feminization surgery require a patient to ask for a minimum of three weeks off work. While this may seem longer than other procedures, the time off from work and any strenuous activity will help to reduce the swelling and pain and once patients return to work they will look normal and not as if they had surgery.
The results will continue to improve as weeks and months go by. The average recovery time for most facial feminization surgery (FFS) procedures is approximately two to three weeks. A combination of facial feminization surgery cosmetic procedures will not increase recovery time.
Post Operative Care (FFS)
Post-op care for FFS patients is pretty standard. Here are some important reminders to note:
- Wounds take an estimated 4-8 weeks to heal.
- Liquid and soft foods must be maintained for 4 to 6 days.
- The mouth must be consistently cleaned with mouthwash.
- No high-impact activities for at least one month after the surgery.
- Avoid smoking and eating spicy food.
- Utilize painkillers for any in case of pain.
- Normal activities can be resumed roughly two weeks after the surgery with the doctor's permission or when the surgical site has been completely healed.
- Keep all follow-up appointments to ensure a full recovery.
- Apply ice packs on the surgical site following the cosmetic surgery
- Avoid lifting heavy objects until the doctor gives you clearance to do so.
Risks and Complications (FFS):
Most risks and complications are very rate but they may include:
- Hematoma or blood clots
- Nerve damage
- Implant failure
- Poor healing
- Pain after the procedure
- Reaction to general anesthesia
FFS surgeries can change lives. It’s not just about looking more feminine and beautiful but also feeling more feminine and beautiful. The face is the first thing we see in the mirror and the first thing we present to the world.
Through these procedures, patients can more closely match their faces to how they feel inside.
The effects of FFS procedures can be seen in as little as just two weeks. These results keep improving as time progresses, wounds heal, and swelling goes down.
Facial feminization surgery can be complete in one surgery. However, a surgeon may recommend multiple feminization procedures to help achieve the patient's desired outcome.
Having said that, medicine is not an exact science. This means that while good results can be expected, there is no guarantee that the surgery will achieve optimal results without additional treatment, such as hormone therapy.
Why choose Thailand as your plastic surgery destination?
On the whole, Thailand is an open and accepting society for transgender people and this has allowed hospitals for gender transformation to flourish and grow. Facilities in Thailand provide first-class treatments, cutting-edge technology, and world-class surgeons performing hundreds of FFS surgeries per year.
Plus, Thailand has another big advantage as a highly competitive destination for Facial Feminization Surgeries as it’s also less expensive compared to other destinations. You still get the best treatments and facilities, but you pay less.
Who is a good candidate for Facial Feminization Surgery (FFS)?
A trans woman could be a good candidate for this type of gender confirmation surgery if:
- They have facial features that they associate with a masculine face and not with their gender identity
- They have been diagnosed with persistent gender dysphoria
- They are of age to make consent
- They have realistic expectations
- They are healthy
What question you should ask your surgeon before doing Facial Feminization Surgery (FFS)?
A highly skilled surgeon will take care to answer every question that a patient may pose before and after performing any procedures. It is often advised for a patient to list the questions on a paper in advance of the consultation.
Some key questions to ask surgeons before facial feminization surgery include:
- Are you a board-certified plastic surgeon?
- How many years of experience do you have in cosmetic surgery?
- Do you have specific experiences with gender reassignment plastic surgery, such as facial masculinization surgery, craniofacial surgical procedures, tracheal shave, nasal surgery, craniofacial surgery, or jaw contouring?
- Are the results I am seeking realistic?
- What are the limitations of FFS surgery?
- Will there be visible scarring?
- Would I need pain medications to relieve pain during my recovery period? If so, until when would I need to take pain medication?
- What is the treatment plan?
- Would I need to see a mental health professional after undergoing sex reassignment surgical procedures?
- Would this surgery help me live by my desired gender?