What is Facial Feminization Surgery?
Facial feminization surgery (FFS) is a phrase generally used to describe a series of procedures – from adding volume to the cheeks to mandibular contouring to rhinoplasty – tailored for each transgender woman to shape and resize masculine features to more typical female features. Each patient’s facial anatomy and expectations are different and therefore the procedures required to achieve her goals will vary. The following procedures are offered at Ann Arbor Plastic Surgery:
- Lowering of the hairline
- Reduction of the supraorbital rim (brow bone)
- Brow lift surgery
- Narrowing the mandibular angles
- Chin contouring
- Fillers and neuromodulators
Who is a candidate for FFS?
The surgeons at Ann Arbor Plastic Surgery follow the World Professional Association for Transgender Health (WPATH) standards of care for transgender individuals seeking surgery. Letters of readiness from mental health providers are not necessary for facial feminization surgery, although a relationship with a mental health professional who has assessed the individual’s case can be helpful throughout the treatment process. Facial feminization surgery has been associated with functional gains in transwomen who desire reconstructive surgery.
How is FFS Performed?
Each of the FFS procedures addresses a distinct aspect of a patient’s appearance and therefore requires a different surgical approach. Depending on which procedures are indicated, they may be scheduled together or on separate dates. Below is an overview of each procedure offered by the surgeons at Ann Arbor Plastic Surgery.
Lowering of the Hairline
This procedure creates a shorter distance between the hairline and eyebrows by surgically lowering it. Hairline advancement is usually performed by removing a long flap of forehead skin through a discrete incision in the hairline and suturing the skin back together. While often part of a facial feminization surgery, those with naturally receding hairlines or prominent foreheads may also opt to undergo this procedure.
Reduction of the Supraorbital Bone
Masculine foreheads typically have a heavy bony ridge in the area just above the eyes and beneath the eyebrows. This is often referred to as “brow bossing.” Forehead contouring surgery involves burring down the supraorbital bone to remove the ridge and create a softer, more naturally feminine, appearance. Patients undergoing forehead recontouring will be required to have a CT scan performed preoperatively to ensure sufficient thickness of this region of bone to safely undertake this method of forehead reduction.
Brow Lift Surgery
Shapely eyebrows with well-defined arches that lie above the brow bone are considered aesthetically pleasing by traditional female beauty standards. On the other hand, male eyebrows tend to be flatter and lie at the level of the brow bone. A brow lift can improve the shape and position of a transwoman’s eyebrows to create a more feminine periorbital appearance.
Men and women tend to have different nasal sizes and shapes, with women having more delicate and less pronounced noses. Rhinoplasty, or cosmetic nose surgery, can change the look of this central feature and dramatically alter a transperson’s appearance during the FFS process.
Masculine faces tend to have wide mandibles with a more square appearance. By surgically narrowing the angles of the lower jawbone by burring this portion of the bone down, the facial shape can be feminized during FFS.
Because the chin is a part of the lower jaw, contouring its shape can add to a more feminine facial appearance. Men tend to have longer, more prominent chins and altering their shape can produce a more feminine facial appearance.
Fillers and Neuromodulators
Nonsurgical treatments, including fillers and neuromodulators like Botox or Dysport, can be an effective alternative to surgery to enhance and feminize facial features. Augmenting the volume of the cheeks and lips with filler is a popular component to the feminization process. Increasing the fullness of the upper and lower lips offers a nonsurgical method to add softness to a transwoman’s face.
Insider Tips for FFS
- Ask your surgeon about his or her experience with the transgender population and WPATH standards of care.
- Inquire about other procedures (top and bottom surgery) that you may be interested in pursuing.
The FFS Consultation
When patients attend their initial appointment, they will be met with a compassionate, respectful surgeon with a focused expertise in facial and body anatomy and transgender patient care. The doctor will provide a full-face assessment while listening to the requests of the individual. Imaging, blood work, and other tests may be necessary for the most comprehensive treatment plan to be created. The doctor may also request that the patient schedule follow-up visits prior to any procedures. Depending on a number of factors and the treatment plan pursued, one or more surgeries may be necessary to complete the FFS process.
FAQs about FFS
What areas of the face are addressed during FFS?
Depending on each transwoman’s appearance, different features may contribute to a masculine look and may benefit from surgical alteration. Most commonly, the bony structures (supraorbital rim, cheeks, jaw, chin), eyebrows, nose, and lips are feminized. In some cases, blepharoplasty, also called eyelid lift or eyelid surgery, is also performed. There is no standard set of procedures as FFS is highly customizable to each patient’s individual appearance and aesthetic goals.
Are there non-surgical procedures that are a part of facial feminization?
Fillers to augment cheek or lip volume and improve deep rhytids are a nonsurgical means to feminize a transwoman’s face. In addition, neuromodulators can relax the brows, crow’s feet, and forehead and soften the appearance of the face.
What is the recovery process like for FFS?
While there are general recovery guidelines for facial plastic surgery, your surgeon will provide specific post-operative instructions depending on which procedures you are planning to undergo. In general, patients will need to keep their head elevated, perform wound care for their incisions, and avoid strenuous activities except for walking following surgery. Generally, patients will require at least one week of downtime for recovery, which may be prolonged with multiple procedures.
Immediately following FFS, you may experience temporary soreness, swelling, bruising, and changes in sensation. You may have small surgical drains in place for several days. Swelling may persist for several months after surgery. The anticipated recovery is dependent on the specific operations performed for an individual patient.
Ann Arbor Plastic Surgery
The Plastic Surgeons with over a decade of education and training are credited with thousands of successful surgeries. The practice’s motto is “beauty revealed,” which is a testament to the natural results the doctors are able to consistently achieve.
For more information on facial feminization surgery options, contact us for a consultation. The Ann Arbor location can be reached at (734) 913-5100, and the Jackson location can be reached at (517) 789-9800.