Facial Feminization Surgery (FFS)
The personalized variety of procedures that might be the final stage of your journey from living as a man to living life as a woman
There are some cosmetic surgeons who specialize in these kinds of surgeries, known collectively as Facial Feminization Surgery or FFS. These surgeons find the unique challenges very exciting, and the difference for the patients that the results can provide, in terms of quality of life and self-image, can be extremely rewarding for them.
There is only a comparative handful of Facial Feminization Surgeons globally, and the costs of FFS treatments are not inexpensive, so traveling abroad for surgery can be doubly beneficial, allowing the patient to choose from a greater number of FFS specialists, as well as offering the opportunity to find lower prices than would otherwise be available.
Countries such as India, Mexico and Belgium are presently some of the best options for the prospective FFS patient.
There are many slight differences, structurally, between the male and the female skull, and it is these small variances that create an appearance of masculinity or femininity.
Virtually all of these can be tackled by modern Facial Feminization Surgery procedures. How many alterations, and how drastic the changes, will depend on your own personal goals, and the degree of masculinity that your face displays in the first place.
The first thing to understand is that facial masculinity and facial femininity, and all of the individual aspects that make up those appearances, exist on a fairly broad spectrum. Even without factoring in a patient’s ethnicity, there is still a fairly wide range of different jaw lines, nose shapes, brow lines, and so on.
Some Facial Feminization patients’ goal is a far more stylized version of femininity, while others would prefer some degree of androgyny. There is no “correct” goal, as this is a very personal thing, although it could be added that a female face with no traces of masculinity to it at all may look rather fake.
We will explain the main differences between male and female facial structure, and explain how it is that Facial Feminization Surgery is able to help. It should be added at this point that these are not exclusively male characteristics, and some women may have some of these features; simply these are features that are more commonly found on the male face.
Facial Feminization Surgery – The Forehead and Brow
Due to male pattern baldness, the male forehead typically is higher than a woman’s, with a higher hairline in the corners. The hairline grows in a different way, as well, with the male hairline forming a kind of “M” shape, sometimes known as a widow’s peak, while the female hairline is higher in the middle, and lower in the corners.
The other major differences are that the male skull typically has a thicker, bony ridge across the brow, which is known as brow bossing, and there are also more pronounced hollows at the temples.
Female eyebrows also tend to lie higher on the brow than men’s, creating a larger distance between the eyebrows and the eyes.
The issue of hairline can be tackled by a Scalp Advance, or Forehead Reduction Surgery, where the scalp is repositioned into the desired position, lowering the hairline. This is clearly only effective where significant hair loss due to male pattern baldness has not caused the hairline to recede too far. In these instances, hair transplant surgery is the obvious solution.
Brow bossing can be either disguised, by smoothing out the area using bone cement, or it can actually be eliminated by grinding down the wall of bone on the brow, and then smoothing out the region. Shaving down the bone can be hugely effective, but is not always a possibility, and depends on the thickness of the bone in this area. Another possibility is a cranioplasty, a reconstructive procedure, whereby the glabullar bone is taken apart, thinned and reassembled using titanium plates and screws.
An optional addition that is quite popular is removing the glabullar frown lines, by excising the muscle. Otherwise, a temporary fix is a possibility, using Botox to freeze the muscle that creates the frown lines.
Facial Feminization Surgery – The Cheeks and Cheekbones
Women’s cheekbones tend to be more defined, and with a greater projection; however it is arguable that much of the feminine appearance of the female cheeks is because they are fuller and rounder, while men tend to have a noticeable hollowing in this area.
The two main ways of feminizing the appearance of the cheeks are either to use cheek implants, or, often more effectively, simply to fill those hollows using the autologous fat transfer method, or by using injectable fillers.
Often enough, the matter will actually resolve itself, as the cheeks will frequently fill-out on their own, as a result of hormone treatment.
Facial Feminization Surgery – The Eyes and Eyebrows
In the typical women, the eyes tend to be rounder and larger as a proportion of the face, as well as having a slight slant to them. Also, the distance between the eyebrows and the eyes is greater in women than men.
There is, of cause, nothing that can be done to surgically to increase the size of the eyes. However, if you have had brow bossing surgery, this will also have the effect of bringing the eyes forward comparative to the forehead. The best option to increase the appearance of the size of the eyes is simply to use eye liner, as women have been doing for many years.
An Eyebrow Lift is often used, unnecessarily, as a way of increasing the distance between the eyes and the eyebrows, where simply plucking the undersides of the eyebrows would be just as effective a method of creating that appearance. Eyebrow lifting is far more appropriate a treatment for drooping eyebrows, a natural part of the aging process; if this does not apply to you, it is probably not necessary. The Eyebrow Lift will also contribute towards a wider-eyed appearance, which is feminizing, and make the patient look more youthful.
A Temporal Brow Lift is sometimes used, where drooping of the eyebrows is not significant, but the patient may benefit from a small elevation of the outer corners of the eyebrows, which can have a rather feminizing effect.
Facial Feminization Surgery – The Nose and Nose Reshaping
The female nose is typically smaller, less broad, and has a more rounded tip. The male nose tends to have wider nostrils, and is less likely to be upturned. However, male and female noses are similar enough to not warrant any specific FFS techniques. Any required reshaping to the nose can easily be covered by traditional Rhinoplasty techniques, and you can find plenty of information about Rhinoplasty elsewhere on this site.
The main caveat is that effective nose reshaping should always be performed with consideration to the context of the rest of the face.
An ultra-feminine button nose, or a cute upturned nose are sometimes done for FFS patients, when they do not really match the rest of the face. This is definitely a mistake. The general shape of the face will often determine the type of nose that will look most natural, and the nose must also flow nicely with the facial contours, especially with the forehead. If Brow Bossing surgery has taken place, then it is possible that some reshaping of the nose may help to balance out the features. But in many cases, noses are fairly androgynous, and probably won’t need to be feminized in any case.
Generally, when an FFS patient has Rhinoplasty performed, it is more as an additional beautification surgery than a genuine FFS procedure.
Facial Feminization Surgery – The Lips and Mouth
The main differences between the female mouth and the male are that a woman’s lips are usually a little fuller, and the distance between the nose and the upper lip is greater on the average male subject. An additional difference is that when a women’s mouth is relaxed and slightly open, her top incisors can be slightly seen, whereas this is typically not the case with men.
Fullness of the lips is achieved by several Lip Augmentation techniques, including injectable fillers, fat transfer, and synthetic implants.
The other differences between the male and female mouth can be achieved by the procedure known as a Lip Lift. This is most commonly performed by making a small ‘v’ shaped incision just under the nose, removing a small amount of skin, and suturing the incision back together, a technique known as the Sub nasal Lip Lift. This method both lifts the middle portion of the lip, reducing the distance between the nose and upper lip, and also reveals that few millimetres of upper teeth, and do produce an effective feminization. Additionally, this type of Lip Lifting makes the upper lip appear fuller.
The procedure does cause a small, fairly discreet scar; most FFS patients find the surgery very helpful in helping them to be perceived as a woman.
One thing that the patient and the surgeon need to consider is that facial balance can be quite a delicate matter, as one change in one area can produce an undesirable effect in other. This is also apparent with the lip lifting procedure, as shortening the distance between the nose and mouth can have the unintended consequence of making the chin look bigger in comparison. If the patient has a larger-than-average chin in the first place, then this can appear more-so after a lip lift.
Facial Feminization Surgery – The Chin and Jaw line
The chin and jaw line are obviously areas which differ quite considerably between the typical male and the typical female.
The male chin is often more square, as well as being larger and wider, while the female chin is smaller and rounder. The male chin is also likely to have a greater projection. The archetypal, strong, male chin is large, square, and jutting-out. The male jaw-line is also characterized by a greater angle to the back corners of the jaw, along with bigger chewing muscles, known as the masseter muscles.
Different surgical approaches are possible for Chin Reduction. Generally, it is the shape of the chin that is more important as a gender recognition sign, more than the actual size of the chin. Reduction Mentoplasty, the most commonly-used technique, involves shaving down the bone to the desired size. This may be simply to remove the corners of a square chin, while at other times it may be more appropriate to reduce more of the actual height. Occasionally, chin reduction may be combined with a small chin implant, to refine the shape of the chin and make it appear more refined.
Another, more drastic method of chin reduction is the Sliding Genioplasty. Here, the bone of the chin is cut through, and sometimes a section is removed, before the chin is moved backwards or forwards into the ideal position. This technique can modify both the height and projection of the chin.
The back of the jaw can also be surgically altered. The greater angle of the corners of the male jaw can be shaved down, in a procedure known as mandibular angle reduction, while the masseter muscles can be reduced surgically, although these are usually quite likely to reduce themselves, due to hormone treatment.
FFS Chin reduction surgery can have a remarkable effect on facial feminization. However, it should again be noted that just as a reduction of the distance between nose and mouth can make the chin appear bigger, so to can the reduction of the chin make the distance between nose and lips more pronounced. For this reason, these two facial elements should always be approached together.
Facial Feminization Surgery – The Neck, The Adam’s Apple and Tracheal Shaving
The two elements of the neck that lead to a more masculine appearance are the thickness of the neck, and the prominence of the Adam’s Apple. The thickness of the neck will usually resolve itself, and find the neck assuming more typically female proportions as a direct result of hormone treatment. Treating the Adam’s Apple is more drastic.
The Adam’s Apple is, contrary to what many people believe, often visible in women, but it is far less pronounced, and angled less noticeably. To create a more feminine appearance, it is often necessary to undergo the Tracheal Shaving procedure. More correctly known as Thyroid Chondroplasty or Chondrolaryngoplasty, the procedure involves an incision, either to the neck or under the chin, and then removing some of the cartilage that makes up the Adam’s Apple.
This is an involved and risky procedure, and if too much of the cartilage is removed, damage is irreversible. One of the potential complications is damage to the voice box. An over-zealous removal of cartilage can result in the front-wall of the voice box being permanently weakened, altering the voice. When you hear a trans gender Male-to-Female patient with a very deep, gravelly voice, there is a high chance that it is because of exactly this procedure! So the ideal is not to attempt to completely remove the Adam’s Apple, but to reduce its angle to the more feminine 120 degree angle.
Other Beautification Procedures Frequently Combined With FFS
The following procedures are ones that are not actually FFS techniques, but are ones that are rejuvenating or beautifying, and that are frequently combined with Facial Feminization.
Face Lift Surgery
Lower Face Lift surgery is frequently a necessity, as chin reduction can often leave skin looser than is desirable.
Neck Lift Surgery
Again, Neck Lift surgery may be beneficial, to tighten-up skin either due to loss of volume after chin reduction and tracheal shaving, or simply as a rejuvenating procedure.
Micro Liposuction is very effective at removing small pockets of stubborn fat. In FFS patients, it can be useful for removing fat from under the chin and other areas.
Laser Hair Removal
Hair Removal is naturally of high importance for FFS patients. Laser Hair Removal is a longer-term, and less painful alternative to electrolysis.
Eye Bag Removal
Blepharoplasty, or Eye Bag Removal Surgery is another popular procedure for FFS patients, that again is not one of the FFS procedures, but that is frequently combined for an extra rejuvenating effect.
Nasolabial Fold Correction
The Nasolabial Folds do not make much difference in terms of which gender a person is perceived as. Nonetheless, reducing the Nasolabial Folds can certainly give a younger appearance.
Facial Feminization Surgery Costs
Facial Feminization Surgery costs are really impossible to estimate, due to the wide range of procedures that may, or may not, be combined to reach your aesthetic end goal.
Also, it is worth being aware that the prices can often be higher than for regular, aesthetic procedures, due to the higher degree of specialization.
Traveling abroad for Facial Feminization will most likely reduce the costs, as well as giving you as an FFS patient access to a greater pool of medical talent than will probably be available in your own country.
The countries that perform the most sex change and related gender reassignment procedures are Thailand and Iran (surprisingly?), so these can be excellent countries to consider as a destination. India, Mexico, Belgium, Greece and Ecuador all also have some excellent surgeons specializing in FFS procedures, and at lower prices than you would pay in the US.
It should be your priority to be find the surgeon most experienced in Facial Feminization Surgery, and one with a good number of photos of his FFS successes. As so many of these surgeries are highly unusual, most cosmetic surgeons simply will never have performed them, and as with all procedures, surgeons do take some time to become competent at them. You should only consider Facial Feminization Surgery with a specialist who has already mastered his art (and it is an art).