Top Considerations When Selecting a Facial Feminization Surgeon

Medically reviewed by Jennifer Richman on December 2, 2024. 

Understanding Facial Feminization Surgery

Facial Feminization Surgery (FFS) is a gender-affirming surgery designed to help trans women, transfeminine and non-binary patients feel more aligned with the apperance of their face. Each FFS procedure is unique to a patient’s goals, existing facial features and other limitations like finances or insurance coverage. During a consultation with a board-certified facial feminization surgeon, you can make an individualized plan for your procedure and have all of your questions answered. 

Generally speaking, FFS refers to a menu of procedures that patients can choose from:

• Hairline advancement: reverses the effects of a receding hairline
• Forehead contouring or brow bone reduction: creates a flatter, more gently sloping forehead and softens the brow ridge
• Eyebrow lift: raises the position of the eyebrows on the face
• Cheek augmentation: increases the volume of cheeks and defines the cheekbones
• Rhinoplasty: reshapes the nose bridge, the tip of the nose and/or other features
• Mandible contouring: creates a softer, slimmer jawline 
• Genioplasty: slims down the chin
• Lip augmentation or a lip lift: creates fuller, more defined lips
• Tracheal shave: reduces the size of the Adam’s Apple

Importance of Choosing the Right Surgeon

Choosing the right surgeon for your FFS procedure is primarily a question of safety. Surgeons who are board-certified and have hospital privileges are likely to be equipped with the tools and experience to keep you safe through the operation and ensure the integrity of your results––for example, a rhinoplasty that leaves you with functional nasal canals for breathing.

The second piece to finding the “right” FFS surgeon has to do with looking for a surgeon who is a good fit to meet your needs and goals. Beyond your medical professional’s bedside manner, each surgeon has a unique approach to designing a surgical plan with their patients. 

Some surgeons create FFS plans based on the dimensions of a patient’s face. Specifically, they let “masculine” and “feminine” averages determine which parts of the face a patient should undergo surgery to alter. For example, the distance between the top of the lips and the base of the nose is in the “male” average range they are referencing, they will recommend a lip lift procedure. This approach can be helpful for patients that want more handholding to figure out which procedures to choose from.

However, many patients are critical of surgeons that use the aforementioned approach. Sometimes, using average measurements to determine if a facial feature is more “masculine” or “feminine” leaves out the fact that conventions of femininity are different across racial and ethnic groups. As a result, other surgeons will prioritize making a plan around a patient’s unique goals. These may include eliminating specific sources of dysphoria or meeting the desire to still “look like themselves” or someone in their family after surgery. Both Dr. Facque (he/him) and Dr. Ley (she/her/they) use this approach to ensure that patients are more active participants in the creation of their FFS plan. You can request a free consultation with them here.

Qualifications and Skills of Top Facial Feminization Surgeons

While there are many accolades a surgeon can have, the two most important qualifications are that they are board certified and that they have specialized training, such as a fellowship, in neck and cranio-facial surgery. Board certification means that the surgeon meets professional standards for their industry and has no cases of medical neglect or other issues that could compromise the integrity of their practice. Membership in professional associations and other awards often have more to do with their paid membership to certain associations. However, if your surgeon is a member of the World Professional Association of Transgender Health Professionals (WPATH), that can be an important indication that they have some expertise around treating trans patients. 

Evaluating Surgeon Experience

One of the most effective ways to evaluate a surgeon’s experience is by reading patient testimonials and reviewing their before and after photo portfolios. When evaluating patient testimonials, it is important to remember that it can take up to 12 months for the final results of surgery to be visible. Depending on an individual’s unique healing timeline, they may not begin to feel satisfied with their results until a month or two has gone by due to inflammation. For instance, patients who undergo jaw contouring sometimes come out of surgery with a jawline more prominent than their original jaw size due to swelling. We generally encourage patients to wait until the 6 to 12 month mark before they start judging their results. 

Top Considerations When Selecting a Facial Feminization Surgeon

Previously, we discussed the importance of choosing a surgeon for FFS that is both board-certified and has hospital privileges. The latter means that in the event of an emergency, they have an agreement with a hospital that would ensure their ability to care for you. Additionally, many FFS patients have to stay in the hospital the night after surgery to be supervised by a care team. This is why having hospital privileges is essential for a facial surgeon.

Other factors that patients often take into consideration are costs, location and availability. If you are interested in traveling to the San Francisco Bay Area for surgery, you can consult our free guide on trans-friendly resources and strategies for saving on travel here. You can find an in-depth discussion of costs and insurance coverage here. Generally speaking, the best way to find out what a surgeon’s waitlist time for FFS is, is by asking their office. That said, that specific information may only be revealed to patients that have booked a consultation with the surgeon. 

San Francisco Bay Area Facial Feminization Surgeons

Two of the most sought after surgeons in the San Francisco Bay Area are Dr. Alexander Facque (he/him) and Dr. Ellie Zara Ley (she/her). 

Dr. Facque is certified by the American Board of Plastic Surgeons and has 6 years of experience in gender-affirming care. He is a member of the queer community devoted to improving the quality of care for trans, nonbinary, and gender diverse communities. In his professional formation, he was valedictorian of his graduating class in medical school, recipient of the Dean’s Scholars Award and finished his training in the Gender Surgery Fellowship under the guidance of Dr. Loren Schecter. He is deeply committed to centering his patients’ needs in the creation of surgical plans and is an advocate for the inclusion of non-binary, high BMI and patients of color in gender-affirming surgical care.

Dr. Ley is a board-certified surgeon, animal lover and one of the only trans women of color to provide gender-affirming surgery. Prior to joining the GCC in 2022, she worked as an assistant clinical instructor of plastic surgery at the University of Utah and worked at a  private practice dedicated to gender surgery in Arizona. Dr. Ley is a recognized expert with vast experience and knowledge, having undergone three plastic surgery fellowships after her medical school residency. Her patients often express appreciation not only for her skill level, but also for her ability to empathize with patients as a trans person herself. In consultations, she creates the space for patients to voice their individual preferences and goals and is open to giving her professional opinion when crafting a surgical plan.

Patient Experiences and Testimonials

Below, you can find the testimonial of one of our former FFS patients, Camille:

Thanks to the entire staff of the Gender Confirmation Center and notably Dr. Alexander Facque, every time I see myself in the mirror and pictures, I am overwhelmed with joy that I get to look like this everyday now. When I compare before and after surgery pictures, I can see the positive changes surgery has made on my face. The further I’m along in my recovery, the more the changes take effect.

I have also improved immensely, emotionally and mentally. I go out of my way to check myself out in the mirror, where before I actively avoided. I rely less on camera tricks while taking selfies, and I take plenty of them. I have a newfound sense of self-confidence in addition to the help of hormones, makeup and developing my aesthetic. Facial surgery and the recovery were some of the most physically and mentally intense things I have gone through, but I know it was the right decision to make. I am so thankful for the opportunity to unlock my fullest potential.

FAQ:

What can I expect out of an FFS consultation with the surgeon?

The surgical consultation is a space for you to get to know your surgeon and create a plan for surgery. Generally, this means talking about your goals, existing facial features, medical history and answering any questions you may have about surgery. After your free consultation, you will receive a quote for your procedure or will advance in the process of soliciting insurance coverage. For more details and tips on how to make the most out of your FFS consultation, click here.

How much does FFS cost?

Facial surgery can cost between $4,500 and $100,000 for cash-pay patients depending on how many procedures are performed. That said, this price range can vary from patient-to-patient based on your unique surgical plan. Patients who can secure insurance coverage for their gender-affirming surgery can drastically reduce these costs. For more information, click here.

What are the risks and complications associated with FFS?

While gender affirming surgery is performed in ways to prevent any risks or complications from occurring, every surgical procedure involves a certain amount of risk. Undergoing FFS with a board-certified surgeon with hospital privileges can drastically reduce these risks. For more information about the risk of complications like infections, seromas, hematomas, changes in skin sensation and more, click here. Please note that all GCC patients who request a revision surgery within the first year after their initial procedure will not be charged for the surgeon fee for a follow-up surgery (although anesthesia and facility fees may still apply).

What is the FFS recovery process like?

While some patients can return to work as early as two weeks after surgery, the recovery process can take around six weeks depending on the type and number of procedures you undergo. That said, it takes around 12 months for the face to fully heal after surgery so that final results are visible and scars have matured. For more detailed recovery instructions and tips, click here.