What is Facial Feminization Surgery?

Medically reviewed by Jennifer Richman on October 09, 2024.

Facial Feminization Surgery (FFS) is a set of gender-affirming procedures patients can choose to achieve a more conventionally feminine appearance. It is specifically designed to alter conventionally masculine facial features to bring them closer in shape and size to conventionally feminine facial features. For patients who are pursuing gender-affirming care, FFS can be a critical part of the transition process. Transgender women, non-binary folks and gender non-conforming patients can choose between procedures that alter the upper (hairline, brow bone & eyebrows), middle (nose & cheeks) and/or lower (lips, chin, jaw & trachea or Adam’s Apple) thirds of the face.

Importance of FFS in Gender Transition

Multiple peer reviewed studies have demonstrated that FFS leads to consistently high quality-of-life outcomes and satisfaction rates. This is the case amongst qualified candidates who undergo quality surgical interventions with reputable, board-certified providers. Ideal candidates for FFS are patients who experience persistent gender dysphoria because of the appearance of their face and have realistic expectations for what surgery can accomplish for them. Having a conversation with a surgeon about your goals in a consultation is a great way to check how realistic your expectations are.

By aligning a patient’s physical appearance with their gender identity, FFS can significantly impact one’s social and emotional well-being at this stage in transition.

Comprehensive Overview of FFS Procedures

Each of the FFS procedures targets a part of the upper, middle, and lower third face. In this article, we include the neck as a part of the lower-third region. The following procedures may be done all at once or in different stages.

You can discuss what procedures would be a good fit for you in a free consultation with Dr. Ley (she/they) or Dr. Facque (he/him).

Here are some of the surgeries used to alter the upper-third of the face. They include:

1. Hairline: The hairline advancement technique can help reverse the effects of a receding hairline, giving the forehead a smaller and rounder appearance. This procedure can potentially eliminate the need for or be used in conjunction with hair transplants.
2. Forehead: Procedures such as forehead contouring or brow bone reduction can create a flatter, more gently sloping forehead and soften the brow ridge.
3. Eyebrows and eyelids: An eyebrow lift will raise the position of the eyebrows on the face; typically, having some or all of the eyebrows rest above the brow bone is associated with a more feminine appearance. A blepharoplasty can also be performed to remove excess skin in the eyelids, giving them a larger appearance.

For the middle- third of the face,  your “mask” (nose and upper cheeks) comes into focus. Here are the procedures you can choose from:

1. Cheeks and Cheekbones: Cheek augmentation through fat grafting or silicone malar (cheekbone) implants can enhance and define the cheekbones. Voluminous cheeks are conventionally associated with a more feminine facial structure.
2. Nose: Rhinoplasty (nose reshaping) can reduce and otherwise reshape the width and/or bridge of the nose. Most commonly, FFS patients request that the bridge of the nose be made thinner and the tip to be inverted, giving the nose a slight upward turn. Patients can also request to adjust the nostrils if they would like. The procedure can involve cutting or reshaping the bones as well as the cartilage.

In our neck and lower-third of the face, surgery can create a masculine or feminine contour based on the shape of our jaw, chin, lips, and Adam’s apple. Here are a few procedures your surgeon might recommend:

1. Chin and Jawline: The chin and jaw can be reduced or contoured through mandible contouring and genioplasty procedures. These techniques can slim down and soften the jawline, creating a more oval, heart, diamond or rectangular shaped face.
2. Lips: A Lip augmentation or a lip lift can create fuller, more defined lips. Most often, estrogen-dominant first puberties leave individuals with less space between their nose and top lip; a lip lift reduces the skin in this area to increase the size of the top lift. Augmenting the lips through fat grafting can also create a more conventionally feminine appearance.
3. Adam’s Apple: A tracheal shave is a technique that involves reducing the size of the Adam’s Apple so it has a less prominent appearance. This procedure is performed in a way to not alter the vocal cords.

The Facial Feminization Surgery Journey

Given how extensive surgery can be for some FFS patients, the surgical journey may seem daunting. Our surgeons, Dr. Ley and Dr. Facque, prioritize creating a personalized surgical plan to alleviate any of your concerns. At the GCC we place your goals at the forefront of any surgical conversation. We want to make sure you feel confident and supported as you begin surgery with us. We will go through the initial consultation, planning, surgery day, and recovery process below to let you know what you might expect.

• Initial Consultation: Before the initial consultation, you will need to turn in a medical history form. Likewise, if you opt for a virtual instead of an in-person consultation, you will need to submit photos of your face for your surgeon to evaluate. Both initial consultations and follow-up phone calls at the GCC are free of charge.
• Quote and/or Insurance Approval: In your consultation, your surgeon will develop a surgical plan tailored to your personal needs. As you discuss with your surgeon the areas of your face you’d like to change, a customized plan will start to become concrete. The specific procedures involved will correspond to your specific goals. Once this is done, cash-pay patients will receive a quote of how much their procedure will cost. Patients who wish to pay with insurance will begin to submit necessary documentation for coverage if they have not done so already.
• Preparing for Surgery: Prior to FFS, you may need to make several lifestyle changes. For example, patients should quit smoking any kind of substance three weeks prior to surgery at the very least. Likewise, there are several restrictions around laser hair removal, dental work and more you can see here.
• Pre-operative Visit: Days or weeks before surgery, you will have a preoperative visit where you can ask any additional questions to our clinical staff. You will sign consent forms that are part of the informed consent process. This visit can be virtual for patients who don’t live in the San Francisco Bay Area, or in-person if you live locally. This is when you will receive information regarding what to expect around surgery, what conveniences you should put in place to be ready for your recovery, medications to stop taking (if any), and your activity milestones after surgery. At the conclusion of your preoperative visit, you should feel comfortable with all of the details surrounding the surgical process.
• Surgery Day: You will receive special instructions on restrictions for the night before and the morning of your surgery. On the day of surgery, please expect to be in surgery for several hours depending on your surgical plan. Our surgeons may recommend splitting multiple surgeries across a couple of weeks to provide time for healing. Your surgeon will inform you of how long your surgery may take.
• Recovery Process: After surgery expect to have gauze or bandages covering your incisions for the first week. You may be provided with compression wraps as well to decrease inflammation around your jaw or forehead. Most patients can return to work 2-4 weeks after surgery so long as it does not involve heavy lifting. The removal of stitches and/or staples may occur a week or so after surgery. Even though your body will do most of the healing in the first six weeks, inflammation can take up to a year to go down. For more information, click here.

What Results Can You Expect from Facial Feminization Surgery?

Some patients report that one of the most difficult parts of recovery from FFS is how long it takes to see the final results. While swelling peaks about 72 hours after surgery, the majority of inflammation takes several months to subside. Even then, patients have to wait a year after surgery to see their final results. This is because it takes 12 months for scars to mature, inflammation to completely settle and for skin to begin to retighten around operated areas.

Being diligent about following our recovery instructions, like scar care, can help you progress in your recovery to see your results sooner. On our website, we keep a readily available stock of Before and After Comparisons of our patients. This might help you get a sense of what you can expect out of surgery.

The following table can give you a general sense of what results you can expect from different FFS procedures.

Frequently Asked Questions (FAQs) About Facial Feminization Surgery:

What is Facial Feminization Surgery?

Facial Feminization surgery is a set of procedures designed for transgender women, non-binary and gender non-conforming patients to experience greater gender congruence with their face. Conventionally, FFS works to reverse the effects of a first, testosterone-dominant puberty on the shape of the skull and/or the soft tissue of the face.

How do I know if FFS is right for me?

FFS has been shown to improve self-confidence and quality of life for transgender women and femmes who experience persistent dysphoria because of the appearance of their face. Our patients consistently report feeling a greater sense of gender euphoria after their surgery. We invite you to schedule a free consultation to see if gender transformation surgery is right for you.

What is the recovery process like?

The recovery process for FFS will vary by individual, since it depends greatly on the number and type of procedures you undergo. During the first 72 hours post-op, you will likely need a support person with you 24/7 to help you change ice packs, assist you with meals and more. Most patients can return to work two to four weeks after surgery, so long as their job does not involve heavy lifting. Although the most intense part of the recovery process takes about two weeks to overcome, patients should avoid vigorous exercise for at least six weeks. For more detailed instructions, click here.

Are the results of FFS permanent?

FFS procedures involve shaving down bone, removing cartilage tissue, and more. The results of these surgeries are long-lasting and may involve some revisions or modifications should you desire them. That said, unlike procedures such as hyaluronic acid injections, FFS results are permanent and do not need retouching to maintain.

What is the cost of FFS, and does insurance cover it? 

For cash-pay patients, FFS can cost between $4,500 and $100,000 depending on the number of procedures you undergo. That said, many of our patients are able to significantly reduce the cost of surgery with insurance coverage. You can read more about insurance coverage for medically necessary, gender-affirming surgeries here.

Why Choose the Gender Confirmation Center for Facial Feminization Surgery?

At the Gender Confirmation Center, our surgeons are board-certified and have extensive experience with medically necessary gender-affirming care. Our patient-centered approach begins at the consultation phase and continues to the rare occasion that a patient requests a revision procedure, as you will always be a part of the GCC community. We provide comprehensive care before, during, and after surgery including our Insurance Concierge Service, which has a 90% success rate in securing coverage for interested patients. We are committed to delivering positive patient experience and exceptional results so our patients may achieve their personal goals. You can schedule a free consultation with us here to begin your journey. We look forward to meeting you.