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Facial Feminization Surgery Procedure Options: Comprehensive Guide

Medically reviewed by Jennifer Richman on December 02, 2024.

Understanding Facial Feminization Surgery (FFS)

Facial feminization surgery (FFS) describes a menu of surgical options designed to give varying regions of the face a more conventionally feminine appearance. Patients can choose between procedure options designed to lower a receding hairline, flatten the forehead, raise the eyebrows, reshape the nose, contour the chin and jaw, reduce the Adam’s Apple and more. Many of these FFS procedures are designed to reverse the effects of a first, testosterone-dominant puberty on the skull shape–features that cannot be changed by hormone replacement therapy (HRT). 

You can request a free, virtual or in-person consultation with our surgeons today to discuss which options would be best for you.

Common Procedures Involved in Facial Feminization Surgery

There are many surgical procedures that fall under the umbrella of FFS. Each of these procedures comes with risks and benefits, so it’s important to have an honest and thorough conversation with your surgeon to discuss the best procedures for your unique facial shape and outcome goals.

Generally speaking, the purpose of FFS is to help transfeminine and non-binary patients resolve issues of gender dysphoria linked to the appearance of their face. FFS procedures can empower individual patients to have an appearance that is more connected to their internal sense of self, and in turn, give them the opportunity to share that with the world.

The following guide goes over procedure options that patients can choose from, why they are often selected, how they are conducted, as well as any drawbacks associated with them.

Upper Third of the Face

Brow bone reduction and cranioplasty

• Why? This procedure is chosen by patients who experience dysphoria from having a prominent brow-ridge and/or forehead. A brow bone that projects out is a common effect of a first, testosterone-dominant puberty, and therefore a common visual cue of masculinity. Having a prominent brown bone can be taken as a signal that results in them being gendered as masculine.
• How? This procedure flattens the shape of the forehead and brow bone. In doing so, it makes the eyes look larger and more visually apparent. A brow bone reduction is performed by opening up the skin above the forehead to allow the surgeon to reshape the bone. Sometimes, it may be necessary to remove the bone covering the frontal sinus of the face, contour the bone down further, and re-set the bone back into place. After being contoured, the bone will be fastened back to the forehead with absorbable or titanium plates (which will not trigger metal detectors after surgery.) This portion of the forehead contouring is called a frontal sinus setback. 
• Drawbacks? To perform the procedure, patients will be left with an incision at the base of the hairline or along the top of the head. The former will leave a scar at the top of the forehead, along the hairline. The visibility of the scar will depend on how your own body heals and your ability to follow scar care protocol. 

Hairline Advancement

• Why? As adults age, a receding hairline is a common effect of having high levels of testosterone in the body. While testosterone blockers as a part of HRT can stop further receding, it cannot grow back hair that has already stopped growing; in other words, HRT cannot reverse a receding hairline. 
• How? This procedure uses an incision around the forehead to reshape the hairline. The focus here is on rounding the corners of M-shaped hairlines, making the forehead appear shorter and more round. This can help eliminate the need for hair transplants on the forehead and is usually performed through the same incision as the brow lift.
• Drawbacks? This procedure leaves a scar at the top of the forehead or the base of the hairline. Although scar care can help reduce its visibility, following care instructions may not always be enough for patients. For example, individuals with richer skin tones may be predisposed to hypopigmentation–meaning that scars take on a lighter coloring than the rest of the skin around them–and as a result, forgo a hairline advancement. If you have a history of keloid scarring or other concerns about scar visibility, a hair transplant might be a better way to reverse a receding hairline.

Brow Lift

• Why? Having the eyebrows sit partially or completely above the brow bone is considered a conventionally feminine facial feature. As a result, undergoing a brow lift can be a source of gender euphoria for many of our patients.
• How? Using the same hairline or coronal incision in the aforementioned procedures, your surgeon will pull up the skin of your forehead to lift the position of your eyebrows. This can either be done with placing absorbable sutures or small implants to help grab and pull this portion of the scalp up into its desired position.
• Drawbacks? As with the two procedures listed above, a brow lift can leave patients with a scar at the base of the hairline or top of the forehead. A brow lift can temporarily lead to upper face tenderness or tightness, similar to the feeling of headaches and mild migraines, during the healing period.

Middle Third of the Face 

Cheek augmentation

• Why? Full cheeks are conventionally associated with femininity. As a result of estrogen hormone replacement therapy, fat in the face will often redistribute to fill in the cheeks. Regardless of whether or not a patient is on HRT, they may want to augment the volume of their cheeks to experience greater gender euphoria.  Cheek augmentations help make the appearance of cheekbones more prominent, helping to give the face more of a heart shape.
• How? A cheek augmentation uses cheek implants, fillers, or an analogous fat transfer from elsewhere on the body to augment the cheeks.
• Drawbacks? Like any analogous fat transfer, there is a small risk that none of the injected fat will hold to the zone it is transferred to. By around the six week mark, whatever fat that holds is considered the final result. That said, significant weight fluctuations after surgery can reverse the results.

Rhinoplasty (aka. “nose job”)

• Why? This procedure reshapes the nose, often with the goal of making it appear smaller and smoother. Patients that experience gender dysphoria because of the size and/or shape of their nasal bridge, the tip of their nose and/or their nostrils can undergo gender-affirming surgical alterations. 
• How? In any rhinoplasty, your surgeon will make a small incision around the base of the nostrils where they can enter into and alter the structure of the nose. Most commonly, a rhinoplasty for FFS involves (1) reducing the size and smoothing out the nasal bridge and (2) rotating the tip of the nose so that it has a slightly upward tip. That said, you can make specific requests to your surgeon during a free consultation. The components of a rhinoplasty will vary based on a patient’s goals and what is possible to modify with the existing structure of their nose. 
• Drawbacks? The incision at the base of the nose will generally fade, becoming nearly invisible. A rhinoplasty can take up to 12 months to fully heal, requiring patience as inflammation ebbs and flows during the recovery process.  

Bottom Third of the Face and Neck

Lip Lift or Lip Augmentation 

• Why? Oftentimes, a first, testosterone-dominant puberty results in a shorter upper lip. Augmenting the size of the upper lip or the volume of both lips can create facial proportions that appear more conventionally feminine.
• How? A lip lift is done by creating a small incision under the nose and removing skin between the nose and upper lip. The upper lip is thereby “lifted,” increasing its size. A lip augmentation is performed through an analogous fat transfer. Fat is taken from another part of the body, filtered and injected into the lips to increase their volume.
• Drawbacks? Some lift lip patients report experiencing a puckered look to their top lip after surgery. A lip augmentation like any analogous fat transfer, there is a small risk that none of the injected fat will hold to the zone it is transferred to. By around the six week mark, whatever fat that holds is considered the final result.

Jaw and Chin Contouring

• Why? For many individuals, a first, testosterone-dominant puberty results in a wide and prominent jawbone and chin. Reducing their size can help create a softer, more conventionally feminine appearance. 
• How? Though these procedures are invasive, they leave no visible external scarring. This is because your surgeon will make an incision at the base of the bottom gumline inside the mouth to enter into the jaw and contour it. If you would like to request that your surgeon contour your chin and jaw to give your face a certain shape–be it rounder, heart-shaped or with a softer, but still square-shaped jaw–you can discuss these preferences in a free, virtual consultation.
• Drawbacks? Although this procedure leaves no visible scarring, it has one of the most difficult healing processes for patients. During the first two weeks of recovery, you will be on a strict soft food diet to avoid hard food traumatizing the mouth incisions. Some degree of swelling in the chin and jaw area is expected, which can also make it more uncomfortable to chew and swallow harder foods. At about two weeks post op to the one or two month mark, you can begin chewing softer foods. You may need to avoid harder foods like nuts until about the one or two month mark, once chewing them stops provoking pain. Additionally, because of the pull of gravity, inflammation takes the longest to resolve here. Patients will generally have to wait 12 months until they can see their final results.

Tracheal shave or Adam’s Apple reduction

• Why? A prominent Adam’s Apple can be a source of gender dysphoria for some trans women and femmes. Reducing its size can give the neck a more conventionally feminine appearance.
• How? This procedure starts with the surgeon making a small incision at the top of the neck. Many surgeons will make the incision under the jaw so that it is less visually apparent when it heals as a scar. From there, the thyroid cartilage is shaved down.
• Drawbacks? A trained, board-certified surgeon should be able to conduct this procedure without causing any damage to the vocal cords. Please note that a tracheal shave will not change the pitch of your voice. Vocal feminization surgery is a separate procedure.

Additional Facial Feminization Procedures

In addition to the procedures listed above, there are additional interventions that can help patients achieve their desired outcomes. Check out the Gender Affirming Facial Surgery (GAFS) article for surgical options to achieve a more masculine, androgynous and-or gender fluid appearance if your goals go beyond or are not aligned with feminization. Likewise, you can talk with one of our highly acclaimed facial surgeons if you are curious about feminizing rejuvenation for our older patients.

Who is a Candidate for Facial Feminization Surgery?

First of all, the Gender Confirmation Center (GCC) does not have gender-identity requirements for any of our procedures. There may be feminine-spectrum trans folks for whom facial feminization might not be a part of their transition. We have served non-binary patients who want multiple procedures done in multiple regions of their faces. Meanwhile, there are binary trans women who only need or request one FFS procedure or intervention to feel affirmed in their gender.

Second, the GCC does not have HRT or Body Mass Index (BMI) requirements for facial surgery eligibility. We use the informed consent method, wherein we go over risks and long-term effects of surgery with adults so that they can make the decision about whether gender-affirming surgery is the right choice for them. 

Consultation Process and Preparation

The Gender Confirmation Center constantly strives to be patient-centered, working with individuals to support them through their unique journey with gender affirming care. Patients can request a free, virtual or in-person consultation with either of our facial surgeons: Dr. Ley (she/they) or Dr. Facque (he/him). Both are passionate about continued learning and carry years of experience serving trans, non-binary and gender non-conforming patients. Their positive reviews and testimonials reflect their expertise in crafting successful FFS plans with their patients. 

Patients who are interested in using insurance to help them pay for surgery will receive free help from our insurance advocacy team to help them acquire all necessary documents. Patients that have all documents ready to apply for insurance pre-approval will be prioritized in scheduling their consultations.

For virtual consultations, patients will need to take and upload photos of their face from seven different angles. This is to help your surgeon make a customized surgical plan to your facial features that will help you meet your unique needs. 

Expected Recovery Timeline After Facial Feminization Surgery

Generally speaking, FFS patients will need around-the-clock care during the first 72 hours after surgery. Regardless of whether or not you are discharged from the hospital the day of your procedure, you will need to ice your face for 20 minutes every hour. Swelling peaks during this time and you will need 24/7 help from a loved one or care professional to manage inflammation.

The most intense recovery period lasts around 2 weeks. During this time, you will need to follow a low-sodium diet, a soft food diet if you underwent jaw or chin contouring, keep compression garments on your face, ice frequently and more. For more detailed information on recovery, click here. 

Risks and Considerations of Facial Feminization Surgery

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. That said, there are various steps we require our patients to take to reduce the risk of a potential complication.

Any surgery involves a risk of infection, seromas, bleeding, and adverse reactions to anesthesia. Sharing your complete medical history such as medications and supplements you are taking alongside allergies can help your surgical team make a plan to reduce these risks.

Specifically for facial surgery, patients run the risk of experiencing delayed healing, nerve injury, changes in skin sensation, asymmetry and more. Undergoing FFS with an experienced, board certified surgeon can help reduce these risks. Likewise, quitting any kind of tobacco and nicotine consumption before surgery can help you significantly reduce the risk of complications like delayed healing or nerve damage.

Emotional and Psychological Impact of Facial Feminization Surgery

In the short-term, FFS can be one of the most difficult surgeries to recover from. Emotionally, many patients experience temporary feelings of post-operative depression and even regret. This is normal as your body heals from a major surgery. Especially after operating on your face, it will take time before inflammation settles and your results become visible. It can be frustrating and jarring for you to get accustomed to a new face, especially when swelling and bruising make it hard to tell what you will look like at the end of healing. 

In the long-term, several peer reviewed studies demonstrate that there is a very low regret rate for gender-affirming facial surgeries performed by properly trained, board-certified surgeons. FFS has shown significant improvement in several quality of life indicators like overall mental health, self-esteem and body image. By relieving a major source of gender dysphoria, many patients report feeling a greater sense of ease and euphoria.

Cost of Facial Feminization Surgery

The cost of FFS varies greatly from patient to patient. On one hand, this is because no one FFS procedure is the same. Depending on the number of procedure options that a patient chooses, you may need to stay a night in the hospital after surgery. The number and type of procedures performed can also thereby increase the costs of hospital and facility fees.

FFS is one of the surgeries that our practice has great success getting covered by certain insurance providers. After you request a free consultation, you can request support from our insurance advocacy team to acquire all the necessary support documents to apply for pre-approval. Insurance coverage can significantly reduce the costs of surgery.

Finding the Right Surgeon for Facial Feminization Surgery

It is important that patients select board-certified surgeons with hospital privileges and proper craniofacial training to undergo FFS. Hospital privileges are particularly important given that many FFS patients spend the night in the hospital after surgery. Not to mention, in the case of any surgical complication, having hospital privileges will ensure that you get the support you need.

From there, so much of picking a surgeon for FFS has to do with finding someone that can meet your personal needs. Reviewing a surgeon’s before and after photo gallery is one way you assess if a surgeon will be able to help you meet your desired results. 

Additionally, the conversation you have with a surgeon during your consultation will help you determine if they are a good fit for you. Every surgeon has a different approach to FFS: some are more forthcoming with their recommendations, while others are more committed to making sure that the surgical plan comes entirely from the patient. Coming prepared with a sense of which features give you dysphoria and what you would like your final results to look like––such as bringing a family photo to the consultation-–can help you figure out if the surgeon is a good fit for you.