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What is Facial Feminization Surgery? Techniques, Incisions, & Surgical Options

Facial feminization surgery (FFS) and Gender Affirming Facial Surgery (GAFS) are a menu of surgical options designed to target features of the face that change during a first testosterone-dominant puberty. By focusing interventions on key areas of the face, GAFS can empower patients to feel more connected to their internal sense of self that they want to share with the world.

There are many surgical procedures that fall under the umbrella of FFS; here we give an overview of a sinus setback, browlift, hairline advancement, cheek augmentation, rhinoplasty, lip lift/augmentation, mandible contouring, genioplasty and tracheal shave/Adam’s Apple reduction. 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.

What Can Facial Feminization Surgery Consist of?

To make things easier, we will categorize the different procedures associated with facial feminization surgery by location on the face. Below is a brief list of the different procedures available in each region of the face/neck, along with a label explaining if the intervention targets the bony structure of the face, the soft tissue/fat compartments, or the skin. For a more in depth analysis of the different interventions, check out our articles on the sidebar broken down by area of the face, which can also be accessed by the hyperlinks on each procedure title.

Upper Third of the Face

• Frontal sinus removal/setback (bony structure)
  • The brow bone can be more protrusive on the face in some people who underwent a first, testosterone-dominant puberty. This procedure reduces or reshapes the brow bone to allow the upper third of the face to appear more open and less prominent.
• Brow lift (skin)
  • A brow lift uses one of a few different techniques to lift the eyebrows, helping to make the eyes appear larger and allows the brows to sit above the brow bone.
• Scalp/hairline advancement (skin)
  • Also called hairline lowering, 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.

Middle Third of the Face 

• Cheek augmentation (soft tissue/fatty compartment)
  • This procedure uses cheek implants, fillers, or analogous fat transfer from elsewhere on the body to augment the cheeks. Cheek augmentations help make the appearance of cheekbones more prominent, helping to give the face more of a heart shape.
• Rhinoplasty (bony structure)
  • This procedure reshapes the nose, often with the goal of making it appear smaller and smoother. This is done by making it more narrow, removing any bumps, straightening any places where the nose appears crooked, and/or helping to alter the shape of the tip of the nose.

Bottom Third of the Face and Neck

• Lip lift/augmentation (soft tissue/fatty compartment) 
  • A lip lift can be done to make the shape of the upper lip more prominent, and can be accompanied by lip augmentation or be done by itself. The lift is done by creating a small incision under the nose and removing skin between the nose and upper lip.
• Mandible contouring (bony structure)
  • For most folks who went through a first, androgenic puberty, the jawbone is prominent and wider. This technique shaves down some of the jaw and reshapes the chin to create a more narrow and softer look to the bottom third of the face.
• Genioplasty (bony structure)
  • A genioplasty helps soften the look of the chin by changing the often square-shape to a more narrow shape.

• Tracheal shave or Adam’s Apple reduction (soft tissue/fatty compartment)
  • For some folks who underwent a first, testosterone-dominant puberty, the thyroid cartilage in the throat area is enlarged. This procedure shaves the neck bump or Adam’s Apple down so it appears less prominently without impacting the vocal cords.

Additional Facial Feminization Procedures

In addition to the procedures listed above, there are also interventions that can help specific groups of folks 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.

FFS and GAFS are not a one-size-fits-all journey. There may be feminine-spectrum trans folks for whom facial feminization might not be a part of their transition. There may be non-binary femme folks who want multiple procedures done in multiple regions of their faces, and there may be binary identified trans women who only ask for one intervention to feel affirmed in their gender.

The Gender Confirmation Center constantly strives to be patient-centered, working with individuals to support them through their unique journey with gender affirming care.