Q: What are the pros and cons of face feminization surgery?

Pros Changes to your bone structure are permanent, and the end result can be dramatic and boost your self-esteem, whether you are looking to affirm your gender or soften features. FFS has a very high satisfaction rating, with type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el of RealSelf members saying it’s “ Worth It .” Many call it life-changing. “I’m loving my new face. I still look like me but more feminine,” says RealSelf member Katerina78993 . Studies have shown it’s safe to combine multiple procedures in one operation. There’s also a financial benefit to incurring the cost of general anesthesia only once and the convenience of a single recovery period. Cons The surgery doesn’t stop the aging process, so you may need soft-tissue maintenance procedures (nonsurgical, like injectable fillers , or surgical) in future years to keep up your look. It’s usually pricey. Because FFS almost always includes several different procedures, the cost can really add up. If you go to a surgeon who isn’t experienced with FFS, you may not get the results you’re looking for. The few RealSelf members who said it was “ Not Worth It ” complain of asymmetry, unnatural-looking hairlines, and visible scars.

Question 1

What is facial feminization surgery (FFS)?

Accepted Answer

Facial feminization surgery (FFS) is a customized combination of procedures that makes a face look more traditionally feminine. Transgender women often undergo facial feminization to affirm their gender identity, but FFS can also appeal to cisgender women who want to soften masculine or androgynous features, such as an angular jawline or prominent forehead.

“FFS is a procedure for anyone interested in softening the characteristics of their facial features. The surgery can involve one or many procedures and is uniquely tailored to each individual,” explains Dr. Toby Mayer, a Beverly Hills, California, plastic surgeon. “The goal of FFS is to modify the facial features just enough to give the impression of femininity, without altering the uniqueness of the individual. Differences between masculine and feminine faces are a combination of subtle features. Under the care of a skilled and experienced surgeon, the results can be awe-inspiring.”

Feminine facial features typically have a smaller chin, a less square jaw, softer cheeks, and plumper lips. The brow bone is usually less prominent, and the forehead lower.

The surgery can be performed in a series of procedures or in a single, long operation. Each area of the face is addressed separately, and various surgical techniques are used, depending on your facial anatomy, the desired outcome, and your surgeon’s preferences or level of experience.

FFS procedures often include:

Forehead reduction and/or brow bone reduction
A brow lift, facelift, neck lift, and/or eyelid surgery (if you want to look more youthful)
Jaw reduction and chin contouring
Rhinoplasty (a nose job)
Cheek and lip augmentation

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Question 2

What are the pros and cons of face feminization surgery?

Accepted Answer

Pros

Changes to your bone structure are permanent, and the end result can be dramatic and boost your self-esteem, whether you are looking to affirm your gender or soften features.
FFS has a very high satisfaction rating, with type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el of RealSelf members saying it’s “Worth It.” Many call it life-changing. “I’m loving my new face. I still look like me but more feminine,” says RealSelf member Katerina78993.
Studies have shown it’s safe to combine multiple procedures in one operation. There’s also a financial benefit to incurring the cost of general anesthesia only once and the convenience of a single recovery period.

Cons

The surgery doesn’t stop the aging process, so you may need soft-tissue maintenance procedures (nonsurgical, like injectable fillers, or surgical) in future years to keep up your look.
It’s usually pricey. Because FFS almost always includes several different procedures, the cost can really add up.
If you go to a surgeon who isn’t experienced with FFS, you may not get the results you’re looking for. The few RealSelf members who said it was “Not Worth It” complain of asymmetry, unnatural-looking hairlines, and visible scars.

Question 3

How much is facial feminization surgery?

Accepted Answer

Your cost will depend on how many procedures you have and their complexity. Other factors include your FFS surgeon’s experience level, their practice location, and the hospital and anesthesiologist’s fee.

See our complete guide to facial feminization surgery costs

Question 4

Facial feminization surgery before and after pictures

Accepted Answer

The facial feminization surgery photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 5

How can you find the best facial feminization surgeon?

Accepted Answer

Find a board-certified plastic surgeon who has extensive experience with facial feminization surgery.

Ask your doctor how many surgeries they perform each year, and make sure they have plenty of facial feminization before and after photos, including patients with similar facial structure to your own.

You can also read FFS reviews from other RealSelf members, to learn more about their experience and see their photos.

Question 6

What happens before facial feminization surgery?

Accepted Answer

Because feminizing facial surgery is customized for every patient, a good consultation pre-op with a board-certified plastic surgeon is key for successfully minimizing masculine features. “An important part of FFS is the consultation to discuss desired expectations, goals, and any other concerns,” says Dr. Mayer. “Additionally, general medical questions and concerns will be discussed, as well as any psychiatric history or emotional concerns. Your surgeon should also be informed of any allergies, medications, and supplements, to avoid adverse reactions or interactions. Lifestyle, diet, activity, preexisting health conditions, and/or risk factors will also be discussed.”

Your surgeon will take photos, X-rays, and digital scans and go over the procedures they suggest with you. Be as honest as you can about what you want to look like and any concerns you have.

Once you’ve made the decision to undergo FFS, a pre-op evaluation will be performed, and some routine lab tests may be done to guard against any medical complications. You’ll be advised to stop smoking (if you smoke) for about four weeks beforehand; take or stop taking certain medications or supplements; and avoid taking any aspirin, anti-inflammatory drugs or certain herbal supplements, since they can increase bleeding.

Question 7

What does facial feminizing surgery entail?

Accepted Answer

Based on your goals and facial structure, your surgeon may suggest a number of surgical FFS procedures, including:

Hairline repositioning (aka hairline advancement or forehead reduction): Moving the hairline down can soften a prominent forehead and change the shape of your face. The procedure typically involves making an incision along the hairline and bringing the scalp forward. A hair transplant along the hairline may also be necessary.
Forehead contouring (aka brow bossing): Shaving down a prominent forehead can make the ridges around your forehead softer. Your surgeon will make a small incision in a hidden area and shave the bone with a file called a rasp.
Brow lift: A high brow line is a decidedly more feminine look. There are several ways to go about it, but they all involve incisions and lifting the skin above the brow bone.
Eyelid surgery (aka a blepharoplasty): This surgical procedure tightens and lifts the skin above and/or under the eyes. The surgeon makes an incision along the natural crease on your lid (or behind the lower lash line, for the lower lid) and removes tissue and fat before stitching the skin back up.
Rhinoplasty (aka a nose job): A narrower, more refined nose can make your face appear more feminine. Reshaping your nose may involve breaking it, removing bone and cartilage, or adding cartilage to create a more defined tip.
Jawline contouring (aka jaw reduction): Tapering a wide jaw or rounding out an overly angular one makes the face appear more feminine. The jawbone may be shaved and also reshaped. Some doctors don’t include jaw surgery, since it can make the face appear unbalanced. They may recommend Botox to slim down the muscles instead.
Chin contouring: Also known as a genioplasty, this procedure modifies the chin, whether to enlarge or reduce it. It usually involves making an incision in the crease below the chin. If the chin requires a reduction, which is common in facial feminization surgery, the bone is shaved down and contoured to create a more feminine appearance. If a chin augmentation is recommended, the bottom part of the chin bone can be modified by cutting and sliding the bone forward or inserting a chin implant to create more projection, without making it wider.
Adam’s apple reduction: Also known as a tracheal shave, this procedure reduces the Adam’s apple, which is much more prominent in the masculine neck. An incision is made above the Adam’s apple, which makes the scar less noticeable.
Voice feminization: “The sole purpose for this procedure is to change the pitch of a male's voice into the female range,” says Dr. Mayer. “It will not help someone sing better, or strengthen their voice. It allows a transgender patient to affirm their gender if their voice sounds female.” Also called laryngoplasty or glottoplasty, voice feminization involves shortening the vocal cords to give a higher pitch.
A facelift or neck lift: These are often necessary to address loose skin that results from bone-reshaping procedures.

Question 8

What happens during facial feminization surgery?

Accepted Answer

Most of the time, FFS will be done in a hospital, under general anesthesia. However, a few procedures, such as hairline advancement and cheek and lip augmentation, can be done with local or even topical anesthesia.

An experienced FFS surgeon will be able to do many of these procedures during one surgery, which typically lasts about five hours. Some RealSelf members say their surgeries lasted as long as eight hours.

A 2019 study published in the journal Aesthetic __Plastic Surgery found that combining a facelift and forehead contouring with a brow lift, cheek implants, rhinoplasty, and jaw contouring can be done safely and effectively in one surgery. Out of 25 patients, seven experienced complications, such as a facelift hematoma and cheek implant infections, but these were known risks of these individual procedures.

After your surgery, the procedure areas will be bandaged. Often, an elastic bandage will be placed around the head, face, and chin, to minimize swelling and support healing. Occasionally, a drain will be placed under the skin, to prevent the accumulation of excess blood or fluid. The drain is temporary and usually removed within a week following surgery.

After the procedure, you’ll be wheeled into a recovery room or suite until sedation wears off.

Prior to being released home or to wherever you will be staying after your procedure, you’ll be given specific instructions for:

Care of your surgical site
Activity restrictions
Sleeping positions (with most facial surgeries, sleeping upright or reclined is typically recommended)
Ointments to apply or medications to take orally in order to aid healing and reduce the risk of infection
Dates and intervals of follow-up visits
Signs of infection or other concerns that warrant a call to your specialist or immediate medical attention

Question 9

How long does it take to recover from facial feminization surgery?

Accepted Answer

Downtime after FFS surgery is typically 7 to 14 days, but your recovery timeline will depend on which procedures you’ve had.

Soft-tissue feminizing surgeries (such as hairline advancement, eyelid surgery, and a brow lift) will generally have a lot less swelling and downtime (mostly a week to 10 days) than bony procedures, such as forehead contouring and a jaw reduction. In those cases, “it can take anywhere from three to four weeks for the swelling and bruising to get to a point where you look presentable,” says Dr. Harrison Lee, a plastic surgeon in Beverly Hills, California. He recommends supplements like arnica and bromelain to resolve swelling and bruising sooner.

Your surgeon may also prescribe pain medication for your FFS recovery, but Dr. Jeffrey Spiegel, a facial plastic surgeon in Newton, Massachusetts, says his patients typically take it only for the first few days.

“Complications should be very rare, if the surgeon is experienced,” says Dr. Mayer. “I’ve never had a bad scar requiring revision, bleeding, or infection in several thousand procedures—though infection can occur with tissue expanders or implants.”

RealSelf Tip: Even after the swelling has gone down following bone restructuring surgery, you’ll have to exercise caution for several months and avoid activities where you can be hit in the face.

Question 10

How soon will you see facial feminization surgery results?

Accepted Answer

You’ll see changes to your facial structure immediately, but it can take at least six months to see the final results. At least some of the results from soft-tissue feminization can also be seen right away, but it may take time for swelling and scars to resolve.

Question 11

Are facial feminization surgery results permanent?

Accepted Answer

Your results should be permanent, but FFS can’t stop the natural aging process. As you age, you may need tweaks here and there to maintain your feminine look.

Question 12

What are the risks and side effects of facial feminization surgery?

Accepted Answer

Like most surgeries, facial feminization surgery risks include prolonged swelling, scarring, infection, bleeding, hematomas (a collection of blood), and poor bone healing. However, most of these side effects are rare with an experienced surgeon.

Question 13

Does insurance cover facial feminization surgery?

Accepted Answer

FFS isn’t typically covered by healthcare insurance, because it’s deemed cosmetic, but many doctors offer payment plans or financing. If you’re undergoing a gender-affirming journey, the Affordable Care Act states that health insurance policies aren’t required to "cover any particular procedure or treatment for transition-related care." However, many of them do. Talk with your provider about whether your particular policy will cover FFS.

Question 14

Are there nonsurgical alternatives to FFS?

Accepted Answer

If you’re not ready to undergo surgery, you can achieve a more feminine look, at least temporarily, with nonsurgical facial feminization procedures.

Cheek augmentation with hyaluronic dermal fillers, such as Restylane orJuvéderm, can fill in sunken cheeks and the areas around the eyes, giving the face a softer, more feminine look.
Lip augmentation with injectable fillers like Restylane Kysse or Juvéderm Volbella can plump thin lips.
Botox can reduce the look of a square jawline when injected into the masseter muscle, which runs down the cheekbone to the lower jaw on both sides of the face. Relaxing this muscle shrinks it over time. It can take a few weeks to work, but results can last up to six months (unlike wrinkle-smoothing effects, which are typically gone in three to four months).

FACIAL FEMINIZATION SURGERY

Toby Mayer, MD

Krista Bennett DeMaio

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	Forehead Reduction surgical	Brow Bone Reduction surgical	Facelift surgical	Neck Lift surgical	Jaw Reduction surgical	Cheek Augmentation surgical	Lip Fillers nonsurgical
Worth It Rating	89%	75%	92%	91%	86%	84%	95%
Average Cost	$9437	Not yet available	$19181	$12422	$13386	Not yet available	$660
Downtime	3–5 days of downtime	Up to 2 weeks of downtime	10–14 days of downtime	1–2 weeks of downtime	2 weeks of downtime	Up to 1 week of downtime	No downtime
Anesthesia	Sedation or general anesthesia plus local anesthesia	General anesthesia	Local w/sedation or general anesthesia	General anesthesia	General anesthesia	General anesthesia	Topical numbing cream

	Cheek Augmentation surgical	Lip Fillers nonsurgical	Botox nonsurgical
Worth It Rating	84%	95%	97%
Average Cost	Not yet available	$660	$593
Downtime	Up to 1 week of downtime	No downtime	No downtime
Anesthesia	General anesthesia	Topical numbing cream	No anesthesia

Toby Mayer, MD

Krista Bennett DeMaio

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