Facial Feminization Surgery: What You Need to Know

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 88% 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.

• Average Cost:
• $37,566

• Range:
• $17,000 - $66,000

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

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

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.

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.

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.

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

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.

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.

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.

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.

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.