Feminizing Gender Confirmation Surgery
While not all transgender women opt for gender confirmation surgery, those who want to give their features a more feminine form—and, in the case of bottom surgery, function—can choose from a range of plastic surgery procedures for the face and body.
Learn more about current options and what they involve.
While not all transgender women opt for gender confirmation surgery, those who want to give their features a more feminine form—and, in the case of bottom surgery, function—can choose from a range of plastic surgery procedures for the face and body.
Learn more about current options and what they involve.
Top treatments
Gender confirmation surgery (aka gender affirmation surgery) for transgender women or nonbinary people can include a number of procedures, to align their physical appearance with their gender identity.
Dr. Aditya Sood, a board-certified plastic surgeon in Skokie, Illinois, notes that “the surgeries can range from facial, breast, and body to genital reconstruction procedures.”
“Gender confirmation surgery is for patients who have been diagnosed with gender dysphoria, usually by their primary care physician as well as a therapist or psychologist,” explains Dr. Justine Lee, a board-certified facial plastic surgeon in Los Angeles. “If there is a portion of their body that has consistently been a cause of their gender dysphoria, then gender confirmation surgery may be indicated. For each patient, it’s very individual. There’s not one particular part that’s always the root cause. Sometimes it’s multiple areas of the body—sometimes it’s only one. It really depends on the patient.”
Nonbinary or transgender patients undergoing gender confirmation surgery of any kind are usually seen and supported by a multidisciplinary team of physicians, working together to guide patients through all aspects of the process.
While not every gender confirmation patient is on hormone therapy, it's useful—and in some cases necessary—in the context of certain body surgeries. “With the exception of gender-neutral patients, most patients visiting our office for gender confirmation procedures have already begun their transition with hormonal manipulation,” Dr. Sood tells us.
Hormones like estrogen tend to be less critical for facial surgeries, however, notes Dr. Lee. While they can improve facial volume and skin texture, they don’t affect bony structures, which are a primary target in facial feminization surgery.
The World Professional Association for Transgender Health (WPATH) has outlined international requirements that patients must meet in order to be eligible for certain gender confirmation surgeries.
“We take into account WPATH guidelines in our decision making, regardless of whether the patient is insured or self-pay,” notes Dr. Sood. “In general, patients must have documentation of gender dysphoria by a psychiatrist, psychologist, hormone replacement MD, or other qualified personnel." They may also require the patient to have lived as a woman for at least a year. Familiarize yourself with the WPATH standards and discuss them with your surgeon during your gender confirmation consultation.
Related: 7 Important Things to Know About Gender Confirmation Surgery
RealSelf Tip: Plastic surgeons who perform transgender surgery typically specialize in certain procedures. Some focus on facial feminization surgery only, while others may also have expertise in transgender breast augmentation or bottom surgeries, like vaginoplasty. It's important to find a board-certified plastic surgeon who is a true authority on your procedures of choice and performs them regularly, with excellent results. (If you don't live in a major metro area, this may involve traveling.)
Both gender-affirming surgery and nonsurgical procedures can be an important part of a gender transition. These are the top procedures that RealSelf doctors and members alike recommend.
| Worth It Rating | 90% | 95% | 100% | 87% | Not yet available |
|---|---|---|---|---|---|
| Average Cost | $29350 | $6875 | $7450 | $13575 | Not yet available |
| Downtime | Varies by procedure | 5–7 days of downtime | Varies by procedure | 7–10 days of downtime | |
| Anesthesia | General anesthesia | General anesthesia | General anesthesia | General anesthesia | No anesthesia |
- Facial feminization surgery (FFS) is often the first surgical step that those undergoing gender confirmation surgery take. “People form perceptions of gender identity based on your face, so facial procedures are frequently one of the most important aspects of gender confirmation surgery,” explains Dr. Lee. The transfeminine and nonbinary patients she treats typically choose to have multiple procedures done during a single surgery. (In a 2019 study, Italian researchers found that full FFS provides greater satisfaction, reduces cost, and curtails the risk of side effects compared to undergoing one procedure at a time.) FFS addresses every aspect of the face, top to bottom, and commonly includes:
- Forehead reduction and brow lift: Making a coronal incision across the top of the head, within the hairline, allows surgeons to access the entire top third of the face. Depending on the patient’s anatomy, reducing the brow bone may involve cutting and repositioning the panels of bone in the central forehead as well as sanding down the sides of the tops of the eye sockets. This gives a male forehead, which is often sloped, the more flat or convex appearance of a female forehead, explains Dr. Lee. A brow lift typically follows, with the aim of elevating the eyebrows to a more feminine position, “half a centimeter to one centimeter above the top of the orbit,” she adds. When moving the scalp to adjust the hairline, the objective is to round out the M-shaped peak that customarily reads as male. If the hairline has receded beyond a point that can be addressed by lowering the hairline, the patient can opt for hair restoration in the future.
- Temple and cheek augmentation: “A classic female face is slightly fuller in the upper face and more tapered in the lower face, for a more heart-shaped appearance,” says Dr. Lee, who commonly adds fat to the temples and cheeks during facial feminization surgery. This also replaces what’s been lost with age, giving the face a more youthful look.
- Rhinoplasty: Feminizing a nose usually means addressing the radix, or root, of the nose, to create a smooth transition between forehead and nose (which may be addressed during the brow surgery), and then narrowing the nose, reducing the dorsum (or bridge) of the nose, and rotating and refining the tip—all while being careful to preserve certain ethnic or family aspects that are key to the patient’s identity.
- Lip augmentation or a lip lift: “The upper lip tends to be much thinner in masculine faces compared to feminine,” says Dr. Lee. To correct this, she’ll often augment the top lip by grafting fat (taken from the forehead) into the upper lip. “Some choose to have a lip lift instead [which shortens the length of the cutaneous upper lip], and sometimes people want both,” she notes. Another option is lip fillers, which offer a temporary, nonsurgical way to add fullness and shape to the body of the lips.
- Chin reduction and jaw reduction: “In masculine faces versus feminine, the chin tends to be 17% taller and also a little wider,” says Dr. Lee, so she’ll often reduce the height and width of the chin by cutting out a wedge of bone and then sliding the remaining pieces back together, or in cases requiring a less dramatic change, sanding bones down to size. The mandible is similarly reduced, for a less angular, more tapered effect.
- Tracheal shave: Also known as an Adam’s apple reduction, “this is a very, very common request, because tracheal cartilage is much more pronounced and protrusive in the masculine patient,” Dr. Lee explains. Your surgeon will explain how to care for each incision site and will prescribe pain medication and an icing routine to help manage post-op discomfort and swelling. Most patients return to work within two to three weeks, though it can take up to a year for swelling to fully resolve. Find doctors who offer facial feminization surgery
Other female gender confirmation procedures include:
- Transgender breast augmentation (top surgery). “The goals of transgender breast augmentation include creating a natural and female type of breast mound,” says Dr. Sood. “Often, the idea of a breast can vary, depending on the patient’s own goals and ideals.” In Dr. Sood’s practice, the procedure generally includes “endoscopic transaxillary breast augmentation with silicone or saline implants, along with very careful release of internal constricting bands and very careful placement of the implant in a dual-plane or subfascial location, above the muscle.” Depending on the patient’s anatomy and the type of implant they choose, incisions may be hidden in the breast fold or around the areola. Following surgery, patients can expect a couple of days of discomfort, which can be managed with prescription pain medications. Find doctors who offer transgender breast augmentation
- Transgender body contouring—which typically includes liposuction paired with a Brazilian butt lift (BBL) or butt implants (and sometimes even a tummy tuck)—helps transgender women achieve a more feminine body shape. A BBL is done under general anesthesia and begins with the doctor performing liposuction, to narrow the waist. Then the fat that was removed during liposuction is purified and injected into the hips and buttocks, to create an hourglass figure. Sometimes implants are also inserted into the buttocks, for a more defined look. Depending on which procedures you choose, recovery will take anywhere from one to six weeks. After the recovery period, results are considered permanent, although weight gain or loss may change your figure over time. Find doctors who offer transgender body contouring
- A vaginoplasty (bottom surgery) creates female genitalia—with functional neovagina, labia, and clitoris—out of the transgender or nonbinary patient’s existing penile and scrotal tissue. It can be performed alongside an orchiectomy, during which the testicles are removed. While there are several techniques, penile inversion vaginoplasty is considered the gold standard. A cavity is created, between the rectum and prostate, to form the neovagina, lined with tissue from the penis and/or scrotum. The urethra is shortened, while the glans of the penis becomes the clitoris. Scrotal skin often forms the labia majora, and labiaplasty may be performed in order to create more refined labia minora. Dilation ensures that the vagina doesn’t contract following surgery. Surgeons typically require patients to use vaginal dilators, on a regular schedule, for at least six months post-op. In a 2018 study out of Germany, examining the impact of transgender bottom surgery on patients' sexuality, researchers found that “orgasms after surgery were experienced more intensely than before in the majority of women in [the] cohort, and neoclitoral sensitivity seems to contribute to enjoyment of sexual activity to a greater extent than neovaginal depth.” Find doctors who offer transgender vaginoplasty
- Laser hair removal uses light energy to destroy hair follicles on your face and body. Combined with hormone replacement therapy (which usually reduces hair growth), it's a popular and effective procedure for many trans women. It takes about 6 to 12 sessions to dramatically reduce unwanted hair. Any stray hairs remaining can be treated with electrolysis. Find providers who offer laser hair removal
Related: I Got My Gender Confirmation Surgery at 54—and I Finally Feel Liberated
Updated July 2, 2021