What does a doctor typically do for facial feminization surgery? What is the average cost of this surgery?

The cost of facial feminization really depends on what types of procedures are required.  Here are some of the more common procedures for facial feminization:1. Forehead reduction with forehead lowering and brow lifting and forehead contouring-  This procedure can be a 3 for 1 in that patients will have their hairline lowered, brows lifted, as well as their forehead reshaped.  Forehead reshaping can be extensive involving removing a portion of the frontal sinus to subtle where the frontal bone is shaved down with a burr.  It is important that patients are taking female hormones for the forehead lowering component as too much testosterone can lead to male pattern baldness.2. Nasal reshaping-  A huge impact on the face is reducing the size and shape of the nose and adding female contours and characteristics.  Surgical request have changed from drastic to more subtle feminine noses which appear natural.3. Jaw reduction- In some patients jaw reduction or chin reduction can help feminize the face.  Jaw reduction can be don with botulinum toxin, although most feminization patients request more permanent changes associated with surgery.4. Adam's apple shave5. Lip and cheek filler- adding softness to the face can help create a softer overall more feminine look

Typically when a patient is interested in FFS surgery, there
are several different procedures available.
However, each patient is unique and based on the patient that will
determine the procedures that I would recommend.

There are many different factors that are involved in FFS
surgery. Budget is mainly the largest
factor that we see. Based on how much
you would like to invest in FFS that will determine how many procedures you can
complete. Some patients come in with a small budget and we can work with them
to help get the most “bang for their buck” as they say. Others come in with a large budget and want a
full facial feminization package completed and we can work with them in
determining which procedures are needed and which ones aren’t needed.

Again, every patient is SO unique. For example-Some patient’s already have a
feminine jaw line so we would focus on the forehead contouring and perhaps a
lip lift. There are also non-bone contouring procedures that are available as
well (soft tissue procedures) that can really help make your face more youthful
as well as feminize! By making your face
look more youthful, we are feminizing and softening it at the same time.

Like I said before-cost can vary based on the procedures that
you would like to accomplish. It is so variable that it’s hard to pinpoint an
exact cost without actually seeing the amount of FFS needed to be done. 

There are several differences in facial features between the genders. Going from above downward, there is the anterior hairline, the contour of the forehead, the height & shape of the eyebrows, the amount of upper eyelid skin available for applying makeup, the size & shape of the nose, the prominence of the cheeks, the fullness and shape of the lips, the shape and prominence of the chin & jawline and, finally, the size of the Adam's apple. Depending on which of these features are out of sync with the desired end goal, determines which of several procedures we employ first. The cost of each procedure varies. The smaller procedures involving the lips, eyes, cheeks, chin, or Adam's apple generally run from $5K to $10K. The more involved procedures such as nose re-shaping or forehead re-contouring could run from $10K to $20K.

Facial feminization surgery for transgender can be divided into two categories:

1- Soft tissue feminization: It requires a facelift, fat grafting, and forehead lift, lip augmentation, as well as some neck and face lipo-sculpturing. This procedure can cost from 8 to 20 thousand dollars.

2- Bony tissue feminization: This requires extensive surgeries for reduction of prominent jaw and mid-face bones, and nasal reshaping in addition of some soft tissue feminization. It is done in stages. It can cost up to 50 thousand dollars
 

There are many procedures that can be done, it depends on what the patients wants and needs as well as the patient's budget. 

For soft tissue, rhinoplasty and lip augmentation make a dramatic change in the face.  Cheek implants, filler or fat grafting can be used to give the cheeks a more rounded soft appearance.  

The bones of the face can be recontoured as well.  The angle of the jaw can be shaved down, as can the chin.  The forehead can be reduced making the brows less prominent. The hairline can also be brought lower or hair can be transplanted from the back of the head. 

The adam's apple can be shaved through a small neck incision.

The prices for these vary and some can be packaged together.

I don't mean to be vague on pricing, but it is so dependent on each patient's needs it is hard to give a blanket statement. 

The best way to proceed is to work with a facial plastic surgeon trained in craniofacial surgery that understands gender affirming surgery

Best of luck,

Dr Rodman

after 15 years performing FFS, I find that most (but not all) patients will benefit more from 1-Forehead,orbital contouring, brow lift and 2- rhinoplasty.In other words and when indicated these 2 procedures alone will give most of the feminization needed.I often recommend them when the budget is limited because they give great results and improvement.typically the costs are between 13-17000 $ ( canadian) depending on the amount of bony work needed. 

Facial feminization surgery requires addressing both the soft tissues components of the face as well as the bony facial skeleton in order to achieve a more balanced, feminine face.  Soft tissue feminization may include performing a facelift, forehead/brow lift, and lip augmentation with injectable fillers (e.g., Restylane, Juvederm, etc.).  Bony feminization entails manipulating the facial skeleton to achieve each patient's specific goals.  This may include frontal sinus contouring, rhinoplasty, use of cheek implants, and mandibular setback / chin reduction (genioplasty) surgery.  

Each patient is unique and each has her own preferences and expectations.  Therefore, each patient will require a different set of procedures, each of which has its own cost.  Packages are sometimes available, as they are in my practice,  in which several procedures are grouped to reduce the total cost if appropriate for a specific patient.   In general, manipulation of the facial skeleton is most effectively performed by a craniofacial surgeon, a plastic surgeon who has pursued additional fellowship training in the complex field of craniofacial surgery.  A craniofacial surgeon who also specializes in cosmetic surgery would be best-suited to provide the most accurate assessment in each patient's case and successfully achieve each patient's feminization goals.