30 yr old transgender woman. What surgeries are needed for Facial Feminization Surgery and what are the costs? (Photos)

Teagan, 

You are starting from an enviable place with a lot of feminine features and good skin already.  Some tweaks I would suggest would be the reduction of your brow ridge.  It is small already, but if you are looking for perfection it could be reduced.  A rhinoplasty, or nose surgery, to make your nose a little smaller and reduce the hump would be feminizing.  You could also consider an upper lift lip to add some volume allow your upper teeth to show at rest.  If you have an adam's apple (tough to see from the photos) you could have that reduced.  Your jaw is already feminine overall.  From the side view it looks the like the angle of your jaw is a little strong, but if this is only visible when your head is turned all the way to the side I would not change it.  If it is prominent all the time you can have that bone reduced.  You could consider a chin implant to help create a more heart shaped face.  I feel like I just mentioned a bunch of procedures, but these are little tweaks, solutions for any features that may bother you.  Overall your face is already very feminine.  There are other procedures, like voice feminization, that you could consider if have any troubles passing 100% of the time.  Good luck. 

Bryan Rolfes, MD

Thank you for sharing your images.  You certainly have a very feminine looking face already.  If you would like to further enhance your facial appearance, there are a few surgical procedures you could consider, but of course, an in-person consultation would best help determine how to proceed.  Hairline Lowering would help reduce the height of the forehead, Brow Reduction Surgery to eliminate the appearance of the brow bone.  A chin implant combined with a rhinoplasty would be an option as well to refine and feminize the nose, and to add projection to the chin for a more defined and feminine jawline.Hope this helps,Dr. Philip SolomonSolomon Facial Plastic, Toronto

Dear Teagan,First of all you are presenting very well and you are already an attractive woman!In my practice I like to think of facial feminization surgery for transgender women no different from aesthetic refinements in cis-gender women.  At the end of the day all faces have masculine and feminine components, you are starting at feminine so this is really just a little refinement.  I feel a lot of bad decisions can be made by considering FFS a bucket list of procedures including skeletal alterations and hairline surgery.  In my opinion these procedures considered as the mainstay of FFS should be reserved as final options after the more significant aspects with lower risks are completed.  From analyzing your pictures I think volume redistribution to balance your face would be the most beneficial and simple.  I use a technique that I call Aesthetic Facial Balancing to achieve feminized and lifted appearances using either off the shelf fillers or your body's own fat.  Focusing on the area around your eyes, brows and high cheeks would give you the biggest bang for the smallest buck.  If you are considering more surgical approaches,  a rhinoplasty to shorten your nose and rotate the tip upwards would be a nice enhancement as well.  The rest of your refinements in my practice would be soft tissue balancing probably with your own fat to push out the chin, make the upper lip appear shorter and make your lower face appear thinner.  I hope this helps!