What is facial feminization surgery (FFS)?

Facial feminization surgery (FFS) changes features on your face so they appear more feminine and less masculine. It might involve one surgery or a series of procedures. FFS can reshape bone, cartilage and soft tissue of the face.

Masculine facial features tend to be square and sharp. The surgery softens these features, creating a face that is more oval-shaped. Additionally, the forehead and brow ridge are reshaped to create a softer contour with feminine highlights. The most common features that FFS addresses are the hairline, forehead, nose and jaw.

Why is facial feminization surgery done?

You may choose FFS if you:

• Are a transgender woman.
• Are a cisgender woman (your gender identity matches the sex assigned at birth) who wants to feminize your face.
• Have a diagnosis of gender dysphoria.

Who shouldn’t have facial feminization surgery?

You may not be a good candidate for FFS if you:

• Are under the age of 18.
• Don’t have realistic expectations about the results.
• Have a health condition that makes surgery dangerous.
• Have a mental health disorder that impairs your ability to make appropriate personal decisions.

Who performs facial feminization surgery?

A plastic surgeon specializing in surgery of the face, head and neck performs facial feminization surgery. This type of healthcare provider specializes in surgery to change or enhance your physical appearance.

How do I prepare for facial feminization surgery?

Before facial feminization surgery, your healthcare provider will perform a thorough personal assessment. They will ask you about your goals for surgery and explain what you can expect during your recovery after the procedure. It's important that you and your surgeon have goals that are aligned and realistic.

Your provider also makes sure you’re in good physical health by:

• Assessing your lifestyle, including smoking or drinking habits.
• Doing a physical exam, including lab tests.
• Identifying risks for potential complications.
• Reviewing your current medications and any allergies you may have.

You might also have imaging scans before facial feminization surgery. X-rays or CT scans take pictures of the bones and soft tissues of your face and skull. Your surgeon may also measure your face, take photographs and assess your skin quality. All of this information helps your surgeon plan your treatment.

What happens during facial feminization surgery?

Facial feminization surgery is different for everyone. The process depends on the facial features you choose to change. You might have one surgery or several, including:

• Hairline lowering: Men are more likely than women to have receding hairlines. Your surgeon may make an incision along the length of your hairline and bring your skin forward over your forehead, preserving the healthy hair follicles, so your hair continues to grow. Hair transplantation is also an option for male-pattern baldness.
• Forehead contouring: Men may have frontal bossing, which is a pronounced bone just above the eyebrow ridge. Your surgeon may surgically remove part of this bone and reshape it to give a smoother appearance.
• Cheek augmentation: Women have higher cheekbones and more fat in their cheeks. Your surgeon may do a cheek augmentation with silicone implants or fat injections. They may take fat from another area of your body such as your thighs.
• Rhinoplasty (nose reshaping): Your surgeon can reduce the width of your nose by removing and reshaping the bone. They may also reshape the bridge and tip of your nose during rhinoplasty so it has smooth contours and a refined, feminine tip.
• Lip lift and augmentation: Women’s top lips tend to be larger and closer to their nose than men’s. Your surgeon can raise the height of your top lip through a small incision under your nostrils. They may also make your lips fuller with fat injections or fillers.
• Chin reduction: Men tend to have larger, square chins. Your surgeon may reduce the size of your chin and reshape it for a more pointed or oval shape. Chin reshaping is also called genioplasty.
• Jaw shave (reduction): Like the chin, men also have wide, square jaws. Through an incision inside your mouth, your surgeon can shave away layers of bone to reduce the size and sharp angles of your jaw. This type of incision means you won’t have a visible scar.
• Tracheal shave: Men tend to have larger Adam’s apples, which is when the cartilage of the trachea (windpipe) protrudes at the front of your throat. During a tracheal shave, a surgeon makes an incision under your chin and shaves away some of the cartilage.

How long does facial feminization surgery last?

If you get a comprehensive FFS as a single surgery, it can take eight to nine hours. Some surgeons recommend splitting the procedures into two surgeries, separated by seven to 10 days or longer. Doing two surgeries gives your face more time to heal between surgeries and allows more flexibility for patients.

What happens after facial feminization surgery?

You’ll have gauze or bandages over your incisions for several days. You might wear compression wraps around your forehead or jaw to reduce inflammation.

You may go home with a surgical drain. A drain is a thin, plastic tube that the surgeon places under your skin. It helps drain blood and fluid to prevent swelling.

Your healthcare provider will probably take out the nonabsorbable stitches a week after your surgery, or they may place absorbable stitches that don't need to be removed. However, after the sutures are removed, you face will still need weeks to continue to healing process until the final result is fully visible.

What are the risks of facial feminization surgery?

Risks of facial feminization surgery include:

• Bleeding.
• Bruising.
• Edema (fluid build-up) and swelling.
• Hair loss (after hairline lowering or forehead contouring).
• Infection.
• Numbness in different parts of the face.
• Poor healing of incisions.
• Reaction to anesthesia.

What are the benefits of face feminization surgery?

Face feminization surgery can help give you the physical appearance of the gender you identify with. Many people who are transitioning from male to female consider this an important step in their transition process. After surgery, you may feel more confident and secure in your gender expression.

What is the recovery process after facial feminization surgery?

Once your provider removes your stitches, you may be able to return to work or light activities. However, it can take months for you to see the full results of the procedure.

When should I see my healthcare provider?

Contact your healthcare provider right away if you experience any of these complications after your surgery:

• Arrhythmia (abnormal heartbeats).
• Chest pain.
• Shortness of breath.
• Signs of symptoms of infection, including increased redness, pain, drainage or swelling.

A note from Cleveland Clinic

Facial feminization surgery (FFS) is a procedure to make your face appear more feminine instead of masculine. FFS can change your hairline, forehead, nose, jaw and other parts of your face. You may consider this surgery if you’re a transgender woman (transitioning from male to female). Most people need several weeks or months to fully recover from FFS.