Which FFS Procedure is the Most Feminizing?

Publication date: 9/2026

Brow bone reduction feminizes the face the most for most people. Chin and jaw come in as a close second. Facial structure varies from person to person so procedures do depend on the individual. Overall, Dr. Mittermiller has seen brow bone reduction as the procedure with the greatest effect on facial femininity.

For patients wondering what estrogen can accomplish on its own before considering surgery, Dr. Mittermiller has written an article about how much hormones change the face and their limitations here.

Dr. Mittermiller explains why the brow ranks first among facial feminization procedures, what the chin and jaw contribute, and how he determines which combination of FFS procedures will help each individual patient the most.

Dr. Paul Mittermiller’s Experience and Research In the Field

In Dr. Mittermiller’s experience, even small reductions to brow bone prominence can make a noticeable difference in gender appearance.

This is backed up by research as well. In a review of 220 consecutive FFS cases, forehead contouring and jaw reshaping were the most commonly requested procedures,¹ with forehead contouring described as the single most important procedure for feminizing a face. Brow bone reduction is a central part of forehead contouring.

Why Does the Forehead Shape Gender Perception?

The upper third of the face carries a large share of the visual information people use to read gender. Men typically have brow ridges, which are the bony prominences above the eyes and across the lower forehead. This is also sometimes called frontal bossing. Female foreheads tend to be smoother without the heavy supraorbital prominences.

In other peer-reviewed research, photographs of men were digitally altered to change the forehead, the nose and lip, or the jaw. In frontal views, the forehead modification was selected as the most feminizing change,² ahead of both the nose and the jaw.

Prominent brow ridges cast a shadow over the eyes which makes the eyes appear deeper set and masculine. Surgery that reduces these prominences opens up the area around the eyes and allows more light to reach them, which softens the entire face.

The right technique for reducing the brow ridge depends on the anatomy of the frontal sinus. Some patients have thick bone that can simply be burred down (a type 1 forehead reduction). Most patients, however, need a type 3 brow bone reduction, in which the front wall of the frontal sinus is reshaped and repositioned to create a smooth, feminine forehead contour. The shape and position of the eyebrows also contribute to a feminine appearance, which is why Dr. Mittermiller evaluates the eyebrows during planning. Incisions for forehead feminization are placed at or behind the hairline, so scars are designed to stay hidden.

You can see examples of these results in Dr. Mittermiller’s brow bone reduction before-and-after photos.

Chin and Jaw Reduction: the Next Most Helpful Procedures

After the brow, Dr. Mittermiller finds that chin and jaw surgery typically contribute the most to facial feminization. The lower face has its own set of masculine prominences. The male jaw tends to be broader, with heavy gonial angles and bulkier masseter muscles.³ The male chin is often taller and more square (wider). Feminine lower faces taper toward a narrower, more pointed chin.

Jaw feminization surgery is designed to reduce the size of the jaw angles and narrow the width of the lower face, while a genioplasty reshapes the chin by reducing its height and width and refining its contour. These procedures are performed through incisions inside the mouth, so they leave no visible scars on the face. Together, chin contouring and jaw contouring change the frame of the lower face from square to tapered, which is one of the defining differences between masculine and feminine facial features.

When Other Procedures Matter Equally

Facial feminization procedures should follow each patient’s unique facial structure. In Dr. Mittermiller’s practice, there are patients for whom other procedures matter just as much. For example, a patient with minimal frontal bossing but a prominent nasal hump and droopy tip may gain the most from a feminizing rhinoplasty. Reshaping the nasal bones and cartilage will create a more feminine profile.

A patient with a tall forehead or significant temple recession may benefit most from hairline feminization, since a lower, rounder female hairline changes the proportions of the entire upper face.

A patient with a prominent Adam’s apple may find that a tracheal shave addresses the feature that draws the most unwanted attention.

Soft-tissue procedures can also play a supporting role. A lip lift shortens the space between the nose and the upper lip and increases tooth show, and cheek augmentation can add the fuller, higher cheek projection associated with feminine faces. Facial feminization surgery is also not limited to transgender women. Dr. Mittermiller performs these procedures for cisgender women seeking feminization of specific facial features as well.

How Dr. Mittermiller Determines Which Procedures Will Help You Most

Because the answer depends on individual facial structure, Dr. Mittermiller begins with a detailed evaluation. During a consultation, he analyzes the proportions of the upper, middle, and lower face and discusses which masculine features are most prominent. He discusses with each patient what is bothering them the most.

For bone work, a CT scan shows the thickness of the forehead bone and the size of the frontal sinus, which determines whether a type 1 or type 3 approach is appropriate. Dr. Mittermiller occasionally uses virtual surgical planning (VSP) for gender-affirming facial surgery, using CT imaging studies to virtually perform the operation before the actual surgical procedure begins.

The goal of this planning is a face that looks natural and balanced. As a plastic surgeon focused on facial feminization surgery, Dr. Mittermiller’s aim is to modify the specific features that read as masculine on your face, in the order that will help you most.

Frequently Asked Questions

Does everyone need brow bone reduction for facial feminization?

While the brow is the best procedure for most patients, the degree of frontal bossing varies considerably. Some patients have relatively smooth foreheads and gain more from jaw and chin contouring, rhinoplasty, or hairline feminization. That is why a CT scan and an in-person evaluation are required for determining what works best for your specific anatomy.

Will hormones feminize the brow or jaw on their own?

Hormone therapy produces modest facial changes and only in the soft tissue. Research in the Journal of Sexual Medicine demonstrates measurable soft-tissue changes using 3D facial scanning, such as increased cheek fullness after 12 months of hormone treatment.⁴ Estrogen, however, does not reshape adult bone, so brow ridges and jaw angles will remain unchanged. Dr. Mittermiller explains this in more detail in his article on how much hormones change the face.

Can FFS procedures be done in stages?

Yes. Some patients address the brow first and consider other procedures later, while others prefer a single operation. Both approaches are reasonable, and the right choice depends on your goals, anatomy, and recovery preferences. Dr. Mittermiller compares the options in his article on staged versus single-stage FFS.

Find Out Which Procedures Would Feminize Your Face the Most

The most feminizing FFS procedure for you depends on your facial structure. Schedule an evaluation consultation with Dr. Mittermiller to discuss which facial feminization procedures would make the biggest difference for your face.

Citations

1. Telang PS (2020) Facial Feminization Surgery: A Review of 220 Consecutive Patients. Indian J Plast Surg 53 (2):244–253. doi:10.1055/s-0040-1716440 https://www.ncbi.nlm.nih.gov/pubmed/32884190
2. Jeffrey Spiegel (2011) Facial determinants of female gender and feminizing forehead cranioplasty. Laryngoscope 121 (2):250–261. doi:10.1002/lary.21187 https://www.ncbi.nlm.nih.gov/pubmed/21271570
3. Telang PS (2020) Facial Feminization Surgery: A Review of 220 Consecutive Patients. Indian Journal of Plastic Surgery 53 (2):244–253. doi:10.1055/s-0040-1716440 https://www.ncbi.nlm.nih.gov/pubmed/32884190
4. Tebbens M, Nota NM, Liberton N, Meijer BA, Kreukels BPC, Forouzanfar T, Verdaasdonk RM, den Heijer M (2019) Gender-Affirming Hormone Treatment Induces Facial Feminization in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures. The Journal of Sexual Medicine 16 (5):746–754. doi:10.1016/j.jsxm.2019.02.011 https://www.ncbi.nlm.nih.gov/pubmed/30926514