What is facial feminization surgery (FFS)?

Facial feminization surgery (FFS) describes a group of procedures that are performed to feminize the face. These operations are commonly performed for transgender women (MTF FFS) and can be performed for cisgender women. The operations usually consist of multiple procedures including those listed below:

Hairline modification
Hair transplants
Brow lift
Forehead reduction, or reduction of brow bossing (type 3 reduction, type 1 reduction)
Orbital rim contouring
Cheek augmentation (cheek implants or fat grafting)
Rhinoplasty
Lip lift
Lip augmentation
Jaw contouring
Genioplasty (chin surgery)
Tracheal shave (chondrolaryngoplasty)

These procedures can be performed in isolation or they can be combined together during one or more operations.

Which facial features commonly differ between cisgender men and women?

There are many facial features that differ between cisgender men and women. These are usually taken from population averages and do not describe an individual person. Some features may be more or less prominent in cisgender men or women and there can be significant variations within genders. The features also vary significantly between individuals with different ethnic backgrounds. The features that are commonly addressed during facial feminization surgery are listed below.

Forehead – Cisgender men generally have a higher hairline with a different shape than cisgender women.[1] Male hairlines tend to be M-shaped and female hairlines tend to be rounded. Cisgender men commonly have more prominent brow bossing.[2]

Cheeks – Cisgender women generally have higher, fuller, and more projected cheeks than men.[3]

Nose – Cisgender women have a greater nasolabial angle than cisgender men.[4] The nasolabial angle is the angle between the upper lip and the lower part of the nose. This is best seen on a profile (side) view. Cisgender women also have a greater frontonasal angle.[5] The frontonasal angle is the angle between the forehead and the nose. Cisgender women are generally more pleased with a greater supratip break than men.[6] The supratip break is the the depression above the tip of the nose as seen on a profile view.

Lips – Cisgender women generally have shorter upper lips and the red portion of the upper lip makes up a larger portion of the entire upper lip.[7]

Mandible – Cisgender women generally have a smaller mandible (lower jaw) than cisgender men.[8] This includes the height at the back of the jaw, the height at the front of the jaw, the width at the back of the jaw, and the width of the chin.[8,9]

Thyroid cartilage – Cisgender men generally have more thyroid cartilages (Adam’s apples) that are more prominently angulated than cisgender women.[10,11]

How do I prepare for facial feminization surgery (FFS)?

The first step is to have a consultation with a surgeon who specializes in facial feminization. They will discuss the facial features concerning to you and may suggest additional procedures.

A CT scan is commonly performed if there are concerns about the forehead or jaw region. The CT scan allows you and the surgeon to better visualize the underlying bone structure of the face to best tailor your surgical treatment.

If the surgery is being performed for gender dysphoria, letters from one or more health providers may be necessary to state the need for facial feminization to help relieve symptoms of gender dysphoria.

During your workup, you will commonly be asked about your medical history. This includes any medical problems that may exist, whether you have previously had surgery, what medications you take, which allergies you have, and whether you have any habits such as smoking or drinking.

How painful is the recovery from facial feminization surgery?

The amount of pain is completely variable depending on the procedures that are chosen. Patients commonly describe jaw contouring and genioplasty to be one of the more painful procedures. You will receive pain medications following the procedure to make you comfortable.

How much time do I need off work for facial feminization surgery?

For many surgeries, taking at least one week off work is ideal. This allows the swelling to subside and for the incisions to become less noticeable. However, depending on the extent of surgery and the desire for privacy, some people opt to take a few weeks off work to allow the incisions to heal more completely and for the swelling to subside more significantly.

What are the risks of facial feminization surgery?

The risks of facial feminization surgery are usually best related to the individual procedures themselves. It is best to review each procedure to learn about the risks associated with them.

Who is a candidate for facial feminization surgery?

It is important to discuss facial feminization surgery with your surgeon to determine your candidacy. There are many facial features that can be addressed to varying degrees. Individual preferences often play a major role in determining which components of facial feminization surgery are right for you.

Related topics

Citations

1. Rodman R, Sturm AK (2018) Hairline Restoration: Difference in Men and Woman-Length and Shape. Facial Plast Surg 34 (2):155-158. doi:10.1055/s-0038-1636905
2. Ousterhout DK (1987) Feminization of the forehead: contour changing to improve female aesthetics. Plast Reconstr Surg 79 (5):701-713. doi:10.1097/00006534-198705000-00003. https://pubmed.ncbi.nlm.nih.gov/3575517/
3. de Maio M (2015) Ethnic and Gender Considerations in the Use of Facial Injectables: Male Patients. Plast Reconstr Surg 136 (5 Suppl):40S-43S. doi:10.1097/PRS.0000000000001729
4. de Freitas DS, de Freitas MR, Janson G, de Freitas KM, Cardoso CL (2014) Nasolabial angle at rest and upon smiling. J Oral Maxillofac Surg 72 (12):2567 e2561-2565. doi:10.1016/j.joms.2014.07.034
5. Anic-Milosevic S, Lapter-Varga M, Slaj M (2008) Analysis of the soft tissue facial profile by means of angular measurements. Eur J Orthod 30 (2):135-140. doi:10.1093/ejo/cjm116
6. Barone M, Cogliandro A, Salzillo R, List E, Panasiti V, Tenna S, Persichetti P (2019) Definition of “Gender Angle” in Caucasian Population. Aesthetic Plast Surg 43 (4):1014-1020. doi:10.1007/s00266-019-01366-w
7. Anic-Milosevic S, Mestrovic S, Prlic A, Slaj M (2010) Proportions in the upper lip-lower lip-chin area of the lower face as determined by photogrammetric method. J Craniomaxillofac Surg 38 (2):90-95. doi:10.1016/j.jcms.2009.03.013
8. Direk F, Uysal, II, Kivrak AS, Unver Dogan N, Fazliogullari Z, Karabulut AK (2018) Reevaluation of Mandibular Morphometry According to Age, Gender, and Side. J Craniofac Surg 29 (4):1054-1059. doi:10.1097/SCS.0000000000004293
9. Siddapur KR (2016) Gender Identification Study of a Dry Human Mandible by Assessing its Measurable Dimensions. Indian Journal of Forensic Medicine & Toxicology 10 (1):89-93. doi:10.5958/0973-9130.2016.00020.7
10. Sagiv D, Eyal A, Mansour J, Nakache G, Wolf M, Primov-Fever A (2016) Novel Anatomic Characteristics of the Laryngeal Framework: A Computed Tomography Evaluation. Otolaryngol Head Neck Surg 154 (4):674-678. doi:10.1177/0194599815627781
11. Glikson E, Sagiv D, Eyal A, Wolf M, Primov-Fever A (2017) The anatomical evolution of the thyroid cartilage from childhood to adulthood: A computed tomography evaluation. Laryngoscope 127 (10):E354-E358. doi:10.1002/lary.26644