Jaw Feminization Surgery (FFS Jaw) – Los Angeles

Jaw feminization surgery produces a more slender, feminine jawline. It is frequently performed as a component of facial feminization surgery (FFS).

Introduction

What is jaw feminization surgery?

Jaw feminization surgery, also referred to as jaw FFS, jaw reduction surgery, or jaw contouring, often involves reducing the angles of the mandible and tapering this towards the chin. Chin surgery, or genioplasty, is frequently performed at the same time to produce a ‘V’-shaped or heart-shaped appearance. (What is a genioplasty?)

The angles of the jaw are the areas located at the back, lower border of the jaw. In general, women have narrower jaws, particularly at the angles. However, there are individual preferences that frequently determine whether this is a critical component of facial feminization surgery (FFS). For example, there are multiple celebrity cisgender women who have what would be considered a masculine jaw. Some cisgender and transgender women prefer to have a more angular jawline.

The chin is another region of the jaw that frequently has dramatic gender differences. Women generally have a shorter, narrower chin. Tapering the chin to round, pointed shape can have a significant effect on one’s appearance.

What is V-line surgery?

V-line jaw surgery is another name given to jaw reduction surgery or jaw feminization surgery to describe the final shape of the lower jaw. The purpose of V-line jaw surgery is to convert the jaw from a square or ‘U’-shape to a ‘V’-shape. As mentioned above, this is accomplished by changing the shape of the jaw and chin..

Why is jaw FFS performed?

Jaw ffs is performed for cisgender women to increase their feminine appearance or for transgender women to relieve symptoms of gender dysphoria. 

What are the benefits of jaw feminization?

Jaw feminization will help to achieve a more feminine facial appearance and can help relieve symptoms of gender dysphoria.

Operative procedure

How is jaw feminization surgery performed?

Jaw feminization is performed under general anesthesia. Incisions are created inside the mouth. These can require a combination of multiple procedures or it can involve one long incision along the inside of the lower lip. 

There are two nerves that provide sensation to the lower lip. These are protected during the operation. Even with careful protection, it is common for patients to have varying degrees of numbness of the lower lip for up to 6-12 months and it can sometimes be permanent.

A combination of either shaving (jaw contouring) or cuts (mandibular angle resections) in the bone are performed to reduce the jaw and feminize the appearance.

What is FFS jaw contouring?

The term jaw contouring refers to shaping the jaw. In general, it refers to shaping the jaw through shaving alone (no cuts). The areas that are commonly addressed during jaw contouring are the mandibular angles and the body of the mandible. Sometimes the chin can be addressed with shaving only.

When the mandibular angles are shaved, this decreases the width of the jaw towards the lower back part of the jaw. When the mandibular body is shaved, this decreases the width of the jaw midway between the chin and the back of the jaw.

Even though FFS jaw contouring can be performed to narrow the width of the lower face, it is not effective for reducing the size of ones jowls. Jowling results with age and this is due to increased laxity of the soft tissues. In most cases, improving one’s jowls requires a facelift. In some scenarios, jaw contouring can actual result in worsening of the jowls. It is important to speak with your surgeon about whether this may occur in your situation.

What are mandibular angle resections?

Mandibular angle resections (aka mandibular angle osteotomies) refers to removing the angles of the jaw at the lower back part of the jaw. This results in narrowing this portion of the jaw while also creating a less square jaw. Some people prefer to have the square appearance of their jaw towards the back. In that case, a mandibular angle resection (mandibular angle osteotomy) may not be the right option.

Mandibular angle resections are most commonly performed through an intraoral approach, however some providers have described approaching the angles through facelift incisions.^{1, 2} It has also been described through a retroauricular approach (incision behind the ear).³

Is jaw feminization surgery dangerous?

Jaw FFS should not be a dangerous procedure. When it is performed by a well-trained surgeon, there are few major risks. As with all operations, the risks of surgery include bleeding, infection, and scarring. There are the usual risks associated with general anesthesia.

The cosmetic risks may include asymmetries or bony irregularities.

There is a chance of injuring the nerves that provide sensation to the lower lip. These nerves are not responsible for movement of the lower lip. It is rare for there to be injury to the nerves that are responsible for motion of the lips.

You will likely be prescribed mouth wash to use after the operation to help keep your mouth clean. You may also be prescribed antibiotics to reduce the risk of infection.

Before proceeding with your operation, you should make sure you find the best jaw ffs surgeon for you.

Recovery

What do the scars look like after jaw feminization?

Since the incisions are located inside the mouth, the scars for jaw FFS are not visible from outside the mouth.

How is recovery from jaw feminization? Is it painful?

Jaw feminization frequently requires making significant changes to the shape and appearance of the jaw. You should expect to have some degree of pain, bruising, swelling, and numbness. Most people prefer to take at least 1 week off work to make it through the acute phase of healing.

The swelling of the lower face can be substantial following the operation. You will be asked to ice your face for the first 48 hours following the procedure and you may be asked to wear a compression garment or some other type of compression dressing to help reduce the swelling. You should also sleep with head elevation on multiple pillows to decrease the amount of pain and swelling you experience following the procedure. It improves dramatically during the first month, but it can take 6 months to 1 year to completely subside.

The pain following the procedure will be managed with medications and is frequently alleviated with oral medications alone. Your surgeon will discuss the postoperative pain management regimen with you prior to your operation.

Maintaining the correct diet following surgery is extremely important. Since the surgery often involves the muscles that help you to chew, it can be painful to eat firm foods following the operation for the first 1-2 weeks. Consider eating more blended foods or liquid foods following the procedure. You will want to maintain an appropriate intake of calories and protein following the surgery to allow for adequate healing.

It is important to keep the mouth clean after FFS by following good oral hygiene. You should use mouthwash regularly during the day and start brushing your teeth as soon as recommended by your physician. 

What should I look out for after surgery?

You should contact your surgeon if you notice anything that seems abnormal. The primary issues about which you will want to contact your surgeon revolve around bleeding and infection. If you develop bleeding that does not stop or a significant increase in swelling on one side of your face, you should contact your surgeon immediately. If you develop fevers, chills, or unusual sweating after the operation, these can be signs of infection and you should contact your surgeon. Other signs of infection include worsening pain or discharge of fluid that tastes bad or has a foul smell.

How long do the results of FFS jaw surgery last?

Jaw feminization surgery results in permanent changes. The face will continue to age, but the bones of the face will not regrow or expand back to a masculine shape.

Preparation

How much does jaw feminization surgery or V-line jaw surgery cost?

Jaw feminization can sometimes be covered by one’s insurance if it is thought to relieve symptoms of gender dysphoria.

Cisgender jaw contouring is not covered by insurance plans. 

According to a 2020 article by RealSelf, the average cost of jaw reduction surgery was $7,325 with a range of $300 – $20,000. (https://www.realself.com/surgical/jaw-reduction) Presumably, the numbers on the low range refer to the cost to the patient after insurance coverage if they have insurance coverage for jaw feminization.

V-line surgery is another name used for jaw feminization surgery and has separate cost estimates listed on RealSelf. An article originally published in 2020 and updated in 2022 states the average cost for V-line surgery to be $9,825 with a range of $2,250 – $21,000. (https://www.realself.com/surgical/v-line-surgery)

How do I prepare for jaw ffs?

You will typically want to arrange time off work prior to having the procedure. Allowing for at least 1 week off work gives enough time for the pain to be better managed and for the swelling to improve to a point where you feel more comfortable being out in public.

During your consultation, you will be asked private questions about your health, prior operations, the medications you take, and any allergies you have to medications. You will also be asked about habits such as smoking or the use of recreational substances. 

You will likely require a CT scan of the face so the surgeon can adequately counsel you and plan for the operation. 

Nonsurgical Jaw Feminization

Is it possible to have jaw feminization without surgery?

The most dramatic results for jaw feminization are achievable with surgery. There are some people who either do not want surgery or are unable to have surgery. In these scenarios, minimal changes can be acquired with nonsurgical jaw feminization. Nonsurgical jaw FFS can be performed with the use of a neuromodulator such as Botox. This is injected into the masseter muscle to achieve the desired effect. The masseter muscles are the large muscles that connect to the jaw that are primarily used for chewing.

Injecting a neuromodulator such as Botox into the masseter muscle weakens the muscle and causes it to decrease in size. This is not a permanent solution and will require repeated injections every 4-6 months to maintain the effect.

What is the cost of nonsurgical jaw feminization?

Nonsurgical jaw FFS involves injection of a neuromodulator such as Botox into the masseter muscles to cause them to shrink, or atrophy. In general, 15-30 units of Botox or required to achieve the desired effect. The cost of Botox ranges between $10-$25 per unit. It is recommended that treatments be performed every 4-6 months to maintain the slimming effect of the nonsurgical treatment. This means the cost of nonsurgical jaw slimming ranges from $150 to $750 per treatment.

Can filler be used for jaw feminization?

Injectable filler is usually not a good option for jaw feminization. In general, jaw contouring for facial feminization involves jaw reduction. Although filler can be used for contouring, it adds volume to the face, which is usually the opposite of the desired goal. Injectable filler can sometimes be used for specific applications during jaw contouring, such as removing fine lines and wrinkles along the jaw, but it is generally not the best option to be used in isolation for jaw reduction.

How do I find the best FFS surgeon near me in Los Angeles, California?

It is important to find a surgeon who you trust who has experience with feminizing operations of the face.

These procedures can be performed only plastic surgeons, craniofacial surgeons, or ENT surgeons with specialty training in facial feminization surgery. It is important to do your research on the potential surgeons to ensure you feel comfortable moving forward.

Before After Photos for Jaw Feminization Surgery

Dr. Mittermiller has a photo gallery containing images involved with facial feminization surgery. There are before after photos of jaw feminization surgery in this gallery. Dr. Mittermiller also has a series of before after photos from patients who do not want their photographs to be shared publicly but who have agreed to allow their photographs to be shared privately to potential patients. These can be reviewed during a consultation. Click the link below to be taken to the photo gallery.

Facial Feminization Surgery Photo Gallery

Citations

1. Porcheray M, Bachelet JT, Brosset S, Daurade M, Mojallal A, Boucher F (2020) Mandibular angle resection using cervicofacial lifting surgical approach: Technical note. J Stomatol Oral Maxillofac Surg 121 (4):434-438. doi:10.1016/j.jormas.2019.12.006 https://pubmed.ncbi.nlm.nih.gov/31866412/
2. Daurade M, Brosset S, Chauvel-Picard J, Sigaux N, Mojallal A, Boucher F (2022) Trans-oral versus cervico-facial lift approach for mandibular angle resection in facial feminization: A retrospective study. J Stomatol Oral Maxillofac Surg 123 (2):257-261. doi:10.1016/j.jormas.2021.03.006 https://pubmed.ncbi.nlm.nih.gov/33798771/
3. Becking AG, Tuinzing DB, Hage JJ, Gooren LJ (2007) Transgender feminization of the facial skeleton. Clin Plast Surg 34 (3):557-564. doi:10.1016/j.cps.2007.04.009 https://pubmed.ncbi.nlm.nih.gov/37048723/