Facial Feminization Surgery – Before and After

This patient underwent the following procedures as part of Facial Feminization Surgery (FFS).
– Type 3 brow bone reduction, orbital contouring, brow lift
– Genioplasty, and jaw contouring

Before and after facial feminization surgery (FFS), front view showing hairline lowering, Type 3 forehead reduction, cheek fat grafting, and jaw reduction.

Before and after full facial feminization surgery (FFS), frontal view showing overall facial balance with hairline advancement, rhinoplasty, and chin contouring.

Before and after FFS left 45-degree view, displaying orbital contouring, feminizing rhinoplasty, cheek volume restoration, and jawline reduction.

Before and after facial feminization surgery (FFS) left 45-degree view with wig, demonstrating orbital contouring, feminizing rhinoplasty, cheek fat transfer, and jawline reduction.

Before and after facial feminization right 45-degree view, showcasing coronal brow lift, orbital rim contouring, cheek fat transfer, and mandible reduction.

Before and after facial feminization surgery right 45-degree view with wig, showing Type 3 forehead reduction, brow lift, cheek volume restoration, and mandible contouring.

Before and after FFS submental view, showing jaw angle reduction, chin re-contouring, and alar base reduction.

Before and after facial feminization surgery downward view, highlighting forehead smoothing, reduction of supraorbital rim bossing, and facial symmetry.

Before and after facial feminization surgery downward left oblique view, showing forehead reduction, hairline advancement, and refined nasal contours.

Before and after FFS downward right oblique view, displaying smooth supraorbital rim reduction, hairline lowering, and feminizing rhinoplasty.

Before and after facial feminization surgery smiling frontal view, showcasing natural smile dynamics, cheek fat grafting, and jawline softening.

Before and after full facial feminization surgery smiling view, highlighting harmonious facial expression, cheek volume, and chin re-contouring.

Hairline lowering and brow lift – Hairline advancement (up to 3.5 cm laterally) significantly reduced the height of the forehead, while the coronal brow lift created a more feminine arch to the brows. These upper-face refinements are best appreciated in the frontal and three-quarter views.

Type 3 brow bone reduction & orbital contouring – Addressing brow bossing, the type 3 brow bone reduction reduced and set back the prominent supraorbital ridge, creating a smooth, gently rounded forehead contour from the hairline down to the nasal bridge. Orbital rim contouring softened the bone surrounding the eyes, which is most evident in the 45-degree oblique and 90-degree profile views.

Feminizing rhinoplasty – A comprehensive rhinoplasty achieved dorsal hump reduction, tip refinement, septal repositioning, and a 3mm alar base/sill reduction. This created a balanced, delicate nasal profile that harmonizes with her softened forehead and lower face, clearly demonstrated across profile, oblique, and submental (upward) views.

Facial fat grafting (cheeks) – Autologous fat transfer to the cheeks and midface restored youthful midface volume and accentuated the cheekbones. This enhancement creates a softer, more rounded facial center, best seen in the lateral photos. Of note, fat graft survival is extremely variable between patients and survival in this patient was relatively minimal.

Mandible contouring & osseous genioplasty – Mandibular angle and body reductions narrowed the lower jaw, while the genioplasty reshaped, centered, shortened, and deprojected the chin. The centering movement of the chin is best seen from the frontal and upward views. The shortening is best seen from the frontal view. The deprojection is best seen from the lateral and oblique views.

Dr. Mittermiller’s approach to facial feminization surgery is to create a result that appears inherently feminine and natural. These before-and-after photos allow patients to observe the comprehensive transformations possible when structural bone work and soft-tissue procedures are combined. Because facial structure and personal goals vary, discussing your specific anatomy and expectations during a private consultation is essential.

Dr. Mittermiller is a plastic surgeon with specialty training in craniofacial surgery and gender-affirming facial surgery. He is primarily located in Los Angeles, California.

Paul Mittermiller, MD

Paul Mittermiller, MD

Facial Feminization Surgery – Before and After