The Face is the first thing people notice about a person. It is also the part of our body that we are most insecure about. This is especially so for people reassigned with the wrong gender at birth whereby the insecurities get magnified.
With the onset of puberty the growth of hair, muscles, and enhanced masculinization, in general, can lead to anxiety and depression among trans-women. This is why facial feminization surgery is one of the most sought after and first procedures that a trans-woman undertakes to realize the aesthetic that she desires and seeks for.
It involves the reconstruction of facial characteristics to make it appear more feminine and softer. It generally appeals to People Assigned Male at Birth (AMAB) but may also appeal to cis-gender and non-binary people who want more refined and feminine facial features.
What is facial feminization surgery (ffs)?
FFS is a cosmetic procedure that generally aims to alter what may be deemed as typically masculine features into what may be perceived as typically feminine facial characteristics. FFS is not characterized by a single procedure and consists of various cosmetic procedures such as rhinoplasty, cheek implantation, brow lift, and lip augmentation.
For transgender women, FFS can be groundbreaking and lead to immensely reducing the harmful effects of gender dysphoria. Matching the outside appearance to what trans-women feel on the inside can have a huge impact on their self worth and esteem and lead to improvements in their personal and professional life as well.
Even though FFS is mostly sought by transgender women, it can also be effectively used by cis-gender and non-binary people to feminize their appearance. The goal is to soften the harsh features perceived to be masculine.
- Consult a board-certified surgeon with an impressive record
- Hormone replacement therapy is to be stopped two weeks before and after surgery
- If under regular medication, consult with your doctor
- If general anesthesia is required, fasting will be recommended by your surgeon
- According to the patient, some other requirements may be recommended by your surgeon which needs to be strictly followed
What are the procedures?
As stated above, FFS does not incorporate just a single surgical procedure but a combination of multiple cosmetic alterations which may be underlined as:
- Hairline correction: Male hairlines are generally higher than females and are marked by receded corners above the temples. Either with ‘scalp advance’ or ‘hair transplantation’, the hairline is given a more rounded appearance.
- Forehead re-contouring: This is done to reshape the forehead and the bones around the eye sockets. The aim is to reduce the large bony ridge of a masculine forehead, and the eyes become more prominent and feminine. This can be combined with a hairline correction procedure to produce a more feminine appearance
- Rhinoplasty: The tip of a female nose is generally slightly more upturned compared to a male. This procedure consists of removing cartilage and bone and remodeling to give a smaller and more feminine nose. This is one of the most delicate and difficult plastic surgeries to perform, and as such, there is not much data on results.
- Lips: Males generally tend to have smaller and thinner lips. Masculine lips also have more distance between the upper lip and the base of the nose. Lip lift, fillers, and augmentation can be carried out to give a fuller, more defined and feminine lips.
- Brow lifting: In FFS, the brows are lifted to give a more refined and feminine appearance. However, this process is not always necessary as some brows only need to be shaped into a more feminine appearance.
- Cheek implants: The aim is to provide the patient with a softer and rounder cheek appearance. However, it is not so common and is recommended by some surgeons only in certain cases. It can involve cheek implants or fat grafting.
- Jaw surgery: This is one of the more invasive surgeries and involves surgically shaving off the bone structure. Men generally tend to have a more broad and prominent jawline. Surgery is undertaken to shave off the bone along the lower edge of the jaw and reduce the chewing muscle to give a more feminine and narrower look. However, there are limitations. An excessive reduction may lead to exposing or severing the nerve.
- Tracheal shave: It includes the reduction of Adam’s apple. Obviously, men tend to have a much prominent tracheal cartilage as compared to females. It requires the literal surgical shaving off of the thyroid cartilage to give it a softer and more feminine outward appearance.
Along with these procedures, numerous other soft tissue procedures may be combined according to the recommendations of the surgeon or the aesthetic desire of the patient. However, these are not compulsory and may be superficial procedures.
Recovery is dependent on the procedures performed. Most patients are required to stay overnight and can leave the very next day. The following precautions should be carried out.
- The face will swell and bruise considerably. Ace bandages are required to be kept around the face 24/7 for a week.
- Escorts are not compulsory but are recommended for emotional help and helping with daily tasks.
- Icing after surgery on the surgical areas can reduce swelling and bruising considerably.
- Pain medications may be recommended a week after the surgery
- Incisions should be cleaned with a gentle cleanser and water.
- Soft foods are recommended after surgery
- A postoperative visit with your doctor is recommended after 7-8 days.
- Most patients can go back to their work after a month. However, this depends on the patient’s physical health.
Risks And Complications
If done correctly by an experienced doctor, the complications are minimum and generally include only swelling and bruising. However, if the doctor is seriously ill-prepared or under-qualified the results can be fatal. Some serious and fatal risks may include:
- Blood loss
- Blood clots
- Visual changes
- Allergic reactions
- Speech Changes
Do keep in mind that these serious consequences are rare and seldom occur.
Some low risks causes can also be noticed such as:
- Weakness and fatigue
- Sore throat
- Swelling and bruising
These complications generally recede within a week or two. However, along with these risks, psychological risks may follow post-op such as depression and anxiety or regret. Active and frequent consultation with your surgeon is to be pursued.
Results: what to expect?
Results will be permanent and will depend on the procedures undertaken. However, to notice the full result of the procedure it can take up to a year after surgery. Scars will be there as with every surgery, but there will be a considerable reduction after a few months of surgery. After a year, scars will be hardly noticeable. After the final results are achieved, patients tend to lead a more confident, happier and fulfilled life. Matching the outside with the inside of the patient is the ultimate goal.
How much does the procedure cost?
It completely depends on the number of procedures taken or in which country it was taken. In the US, it can range anywhere from 20,000 USD to 50,000 USD for out of pocket costs. In Thailand where surgeries like these are common, the cost ranges from 13000 USD to 15000 USD. It depends on your geographical location and the surgeon you consult. If it is too cheap, it may be because the surgeon is not experienced. Proper research should be undertaken.
Is the procedure safe?
A: It is safe most of the time. However, serious consequences sometimes occur. Ill experienced and under-qualified doctors are to be avoided at all cost.
What is the recovery time?
A: Generally 1-2 months.
How long does the surgery last?
A: Depends on the number of procedure undertaken. Typically, 5-10 hours.
Do only trans women require FFS?
A: It is available to everyone regardless of gender or gender identity.
Is it covered by insurance?
A: It depends on your country. In the US, FFS may be covered by insurance, but it typically includes only a small portion of the total fee.