Facial Feminization Surgery (FFS)

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Facial feminization surgery (FFS) is an important part of the male to female transformation. At UCSF Facial Plastic Surgery, we are proud to be a destination and thought leader for patients seeking FFS. We understand the importance of this surgery and its role in helping our patients transform their faces to better align with their inner selves. FFS is one part of an overall feminization strategy that includes hormone therapy and potentially a variety of other surgical procedures in other areas of the body.

FFS broadly describes a group of surgeries that create a feminine appearance of the face. After a thorough discussion and examination of each patient by our surgeons, including a detaile 2-D and 3-D evaluation, a surgical plan is jointly created with the patient’s direct input and desires. This carefully customized surgical plan aims to help our patients confidently look and feel feminine.

Facial Feminization Surgery (FFS)

A variety of surgical procedures are used in FFS and are performed in combination to produce a powerful and elegant effect:

Hairline Advancement

The male hairline can have peaks at the temples and may be recessed. Using scalp advancement, the hairline is moved forward and the peaks are removed. Incisions are created in the scalp to accomplish this. This creates a rounded hairline that is more typical of a female hair line. These effects have been studied by our team and precise measurements have been recorded and published, all of which allows for predictable results for our patients.

Brow Lift

As the male appearing eyebrow sits lower on the forehead, elevating the eyebrows produces a more feminine appearance. A variety of methods can be used to raise the eyebrows and our surgeons will discuss these techniques. The amount of possible lift during the operation has been established in the literature by our team.

Forehead and Orbital Rim Contouring

The male-type forehead has characteristic excess bone above the eyebrows, primarily in the lower forehead and above the eyes. Removing the “extra” bone and moving the forehead bone into a more female appearing position creates a powerful change that is essential for feminization of the upper part of the face. Using literally thousands of detailed 3-D facial scans, the surgeons on our team have performed ground-breaking analyses the demonstrate the relative volume and contour differences between male and female faces. This research permits the development of a surgical plan for feminization that approaches the ideal result for virtually any facial shape.

Eyelid Surgery

The eyes and eyelids are the central point of gaze when looking at a face, and they can convey much of a person’s emotion and personality. However, the eyelids can change with age. By rejuvenating them, opening the orbits, and making the eyelids appear younger, a beautiful and feminine appearance is created around the eyes.

Chin and Jaw Modification

The female appearing jaw is typically more pointed and tapered than the male appearing jaw. The male jaw bone has extra bone that creates these differences. This extra bone can be removed to taper, thin, and feminize the lower face. The chin itself is also typically square in shape in the male face. Tapering the bone and adjusting the tissues that make up the chin create a feminized, refined, and elegant appearing chin. A chin implant may be required to produce these changes. Our surgeons discuss these surgical techniques with you.

Cheek Augmentation

The female face is known to have defined and high cheeks, with the widest part of the female face occurring at the cheeks. By performing cheek augmentation with fat grafting or implants to the cheek bones, the face can be significantly feminized. A beautiful, curved contour of the face is created that is natural and carries a beautiful feminine appearance.


The nose is the center of the face and is a major focus point in FFS. The male appearing nose is wider, longer, and extends further out from the face. The tip of the female nose is also turned slightly more upward and is smaller. Therefore, to feminize the nose, a rhinoplasty is performed to create a more petite nose that matches the surrounding feminized face. A rhinoplasty changes the shape of the nose by altering the bone and cartilage that make up the nose. Our surgeons are skilled in rhinoplasty to perform these essential changes to the nose.

Upper Lip Shortening

The upper lip is typically longer in males. Shortening a long upper lip complements the feminized nose to create a harmonious female appearance in the mid portion of the face.

Facelift and Neck Lift

While a facelift and neck lift are typically used to help reverse the signs of facial aging, they can be an important part of FFS. As the face ages, masculine features can become more visible. Therefore, reducing signs of aging and excess skin of the face and neck can help to create a more feminine appearance of the face. Facelift and neck lift can be an important overall part of FFS. Our surgeons carefully assess the face to determine if facelift and neck lift procedures may provide additional feminization.

Tracheal Shave

The Adam’s Apple (or thyroid cartilage) is larger and more visible in the male neck. Reduction of this prominence may be performed to make the contour of the neck smoother and more feminine. Our surgeons have developed a revolutionary scarless technique. Instead of simply making an external neck insicion which can further the misgendering, our surgeons have developed a technique to expose the adam’s apple through an intra-oral incision. The enables our team to reduce the cartilage and feminize the neck without making any neck incisions or scars at all.

Vocal Feminization

Additionally, speech therapy is critical for retraining voice and speech patterns. Prior to performing any voice alteration surgery, our team recommends a consultation and evaluation with our speech and language specialists, to make the speaking patterns as feminine as possible. After completing a comprehensive therapeutic treatment course, patients may elect to proceed with actual vocal alteration surgery.


How to Prepare for Facial Feminization Surgery

There are several steps to take while preparing for facial feminization surgery. Your surgeon may require you to have a medical evaluation or undergo laboratory testing. New medications may need to be taken, or your current medications may need to be adjusted. You will be asked to stop smoking and to avoid taking medications that increase the risk of bleeding, such as anti-inflammatory drugs, aspirin, and herbal supplements.

FFS is performed in as hospital or surgery setting using general anesthesia. Some procedures may be done on an outpatient basis. The surgeon will provide additional information about what needs to be done before the surgery.

What Recovery Is Like After Facial Feminization Surgery

After surgery, bandages or gauze may be placed on your incisions. A support garment or elastic bandage will be used to avoid swelling after extensive surgery. A small drain may be placed under the skin to remove blood or other fluids. Specific instructions will be provided about medications to take orally or apply, what to watch for and when to call the surgery practice, and when to follow up about the surgery.

Swelling will be considerable for the first several days or weeks. Ice packs are extremely helpful for the first 48-72 hours after surgery.

This is the time to ask any questions you might have. Recovery will typically take several weeks. The facial shape will improve, and swelling will decrease during that time. Make sure to follow your surgeon’s instructions and go to all follow-up visits.

What should I expect from facial feminization surgery?

Directly after the surgery, you can experience some bleeding, bruising, and swelling. Once the inflammation and swelling go down, your face will have a much more traditionally female appearance. FFS can make it easier for others to see you as your actual gender and make the person you see in the mirror seem more accurate to how you feel inside.

How long does facial feminization surgery take?

It depends on how many surgeries are being done. If all the comprehensive surgeries are done at once, the process may take as much as nine hours or more. Many recommend separating the procedures with a break of weeks to months in between. This lets your face heal in between and can be easier to fit into your schedule than an extended surgery.

How much does facial feminization surgery cost?

Costs can vary to a wide degree since so many surgeries fall under the FFS umbrella. However, the average cost is around $26,000 based on recent surveys. Those who choose to have more surgeries can expect the cost to be more expensive than those who only have one or two. Having all of the surgeries done will increase the price but also offers the best results for many women.

Does facial feminization surgery hurt?

During the surgery, nothing will be felt. General anesthesia is used using the supervision of an anesthesiologist. After the surgery is complete, you can experience inflammation, bruising, and swelling. This peaks two to three days after surgery and can typically be controlled with over-the-counter medications.

Facial Feminization Surgery: Before and After