Facial feminization surgery

Facial feminization surgery (FFS) is a set of reconstructive surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features. FFS can include various bony and soft tissue procedures such as brow lift, rhinoplasty, cheek implantation, and lip augmentation.

Faces contain secondary sex characteristics that make male and female faces readily distinguishable, including the shape of the forehead, nose, lips, cheeks, chin, and jawline; the features in the upper third of the face seem to be the most important, and subtle changes in the lips can have a strong effect.

For some transgender women and non binary people, FFS is medically necessary to treat gender dysphoria. It can be just as important or even more important than genital forms of sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women; data on these sorts of outcomes are limited by small study size and confounding variables like other feminization procedures. While most FFS patients are transgender women, some cisgender women who feel that their faces are too masculine will also undergo FFS.

FFS candidates should wait until the bones of their skull have stopped growing before undergoing FFS. The way to determine if the bones of the skull have stopped growing is to take successive radiographs of the mandible and wrist bones to make sure that bone growth has stopped.

The surgical procedures most frequently performed during FFS include the following.

Some studies have shown that the shape of the forehead is one of the key differences between cisgender males and cisgender females. Hairline correction, forehead recontouring, eye socket recontouring, and brow lift are procedures often performed at the same time, with rhinoplasty in mind. They are detailed below.

In males, the hairline is often higher than in females and usually has receded corners above the temples that give it an "M" shape. The hairline can be moved forward and given a more rounded shape, either with a procedure called a "scalp advance" wherein the scalp is lifted and repositioned, or with hair transplantation.

Cisgender males tend to have a horizontal ridge of bone running across the forehead just above eyebrow level called the brow ridge (or "brow bossing"), which includes the "supraorbital rims" (the lower edge, on which the eyebrows sit). Cisgender males also tend to have indented temples and a flatter forehead than females.