What is a Male-to-Female Facial Reconstruction/Contouring?
Facial feminization surgery (FFS) is a collection of different procedures that can be performed during a single surgery. It is designed to alter common male facial features to bring them closer in shape and size to typical female facial features. Facial feminization is an important part of transgender surgery. After all, the face is the first physical attribute people notice. FFS can include various bony and soft tissue procedures such as:
- Thyroid chondroplasty – also referred to as a tracheal shave, is one of the most common surgery performed for transgender women. A tracheal shave is a delicate surgical procedure that reduces the prominence of the Adam’s apple by shaving down through the cartilage through an incision in the throat. Since a prominent Adam’s apple is a typical male gender characteristic, it helps those who are uncomfortable with the size of their Adam’s apple.
- Brow lift – Men generally have lower eyebrows relative to the position of their brow ridges when compared to women. Men’s eyebrows tend to be below their brow ridges while women’s eyebrows tend to be above their brow ridges. A brow lift raises the eyebrows, resulting in a face with a more feminine appearance.
- Forehead contouring – Forehead contouring is a surgical procedure that alters the shape of a male forehead to that of a female forehead. Males typically 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). Males also tend to have indented temples and a flatter forehead than females.
- Malar (cheek) implants – Females typically have fuller cheeks and more forward projection in their cheekbones then men do. Cutting away bone and repositioning the facial bones reshape the cheeks. Augmenting the cheeks with implants or with fat harvested from other parts of the body is common. There are a variety of implant materials available, depending on the needs of the patient. Risks of implants include infection, and the implant moving and becoming asymmetrical.
- Jaw and/or chin re-shaping – Male chins generally have a more square base, tend to be longer and wider than those of females, and tend to project outward more than female chins. Male jawlines tend to extend outward from the chin at a wider angle than those of females, and to have a sharp corner at the back. The chin can be reduced in length either by bone shaving or with a procedure called a “sliding genioplasty”, where a section of bone is removed. The jaw can be reshaped through jaw reduction surgery, and this is sometimes done through the mouth. The chewing muscles can also be reduced to make the jaw appear narrower. Risks include:
- Damage to the mental nerve that runs through the chin and jaw; other risks include
- Damage to tooth roots
- Damage to the mentalis muscle that controls the lower lip and is at the edges of the chin.Lip shortening – Subtle changes to the length of lips can have a significant effect on feminization. The distance between the base of the nose and the top of the upper lip tends to be longer in males than in females, and the upper lip is longer. Lip shortening places the upper lip in a more feminine position, and often exposes part of the upper incisor teeth.
- Scalp (hairline) advancement – In males the hairline is often higher than that of females, and typically has receded corners above the temples that give it an “M” shape. With a hairline correction surgical procedure, 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 grafting. During your pre-op assessment, Dr. Sinclair will discuss the options with you and help you choose the right procedure.
- Rhinoplasty – Males tend to have larger, longer, and wider noses than females. In addition, the tip of the female nose will more often visibly point slightly upwards than that of a male. Rhinoplasty involves removing bone, cartilage and remodeling what remains. In most cases this is performed in an open procedure, but endonasal procedures have been used; in all cases when reducing the nose there is a risk of interfering with nasal valve function. Standard rhinoplasty procedures are generally used. There is limited data on outcomes.
Who would be a good candidate for this procedure?
Every transgender person can be feminized. The specific procedures that would be appropriate depend on the degree of a person’s masculine features.
How Do I Prepare for the procedure?
Because this surgery is irreversible, it is imperative to have a thorough pre-op assessment with Dr. Sinclair, in order to fully understand the nature of the procedure and the post-op process. Each procedure has multiple methods, and Dr. Sinclair will work with you to tailor your surgery for your particular needs.
What will the procedure change/correct/accomplish?
Common male facial features are altered to bring them closer in shape and size to typical female facial features.
What are the potential risks/complications/side effects?
- Nerve paralysis
- Additional surgery
Will I go home the same day, or will I need to spend the night at the hospital?
Facial feminization is an outpatient procedure, and you will go home the same day.
How Long is the Recovery?
Initial recovery is 2 weeks, and social activities can be resumed after 3 weeks.