Aesthetic Facial Feminization Surgery

Aesthetic feminization surgery is any procedure that enhances your facial proportions after feminization surgery. These procedures target specific areas of the face not modified during standard procedures. 

The aim of aesthetic surgery is rejuvenation and beautification. 

Our goal is to help you attain the natural and feminine look you desire. So, we offer the following aesthetic procedures which may accompany standard feminization procedures:

  • Blepharoplasty, surgery to the eyelids
  • Otoplasty, surgery to reduce the size of the ears
  • Bichectomy, removal of fat on the cheeks
  • Neck Liposuction, removal of fat in the neck area
  • Facial Lipo Feminization, adding volume to the face by fat distribution

These complementary procedures target the soft tissues of the face rather than the bone structure. They harmonize a feminized face so the cranial structure and soft tissues are in desired proportions.

We strive for results that change your life positively. To achieve this, we study your face shape and characteristics. We consider your skin type, age, ethnicity, aesthetic preferences, and the outcomes you want before recommending any procedure. Our philosophy is to suggest a plan to maximize your results while highlighting your natural beauty.

You can meet us for a free consultation to discuss your goals. We specialize in creating natural, feminine results with FFS, which many patients report reduces gender dysphoria.  

Blepharoplasty – Eyelid Surgery

Your eyes and expressions have a tremendous impact on your overall look. Unfortunately, your eyes are the first area to show signs of aging. The skin around the eyes is half as thick as the rest of your face. In addition to this, you exercise the eyes more than other parts of your face. Even more than your mouth. 

Due to this combination of genetics, eye area exercise, thinner skin and weaker internal support it’s clear to see why this area shows aging first. Sun damage, stress and fatigue accelerate the aging process around the eyes. 

The aging process produces bags, pouches and excess skin around the eyes. A blepharoplasty helps control the aging process around the eyes. 

In some cases, when excess eyelid tissue or bags under eyes are present, the blepharoplasty is combined with forehead feminization. During upper eyelid surgery, the incision is made along your natural skin lines and creases to remove saggy folds that cause heaviness. The fat cells resulting in bags under the eyes may also be excised. Then, the incisions are sutured.

Removing this unwanted skin and fat returns your face in a more youthful appearance. 

If you want to rejuvenate the skin, a chemical peel during eyelid surgery can further reduce wrinkles and crow’s feet around the eyes. If the muscles of the lower lids and/or skin need to be tightened, we can also employ a technique that involves making a small, almost invisible incision under the lower eyelashes. This incision is closed with very fine stitches and removed 5-7 days after surgery.

Ask if you are a candidate for a blepharoplasty in combination with a forehead reconstruction or rhinoplasty, if needed. 

Otoplasty – Ear surgery

Otoplasty, or ear pinning, remodels protruding ears by modifying their size and shape. For this, we make a hidden incision behind the ear and remove excess cartilage. Otoplasty results in optimal facial feature proportions.

Anatomically the male and female ear is the same, however men’s ears are usually larger. With an earlobe reduction we reduce your ear size, for a younger and more feminine look.

Jacqueline L

Age 70
Country United Kingdom

Neck Liposuction

Neck liposuction eliminates the excess fat under the chin. As a result, the transition between your lower jaw and neck becomes more defined. We perform this with a fine blunt cannula by creating micro-incisions below the chin and earlobes, then gently suctioning out fat deposits. 

For three to four weeks post operation you will need to wear an elastic chin mask to ensure that swelling is reduced and soft tissues heal correctly. During this time the chin mask promotes elasticity in the area.  

Bichectomy Buccal Fat Pad removal

Bichat (buccal fat pad) is a fat deposit located in the thickness of both cheeks. The buccal fat forms an intimate relationship with two muscles, the buccinator and masseter muscles.  Together they create rounder fuller faces for some people. 

Through a very small incision (about 5 mm) located in the gums inside the mouth, we can remove the buccal fat pad in a very safe way, leaving an invisible scar. You begin to see the results within 6 months and achieve full cheek reduction within a year.

Facial Lipo Feminization (FLF)

Fat distribution is different in men and women. Hormone therapy helps with the redistribution of fat, but does not completely solve the issue.  

Dr. Sydney Coleman first described autologous fat grafting more than 20 years ago. Since, the technique has advanced to the standards and protocols upon which facial lipo feminization is performed today. 

The goal of this technique is to redistribute fat to heighten the femininity of your face.

The reasons for using fat transfer on the face/skin are:

  1. To increase the volume of facial regions such as the cheeks, periorbital regions (around the eye sockets), paranasal area (around the nose) or lips (microfat).
  2. To improve your skin quality, thanks to the nourishing and restorative effect that fat transfer has on it (nanofat).

Thanks to new microfat and nanofat grafting techniques, we can offer this complementary procedure alongside forehead surgery. Micro and nanofat techniques provide rejuvenation and maximize your aesthetic results. 


To perform Facial lipo feminization (FLF) we normally take fat from the abdomen, inner thigh or hips. The fat then undergoes a purifying process before we transfer it to specific locations of the face. The procedure enhances and adds volume to key facial areas. The final look is a fuller, more feminine face. 

We perform fat transfers under general or local anaesthesia with intravenous (IV) sedation depending on the amount of fat required for the look you want to attain. 

The main advantage of the fat transfer procedure is the use of your own body fat. The body will not reject the transfer since the fat comes from your body. 

Differences between conventional Lipofilling, Microfat and Nanofat?

Traditionally, fat was injected using larger-diameter cannulas than those used today, as it was initially believed that fat cells (adipocytes) could be damaged if they passed through very narrow regions. This belief determined the method, since the fat was deposited in larger amounts with a lower probability of survival, due to the lack of vascularization, and a greater risk of irregular surfaces (nodules).

Microfat: once the fat tissue has been collected with special cannulas and dialyzed with a specific membrane system, it can be injected using microcannulas (0.7 and 0.9 mm) in the regions where additional volume is desired. Despite the small size of the cannulas, the adipocytes are able to pass through them without becoming damaged. The injection is done using the technique described by Dr. Coleman in the form of small deposits separated by a specific distance, which allows the deposits to receive adequate blood supply, thus ensuring the survival of the graft. Another advantage of microfat grafting is that it prevents the appearance of nodules or irregularities after surgery.

Nanofat: in this case the fat is not directly injected after processing, but filtered again using a special system during which the cellular portion is discarded. The material produced contains the necessary growth factors to stimulate the skin, improving its characteristics. This material is usually injected into the most superficial layers of the skin to fill fine wrinkles and improve skin quality and pigmentation (for example, tear trough filling, dark hollows correction, etc.).

Indications and Treatment Areas

Gender identity and facial expression are most notable in the eye and mouth areas. These regions also benefit the most from fat injections. The main targets for treatment are the cheeks, periorbital region and lips. However, fat can also be injected into other areas of the face to improve skin quality.


Fat is a “permanent filler,” unlike conventional filling materials, which are usually reabsorbed after 3-6 months. After the lipofilling procedure is done, the fat undergoes a partial reabsorption process that continues for a few months, finishing after approximately 6-9 months. This reabsorption depends on various factors:

  • The quality of the donor fat
  • The anatomical area of the graft
  • The skin characteristics and metabolism of the patient. 

If the objective is an augmentation of volume, such as in the cheeks and lips, several sessions may be necessary. Given the gradual reabsorption, it is not predictable to over-correct the treated area. 

See Dr. Bellinga explain some of the basics about Facial Lipo Feminization (FLF) in the video below.

Book your Consultation

We offer both online as in-person consultations in our clinic in Marbella, Spain.

Our consultations are free of costs and a great aid for those patients seeking advice to start their journey.