Blog | Facial Gender Journal | Latest Publications FFS Surgery
avoid facial feminization scars

Facial Feminization Scars | 3 Pillars of Facialteam’s approach

May 7, 2021
Reading Time: 6 minutes

Facial Feminization scars

Nobody wants facial feminization scars. Obtaining the best results possible is a top priority. But does that mean leaving behind unsightly scars?

Many prospective patients are apprehensive about a relatively invasive procedure being done on the most visible part of the body—the face.

Will the results look natural enough or will I look like I’ve “had work done”?  Will there be obvious facial feminization scars? Will I still be recognizable after FFS surgery? Will the results be aggressive enough to alleviate my gender dysphoria? Will I get misgendered less? What if it’s too conservative and I need more work?

Read on to find out what you to expect from your FFS surgery.

Facialteam’s FFS surgery philosophy

Facialteam has the expertise to generate dramatic results with the most aggressive techniques available–respecting safety and as long as this will create a natural gender-affirming result.  After all, in another 10 or 20 years time we want our patients to still be happy with how their bone contours have been feminised.

However,  Three common concerns are the basis of our philosophy at Facialteam. We call them the three pillars of facial feminization surgery, although nothing is set in stone, you can say they are the foundations we start with.

Our world-class surgical team has developed this stance over the course of nearly 15 years of specializing in facial feminization and facial gender confirmation surgery (FGCS). The goal is to reveal the feminine face you were born with, waiting to be rediscovered as much as possible, with dramatic yet natural results that patients love.

1. Natural results

Natural results in FFS surgery are obtained by focussing on just the facial features which contribute to a masculine appearance.

Finding the perfect balance between subtle and dramatic may or may not require aggressive techniques. That depends on the surgical plan you develop together with your surgical team.

Performing just the essential surgery for aesthetic reasons means results are likely to look natural and you will still look like a member of your family. Nothing like the artificial appearance you might associate with someone who has gone a bit overboard with plastic surgery.

This is why our initial consultation is so important. Our experts discuss with you which features masculinize your face the most and which do not. Also, we can talk about how far to take each procedure, to the millimeter, for maximum feminization while avoiding that unnatural-look.

To see the kind of FFS results you might expect, visit our facial feminization surgery, before and after gallery.

2. Invisible/hidden facial feminization scars

Unfortunately, some of the conventional techniques involve leaving visible facial feminization scars. Nobody wants to walk away from a surgical procedure with a scar that needs hiding.

For this reason, aim for scars that are invisible or easily hidden. This is done by opting for incisions inside the mouth or behind the hairline, when possible.

The hairline lowering, or scalp advancement, procedure involves an incision made at the hairline. This incision scar, aside from not adequately correcting the M-shape hairline, may be visible after healing and is not easily hidden. On the other hand, Facialteam’s innovative surgical approach gives you the confidence of knowing that unsightly scars won’t “give you away.”

3. Maintain your core identity

You’re you, and you will still recognize yourself as you after surgery. This is perhaps our most important goal when performing FFS surgery.

As Alexandra Hamer states in her thesis on facial gender, many people don’t realize that everyone began with feminine facial contours, regardless of the sex on their birth certificate or gender identity. This is because masculinization of the face is an additive process that happens during puberty.

As children, we all had “feminine-version” facial features. So the gender-affirming surgery is a “subtractive process” on the masculinized excess volumes, returning to the more feminine version of your facial bone. It’s still your face, just a more feminine version of it.

These three pillars — natural results, hidden facial feminization scars, and core family identity — guide our surgical team when discussing your objectives.

Too aggressive vs. too subtle in FFS

If you’ve got natural-looking FFS results, sometimes people are unlikely to suspect that you’ve had surgery. They might even say they see no difference. Or maybe they notice something changed, but can’t pin what it is. That does not mean that the effect has been too conservative. Sometimes, less is more.

Many patients are initially confused about where to draw the line between what is too subtle and too aggressive in facial feminisation. That’s no surprise given that perceptions of femininity, a social construct, vary according to culture, generation, ideology even…and are constantly in flux as mass media images feed us an evolving status-quo on what’s feminine and what’s beautiful.

“…while some of the simulated changes aren’t super dramatic, they do make a huge difference (I think) in moving my face from one that looks more masculine to one that much more clearly falls in the feminine range of facial features.”

Most important is that you are happy with what you see in yourself and the objectives were clear and met. To get there, communication with the surgeons is key.

What’s too subtle in facial gender affirming surgery?

Surgery is too subtle when the detectable change between the before/after comparison once healed (after 12 months minimum) has not met the objectives agreed upon with the surgical team.

Myth:  Subtle virtual simulations mean the surgeon is too subtle.

Although a good exploration tool, virtual simulations (VFFS) aren’t a representations of actual results, only an approximation to help you determine what you want from facial surgery.  These projections are not meant to judge the level of aggressiveness of the surgeon. It is just a 2-dimensional photoshop, after all. The actual results are typically more dramatic. VFFS will not show exact outcomes and can help adjust patient expectations as to the potential of each procedure.

If you’re worried that the procedures planned for you will mean the results are too subtle, be sure to raise this topic with our specialists so they can explain the thinking behind your tailored plan.

What’s too aggressive in facial feminizing surgery?

It can be hard to put your finger on exactly what constitutes taking plastic surgery too far, but we know it when we see it. As mentioned earlier, the unnaturally permanent “surprised look,” over-exaggerated lips and cheeks, or too-straight hairline are just some examples of errors in over-the-top surgery or inexpert.

Being too aggressive in FFS surgery can mean several things:

  • performing unnecessary procedures for unjustified aesthetic reasons, so you end up with an unnatural look.
  • practicing experimental procedures without proper testing, which can lead to unpredictable complications.
  • not respecting the proven anatomically safe parameters of surgery, established to help prevent the numerous potential complications of surgery.

Myth: Facialteam is not aggressive enough (i.e. aggressive surgery gets better results).

Facialteam is experienced, analytical, consistent, precise, comprehensive, transparent and particularly communicative regarding your objectives. Facialteam has capacity to effect dramatic change, within parameters of safety and faithful to a natural look.

Some Facialteam patients change dramatically after surgery. They have likely had an larger amount of bone changed, because they had a larger excess. Others are indeed more subtle. They have likely opted for a slighter change–maybe that’s all they need. That’s the beauty of the bone sculpting expertise. It is measured to the milimeter, whereas soft tissue is less predictable.

More procedures or more complexity often means a longer recovery time and a higher investment, both financially and in medical risk.  However, you want what you are paying for, this is your one and only face, and you’ve just got one shot at it.  So take your time to think it over. Make sure the vision of your chosen surgical team are in line with your own long-term personal goals.

What to expect from facial gender surgery?

The most important thing is to be realistic about the effects that your FFS will have and its impact on your self-perception. If your expectations are too high from the beginning you will be setting yourself up for failure.

What’s the difference between beautification and feminization? We’re here to bring out the unique femininity in your face, not to create an artificial look that fits with the generic standards of beauty of today.

Despite being among the most dedicated and experienced facial gender surgeons out there, none can claim to wave a magic wand and make all problems disappear. So adjusting to reasonable expectations before you embark on this process is crucial.  Facial feminising surgery is not for everyone nor is it always necessary.

“I think that’s the better standard to go by: choose a surgeon and discuss the outcomes with that surgeon that are important to you— the changes you want to see in order to be satisfied with the results.”

And, finally, be clear when communicating:  what you like, what you don’t, what the ideal results for you would be, what you are unsure of…and then listen closely to the specialists’ explanations.

We pride ourselves on our open and honest communication with our patients of diverse gender identities, and we look forward to discussing your unique needs.