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What is FFS surgery?

April 5, 2019

The Basics of FFS Surgery, aka Facial Feminization Surgery

As society’s attitudes towards transgender people slowly shift, topics such as FFS Surgery are becoming more openly discussed.  At the same time, the medical community is reaching a consensus on the importance of face feminization for the overall wellbeing of trans women. But for many people, the concept of FFS surgery remains somewhat mysterious. That’s why we at FACIALTEAM wanted to put together this simple guide to the basics of facial feminization surgery.

In this post, we’ll briefly define FFS Surgery and discuss what it is, what types of procedures it includes, and what patients can expect if they decide to embark on this journey. “FFS” or “FFS Surgery,” as it is commonly searched on the internet (albeit grammatically incorrect), are acronyms for Facial Feminisation Surgery–not to be confused with the initials of an expletive used on social media ;).  First however, a mini video explanation about what to look for in an optimal FFS Surgery process:

What is Facial Feminization Surgery? Who gets facial feminization surgery? 

First, let’s define facial feminising surgery, an umbrella term for a group of maxillofacial and plastic surgery techniques employed in what may also be referred to as Facial Gender Confirmation Surgery (FGCS) and Facial Harmonization Surgery. It is exactly as it sounds: any surgery designed to alter the facial appearance, usually to reduce any excessively prominent feature or to become more stereotypically feminine. The topic is most frequent in the context of transgender women, sometimes referred to as “MtF.”

However, face feminization surgery is sought for by people of any and all genders, which is much more diverse social construct than the traditional binary roles of “male or female”: trans-feminine, gender-queer, gender fluid, two-spirit and more.

Anyone who wishes to balance and harmonize their facial features could be a candidate for this type of surgery.

Specifically, in the case of male-to-female patients undergoing a medical gender transition, it is far from a cosmetic whim. On the contrary, FFS surgery can truly be a life-saving treatment. Hundreds of testimonials prove that gender-affirming treatment opens the door to improved self-perception, greater integration in the community, and helps to avoid the consequences of social isolation, suicide, hate violence and crippling discrimination.

FACIALTEAM, World Leader in Facial Feminization SurgeryFACIALTEAM, World Leader in Facial Feminization Surgery


Define FFS Surgery: What procedures are included in facial feminization?

So, exactly what is FFS Surgery? What kind of operation does it entail? The combination of surgical techniques employed in a personalized FFS Surgery treatment plan is highly individualized. It all depends on the patient’s goals, features, underlying facial structure, and overall health. There is no one-size-fits-all set of procedures used in facial feminization as the types and combinations of techniques are adapted to be more aggressive or subtle according to anatomical limitations and the individual patient’s goals. For example, a patient with an underbite or overbite that is a candidate for an orthognathic correction of the jaw should be presented with a plan that addresses both issues, the anomaly of the skull and feminization.

This is a topic for another entire blog post, since every face has a unique combination and each person also has different objectives…and more importantly, distinct perspective.  Patients already high on the extremely subjective conceptual scales of femininity or attractiveness (many patients under the age of 24 for example) tend to require more subtle touches of the bone or use of Facial LipoFeminization (FLF) for beautification and are more demanding of finer results.  On the other hand, patients with numerous prominent masculine markers will inevitably require multiple bone procedures or to a more aggressive extent, so the resulting differences are often considerably visible.

Some of the most common approaches of facial gender surgery include:


– Brow & Orbital reduction surgery

– Jaw reduction and/or reshaping

– Chin surgery, reconstruction and contouring

Facial cosmetic surgery of soft tissue structures

– Lip lift or lip surgery

– Blepharoplasty (eyelid surgery)

– Neck liposuction

Other procedures that are helpful for feminizing the face

– Hairline feminization via hair transplants or lowering

– Rhinoplasty (nose job)

– Adam’s apple reduction (tracheaL shave)

As mentioned, in face feminization surgery, specific procedures are recommended in varying degrees. Procedures are selected based on each patient’s unique case, with the goal of softening certain exaggerated features that have a masculinizing effect on facial harmony. The objective is a naturally more feminine appearance without an obvious “operated” look and, more importantly, without visible scars.  Any professional who promises a “scarless” surgery is misleading since an incision is always necessary.

What is involved in getting FFS surgery?

The very first step in any facial feminization process is an in-depth, personalized evaluation with a FFS Surgery specialist. It is advisable to meet with multiple facial feminization providers for an initial consultation so you may make a more informed decision about who is the right expert for you. Although there are many plastic surgeons who offer FFS Surgery, it’s best to concentrate on providers with a proven track record specifically in transgender surgery.

This consultation should include a conversation about what your desires and expectations are and the type of results you want from your facial gender-affirming treatments. It is the specialist’s responsibility to help adjust those expectations into realistic parameters given your existing facial features and personal objectives as well as your safety. It’s always good to ask what degree of correction they may achieve in each procedure, typical complications that exist, as well as the total times this particular surgery has been performed so you know they have experience.

The cost of the FFS surgery treatment plan proposed by each specialist should be presented in a formally written quote. As each patient’s face is so unique, it an oversimplification of services to have a predefined price list for each procedure, which does not factor in the surrounding care and coordination provided. For example, there are many different factors that can affect the cost of forehead feminization surgery. The type of forehead osteotomy, if it is a corrective surgery, the location of the incision, whether how the eye orbits or hairline is feminized, if hair transplants will be harvested, etc. All of these aspects need to be assessed on a case-by-case basis. As formerly suggested, comparisons should also value the numerous logistical aspects that, in combination, represent the global patient care:

• Hospital ICU availability
• Necessary medication packs
• Provisions of self-care kits with special shampoos, sprays, creams, etc.
• Emergency insurance coverage duration
• Provisions for companions in the hospital
• Accommodations or transport that is (or not) included
• Inclusion of healing treatments like hilotherapy (facial cooling mask), acupuncture, lymphatic drainage, nursing “home” visits, or psychological support.

It is often the small details which make for a low-stress FFS Surgery experience.

The current now in aesthetic surgery, after well-known cases of overdoing, is that “less is more,” but this requires creative changes in the approaches to both reduce trauma to tissues while obtaining highly predictable target results, be it more or less aggressive or subtle. The key to optimal FFS Surgery is balance and harmony. Surgical outcomes at FACIALTEAM aim to reveal the feminine face that is already yours, that changed due to the effects of puberty. The experience would be incomplete without a comprehensive approach to patient care before, during, and long after surgery.

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