What is Facial Feminization Surgery?
The definitive guide for Facial Feminization Surgery
Facialteam wants to congratulate you on taking a big step in your gender affirming journey. Embracing change is not easy. Everyday, people subconsciously assign you into a very narrow selection of gender options. Society teaches us from an early age that the status quo is just male or female. This means prescribing gender based on gender expression is second nature for most people.
As a result, Facial Feminization Surgery (FFS) is more important than ever for people experiencing gender dysphoria. Also known as Facial Gender Affirming Surgery, FFS is an integral step in transitioning and helps you to be recognized as the gender you present and identify.
Facial Feminization Surgery, often referred to as FFS Surgery, is a set of procedures that modify your facial characteristics. The operations aim to reduce salient masculine features to give your face a naturally feminine appearance. The outcomes achieved through FFS makes it an excellent choice for male-to-female (MtF) members of the trans community.
We personalize our recommendations for each person. Individualization includes getting to know surgeons, creating a plan to realize your goals and understanding your unique facial structure.
Despite its importance, some people are unsure what facial feminization entails. So, we have created this guide to help you understand the procedures and terms used in FFS.
Facial Feminization Surgery or Facial Harmonization Surgery
Facial Feminization Surgery is a widely known term for making a face more feminine. The term is quite broad and it can be difficult to understand the subtle differences in the nuanced language used by professionals. A clear overview will help you choose the ideal procedures for your goals.
When speaking about FFS, it is common to hear two acronyms:
- FFS: Facial Feminization Surgery
We use this term to describe FFS for trans and other gender-nonconforming people. The objectives of FFS and FHS are the same. However, within each subcategory, the procedures may differ.
- FHS: Facial Harmonization Surgery
Facial Harmonization Surgery can include some of the same procedures as FFS, but the goal is to balance the profile of faces, regardless of gender, with irregular factions, such as unusually wide jawbones or prominent foreheads.
These two terms are not interchangeable, although they have similar goals. The means used to achieve the goals will differ between FFS and FHS.
FFS and FHS (Facial harmonization surgery) increase the chances of correct identification of your gender. Consistent gendering leads to feeling more welcomed and less stressed when meeting people. A decrease in misgendering is shown to have profoundly beneficial impacts on both personal and professional life.
What procedures are involved in Facial Feminization Surgery?
Facial feminization surgery can involve one or many procedures. Such operations usually include forehead reduction, jaw and chin contouring, rhinoplasty, tracheal shave, and lip feminization surgery. In addition, you may opt to feminize your facial features in one or multiple stages. At times, you may also have FFS procedures in conjunction with other types of body or cosmetic surgery.
The operations involved with FFS surgery can refine and balance your profile features. It does this by feminizing the nose, decreasing the chin’s size, modifying the jaw’s shape, making the lips fuller, and shaving down the Adam’s apple.
Facial Feminization Surgery is reported to be very effective in reducing psychological stress caused by gender dysphoria, according to both scientific studies and a large body of empirical evidence.
As pioneers in our field, we want to help you understand the key aspects of FFS so you may make an informed decision. Before you decide whether a surgical plan is right for you, it’s important to comprehend what it entails and how it works.
This article will provide a concise and detailed explanation of each procedure within the scope of facial gender confirmation surgery. By the end of this article, you will understand how FFS could be beneficial for your transition journey.
There is debate on whether a jawline perception can cause someone to misgender you. However, the masculine features of the jaw are universal. To harmonize your jaw, we assess its structure within the frame of your face. We understand that femininity depends on overall facial structure as much as its harmonized features.
So, we frame your face to produce natural, harmonized features.
There are key differences between feminine and masculine jawlines. So, feminizing the area is important for gender confirmation surgery. A prominent, angular jawline typically characterizes the male face.
Meanwhile, a more rounded jawline can have a feminizing effect as delicate characteristics are what societal norms consider female. Jaw feminization will narrow and reduce the sharpness of the jaw angle. We can modify the squared or “heavy jaw” look associated with masculine features to produce feminized facial characteristics.
To accurately produce lasting results, we have developed an advanced method called JAWContour®. It is our solution to the problems we have seen with jaw feminization over the past 14 years. After more than 800 jaw surgeries, we can offer minimally invasive surgery with the security of 3D planning and ultrasonic technology.
No single feature defines a face as masculine or feminine. Instead, it is how the parts of your face harmonize to create an overall look of masculinity or femininity. However, your eye orbits, eyebrows and forehead are some of the most expressive parts of your face.
FOREContour® is our patented method which consists of a series of technologies and procedures personalized to maximize the feminine contours and volumes that your facial structure had before the effects of hormones in puberty. So, forehead feminization has the capacity to generate a dramatic change in your gender perception.
For natural and lasting results, you need experience and expertise in feminising the upper third of the face. Proper planning and evaluation play a fundamental role in the successful execution of the feminizing techniques applied in your case.
Over 1800 patients have trusted us for forehead feminization since 2008.
Our patients have shared the life-changing results they have achieved with forehead feminizing surgery and we’re proud of our high rates of satisfaction. The accounts by our patients inspire confidence in a society where gender plays such a vital role in our patient’s daily lives.
The gender of the chin is an important aspect of facial feminization.
Chin feminization involves the modification of the position, format and volumes of the chin region to give it a more feminine appearance. The procedure usually involves minimizing excess height and rounding the square shape which is typical of masculine chins. We often combine chin feminizing with jaw surgery or under-chin liposuction to further refine the area.
Facialteam’s chin FFS methodology involves JAWContour®, an innovative approach that combines 3D planning and minimally invasive surgery thanks to ultrasonic technology. Our protocols in chin feminization are based on substantial scientific research and over 14 years of experience.
JAWContour® and other advanced maxillofacial techniques for the chin permit us to modify the dimensions of your chin region with millimetrical accuracy, for a highly predictable and stable result.
Hair and Hairline Feminization
Hairlines are a fine detail that can help avoid people misgendering you. The differences in male and female hairlines are subtle but have a big impact on overall gender expression. Understanding the differences in masculine and feminine hairline patterns is crucial for creating a natural, feminine appearance.
The center point of a female hairline is often higher than the male hairline and it has a different shape. Male hairlines are generally an M, and women’s hairlines are an inverted U. In addition, there is also a difference in thickness. As you age, male pattern baldness can be a physical sign of undesired male attributes in facial appearance. We are here to help address this issue by assisting you in feminizing your hairline.
We offer multiple techniques for feminizing your hairline. As we personalize our approach for your facial features, we may recommend meeting your goals in different ways. We have outlined this in detail to help you understand hairlines and the best approaches for feminizing them. We base our techniques on research and scientific evidence.
You can understand your hairline more in our guide. It can give you a good idea of what you might expect from hairline feminization surgery.
The nose is a primary indicator of your gender as it is situated in the center of your face. It attracts attention if your facial features are unbalanced with your nose. A masculine nose has a wider bridge, larger nostrils and the nasal base is larger. To create feminine features on the nose, we can remove arches and bends on the bridge.
The procedure will give you naturally feminine features by altering the nose internally and/or reshaping and moving the nasal cartilage. Rhinoplasty is a delicate process regardless of gender and is known as one of the most difficult plastic surgery procedures, with the highest redoing rates.
The biggest challenge with feminizing a masculine nose is ensuring that it harmonizes the feminine face, the “new nose” must be well balanced with the rest of your face. Failure to do so can result in a nose that is not feminine or natural.
REVONose® is our in-house developed method. We perform nose feminization using tested ultrasonic techniques that minimize soft-tissue trauma, hence improving the healing process and final result. Although this procedure is difficult to get right, we have worked hard to master the art of creating naturally feminine noses that fit your facial features.
We can significantly reduce your Adam’s apple surgically with a procedure known as tracheal shave. It is also commonly referred to as a thyroid cartilage reduction or Adam’s apple reduction. It involves shaving the thyroid cartilage down to reduce the size of the Adam’s apple. The procedure effectively makes the neck and throat appear more feminine and fulfills the goals of FFS.
Typically the procedure, medically called a chondrolaryngoplasty, involves an incision in a skin crease just under the chin so that we hide possible scarring. Then we identify the area of the thyroid cartilage that needs to be shaved. We do not make incisions on the front surface of the neck. Incisions on the throat result in very undesirable outcomes.
A visible scar can stick to the cartilage beneath your skin. This adhesion can cause the tissues to move up and down when you swallow. Our method TContour® revolutionizes tracheal shaves, we have outlined the procedure and our specific technique in detail.
Lips can be masculine for many reasons, like your age or the distance between them and your nose. Lip feminization may include a lip lift, lip augmentation, or both. The procedures you need and our recommendations depend on your goals and features.
We often perform lip feminization as a part of a larger facial feminization surgical process. The most typical lip FFS procedures include:
- Upper lip lift (reduction) lifts the upper lip to a more feminine and “open” position. In doing so, we can increase the visibility of your teeth. A lip lift makes the lips – and the entire face – look more feminine and produces a more youthful look.
- Lip Augmentation (Lip Filling) makes the lips fuller and more feminine. Lip augmentation may be done either through the use of injectable fillers or fat transfer injections.
Full and rounder lips are more feminine. Lower and thinner lips are masculine. A lip lift creates the appearance of fuller lips without needing multiple visits to our office for dermal fillers. We individualize this procedure to create a more prominent cupid’s bow or create more balance for you to meet your feminizing goals.
Our technique is unique because we take advantage of your natural creases to hide scarring. Our combined experience and team of surgeons dedicated solely to FFS make lasting scar-free results a reality.
Complementary procedures are additional surgeries that can further feminize your face and harmonize your features. They are also known as aesthetic surgery.
Often they include the following procedures:
- Blepharoplasty (eyelid surgery)
- Otoplasty (ear surgery)
- Bichectomy (cheek fat removal)
- Neck Liposuction
- Facial Lipo Feminization
These procedures are additional. They are not the most common procedures performed for FFS. The main facial gender surgery procedures are outlined above and can include one or multiple procedures.
These procedures may also be effective in reducing stress caused by gender dysphoria. They can also help your results become more satisfactory and natural. We have special procedures and protocols in place for complementary procedures. Through years of experience, we have identified the most common procedures that people seek in addition to standard FFS operations.
We take your goals into account for each procedure that we recommend. You may need to wait some time after procedures before we can recommend any complementary procedure. Waiting times are important for your safety and well-being.
You can read about our complimentary procedures and how they will help you attain a feminine look. We outline the methods and our techniques in detail. The techniques we use will create nearly invisible scarring, and in some cases, will have no visible scarring.
Redoing Facial Feminization Surgery
Unfortunately, a common procedure for us involves correcting surgeries performed by other surgeons that have not produced satisfactory results. While surgeons may technically know how to perform facial feminization procedures like cheek augmentation, brow lift, or forehead contouring, it does not mean they can achieve natural results.
We understand the subtle qualities that make a face feminine. The difference between feminine and beautiful is slight and often overlaps. For authentic feminine gender expression, a surgeon must understand the science and structural portions that make a face feminine.
Our team has helped many people to feminize their looks. We know the techniques and the structural differences between masculine and feminine faces.
The knowledge we gained throughout our experience is of great aid when deciding the best approach for redoing your FFS Surgery.
Facialteam’s philosophy is based on precision, predictability and natural results that reflect the most feminine version of you — without visible scars.
Each face requires a different series of procedures in order to achieve a unique, more harmonious and feminine look. FFS is much more than just employing the correct procedure; it is understanding the global relation of all facial features within the frame of gender traits and how specific changes will affect your overall look.
We prioritize your safety, goals and satisfaction, which is why communication is key to the patient-clinic relationship.
So, we continually evaluate our protocols and look for ways to improve them. Our multidisciplinary approach to patient care and services is a product of that. We respect your gender identity and our detail-oriented care attends to many of your emotional and physical needs during the FFS process.
We anchor our FFS approach to three central tenets:
- Science-based analysis in a personalized assessment process
- Comprehensive & ethical care system
- Natural, precise and stable outcomes
How much does facial feminization surgery cost?
Quotes for facial feminization can range from €8,000 to €45,000, including hospital and anesthesia fees. The cost will depend on each patient due to the type and number of procedures needed to attain your desired look.
The following services are included in all our quotes;
- Pre-operative consultation, standard pre-operative preparations and necessary revisions
- Preoperative and postoperative CT-scan
- Material costs
- Costs for the operating theater and general anesthesia
- 1 night in hospital
- Postoperative accommodation (average of 12 nights, variable according to procedure and surgery dates in case your surgery is in Marbella. For Barcelona patients we can suggest a nearby Hotel)
- Lymphatic drainage massage
- Acupuncture service
- 24 hour coordination support
- Post-operative nursing care
- Health insurance for surgical complications up to 30 days after your surgery
Our recommendation is to obtain quotes from multiple centers. Each will have a different approach and include (or exclude) important aspects on your transition journey, so it is important to order priorities:
- Local transportation
- Wellness services
- Knowledge of facial feminization
- Level of skill
- Proven results
- Feeling comfortable communicating with the surgeons
Facial gender confirmation surgery is an investment in yourself and your future. So, we recommend considering multiple criteria when choosing a surgeon – even if it is not our practice.
At Facialteam, we include all of these services in our comprehensive care because we want you to have a satisfactory experience. Choosing a surgeon will inevitably cost you time, and a center should give you the complete care you deserve.
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.
Why is Facial Feminization Surgery so expensive?
Any surgery requires a significant investment of time and money, which unfortunately is prohibitive for the majority. Our patients, typically assigned male at birth (AMAB), represent people who have been able to make FFS Surgery happen in one way or another, against all odds. Today it may seem like an insurmountable goal, so we only ask you to persist as many of these people did. Even in difficult situations, we’ve seen people overcome what was once perceived impossible.
Funding your facial feminization procedures is a common concern for many people. Most must pay for their feminization journey out of pocket. Some country’s medical insurance providers include FFS procedures, but this could limit you to working with in-network providers. Due to the cost of the FFS surgery, people look for various ways to fund their procedures.
Common methods to saving money for FFS include crowdfunding, personal loans, or accessing pension/superannuation funds or similar. Since the process will take a lot of time and inevitably cause stress, you should choose a clinic that takes this into consideration in their policies. Our mission is to help you and provide the best and most comprehensive trans healthcare.
Facialteam is on a WPATH workgroup with the overall goal for a future in which Facial Feminization Surgery may be insured by more healthcare plans so we may help more people with financial challenges. We take each patient’s satisfaction seriously, so currently the priority of our pricing schedules is maximum quality in care and precision in results.
This technique is based on several scientific articles produced by our group throughout our clinical practice. Our academic literature is a record of our dedication to the science of feminization surgery of the upper facial third since 2008.
Prospective Quality of Life Outcomes after Facial Gender Affirmation Surgery: An International Multicenter Study
Social Perception of Facial Feminization Surgery Outcomes: Does Gender Identity Alter Gaze?
Comprehensive Care of the Transgender Patient
Facial Gender Confirmation Surgery: A New Nomenclature
Facial Gender Confirmation Surgery: A Protocol for Diagnosis, Surgical Planning, and Postoperative Management
Facial gender confirmation surgery—review of the literature and recommendations for Version 8 of the WPATH Standards of Care
A History of Transgender Surgery
Gender confirmation procedures are not new. People have been searching for ways to address gender dysphoria for over 100 years. Here is a brief outline of the history of FFS and how it has led us to the remarkable advancements that allow us to produce natural lasting results for every patient.
1930: The Einstein of Sex
In 1930 Richter consulted with Dr. Hirschfield and Dr. Erwin Gohrbrandt, who performed a penectomy and vaginal reconstruction surgery. In the same year, Lili Elbe, a Danish trans woman, became the second recorded case of gender confirmation surgery performed under the supervision of Dr. Magnus Hirschfield.
Dr. Hirschfield was named the ‘Einstein of Sex.’ Today people consider him a pioneer of modern-day transgender healthcare as he founded the Institute for sexual science. The founding of the Institute paved the way for modern transgender healthcare as we know it. He and the Institute became known for the study of Sexology. People from around the world visit it.
The Institute served to educate the public and give greater insight into transgender people.
1950: Hormone Therapy
In the 1950s, hormone therapy for trans women was introduced. One of the pioneers in the field was Dr. Harry Benjamin, a colleague of Dr. Hirschfield. Dr. Benjamin became internationally known for his efforts to advance the field of transgender healthcare. His book, ‘The Transsexual Phenomenon, was the first book explaining gender-affirming healthcare procedures.
He went on to publish many papers and lectured professional audiences extensively on trans healthcare. Dr. Benjamin treated hundreds of patients in collaboration with carefully selected colleagues over the next five decades.
1952: Front Page in New York
Christine Jørgensen made the front page of the New York Daily News and became an overnight sensation after her gender confirmation surgery in Denmark. She used her overnight fame to become an advocate for trans rights worldwide.
1966: The first MTF surgery in the USA
In 1966, surgeons at John Hopkins University Medical Center, a research institution Facialteam has collaborated with, performed the first MTF surgery under Dr. Elmer Belt.
1975: A second Advocate for the community
Renée Richards underwent male-to-female gender confirmation surgery and successfully advocated for transgender people’s recognization as their true gender identity.
The 1980’s: Facial Feminization Surgery Begins
The first facial feminization surgery took place in 1983. Dr. Darrell Pratt and Dr. Douglas Ousterhout received a request from a patient named “Lucy.” She wanted plastic surgery to make her face look more feminine. Dr. Ousterhout was a maxillofacial surgeon who studied craniofacial surgery. He understood that femininity depends on facial structure, not just a beautiful look.
By detailing and studying the differences between male and female skeletons, Dr. Ousterhout offered several procedures to alter the forehead of transgender patients by making them more feminine. He went on to publish articles in 1987 outlining forehead feminization. He was known as a pioneer in facial feminization surgery.
In 1998 Dr. Ousterhout left the University and shifted his focus from research to caring for the transgender community.
2004: Dr. Capitán and Dr. Simon
Dr. Luis Capitán and Dr. Daniel Simon completed residency programs in Oral and Maxillofacial Surgery. Then they complete Craniofacial Surgery fellowships in the United Kingdom and Belgium, respectively.
2008: Facialteam has its origins
The two surgeons decide to dedicate their energy to FFS and focus on developing the field of FFS. They have their first email evaluations and operate on their first FFS patient.
2010: Facialteam begins offering world-class transgender healthcare
“FacialTeam” is legally incorporated as a company by Dr. Capitán and Dr. Simon, with a staff of 4 people who still work with us. We created our first logo.
2011: An international effort for equality
Facialteam opens its offices in São Paulo, Brazil. Facialteam partners with HC International Hospital (Marbella, Spain), setting up the team’s first facilities. We begin offering Skype consultations.
2013: Further innovations for Trans healthcare
We integrate Virtual FFS into our consultations in London. We began collaborating with Alexandra Hamer. Our team consolidates Aesthetic procedures by inviting Dr. Raúl Jiménez Bellinga, an aesthetic surgeon specializing in FFS, to join Facialteam.
Our surgeons perform the first simultaneous hair transplant (SHT). Facialteam operates on its 100th patient. We attended our first international scientific conference as guest lecturers (Dr. Capitán, ICOMS, Barcelona, Spain). We joined the World Professional Association for Transgender Health (WPATH).
2020: Our work continues so you can attain natural results
As of 2020, we have operated on a total of 1800 FFS patients from 62 countries since our origins, performing a cumulative total of 5800 procedures.
Facialteam still managed to provide safe FFS for 200+ patients with a 0% incidence of Covid transmission the entire year, thanks to the rapid development of Covid-safe protocols. Notably, our dedicated monitoring system for traveling patients has obtained 100% of the medical exception visas requested by North American Patients.
Despite canceling our live events, we launched two webinars for patients and celebrated more than ten virtual orientation events. Facialteam’s tradition of open access continues with 1000+ free FFS consultations this year, including 400+ digital simulations and 100+ free CT. We provided local transport to and from our facilities as a courtesy for making the trip to visit us in Marbella.
Our research and development department published three scientific articles in leading medical journals, with another four groundbreaking studies already accepted for 2021.
We convert the 2nd Training & Education Workshop for professionals into a 2-day virtual event featuring 18 leading experts in facial feminization surgery.
Our surgeons presented at five professional congresses worldwide, notably the 23rd WPATH and the International Academy of Aesthetics (IAA). We raise visibility of a diverse range of trans topics in over 60 blog posts and 40 live stream interviews.
Facialteam supported the international TNBI community via the endowment of a giant-sized mural in honor of Trans Pride in Spain and generous sponsorships of trans performance artists and trans athletes.
Against all odds, our team grows.
We set up a new center in Barcelona and expanded our staff to more than 50 unique and carefully selected individuals.
2022: We continue providing the best trans healthcare for FFS
As of 2022, we are proud to continue our work to advance FFS worldwide for the trans community. Our innovations and research have led to the most comprehensive care you can find. Our specialization and experience are unparalleled in our field.
We invite you to come to visit us in Spain. You will see why so many have trusted us with their facial feminization journey.
Do you want to speak with an FFS Surgeon?
We offer free consultations to help kickstart your FFS journey.
Speak with a highly experienced FFS surgeon who'll after a careful revision of your facial features, recommend which procedures are right for you. A consultation with our team will help clarify any questions or doubts many patients face.
Our consultations are free of costs, no strings attached.