Facial gender confirmation surgery, also known as facial feminization surgery (FFS) is a series of procedures tailored for individual transgender patients to feminize facial features in the treatment of gender dysphoria. Facial feminization may include eyebrow lift, lowering of the hairline, cheek augmentation, nose surgery/rhinoplasty, upper lip lift, jaw reduction, chin shaping, reduction of the brow bone, setback/reduction of the forehead, and 'trach shave,' a reduction of thyroid cartilage.
UW Health provides these facial feminization services:
- Eyebrows: an open or endoscopic brow lift will elevate the eyebrows to produce a more feminine appearance. Your physician can explain the various techniques used to raise eyebrows.
- Eyelids: Reducing bags under the eyes to create a more youthful look or produce a more feminine appearance of the upper eyelids.
- Hairline: using scalp enhancement, the hairline is moved forward (lowered) to remove ‘peaks’ and create a rounded hairline more typical of females.
- Cheeks: increasing the shape and fullness of the cheeks through injections, implants or grafting to produce a more rounded, feminine appearance.
- Nose: altering the bone and cartilage to make the nose shorter and narrower creates a more feminine appearance (rhinoplasty).
- Lips: creating a softer, fuller upper life and defined 'cupid's bow' to create a more feminine appearance.
- Jaw: reducing the squareness of the jaw to a more tapered shape will create a more feminine appearance.
- Chin: softening the angles of the chin to produce a more feminine appearance.
- Brow bone: reducing the supraorbital rim (brow bone) in males, who have more bone above their eyebrows especially in the lower forehead and above their eyes will create a more feminine appearance.
- Forehead: reducing, removing and shaping the ridge of bone across the forehead to produce a more feminine appearance.
- Neck: a "trach shave" reduces the amount of thyroid cartilage that protrudes from the neck to create a more feminine profile.
Frequently Asked Questions
Who is a good candidate for facial feminization surgery?
The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care. Letters of readiness from mental health providers are not necessary for facial feminization surgery. Gender expansive patients and patients with gender dysphoria are candidates for facial feminization surgery. Facial feminization surgery has been shown to improve quality of life in transgender women who are experiencing gender dysphoria.
What is the difference between a Type 1 and Type 3 forehead cranioplasty?
Changes to the upper third of the face has been recognized as an important marker of femininity. Surgery can remove and shape the ridge of bone across the forehead (called brow bossing) along with the bone overhanging the eyebrows. Underneath the frontal (forehead) bone is an air-filled cavity called the frontal sinus. Some patients have very little bossing, or a very thick bone covering the sinus, and can have a Type 1 forehead cranioplasty to shave down the heavy bone. More often, patients will have a thin layer of bone covering the frontal sinus and require Type 3 forehead cranioplasty to remove the thin layer of bone, sculpt the brow, and set back the forehead bone in a feminized place. This procedure is often combined with a brow lift and hairline surgery. Your doctor may order an x-ray of your skull or review any prior imaging you had in the past to recommend a Type 1 or Type 3.
Who is a good candidate for hairline surgery and hair transplants?
Surgery can be performed to address the hairline shape and height, often at the same time as surgery to the forehead and brow position. For some patients, hairline advancement can be used to lower a high hairline and round the recessed corners often found in the male scalp. For those with a very high hairline, high “M” shaped corners, or in those whose scalp is not as mobile, your surgeon may recommend a hair transplant. Hair transplants are not currently performed at UW Health.
What are options to increase the fullness of the cheeks?
Feminine cheeks are round and full. For many patients, hormone therapy with estrogen will naturally increase the size of their cheeks after 1-2 years. Filler injections can be used to augment the size of the cheeks during this time, or to add additional volume. The procedure is done quickly in the clinic and may last 12 to 24 months, depending on the type of filler used. More permanent options include surgery using cheek implants or fat grafting, which are surgeries performed in the operating room. Fat grafting is a procedure where fat is harvested from the belly or leg and “transferred” to the face.
Does insurance cover facial gender confirmation surgery?
Many insurance carriers now cover these operations in the treatment of gender dysphoria. Your doctor will submit a prior authorization to determine coverage. You may also directly check with your insurance to determine if these are covered procedures.
What should I do in the time leading up to my facial feminization surgery?
Your doctor will give you instructions before your facial feminization surgery, including guidelines on eating, drinking and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure. Hormonal therapy (estrogens) must be stopped prior to surgery to prevent blood clots. Your doctor will instruct you on when to start and stop these medications.
What should I expect following a facial feminization procedure?
Immediately following facial feminization surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking from anesthesia and changes in sensation. Your head may be wrapped with gauze or you may have small surgical drains in place for several days. Swelling make take several months to resolve after surgery. The anticipated recovery is dependent on the specific operations performed for an individual patient.