Plastic Surgery: Facial Feminization Surgery


When we see someone, it takes only a split second for our brain to process hundreds of visual cues to decide a person’s gender, age, and mood. Facial feminization surgery (FFS) serves to modify the underlying facial bone structure in order to change masculine cues to feminine cues. This can be complemented by “soft tissue” surgery such as alteration of the hairline, eyebrows, and lips. While surgery can be very beneficial, other cues such as hairstyling and makeup are also equally important in feminizing the face.

Two faces merging

Fellowship-trained in craniofacial surgery, Dr. Jerry Chao is uniquely equipped and qualified to analyze and correct your underlying facial bone structure with the utmost care, skill, and safety.

Brow – Probably the most important facial feminizing procedure is feminization of the brow bone. Depending on your particular anatomy, obtaining the best result involves a combination of repositioning and shaving the bones of the brow (frontal sinus setback surgery). The eyebrows themselves can also be lifted concurrently to obtain ideal feminization of this region.

Nose – Rhinoplasty can be performed to reduce the width of the nose, feminize the tip, lower the bridge, and even improve your breathing. Every nose is different, and Dr. Chao will discuss with you an individualized surgery plan for yours.

Cheeks – Full cheeks can enhance a beautiful, feminine appearance. There are many ways to augment the cheeks, however many of these techniques have disadvantages such as being temporary (fillers), drooping over time with gravity and needing multiple sessions (fat injections), or carrying a lifetime risk of infection or implant movement (cheek implants). As a craniofacial specialist, Dr. Chao also performs an ideal alternative – by making precise cuts in your cheekbones to reposition them, this provides enhancement of your own natural cheekbones. This is done without any external scars.

Lips – Lip augmentation can be performed with fillers or your own tissues to enhance and feminize lip appearance.

Jaw and Chin – The lower jaw bone (mandible) can be contoured and “lifted” to feminize the shape of the jaw border and soften the chin structure. Botox can be injected to soften enlarged chewing muscles.

Frequently Asked Questions

Am I A Good Candidate For Facial Feminization Surgery (FFS)?

You may be a great candidate for facial feminization surgery if you have facial features that are subconsciously associated with a masculine face. These include the shape and size of the hairline, brow bone, eyebrows, nose, cheekbones, lips, and jaw/chin. Every face is different, and Dr. Chao will develop with you an individualized treatment plan. Dr. Chao will discuss with you realistic expectations with facial feminization surgery (FFS), and how the surgery can help you in your transition.

At your visit, your doctor will assess:

  • Your overall physical health and medical history
  • Discuss whether you are a good candidate for surgery and expected outcome
  • Take photographs for your medical record
  • Perform a detailed physical exam of the face
  • Your expectations and motivations for surgery.
What Are The Risks Of Facial Feminization Surgery (FFS)?

Risks vary based on the planned surgery. General possible risks of surgery on the facial skin and skeleton include bleeding, infection, poor healing or scarring, asymmetry, malposition, poor bone healing, unintended fracture of facial bones, contour abnormalities, dental injury, nerve injury (with facial numbness or weakness), injury to the brain or facial sinuses, and need for revision. A CT scan will usually be performed to assess your facial anatomy to plan and optimize your safety during surgery.

How Is Facial Feminization Surgery (FFS) Surgery Done?

During your consultation, Dr. Chao will address the areas of the face to feminize, and discuss what combination of procedures can be done together. Patients undergoing full facial feminization will possibly need staging of the surgeries (two or more surgeries) to reduce risks associated with very long surgery. Given the precision and care that are essential in performing these surgeries on the facial bones, we recommend that you seek a board-certified specialist with extensive experience in craniomaxillofacial surgery.

These are the most common facial feminization surgeries (FFS) that are performed by Dr. Chao:

  • Brow bone reduction / Frontal sinus setback – An incision is placed along the hairline or hidden in the hair, depending on the surgical plan on moving the hairline. The thin bone overlying the frontal sinus is carefully removed and the entire brow region is contoured. The removed bone is also cut and reshaped, and replaced using small plates and screws. In most patients, this procedure is arguably the most important step in feminizing the face. Simple shaving of the brow bone is usually not enough for optimal results, unless the patient has very thick bone over the frontal sinus, or does not have a frontal sinus at all. The majority of patients obtain the optimal result with frontal sinus setback surgery. The hairline and brow position can also be adjusted at the same time. This surgery takes approximately 2-3 hours.
  • Rhinoplasty (Nose job) – This FFS surgery demands the most finesse and the surgery itself varies based on the individual nose. This may involve reducing or augmenting the bridge of the nose, straightening a crooked nose, narrowing the nose, and adjusting tip shape and position. Pre-surgery breathing problems are important to discuss, as these can also be addressed during the surgery. Often, cartilage will be taken from another area of the body (nasal septum, ear, or rib) to accomplish the goals of the rhinoplasty. This surgery varies on the degree of work required, however is typically 2-4 hours.
  • Cheekbone enhancement – Incisions are made in the mouth. The cheekbones are precisely cut and repositioned. Bone is typically taken from another area of the face to fill in gaps in the bone, and the new position is secured using small plates and screws. This surgery takes approximately 1-2 hours.
  • Mandible / jaw bone / chin – Incisions are made in the mouth to contour and remove portions of the mandible that appear too prominent. A wide chin can also be feminized by removing portions of bone and repositioning the chin, and this often requires stabilization of the chin bone using plates and screws. This surgery varies based on the degree of bone removal, and takes approximately 1-3 hours.
What Will My Recovery Be Like After Facial Feminization Surgery (FFS)?

The site of surgery will be swollen after FFS, and full results cannot be appreciated until the swelling has subsided. This varies from patient to patient, however, the bulk of the swelling will be gone after 1 month. Complete resolution of swelling can take several months to one year. Timing to return to work depends on the nature of the work, however usually averages 1-2 weeks, depending on your comfort level being at work while the face still appears swollen.

Sometimes if extensive surgery was performed, you will stay in the hospital one night to make sure you are comfortable prior to going home. You will have activity restrictions for 4-6 weeks after surgery, in order to avoid injury to the healing bones and tissues. Certain FFS procedures will require placement of small plates and screws to hold the bones in their new position to allow them to heal. These are usually permanent and are not noticeable by patients – they can, however, be removed after full bony healing in the rare case that you notice them. If surgery was done from inside the mouth, then you will be instructed to drink a liquid diet for 48 hours, and soft foods for 1-2 weeks. Mouth hygiene is important after surgery to keep the incisions clean.