Facial Feminization Surgery

Surgeries are an option for anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.

This might include hormone therapy and transition-related surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person has surgery – it’s a decision that’s yours to make.

What is facial feminization surgery (FFS)?

Facial feminization surgery is often known as “FFS”. It’s a surgery for people who would like to change their facial appearance in a way that’s socially perceived as “feminine”. FFS is a general term that can refer to multiple different surgeries, which can be performed simultaneously or in stages. You can choose from a range of procedures depending on your surgeon, anatomy, insurance coverage or personal preference. 

Why do people get FFS? 

There are many reasons someone might get FFS. The most common is that it can help ease feelings of dysphoria, which improves your wellbeing. It can help you feel more comfortable with yourself or more comfortable in public. For some people, this may make them feel safer. However, it’s important to know that this varies greatly depending on someone’s individual experience, and that FFS does not always dictate someone’s safety.

Alternative treatment options

If you’re not ready for surgery or are still exploring your options, there are other ways you can change your facial appearance. Hormone therapy with estrogen is one way to potentially do this. In some people, estrogen can change your skin texture and facial fat distribution. However, the amount of change you can have with hormone therapy and the time this takes will vary depending on factors like age and genetics. Some people will have more noticeable results than others, so remember to be kind to yourself!

Other alternative treatments for facial feminization include electrolysis or laser hair removal, Botox and injectable fillers. Electrolysis or laser hair removal can remove facial hair permanently. The effects of Botox generally last three to four months and fillers can last from three months to a year or more, depending on the type of product used.

Surgical techniques

FFS is a general name for facial surgeries that produce a “feminizing” effect. They can be performed either on their own or together in one surgery. The surgical elements you choose will come down to your surgeon, your current anatomy and your goals. Since the effects of estrogen on facial fat distribution can be gradual, some people on hormones will wait a few years before FFS.

In your pre-surgery consultation you’ll have a chance to discuss all of these options and find what works best for you. There are many different surgeries that can be performed as part of FFS. The most common ones are:

Rhinoplasty

• Also known as a “nose job” or “rhino”

• The surgeon removes and/or reshapes cartilage and soft tissue to change the shape of the nose

• When performed as part of FFS, the tip of the nose is usually slightly elevated and humps are smoothed. The nose may be narrowed and ridges may also be smoothed.

• In a “closed rhinoplasty”, incisions are made inside the nose. In an “open rhinoplasty”, incisions are made inside the nose and across the columella (the skin separating your nostrils).

Brow bone reduction

• Also known as “forehead contouring”

• A long incision is made at the hairline or on the scalp where hair already grows

• The surgeon removes and/or reshapes bone of the brow ridge and/or forehead and/or the upper portion of the eye socket. This creates a smoother, less prominent profile

Hairline lowering

• Often performed in combination with brow bone reduction

• Using the same incision as brow bone reduction, the surgeon removes a strip of forehead skin and closes the incision to bring the hairline down. For this procedure, the incision must be made at (instead of above) the hairline. This means a scar is always visible.

Hair transplant 

• An alternative method of hairline lowering that leaves less scarring. This can also be used to hide scars from other procedures, such as brow bone reduction.

• The surgeon removes hair follicles from one part of the scalp (usually the back) and implants them in another area. 

• Hair follicles can be transplanted by removing a long strip of skin, known as follicular unit transplantation (FUT). Another method is by removing individual follicles, known as follicular unit extraction (FUE).

Brow lift

• The surgeon raises the skin of the forehead to lift the eyebrows and open the eye area

• This uses the same incision as brow bone reduction and hairline lowering

Jaw reduction

• The surgeon removes and/or reshapes bone of the jaw to create a smoother shape

• Incisions are made inside the mouth

Chin contouring

• Often performed in combination with jaw reduction

• The surgeon removes and/or reshapes bone of the chin to create a smoother, more tapered shape. The chin bone can also be repositioned to make it more or less prominent.

• Incisions are made inside the mouth

Fat transfer

• The surgeon removes fat from one part of your body and injects this into areas of the face like cheeks, lips or temples

• Fat transfer can provide longer-lasting results than facial filler. It can also look and feel more natural, because it is a substance from your own body. 

Tracheal shave

• The surgeon removes parts of the thyroid cartilage to reduce the “Adam’s apple”

• A single incision is made on the neck. Some surgeons offer endoscopic tracheal shave, where an incision is made in the mouth and the surgeon inserts a small camera to guide the procedure.

Side effects and risks

The side effects and risks of FFS will vary greatly depending on the procedures you choose. For information on the specific side effects and risks of each surgery, we recommend consulting with your surgical team directly.

General surgery risks

There are some general risks that come with most surgeries. They are:

• Bleeding

• Blood clots in your legs or lungs

• Injury to surrounding organs, nerves or blood vessels

• Hematoma (a collection of blood) or seroma (a collection of fluid)

• Infection or abscess

• Wound opening or delayed healing

• Chronic pain

• Scarring

• Feeling dissatisfied with the outcome

• Feelings of regret about surgery

These risks can be higher with certain medications and health conditions. This includes immune conditions, immunosuppressant drugs, clotting disorders, or if you smoke. Tell your doctor about any medications and supplements you take, along with any health conditions you have (even if they don’t seem relevant!). 

Anesthetic risks

FFS usually requires going under general anesthetic. General anesthetic has the following risks (most of which are very rare):

• Nausea/vomiting

• Damaged teeth

• Aspiration pneumonia (pneumonia from inhaling liquid like saliva or vomit)

• Respiratory failure (i.e. stopping breathing)

• Heart attack

• Coma

• Death

Ready for surgery?

If you’d like to get FFS, your surgeon may require an assessment to confirm you’re ready for surgery. In other cases you may be able to self-refer. This will depend on your surgeon’s protocol.

FFS is only covered by provincial health insurance in the Yukon. For patients in other provinces, you will have to pay out of pocket or use private insurance. Private insurance companies may cover some or all of the cost of FFS, but this will vary by provider.

If you live in Ontario, Foria can provide your assessment. See our Surgical Referrals in Ontario article for more information. However, because FFS is not covered by provincial health insurance, please reach out to our team at support@foriaclinic.com prior to booking an assessment. 

Unfortunately we are unable to provide assessments in Alberta at this time.

by Foria Clinical Team

Feb 5, 2024・ minute read

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