Questions and Answers about Facial Feminization Surgery

Facial feminization surgery (FFS) is a set of surgical procedures that aim to modify the facial features of a person to make them more feminine. FFS is often sought by transgender women who want to align their appearance with their gender identity, but it can also be done for cisgender women who want to enhance their femininity or correct facial deformities.

FFS can involve various operations on different parts of the face, such as the forehead, brow, nose, cheek, jaw, chin, hairline, and trachea. The results of FFS can vary depending on the individual’s facial anatomy, goals, expectations, and surgeon’s skill and experience.

In this article, we will answer some of the most common questions that people have about FFS, such as:

• What are the benefits and risks of FFS?
• How much does FFS cost and where can I get it done?
• How do I choose a good surgeon for FFS?
• What are the different types of FFS procedures and how are they done?
• How long is the recovery process and what should I expect after FFS?

What are the benefits and risks of FFS?

The main benefit of FFS is that it can improve the psychological well-being and quality of life of people who are unhappy with their facial features. FFS can help them feel more comfortable and confident in their own skin, and reduce the stress and anxiety that they may face due to social stigma, discrimination, or harassment. FFS can also help them pass more easily as their desired gender, which can increase their safety and social acceptance.

Some of the risks of FFS include:

• Infection, bleeding, bruising, swelling, scarring, nerve damage, or loss of sensation in the operated areas
• Asymmetry, overcorrection, undercorrection, or dissatisfaction with the aesthetic outcome
• Complications related to anesthesia, such as allergic reactions, nausea, vomiting, or respiratory problems
• Need for revision surgery, either to correct complications or to achieve better results

The risks of FFS can be minimized by choosing a qualified and experienced surgeon, following the preoperative and postoperative instructions, and having realistic expectations.

How much does FFS cost and where can I get it done?

The cost of FFS depends on several factors, such as:

• The number and type of procedures involved
• The location and reputation of the clinic and the surgeon
• The complexity and duration of the surgery
• The anesthesia and hospital fees
• The medication and aftercare expenses

The average cost of FFS can range from $20,000 to $50,000 USD, but it can be higher or lower depending on the individual case. FFS is not usually covered by insurance, unless it is deemed medically necessary by a mental health professional.

FFS can be done in many countries around the world, but some of the most popular destinations are:

• Turkey: Turkey is one of the leading countries in cosmetic surgery, offering high-quality services at affordable prices. Turkey has many skilled and experienced surgeons who specialize in FFS, and many modern and accredited clinics that cater to international patients. Turkey is also a beautiful and diverse country that offers a rich cultural and historical heritage, as well as stunning natural scenery. One of the best cities to get FFS in Turkey is Antalya, which is located on the Mediterranean coast and is known for its sunny weather, sandy beaches, and ancient ruins.
• Thailand: Thailand is another popular destination for cosmetic surgery, especially for transgender patients. Thailand has a long history and tradition of gender diversity and acceptance, and many surgeons who are experts in FFS. Thailand also has a vibrant and exotic culture, a friendly and hospitable people, and a tropical climate. One of the best cities to get FFS in Thailand is Bangkok, which is the capital and the largest city of the country, and offers a mix of modern and traditional attractions, as well as a lively nightlife and entertainment scene.
• Spain: Spain is a European country that offers high standards of medical care and safety, as well as a diverse and attractive culture and lifestyle. Spain has many renowned and reputable surgeons who perform FFS, and many state-of-the-art and comfortable clinics that provide excellent patient care. Spain is also a sunny and warm country that boasts a rich artistic and architectural heritage, a delicious cuisine, and a festive and relaxed atmosphere. One of the best cities to get FFS in Spain is Barcelona, which is located on the Mediterranean coast and is known for its cosmopolitan and creative vibe, its stunning landmarks designed by Gaudi, and its lively and colorful festivals.

How do I choose a good surgeon for FFS?

Choosing a good surgeon for FFS is one of the most important decisions that you will make, as it will affect the outcome and the safety of your surgery. Here are some tips to help you choose a good surgeon for FFS:

• Do your research: Look for information about the surgeon’s qualifications, experience, reputation, and results. You can check their website, social media, online reviews, testimonials, before and after photos, and videos. You can also ask for referrals from other patients who have had FFS with them.
• Consult with them: Schedule a consultation with the surgeon to discuss your goals, expectations, and concerns. You can ask them questions about their approach, technique, and recommendations for your case. You can also ask them about the risks, complications, and recovery process of FFS. You should feel comfortable and confident with the surgeon, and they should listen to you and respect your wishes.
• Compare your options: You can consult with more than one surgeon to compare their opinions, prices, and services. You can also compare the clinics, facilities, and staff that they work with. You should choose the surgeon and the clinic that offer the best value for your money, and that meet your needs and preferences.

What are the different types of FFS procedures and how are they done?

FFS can involve different types of procedures, depending on the facial features that you want to feminize. Some of the most common FFS procedures are:

• Forehead lift/recontouring: This procedure aims to smooth and flatten the forehead, and reduce the brow ridge, which are typically more prominent and angular in men. The surgeon makes an incision along the hairline, lifts the skin and the muscles, and reshapes the underlying bone using a burr or a saw. The surgeon may also perform a brow lift/shaping, which raises and arches the eyebrows to create a more feminine and expressive look. The incision is then closed with sutures or staples, and the excess skin is trimmed.
• Rhinoplasty (nose surgery): This procedure aims to refine and feminize the nose, which is usually larger and wider in men. The surgeon makes an incision either inside the nostrils or across the base of the nose, and modifies the cartilage and the bone to change the shape, size, and angle of the nose. The surgeon may also improve the breathing function of the nose by correcting any deviated septum or enlarged turbinates. The incision is then closed with sutures or tape, and a splint is applied to support the nose.
• Cheek augmentation/repositioning: This procedure aims to enhance and feminize the cheekbones, which are usually flatter and lower in men. The surgeon makes an incision either inside the mouth or below the lower eyelashes, and inserts an implant or a fat graft to add volume and projection to the cheeks. The surgeon may also lift and reposition the soft tissues of the cheeks to create a more defined and youthful contour. The incision is then closed with sutures or glue, and a bandage is applied to protect the cheeks.
• Jawline reduction/reshaping: This procedure aims to slim and feminize the jawline, which is usually wider and squarer in men. The surgeon makes an incision either inside the mouth or behind the ear, and removes or shaves off the excess bone and muscle from the lower jaw. The surgeon may also tighten and lift the skin and the soft tissues of the lower face and neck to create a more smooth and elegant jawline. The incision is then closed with sutures or clips, and a compression garment is applied to reduce the swelling and bruising.
• Chin reshaping/reduction: This procedure aims to soften and feminize the chin, which is usually larger and more protruding in men. The surgeon makes an incision either inside the mouth or under the chin, and modifies the shape and size of the chin bone using a burr or a saw. The surgeon may also perform a genioplasty, which moves the chin forward or backward to improve the facial balance and harmony. The incision is then closed with sutures or glue, and a bandage is applied to protect the chin.
• Hairline lowering: This procedure aims to lower and feminize the hairline, which is usually higher and more receding in men. The surgeon makes an incision along the hairline, and removes a strip of skin and hair from the forehead. The surgeon then pulls the scalp forward and downward, and attaches it to the remaining skin with sutures or staples. The surgeon may also perform a hair transplant, which transfers hair follicles from the back or the sides of the head to the front or the top of the head to fill in any bald or thinning areas.
• Tracheal shave (Adam’s apple reduction): This procedure aims to reduce and feminize the trachea, which is usually larger and more visible in men. The surgeon makes an incision either in a natural crease of the neck or behind the ear, and exposes the trachea. The surgeon then shaves off the excess cartilage from the trachea, and smooths the surface to create a more flat and feminine appearance. The incision is then closed with sutures or glue, and a bandage is applied to protect the neck.

How long is the recovery process and what should I expect after FFS?

The recovery process after FFS varies depending on the type and number of procedures performed, the individual’s healing ability, and the surgeon’s instructions. In general, the recovery process can be divided into three phases:

• The immediate postoperative phase: This phase lasts for about one to two weeks after the surgery, and is the most critical and uncomfortable period. During this phase, the patient may experience pain, swelling, bruising, numbness, tightness, or itching in the operated areas. The patient may also have difficulty breathing, eating, talking, or sleeping. The patient will need to take antibiotics, painkillers, and anti-inflammatory drugs to prevent infection and reduce discomfort. The patient will also need to wear bandages, splints, or compression garments to support and protect the face. The patient will need to avoid any strenuous activity, smoking, alcohol, sun exposure, or makeup. The patient will need to visit the surgeon regularly for check-ups and dressing changes.
• The intermediate postoperative phase: This phase lasts for about two to three months after the surgery, and is the period when the swelling and bruising gradually subside and the results become more visible. During this phase, the patient may still feel some discomfort, numbness, or tightness in the face, but they will be able to resume most of their normal activities. The patient will need to continue taking care of the incisions and scars, and apply moisturizer, sunscreen, and scar gel to promote healing and prevent hyperpigmentation. The patient will also need to massage the face gently to improve blood circulation and reduce stiffness. The patient may still need to wear some bandages, splints, or compression garments for some time, depending on the surgeon’s advice.
• The final postoperative phase: This phase lasts for about six to twelve months after the surgery, and is the period when the face fully heals and settles into its final shape. During this phase, the patient may still experience some minor changes in the face, such as slight swelling, numbness, or sensitivity, but they will be mostly resolved. The patient will be able to enjoy the full benefits and effects of FFS, and feel more confident and happy with their appearance. The patient will need to maintain a healthy lifestyle, and protect the face from any trauma or damage. The patient will also need to follow up with the surgeon periodically to monitor the long-term outcome and satisfaction.

Conclusion

FFS is a complex and personalized surgery that can transform the facial features of a person to make them more feminine and congruent with their gender identity. FFS can have a positive impact on the psychological and social well-being of the patient, as well as their aesthetic and functional aspects. FFS can involve different types of procedures, such as forehead lift, brow lift, rhinoplasty, cheek augmentation, jaw reduction, chin reshaping, hairline lowering, and tracheal shave. FFS can be done in various countries, such as Turkey, Thailand, and Spain, where there are many qualified and experienced surgeons who offer high-quality and affordable services. FFS requires a careful and thorough preparation, consultation, and selection of the surgeon and the clinic, as well as a proper and diligent recovery and aftercare process. FFS can have some risks and complications, such as infection, bleeding, scarring, nerve damage, asymmetry, dissatisfaction, or need for revision surgery, but they can be minimized by following the surgeon’s instructions and having realistic expectations. FFS can be a life-changing and rewarding surgery for many people who want to achieve a more feminine and harmonious facial appearance.

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FAQ

What is the difference between FFS and gender confirmation surgery?

FFS is a type of cosmetic surgery that focuses on the facial features, while gender confirmation surgery (GCS) is a type of reconstructive surgery that focuses on the genitalia. FFS and GCS have different goals and outcomes, and they are not mutually exclusive. Some transgender people may choose to have both FFS and GCS, some may choose to have only one of them, and some may choose to have neither of them.

How do I know if I need FFS?

There is no definitive answer to this question, as it depends on your personal feelings, preferences, and expectations. Some transgender people may feel that their facial features are already feminine enough, or that they do not want to alter their natural appearance. Some transgender people may feel that their facial features are a source of dysphoria, or that they want to improve their femininity and passing ability. The decision to have FFS is a personal one, and you should consult with a mental health professional and a surgeon to explore your options and motivations.

Am I too old or too young for FFS?

There is no age limit for FFS, as long as you are in good physical and mental health, and you have realistic expectations. However, some factors may affect the timing and the outcome of FFS, such as:

• Hormone therapy: Hormone therapy can have some effects on the facial features, such as fat redistribution, skin texture, and hair growth. It is recommended to wait at least one year after starting hormone therapy before having FFS, to allow the hormones to stabilize and to see the changes that they may produce.
• Bone growth: Bone growth can affect the shape and size of the facial features, especially the forehead, brow, nose, jaw, and chin. It is recommended to wait until the bone growth is complete before having FFS, to avoid any potential complications or revisions. Bone growth usually stops around the age of 18 for females and 21 for males, but it may vary depending on the individual.
• Psychosocial development: Psychosocial development can affect the emotional and cognitive maturity, as well as the identity formation and expression, of a person. It is recommended to wait until the psychosocial development is stable and consistent before having FFS, to ensure that the decision is well-informed and voluntary. Psychosocial development usually continues until the mid-20s, but it may vary depending on the individual.

How do I prepare for FFS?

There are some steps that you can take to prepare for FFS, such as:

• Do your research: Learn as much as you can about FFS, the procedures involved, the risks and benefits, the costs and financing, and the surgeons and clinics available. You can use various sources of information, such as websites, books, articles, videos, forums, blogs, and social media. You can also talk to other people who have had FFS, and ask them about their experiences and advice.
• Consult with a surgeon: Find a qualified and experienced surgeon who specializes in FFS, and schedule a consultation with them. During the consultation, you can discuss your goals, expectations, and concerns, and ask them any questions that you may have. You can also ask them to show you their portfolio, credentials, and reviews, and to perform a facial analysis and a simulation of the expected results. You should feel comfortable and confident with the surgeon, and they should listen to you and respect your wishes.
• Get a letter of recommendation: Depending on the surgeon and the clinic, you may need to get a letter of recommendation from a mental health professional, such as a psychologist, psychiatrist, or therapist, who can attest to your gender identity, dysphoria, and readiness for FFS. You may also need to get a letter of clearance from your primary care physician, who can confirm your physical health and medical history.
• Follow the preoperative instructions: Before the surgery, you will need to follow some preoperative instructions given by the surgeon, such as:
  • Stop smoking, drinking alcohol, and taking any drugs or supplements that may interfere with the surgery or the anesthesia, such as aspirin, ibuprofen, vitamin E, or herbal remedies, at least two weeks before the surgery.
  • Arrange for someone to accompany you to the clinic, and to stay with you for at least 24 hours after the surgery, to help you with your recovery and transportation.
  • Pack a bag with some essentials, such as your identification, insurance, medication, toiletries, comfortable clothes, pillows, ice packs, books, or music.
  • Do not eat or drink anything, except for a sip of water with your medication, for at least eight hours before the surgery.
  • Wash your face and hair with a mild soap or shampoo, and do not apply any makeup, lotion, or perfume, on the day of the surgery.

What happens during FFS?

FFS is usually performed under general anesthesia, which means that you will be asleep and unaware of the surgery. The duration of the surgery depends on the number and type of procedures involved, but it can range from two to eight hours. During the surgery, the surgeon will make incisions in strategic locations, such as along the hairline, inside the mouth, or behind the ear, to access the facial structures. The surgeon will then modify the bone, cartilage, muscle, fat, and skin of the face, using various techniques and instruments, such as a burr, a saw, a scalpel, a scissors, a needle, or a syringe. The surgeon will then close the incisions with sutures, staples, tape, or glue, and apply bandages, splints, or compression garments to protect and support the face. The surgeon will then transfer you to a recovery room, where you will be monitored by a medical staff until you wake up.

What should I expect after FFS?

After FFS, you will need to follow some postoperative instructions given by the surgeon, such as:

• Take your medication as prescribed, such as antibiotics, painkillers, and anti-inflammatory drugs, to prevent infection and reduce discomfort.
• Keep your head elevated and apply ice packs to your face to reduce the swelling and bruising.
• Avoid any strenuous activity, smoking, alcohol, sun exposure, or makeup, for at least two weeks after the surgery.
• Clean your incisions and scars gently with a mild soap or saline solution, and apply moisturizer, sunscreen, and scar gel as directed by the surgeon.
• Massage your face gently to improve blood circulation and reduce stiffness, as instructed by the surgeon.
• Wear your bandages, splints, or compression garments as long as the surgeon recommends, and change them as needed.
• Visit the surgeon regularly for check-ups and dressing changes, and contact them if you have any signs of infection, bleeding, or complications, such as fever, pus, redness, or severe pain.
• Be patient and optimistic, as the final results of FFS may take several months to appear, and you may experience some changes in your face, such as slight swelling, numbness, or sensitivity, until then.

How will FFS affect my voice?

FFS will not directly affect your voice, as it does not involve any surgery on the vocal cords or the larynx. However, FFS may indirectly affect your voice, as it may change the shape and size of your oral and nasal cavities, which can affect the resonance and quality of your voice. FFS may also affect your voice temporarily, as you may experience some swelling, bruising, or pain in your face, which can make it difficult to speak or sing. These effects are usually minor and temporary, and they will resolve as your face heals and settles. If you want to change your voice to make it more feminine, you may need to undergo a separate procedure called voice feminization surgery (VFS), or to practice some voice therapy exercises.

How will FFS affect my facial expressions and emotions?

FFS will not affect your facial expressions and emotions, as it does not alter the function or the sensation of your facial muscles or nerves. However, FFS may affect your facial expressions and emotions temporarily, as you may experience some swelling, bruising, numbness, or tightness in your face, which can limit your ability to smile, frown, or show other emotions. These effects are usually minor and temporary, and they will resolve as your face heals and settles. FFS may also affect your facial expressions and emotions positively, as it may improve your self-esteem, confidence, and happiness, and make you feel more comfortable and expressive with your face.

How will FFS affect my relationships and social life?

FFS may affect your relationships and social life in various ways, depending on your personal situation and expectations. Some of the possible effects are:

• FFS may improve your relationships and social life, as it may make you feel more confident and attractive, and reduce the stress and anxiety that you may face due to social stigma, discrimination, or harassment. FFS may also help you pass more easily as your desired gender, which can increase your safety and social acceptance.
• FFS may change your relationships and social life, as it may alter your appearance and identity, and make you look different from your previous self. FFS may also make you more visible and noticeable, and attract more attention and curiosity from others. FFS may require you to adjust to your new face, and to explain or disclose your transition to your family, friends, partners, or colleagues.
• FFS may challenge your relationships and social life, as it may cause some conflicts or misunderstandings with your loved ones, who may not support or accept your decision to have FFS. FFS may also expose you to some negative or hostile reactions from others, who may not respect or appreciate your new face. FFS may require you to cope with some emotional or social issues, such as isolation, rejection, or discrimination.

FFS is a personal and individual decision, and you should not let others influence or pressure you to have or not to have FFS. You should also seek support and guidance from a mental health professional, a support group, or a trusted person, who can help you with your transition and your relationships and social life.

How long do the results of FFS last?

The results of FFS are permanent, as they involve changes in the bone, cartilage, muscle, fat, and skin of the face. However, the results of FFS may be affected by some factors, such as:

• Aging: Aging can cause some changes in the face, such as sagging, wrinkling, or thinning of the skin, loss of volume or elasticity of the tissues, or shifting of the implants or the fat grafts. Aging can affect the appearance and the quality of the results of FFS, and may require some maintenance or revision procedures, such as facelift, neck lift, or filler injections.
• Weight fluctuations: Weight fluctuations can cause some changes in the face, such as gain or loss of fat, muscle, or water in the cheeks, chin, or neck. Weight fluctuations can affect the shape and size of the face, and may alter the balance and harmony of the results of FFS, and may require some adjustment or correction procedures, such as liposuction, fat transfer, or implant removal or replacement.
• Hormone therapy: Hormone therapy can have some effects on the face, such as fat redistribution, skin texture, or hair growth. Hormone therapy can enhance or complement the results of FFS, and may improve the femininity and passing ability of the patient. However, hormone therapy can also have some side effects, such as acne, dryness, or sensitivity of the skin, which may require some treatment or care.

How do I finance FFS?

FFS is a costly surgery, and it is not usually covered by insurance, unless it is deemed medically necessary by a mental health professional. Therefore, many patients may need to find alternative ways to finance FFS, such as:

• Saving: Saving is the most straightforward and reliable way to finance FFS, as it does not involve any interest, fees, or debt. However, saving may take a long time and require a lot of discipline and sacrifice, and it may not be feasible for some patients who have low income or high expenses.
• Crowdfunding: Crowdfunding is a way to raise money from a large number of people, usually through online platforms, such as GoFundMe, Kickstarter, or Indiegogo. Crowdfunding can be a fast and easy way to finance FFS, as it can reach a wide audience and generate a lot of support and donations. However, crowdfunding may also involve some challenges and risks, such as competition, fraud, taxes, or fees, and it may not guarantee the full amount or the timely delivery of the funds.
• Loans: Loans are a way to borrow money from a bank, a credit union, or a private lender, usually with some interest, fees, and repayment terms. Loans can be a convenient and flexible way to finance FFS, as they can provide a large amount of money in a short time and allow the patient to choose the best surgeon and clinic for their case. However, loans may also involve some drawbacks and dangers, such as high interest rates, hidden charges, strict conditions, or debt problems, and they may depend on the patient’s credit score, income, and assets.

How do I find a support group for FFS?

Finding a support group for FFS can be beneficial for the patient, as it can provide them with information, advice, encouragement, and companionship from other people who have had or are planning to have FFS. Finding a support group for FFS can be done in various ways, such as:

• Online: Online support groups are groups that communicate through the internet, using websites, forums, blogs, social media, or chat rooms. Online support groups can be accessible and convenient, as they can be joined from anywhere and anytime, and they can offer a large and diverse community of members. However, online support groups may also have some limitations and risks, such as lack of privacy, security, or moderation, or potential for misinformation, harassment, or trolling.
• Offline: Offline support groups are groups that meet in person, usually in a local area, using venues, events, or activities. Offline support groups can be personal and interactive, as they can allow face-to-face contact and direct feedback from the members. However, offline support groups may also have some challenges and barriers, such as availability, accessibility, or compatibility, or potential for discrimination, judgment, or conflict.