Facial feminization surgery encompasses a broad range of procedures to change masculine facial features into feminine features. Examples include having your hairline moved to create a smaller forehead, having your lips and cheekbones augmented, or having your jaw and chin reshaped and resized. You also might need skin-tightening surgery, such as a face-lift.
Facial feminization surgery might be done as a step in the process of treating distress due to a difference between experienced or expressed gender and sex assigned at birth (gender dysphoria). The techniques can help transgender women transition physically to their self-affirmed gender.
Many facial features, such as the eyes, jaw and brow, reflect gender differences. While other body parts can be covered or hidden, facial features are readily seen. For transgender people who have a gender identity that differs from the sex assigned to them at birth, altering these characteristics can be essential in their transition. Being seen as women can also help transgender women avoid harassment and discrimination.
However, facial feminization surgery isn't right for every transgender woman. Your doctor might recommend against these surgeries if you have:
Like any other type of major surgery, many types of feminizing surgery pose a risk of bleeding, infection, damage to nearby structures, facial asymmetry and an adverse reaction to anesthesia. Other complications might include:
Sometimes additional surgery is needed to correct facial asymmetry and improve the final outcome.
Feminizing surgeries are typically deferred until adulthood.
Before facial feminization surgery, you'll meet with your surgeon. Consult a surgeon who is board certified and experienced in the procedures you desire.
Every person has a unique facial structure. Your surgeon will ask you about your own ideas about your face and recommend procedures that will most effectively contribute to the feminization of your face. Your surgeon will also describe your potential results.
To plan your surgery, you might need a CT scan. This will allow your surgeon to obtain detailed anatomical information. Your face will also be photographed before and at several intervals after your surgery.
The surgeon will refer you for an appointment to discuss your anesthesia. Follow your doctor's specific instructions on preparing for your procedures, including guidelines on eating and drinking, adjusting current medications, and quitting smoking. Your doctor will also give you instructions to follow after your surgery to improve your results.
In addition, before you can have certain feminizing surgeries, you'll be required to meet specific criteria. To start, your doctor will evaluate your health to rule out or address any medical conditions that might affect or contraindicate treatment. The evaluation might include:
Although giving your informed consent after a discussion about the risks and benefits of the procedure is an acceptable standard of care, most surgeons and insurance companies will require a mental health evaluation by a provider with expertise in transgender health. The evaluation might assess:
Since facial feminization surgery might cause irreversible physical changes, you must give informed consent after thoroughly discussing:
Health insurance might not cover surgical procedures considered cosmetic for the general population, even though these procedures might be essential to alleviating your gender dysphoria.
You might also consider talking to others who've had facial feminization surgery before taking this step. They can help you shape your expectations of what can be achieved and what personal and social problems you might experience during treatment.
Facial feminization surgery might include:
Other possible head and neck procedures include:
You also might need skin-tightening surgery, such as a face-lift or other treatments.
After surgery, expect to experience pain, redness and swelling in your face, most noticeably in your eyes, nose, jaw and chin. Avoid overexertion for one month. You can begin moderate exercise within three to six months.
Chewing and swallowing might be difficult due to incisions and swelling. Your surgeon might recommend that you work with a nutritionist to make sure you get enough nutrients following surgery. A healthy diet is an important part of your recovery.
Definitive and stable results might not appear until up to a year after facial feminization surgery. During your recovery period, you'll continue to talk to specialists involved in your treatment about the evolution of your facial features and any complications you experience.
Facial feminization surgery can be an important part of gender transition. Research suggests that these surgeries can dramatically improve the quality of life in transgender women.