During puberty, testosterone causes many changes in Male to Female (MtF) bodies, including development of the skull and facial bones, as well as cartilage in the face and neck. After puberty, although hormone therapy can make the skin of the face look softer and can bring about minor changes to the fat/muscle structure of the face, the basic structure of the face and neck can’t be changed by hormones; only surgery can reshape the contours of bone and cartilage.

         MtFs have varying beliefs about face and neck surgery. Some feel it is very important in helping reduce their gender dysphoria. Others are concerned that MtFs may feel pressure to get face and neck surgery to conform with conventional standards of attractiveness of women. Like any other types of SRS, there is no right or wrong answer in terms of whether to get face or neck surgery: it is a personal decision.

         FFS includes two types of techniques: surgery on the bones or cartilages of the skull, or work on the soft tissue that covers the bone/cartilage. Bone reconstruction in FFS is based on the differences between the average “male” and “female” skull. Soft tissue work may be done to amplify the work done on bone, or instead of bone reconstruction, if relatively minor changes are sought. Soft tissue work is less invasive than bone reconstruction.

FFS includes the following procedures :​

  • Brow shaving : grinding down the orbital rims (upper edge of eye sockets) to remove brow bossing forehead implant: using synthetic bone-filler to round out a flat forehead

  • Brow lifting : tightening of the skin on the forehead and raising of the eyebrows

  • Scalp advancement : bringing the scalp and hairline forward

  • Jaw reshaping : removing bone from the back corner of the jaw, possibly with removal of part of the masseter muscle to make it less prominent

  • Chin reshaping : removing bone from the chin and reshaping it so it looks more tapered, less square, and shorter

  • Chin augmentation : using implants if the chin is receding

  • Nose reshaping/reconstruction : to change the appearance of the nose is called rhinoplasty. Some MTFs want their nostrils or the tip of their nose to look different. Other times surgery on the bridge of the nose will be recommended to MTFs who are having forehead surgery, so the flow from nose to forehead looks smooth. The surgical changes to the nose that can be done as part of FFS include:

    • reducing the bone from the bridge of the nose to make it flatter

    • reducing the width of the nose to make it thinner

    • shortening the nose by removing some of the cartilage at the tip of the nose narrowing the nostrils

  • Micro fat grafting : to make cheeks more prominent and make the lips look fuller.

  • Tracheal shave : to reduce the size and noticeability of the laryngeal prominence.

Timing of face/neck surgery​

         Most FFS techniques can be done at any point in transition (at the start, in the middle, or after you have had other surgeries). If you want both forehead and nose surgery, it is recommended that they be done together, as changes to the forehead can affect the shape of the nose.​

Risks and possible complications of face/neck surgery​

The patient should be aware of risks and possible complications. Vaginoplasty is done under general anesthesia. Possible complications specific to vaginoplasty include:

  • Adverse reaction to anaesthesia

  • Blood clots

  • Excessive bleeding

  • Wound infection

  • Slow healing

  • Numbness (most are temporary)

  • Scar problems

Facial Feminization Surgery (FFS)

Post-operative care​

The aftercare instructions are different following different types of facial surgery and depend on the specific technique used. Talk with your surgeon before surgery to make sure you understand what to expect and what you need to do after being discharged from the hospital, as well as pain treatment options.​


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