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Facial feminization surgery

Facial feminization surgery includes a range of procedures that change the shape of the face to look more feminine. The surgery can change the look of the cheekbones, brow, lips, jaw and chin. It may include hair transplants or moving the hairline to make a smaller forehead. Skin-tightening surgery, such as a face-lift, might be involved too.

Facial feminization surgery may be done to help treat distress that can happen when a person’s gender identity differs from the sex assigned at birth or from sex-related physical features. This condition is called gender dysphoria. Facial feminization surgery can help better align facial features with a person’s gender identity.

Many facial features, including the jaw, brow and chin, reflect sex differences. While other body parts can be covered or hidden, facial features are easy to see. For some people who have a gender identity that differs from the sex assigned to them at birth, changing facial features is an important step in affirming their gender.

Some risks linked to facial feminization surgery are the same as the risks of other types of major surgery, including:

Other risks of facial feminization surgery include:

Before surgery, you meet with your surgeon. Work with a surgeon who is board certified and experienced in facial feminization procedures. Every person has a unique facial structure. Talk with your surgeon about your expectations and goals for the surgery. From that information, the surgeon can suggest procedures that will be most likely to meet those goals.

The surgeon also may give you information on details such as the type of anesthesia that will be used during surgery. Talk with your surgeon about the follow-up care you may need after surgery.

Follow your healthcare team’s directions on getting ready for surgery This often includes guidelines on eating and drinking. You may need to make changes in the medicine you take. You also may need to stop using nicotine, including vaping, smoking and chewing tobacco.

You might need a CT scan before surgery to help with surgery planning. The scan can give your surgeon detailed information about your face structure. A member of your healthcare team likely will take photos of your face before surgery too.

Consent

Facial feminization surgery might cause changes that can’t be changed back. Because of that, you must give your informed consent for the surgery. Before you give consent, have a detailed conversation about the following with your healthcare professional:

Evaluation for surgery

Before surgery, a healthcare professional checks for medical conditions that might prevent you from having surgery or that could affect the procedure. This evaluation may be done by a provider with expertise in transgender medicine. You also may have a behavioral health evaluation with a healthcare professional who has expertise in transgender health. These evaluations help ensure that you’ll have support for your daily needs, wound care and emotional health after surgery.

Other considerations

Health insurance coverage for facial feminization surgery varies widely. Before you have surgery, check with your insurance provider to see what’s covered.

Before surgery, you might want to talk with other people who have had facial feminization surgery. If you don’t know someone, ask your healthcare professional about support groups in your area or online resources you can trust. People who have had these surgeries may be able to help you set your expectations and goals for the surgery.

During the procedure

Facial feminization surgery might include:

Other head and neck surgeries to create a more feminine look include:

You also might consider skin-tightening surgery, such as a face-lift or other similar treatments.

After the procedure

After surgery, you likely will have pain, redness and swelling in your face. These symptoms usually are most noticeable in the eyes, nose, jaw and chin.

Follow the directions your care team gives you about what you can and can’t do after surgery. People who have facial feminization surgery usually need to rest and recover for about one month. After that, most people can return to their usual routines. But talk to your healthcare professional if you have questions about activities after surgery.

It might be hard to chew and swallow right after the surgery due to stitches and swelling. Your surgeon may suggest that you see a dietitian to make sure you get the nutrients you need. A healthy diet is an important part of recovery.

During your recovery, it may be helpful to talk with a mental health professional who specializes in gender-affirming care. That professional can support you and work with you as you adjust to physical, emotional and social changes after surgery.

You might not see the full and final results of facial feminization surgery for about a year. During recovery, schedule follow-up appointments with your care team. At those appointments, your healthcare professional can check your healing and talk with you about concerns or questions you have.

If you are not happy with the results of the surgery, you may need another surgery to make more changes to your face. You also might need more surgery if your facial features look out of balance after you’ve fully healed.

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