There is no singular feature that defines a feminine or masculine face; it’s a combination of multiple features and the ratio of feminine to masculine features, hence the staged approach to facial surgery.
Due to genetic variation and the effects of sex hormones like estrogen and testosterone during puberty, men and women tend to have different facial characteristics. Facial features traditionally considered masculine include a prominent brow, nose and chin, thick eyebrows, a square jaw, a long face, and a visible Adam’s apple. In short – chiselled, more angular features. In contrast, women usually possess softer, rounder facial characteristics—a smooth forehead without bossing, a pointed chin, a more delicate nose, fuller cheeks, and an arched brow. Regardless of these “traditional” standards, you are unique!
Before deciding on the procedure, it’s best to ask around in your local queer community for references to certified medical professionals with experience in treating trans and/or non-binary folks. You must also be fully aware of and prepared for the social implications of undergoing this surgery, in addition to the implications in countries that do not recognise your trans status, such as legal documentation that requires a photograph.
When you meet your surgeon for the first time, discuss any doubts or questions you may have. As with any surgical procedure, you must disclose your medical history, current medications and/or supplements, and so on. You will also need to take x-rays, photos and a 3D scan showing your facial bones and tissue, to provide a baseline for evaluation – a “before” and “after”.
The surgical procedures involved in facial surgery are considered outpatient treatment, so you’ll be able to go home after a short observation period or, when necessary, an overnight stay. Make sure you have someone with you, as you’ll be groggy from the anaesthesia.
You will need time off work to recover after each surgical procedure, as there will be some bruising and swelling and some degree of pain. Your surgeon will advise you on pre and postoperative care. Rest well, and let your body recover. You might also need to eat liquid foods for a while after jaw surgery, so stock up on nutritious soups and shakes! During the initial days of your recovery, your bathing routine should only be sponge baths until your surgeon gives you the ok to take a shower (phew!).
Facial feminisation surgery
Facial feminisation surgery, or FFS, helps create a more feminine appearance of the face. It can be a series of plastic surgery procedures in a staged approach, instead of a single surgery.
The World Professional Organisation for Transgender Health (WPATH) regards FFS as both medically necessary and essential for the wellbeing of transgender individuals, as this allows us to adapt more easily to the workplace and social and family environments1. For those who feel that hormone therapy has not given them the desired face shape, this is an option that can help boost confidence and reduce dysphoria.
Cis women may also undergo the same procedure, as well as non-binary folks seeking a more feminine appearance.
In FFS, your forehead, brows, nose, cheeks, and jaw are reshaped. The Adam’s apple may be minimised as well through tracheal shaving. In addition to the surgical procedures, non-surgical treatments such as cosmetic fillers, botox, fat grafting, and liposuction may be included. Voice therapy is another non-surgical option.
Depending on your requirements and desired outcome, your surgeon may suggest one or more of the following procedures2:
Forehead and hairline contouring
The forehead and hairline are reshaped to create a more oval or heart-shaped face. Your surgeon will measure the existing bone structure and carefully work around the frontal sinuses behind your forehead bone.
The procedure may include reducing the bony ridge above your eyes, by grinding or shaving it down, or cutting a piece and replacing it with a smoother bone graft. An incision will be made across your forehead, from ear to ear. The incision will be closed with sutures that will not need to be removed, and there will be a drain in place to remove excess blood and fluid. The drain will be removed before you go home.
Brow lift and eyelid lift
The brow is elevated to give the eyes a feminine appearance. For patients also choosing forehead and hairline contouring, the brow can be lifted through the same incision. If you’re only having a brow lift, your surgeon will make a few small incisions in the hairline or a single incision around the brow line.
In older patients, the eyelids may also be lifted through incisions either hidden in the crease of the eyelid or behind it to minimise visible scars.
Nose surgery
The nose-reshaping operation is called a rhinoplasty (a.k.a nose job) and is used to reduce the width and shape of the nose. The procedure can involve cutting or reshaping the bones and cartilage. A rhinoplasty can also shape the bridge and the tip of the nose to give them a more delicate appearance.
Jaw contouring and chin reduction
This is probably the most in-depth procedure. You may need to undergo an evaluation by a dentist or orthodontist to ensure your teeth and bones are healthy.
In mandibular angle recontouring, the corners of the lower jaw are shaved to create a softer angle.
For genioplasty, the chin bone is cut and pushed forward, as an alternative to a chin implant. The chin bone may be shaved.
Jaw surgery requires an incision to be made inside your mouth. To keep your mouth clean in the weeks following the surgery (since you can’t brush), your surgeon will provide you with a prescription mouthwash.
Tracheal shave
The fancy term for this is chondrolaryngoplasty, and this procedure reduces the size of the Adam’s apple, which tends to be larger in folks assigned male at birth.
The surgery itself takes just a couple of hours. Your surgeon will make an incision in a less obvious area, or within the natural creases of your neck. Some of the cartilage on front of the larynx will be shaved to make it smaller, and the incision is then closed with sutures.
You may experience swelling and bruising and difficulty swallowing. Your voice may also be a bit hoarse. These complications will clear up within a week or so, so don’t worry! A more serious complication is damage to your vocal cords.
Liposuction and fat grafting
To shape the face, your surgeon may recommend this procedure that basically transfers fat from one area of the body to add volume and smooth out hollow or sunken areas. A silicone implant may also be added, depending on your goals.
Facial masculinisation surgery
The face offers important clues to one’s identity, and as such obtaining a more masculine facial appearance is an important treatment goal for many trans men and/or non-binary folks. While it is a personal decision, it can help alleviate some dysphoria and make social integration smoother.
Facial masculinisation surgery, or FMS, like FFS, involves a combination of procedures based on your goals. The procedures that may be performed during FMS include forehead lengthening/augmentation, cheek augmentation, rhinoplasty, chin recontouring, jaw contouring, and thyroid cartilage enhancement (enlarging the Adam’s apple).
Depending on your requirements and desired outcome, your surgeon may suggest one or more of the following procedures3:
Forehead Lengthening/Augmentation
Lengthening the forehead by increasing the distance between the eyebrows and hairline can create a more masculine appearance. Additionally, forehead augmentation can create a larger, more angular forehead. With both procedures, the surgical incision is made within the hairline to avoid visible scarring. The scalp is then lifted and pulled backwards. In augmentation, a prosthetic material is used to shape the forehead.
Cheek Augmentation
During cheek augmentation, implants are placed in between the bone and the skin to create a more angular and masculine shape. Because the surgical incision is made inside the mouth, cheek augmentation leaves no visible scars.
Rhinoplasty
With rhinoplasty (“nose job”) performed during FMS, the goal is to create a larger and/or wider nose or increase the nasal projection. Because every nose is different, this tends to be a very individualised procedure, and several surgical techniques can be utilised to obtain the best possible aesthetic result. Surgical incisions from rhinoplasty usually heal very well with minimal scarring. After rhinoplasty, a cast will be placed on the nose for about one week, along with absorbable sutures to close the surgical incisions.
Chin Recontouring
Because male chins tend to be longer and squarer, the goal of chin recontouring is to increase the size of the chin for a more angular appearance. An incision is made inside the mouth and the bone is moved to reshape and recontour the chin, and implants may also be used.
Jaw Contouring
Jaw contouring is a useful procedure to create masculine facial proportions, increase the overall width of the face, and provide definition between the lower face and neck. During a jaw contouring procedure, the surgeon places an implant into the jaw through an incision in the mouth. This technique avoids visible facial scarring.
Thyroid Cartilage Enhancement
The Adam’s apple, a prominent notch in the thyroid cartilage, is one of the more visible differences between the male and female visage. With thyroid cartilage enhancement, a small incision is made below the chin and an implant is placed in the throat area. The neck muscles are then closed over the implant to protect the vocal cords. Some vocal weakness is expected during the first few weeks post-surgery, so don’t be alarmed. Take note that this procedure alone will not deepen your voice, as voice changes are mainly attributed to hormones.
