Facial Feminization Surgery (FFS)
Facial feminization surgery, or FFS, is a surgery defined by a set of procedures that aim to alter masculine-looking facial features to create a more feminine appearance. These procedures enable patients to obtain critical gender-affirmation of the face. FFS is often sought by transgender women and gender diverse individuals who wish to have a more feminine appearance, but aspects of this surgery can also be performed on cisgender women who have naturally masculine-looking facial features.
For FFS, a variety of procedures can be performed throughout the entire face, including forehead and orbital rim contouring, browlift, hairline rounding and advancement, jaw and chin reshaping, nose reshaping (rhinoplasty), cheek and lip augmentation, upper lip lift, Adam’s apple reduction (tracheal shave), eyelid surgery (blepharoplasty), facelift, and neck lift. When performed in the correct combination, the overall effect is transformational.
Facial feminization surgery is a detail-oriented and complex surgery that is best performed by a facial plastic surgeon, such as Dr. Seth, who has extensive knowledge and experience in craniofacial and soft tissue surgery of the head, neck, and face.
Dr. Seth is a nationally recognized expert in gender-affirming facial surgery (GFS) and will help create an outward facial appearance that aligns with your inner self. Dr. Seth is dedicated to giving you the confidence to be your best.
Each facial feminization surgery is customized with each patient during a thorough examination and discussion with Dr. Rahul Seth. A detailed facial evaluation, combined with consideration of patient goals, helps inform which elements of the surgery are best suited for each patient. Using 3D photography and software, Dr. Seth creates a 3D image of your face that he alters with you so that together your surgical plan can be created. This allows you to see the anticipated result and have confidence that your surgeon knows each of your desires and goals for your face.
Hairline advancement surgery is also known as a forehead reduction or hairline lowering surgery. Hairline advancement surgery helps to create a more rounded hairline, reduces temporal recessions and widow’s peak, and brings the hairline forward. These changes enable a more youthful and feminine appearance.
The procedure involves making an incision along the existing hairline and then removing a strip of skin and the temple recessions to move the hairline forward. The incision is strategically designed so that hairs can grow through the incision to disguise and hide it. The incision gives access to the brow area to perform forehead bone contouring and brow lift.
This procedure helps create a more younger and more feminine appearance by elevating the eyebrows to sit higher in relation to the orbital rim. The masculine configuration of the brow is to sit at the level of the upper bone ridge of the orbit, while the feminine configuration of the brow is above the upper orbital rim.
Multiple different techniques can be used to lift the brow. When a hairline advancement is performed and the forehead height is shortened, the brows are accessible and secured in a higher position to feminize. Securing the brow is done with sutures and with bone-anchored fixation, both of which are essential to maintain longevity of the elevated brow position.
Bone Contouring Of The Forehead, Brow & Orbital Rims
The differences in skull anatomy between males and females are pronounced in the forehead and orbital rim area. Particularly, the prominence of bone at the brow is one of the most differentiating factors.
Forehead contouring surgery, also known as forehead reshaping or brow reduction surgery, is a procedure that alters the shape and size of the forehead so that it is more feminine in appearance.
The technique requires removal of bone from the forehead and orbital rims. This involves drilling of the bone that makes the shape of the brow. Additionally, for most patients, a portion of the frontal / forehead bone (the anterior table of the frontal sinus) is removed and then repositioned to reduce brow size and projection. This is known as “frontal table set-back”, or “anterior table set-back”. The bone is secured with plates and screws in its new feminized position.
Chin & Jaw Modification
Mandible reduction surgery, also known as chin and jaw reduction surgery, is a procedure that is done to reduce the size and projection of the jawline to create a more feminine appearance.
The procedure involves making an incision inside the mouth along the lower jaw to reveal the jawbone (mandible). A drill and a precise, specialized ultrasonic bone aspirator is used to carefully craft the mandible at the angles, main body, and chin areas of the mandible as per the specifics of the patient’s goals. The muscle in the chin can also be altered to be smaller and the cleft of the chin is reversed, all without making any incisions on the skin. Overall, the jawline is made more delicate and feminine with emphasis to create a balanced V-shape jaw.
Depending on the desired jaw shape, some patients may need a chin implant in addition to reduction of other areas of the jaw bone. A customized approach is created for each patient in order to create balance of the jaw with the rest of the face.
The cheeks are typically the widest part of the feminine face. Additionally, the feminine cheek has a rounded, volumized appearance.
Cheek augmentation is a surgical procedure that is used to enhance the shape and size of the cheeks. The procedure can be done to create a more feminine shape.
There are several different techniques that Dr. Seth uses to perform cheek augmentation, including the use of implants, the use of injectable fillers, fat transfer, or a combination of these.
Implants are typically made of silicone or porous polyethylene and come in various sizes and shapes. The cheek implant is placed through an incision inside the mouth and occasionally also in the lower eyelid. It is then positioned and secured to the bone. Dr. Seth utilizes implants when there is lack of bone volume and support of the cheekbone (maxilla).
Fat transfer (fat grafting) is a technique that involves removing fat from one area of the body, most often the abdomen and flanks (love handles), processing and purifying it, and then injecting it into the cheeks to add volume and create shaping definition. For volumizing the cheeks, Dr. Seth’s preference is to use fat transfer as it creates a natural, rounded, and soft volumization. Depending on the amount of fat needed and the amount of cheek bone present, Dr. Seth may recommend combining fat transfer with cheek implants.
Injectable fillers are another option for cheek augmentation. They are a non-surgical option that can be used to add cheek volume. The fillers are injected through a small needle and the procedure is usually done under local anesthesia. Dr. Seth uses fillers in patients who prefer not to have surgery.
Rhinoplasty is commonly referred to as nose job or nose reshaping. Feminizing rhinoplasty, also known as female nose reshaping, is a surgical procedure that is used to alter the shape of the nose to create a more feminine appearance. It is often a significant component of facial feminization surgery, especially because it must be sculpted to gently curve into the reduced and feminized brow ridge.
Feminizing rhinoplasty can involve a variety of techniques to achieve the desired outcome, such as reducing the size of the nose, refining the tip, and narrowing the nostrils. The goal is to create a more delicate and refined nose that is in harmony with the rest of the face, and the gender identity of the patient.
To accomplish the procedure, the size of the nasal bones and cartilage are often reduced. The tip of the nose is made more refined by reducing the size of the tip and reshaping the cartilage. The nostrils may be narrowed to create a more refined and delicate appearance.
Feminizing rhinoplasty is a complex and delicate procedure that should only be performed by a highly skilled and experienced surgeon such as Dr. Seth. Having performed nearly a thousand rhinoplasties, Dr. Seth brings a keen and experienced skill set to rhinoplasty that maximizes both aesthetic results and functionality of the nose to breathe.
Adam's Apple Reduction
Adam’s apple reduction, also known as thyroid cartilage reduction or more commonly as ‘tracheal shave’, is a surgical procedure that is used to reduce the size of the Adam’s apple (thyroid cartilage) in individuals who have a prominent or masculine-appearing Adam’s apple.
Transcervical chondrolaryngoplasty (tracheal shave through the neck skin):
The procedure involves making an incision in the skin of the neck to access the Adam’s apple. Areas of the thyroid cartilage that create the Adam’s apple prominence are identified through the incision. To hide the incision, it is placed in the upper neck in the area under the chin or in a skin crease. Despite these efforts, it can be noticeable.
Transoral chondrolaryngoplasty (scarless tracheal shave, through the mouth):
Since the scar through at the neck skin can remain visible, Dr. Seth pioneered the ability to perform the operation through the mouth without needing a neck incision. This is called the transoral chondrolaryngoplasty or “scarless tracheal shave.” While originally described in Israel and done with specialized and bulky cameras and instruments placed under the skin of the neck,, Dr. Seth’s technique smoothly allows the ability to perform the tracheal shave from the mouth.
Identifying the vocal cords:
The thyroid cartilage is the ‘voice box’ and contains the vocal cords that produce
our voice. Therefore, it is essential that these structures are preserved and remain unharmed, while maximizing the amount of Adam’s apple removed. In both the transoral and transcervical approaches, Dr. Seth uses a small fiberoptic camera to identify the location of the vocal cords inside the thyroid cartilage. This step is essential to locate and protect the vocal cords.
Additionally, speech therapy is critical for retraining voice and speech patterns. Prior to performing any voice alteration surgery, our team recommends a consultation and evaluation with our speech and language specialists, to make the speaking patterns as feminine as possible. After completing a comprehensive therapeutic treatment course, patients may elect to proceed with actual vocal alteration surgery. Although Dr. Seth does not perform voice surgery, he can connect you with physicians who can help perform these procedures.
Eyelid surgery, or blepharoplasty, can treat loose or sagging skin, bags under the eyes, and excess skin and wrinkles of the eyelids. It can be performed on the upper lids, lower lids, or both to rejuvenate the eye area and create a younger and more feminine appearance.
Upper eyelid surgery, also known as upper blepharoplasty, involves making an incision along the natural crease of the upper eyelid. Excess skin from the upper eyelid is removed. The eyes are a central focus point of the face and the feminine appearing eye is more open, particularly in proportion to the size of the rest of the face when compared to the masculine face. Blepharoplasty helps to open the eyes and create a more feminine appearance. Combined with browlifting, this
Lower eyelid surgery, also known as lower blepharoplasty, involves making an incision along the lower lash line or inside the lower eyelid. The surgeon will then remove excess skin, fat, and muscle from the lower eyelid to create a more youthful and refreshed appearance.
Face & Neck Lift
A facelift and neck lift can be to help reverse the signs of aging, but they are also an important part of facial feminization surgery. As we age, many masculine features become more prominent, emphasizing the contrast between men and women. Reducing signs of aging can minimize the contrast and lead to a more feminine facial appearance.
Upper Lip Shortening / Lip Lift
The proportion of skin between the top of the upper lip and the bottom of the nose is typically larger in males. Shortening the length of this area can create a more feminine appearance and can complement a rhinoplasty procedure.
Gender-affirming facial surgery / facial feminization surgery (FFS) is a good option for you if:
- have been diagnosed with persistent gender dysphoria
- have an established gender identity and lived experience living as a member of your desired sex
- are of the age to provide surgery consent
- are physically and mentally healthy
- are a non-smoker
- have a positive outlook and realistic expectations
Depending on the number and type of procedures selected, you may elect to break your surgery into multiple phases, focusing on different areas of the face for each procedure, or choose to do most of it together. Dr. Seth works with you
Oftentimes, several surgeries are interdependent and must be done in tandem to achieve the optimal results. For example, forehead contouring, rhinoplasty, and mandible reduction are often performed in conjunction with one another.
Surgery is performed at a credentialed surgery center or hospital. Depending on the length of the surgery, you may stay overnight at the center.
Dr. Seth recommends that patients have someone to spend the first 48 hours with them for careful monitoring. We are happy to arrange for a home nursing service if desired.
Following surgery, Dr. Seth will bandage the incision and provide an elastic compression dressing to wear. You may also be given drainage tubes to help you with your healing; these will be removed the following day. Any surgical clips or stitches used on your incision will be removed after one to two weeks.
Throughout your recovery, we recommend patients be gentle with their face and hair; wait to shower until two days post-treatment. Patients may experience swelling, bruising, numbness, and a feeling of tightness or tension in the face and neck. Most of these issues usually resolve within four weeks, and sensation typically returns to normal within a few months.
Pain medication is prescribed for pain relief but most patients are able to wean themselves off in several days, taking Tylenol and Motrin only as needed.
Recovery time will depend on the scope and breadth of your surgery. We recommend patients do not engage in any vigorous physical activity for two weeks after their surgery. At two weeks, most patients can resume light activity. And, at four weeks, patients can return to normal activity levels. Each patient is counseled and instructed on post-surgical care by our team.
How To Get Started
If you’re interested in a Facial Feminization Surgery or want to learn more about your options with Dr. Rahul Seth, please request a consultation online or by phone at (925) 357-9050.
During your consultation, you will have time to discuss your goals and treatment options. During this process, you will get to know Dr. Seth and the Golden State Plastics team that will be with you every step of your journey. Once your consultation is complete and your unique treatment plan is created you will work with the Golden State Plastics team to schedule surgery. Once your surgery is scheduled, you will receive a pre-operative appointment to review your procedure, post-operative instructions, and expectations on your road to recovery.
Frequently Asked Questions
Facial feminization surgery is a set of surgical procedures designed to modify the facial features and create a more feminine appearance. It is typically performed on transgender women or individuals seeking a more feminine facial aesthetic.
The specific procedures included in FFS can vary depending on individual needs and goals. Common procedures that Dr. Seth performs as a comprehensive approach to FFS include involve feminizing frontal cranioplasty, brow contouring, forehead reduction with hairline advancement, brow lift, rhinoplasty (nose reshaping), nasal alar base reduction, lip lift, cheek augmentation (using fat from another part of the body, implants, or both), lip augmentation, jaw reduction, chin reshaping, tracheal shave (Adam’s apple reduction), neck liposuction, blepharoplasty, facelift, neck lift, and buccal fat removal.
Dr. Seth takes time with you during the consultation to understand your needs and desires. Importantly, he will create a 3D image of your face on the computer screen. With a software program, he will be able to change the shape of your facial features to simulate results and determine the degree of change you would like to have on your face. With this, you can have confidence in your communication with Dr. Seth to provide you the surgery you need.
The duration of facial feminization surgery depends on the complexity and combination of procedures being performed. It can range from several hours to a full day. Dr. Seth will be able to provide a rough estimate during your consultation.
Performing any surgery on the face or body will leave a scar. However, Dr. Seth carefully designs areas of incision so that scars are maximally hidden. Dr. Seth creates incisions in areas that are hidden by your hair or are inside your mouth. In fact, Dr. Seth is the first in the United States to publish results of the scarless tracheal shave.
Yes, Dr. Seth is commonly referred patients to have revision surgery. With his high outcomes and well known expertise in the area, he is by patients and other facial surgeons to perform revision facial surgery.
Yes, Dr Seth is the innovator of the scarless approach that does not require the limitations of cameras. He was the first in the world to publish his results. He regularly performs this procedure with high outcomes. Whether you would like to combine the scarless approach with your complete FFS or just have the scarless tracheal shave approach, Dr. Seth can perform this surgery.
The recovery period for FFS can vary depending on the extent of the procedures performed. Swelling and bruising are common after surgery and gradually subside over several weeks. Full recovery and final results can take several months. During the initial recovery, there may be some discomfort for which you will be provided pain medication. Prior to the surgery, you will have a dedicated appointment to review instructions on post-operative care.
Facial feminization surgery aims to soften and feminize facial features, but it cannot completely eliminate all masculine features. The extent of feminization achieved will depend on various factors, including your individual anatomy, the procedures performed, and your overall goals. Realistic expectations and open communication with Dr. Seth regarding your goals is important. Likewise, he will provide you with a realistic picture of what is possible with surgery.
As with any surgical procedure, there are risks involved with facial feminization surgery. Possible complications can include bleeding, infection, adverse reactions to anesthesia, scarring, asymmetry, changes in sensation and numbness, pain, vision changes, and dissatisfaction with the aesthetic outcome. It’s crucial to discuss these risks with Dr. Seth. Although Dr. Seth’s complication rate is very low, FFS is a major surgery and you should be well informed of potential risks even if they are unlikely.
Dr. Seth is a nationally recognized expert in facial feminization surgery. He has performed over a thousand FFS procedures and is well known for his excellent outcomes. In fact, he has published his outcomes in the official Facial Plastic Surgery journal. He is also an innovator in the field and has created the scarless tracheal shave technique, the chin muscle and chin dimple removal procedure (mentalis imbrication), and has innovated multiple approaches for facial masculinization. His expertise is further cemented by being co-editor of an operative techniques issue regarding gender-affirming facial surgery and an upcoming textbook on gender-affirming facial surgery.
Furthermore, Dr. Seth takes the time to know you and your desires through discussion and computer modeling of your face. His patients find him to be a kind and dedicated individual. He has a deep passion for gender-affirming facial surgery and believes strongly in the importance of this surgery for his patients. He knows that this is a life altering and vital surgery for you and does everything he can to give you the best outcome possible.
Before & After