Facial feminization surgery consists of a group of surgical procedures that transform the features of a face from male to female. Facial feminization includes surgical manipulation of the hairline, brow, nose, and chin.
The characteristics of a person’s face are often the first aspect we notice when approaching someone. The face is our portal to interact with the outside world. In a glimpse, even a young child will subconsciously assess whether the person in front of them is male or female based on the facial structure.
FFS is a group of procedures that transform the features of a face from male to female, involving surgical manipulation of bone and soft tissues. Many of our patients regard this as an essential process in gender confirmation to gain full social acceptance. Male and female faces have very distinguishing features. In general, a woman’s face will have softer, smaller, more delicate, and rounder features with an oval-shaped face, compared to the larger, more square-shaped face of a man.
Women have shorter, flatter foreheads with a rounded hairline. The eyebrows are typically higher and more arched. Men have a square or rectangular hairline, a heavier brow, and lower, flatter eyebrows. The bridge of the female nose is straight to mildly concave, with a slightly upturned and smaller tip. A male nose is broader with a wider tip. The female chin is smaller and less prominent than the male chin, as is the Adam’s Apple.
Although these are aesthetic guidelines, every patient is different. Dr. Crane and Dr. Satterwhite understand that an individualized plan addressing each patient’s cosmetic concerns is the best way to optimize results with facial feminization surgery. There is no “one-size-fits-all” approach to treating your face, your precious window to the world. Not every patient will require “full” facial feminization. The procedures performed will be determined after detailed discussions and analysis, upon which you and the surgeon determine a very specific, personalized plan.
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This involves a series of steps to shape the forehead to match female aesthetics. Through a hairline incision, the brow is approached. In most patients, excess bone over the brow (overlying the frontal sinus) is cut away, and then repositioned to a less prominent position. Additional burring of the brow and orbits is performed, creating a more open appearance of the eyes. The eyebrows are elevated to create a more feminine arch. In the appropriate patients, scalp advancement shortens the forehead and rounds out the hairline. Patients with an excessively recessed hairline or prior operations may not be ideal candidates, and will have to consider other options such as hair transplantation or the use of a hairpiece.
Male cheeks tend to be broad and flat, while those of females tend to appear more prominent and refined. Multiple options are available including fat grafting, bone grafting, and the use of synthetic implants. Incisions are generally made inside the mouth.
Operating on the nose requires a very individualized approach. In general, an incision is made along the base of the nose (along the columella) to allow surgical access. Hump reduction is performed, and a series of controlled fractures (osteotomies) are used to narrow the bridge. The tip of the nose is narrowed and refined. Asymmetries in the nose and septum (inside your nose) may also be addressed.
Female lips tend to be fuller, especially the upper lip. In aesthetically-pleasing female lips, the upper lip projects slightly over the lower lip. Achieving pouty lips can be accomplished through several means: injecting fat, surgically inserting a dermal graft (using a piece of your own skin), or by using temporary biologic injectable materials (such as hyaluronic acid). Women tend to have a shorter distance between the base of the nose and the vermilion (the red part of the lip), and they also have more tooth (“incisor”) show when lips are relaxed. A “lip lift” can be performed to create these feminine qualities.
Hallmark features of a male face include a broad, tall, heavy jaw that flares out and has a more prominent angle (gonial angle) in the back. Through an incision inside the mouth, the jaw can be contoured to make it more feminine. This involves cutting away the excessive bony angle and rounding out the back part of the jaw. Burring along the sides further tapers the jawline
Through an incision inside the mouth, a sliding genioplasty is performed to decrease the height and width of the chin. Based on pre-operative assessment, a sliver of bone is removed to decrease the size. After cutting and resizing the bone of the chin, it is then held into place with small plates.
Thyroid Cartilage Reduction (“Tracheal Shave”)
Through a small, well-concealed neck incision, the Adam’s apple is accessed. The upper portion of the thyroid cartilage is sharply reduced to create a more feminine neckline. It is important to note that temporary speech changes may occur after the operation.
Modification of your voice can be performed to fully complete the process of feminization. Dr. Crane and Dr. Satterwhite work in conjunction with Dr. Mark Courey, professor of ENT and Director of the Voice Center at the University of California San Francisco, who specializes in surgical voice feminization. During your FFS, Dr. Courey can perform vocal cord modification at the same time. Additional information about Dr. Courey can be found at http://www.ucsfhealth.org/mark.courey.