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Having a softer and more feminine face is the goal of facial feminization surgery. (FFS) While most commonly associated with the transgender patient, FFS is also used for the non-transgender female who feels their facial appearance is too masculine or has one facial feature that is considered excessively strong for their facial appearance.

Facial feminization surgery is a collection of reshaping procedures that can be done from the skull down to the neck. The three major facial thirds are analyzed and a treatment plan is established for the maximal feminizing effect. Most FFS procedures involve bone reduction/reshaping although a few of the changes involve just soft tissue. While some treatment centers offer a standard ‘FFS oackage’  it is important to realize that not every patient needs the exact same FFS surgery. And not every FFS procedure is always done in a single surgery.  But almost all FFS surgeries involves multiple facial procedures done at the same time.

Preoperative Evaluation

Since most of the facial changes done in FFS are largely either irreversible or difficult to reverse, it is critically important that the patient has the best knowledge as to what the impact of the proposed procedures will create. While any FFS procedure can be performed on a patient who seeks the surgery, the critical question is whether such changes will produce the desired aesthetic outcome. This speaks to the value of undergoing preoperative computer imaging to see the effects the selected facial changes may create. While computer imaging is an approximation of the surgeon’s belief as to how the facial changes may appear after surgery, it provides an invaluable visual guide for the patient to determine both the value of the surgery and what facial procedures would work the best. No form of structural facial surgery should be done without a preoperative computer imaging evaluation.

Facial Feminization Surgery Procedures

Facial feminization surgery (FFS) is most common performed by board-certified plastic surgeons, all of which specialize in this type of facial surgery and many of whom have had craniofacial surgical training and experience. Surgery may be performed in an outpatient surgery center or a hospital depending upon what procedures are been done and whether the procedures may be covered by insurance. Time in surgery depends on the location and number of facial procedures being done.  Surgery could be one hour or take up to 8 to 10 hours to perform. The facial procedures are always performed under general anesthesia (asleep). You can discuss the appropriate type of anesthesia with your doctor and the anesthesiologist. Some FFS procedures are done as an outpatient but more extensive facial reshaping procedures will require an overnight stay.

FFS  procedures are divided into four zones of treatment; skull/forehead, midface, lower jaw and neck which will be discussed in subsequent writings.

Dr. Barry Eppley

Indianapolis, Indiana

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