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Female face

Facial feminization surgery (FFS) is a well recognized collection of facial reshaping procedures that is largely reductive in nature. While most commonly associated with the male to female transgender patient, it also applies to non-transgender women who simply want to soften their facial features. It is a collection of mainly facial bony changes to reshape the forehead, nose, cheeks, jawline and trachea.  A few soft tissues procedures also can be done like lip augmentation.

In the Published Ahead of Print section of the March/April 2019 Journal of Craniofacial Surgery, an article was published entitled ‘ Evolution of Full Facial Feminization SurgeryCreating the Gendered Face With an All-in-one Procedure’. In this paper the authors describe their approach to facial feminization surgery in a single surgery to which they give it the name….all-in-one procedure. They describe their experience with this FFS surgery in forty-nine (49) patients over a fourteen (14) year period. Retrospectively they identified nine (9) patients, age 19 to 33 years old, who had this all-in-one FFS procedure. The average operative time was 280 minutes. (just under five (5) hours) All patients were discharged the day after surgery. No infections, wound healing problems, or nerve damage were reported. Patients returned to work within 30 days after surgery.

I find that a standard approach to many FFS patients is not really ideal. Not every patient needs the exact same facial procedures nor do some of the procedures create the best return on investment for every patient. An individualized approach should be done for each patient establishing levels of value for the various facial areas in terms of creating a feminizing change. I break these down into critical procedures (Level 1), good to do but not absolutely essential procedures (level 2) and nose mod you can but has the least effect procedures. (level 3)

This establishment of levels of FFS processes for patients is critical due to economics. If the cost of surgery was irrelevant then every patient could have all of the available facial procedures. But when cost is considered it is important to determine which facial procedures have a good ROI. (return on investment)

But what thus paper does clearly show is that FFS surgery, no matter how extensive can be safely performed as an overnight stay. In addition FFDS surgery is associated with a fairly low rate of complications or adverse long-term effects.

Dr. Barry Eppley

Indianapolis, Indiana

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