FACIAL FEMINIZATION

MTF What is Facial Feminization Surgery?

Facial feminization surgery or FFS softens masculine features making them more feminine. There are certain facial characteristics that cue others to think of someone as male or female. Facial feminization surgery can change those features to make them appear more traditionally female. Many transgender women easier time presenting as female and a decrease in dysphoria after FFS.

Facial Feminization is a combination of surgeries to soften both the soft tissue and bony structures of the face. Because every patient is different, the surgeries needed may vary from patient to patient. Also, each patient has different areas that cause strong dysphoria. Still, most transgender women desire surgery on the hairline, forehead (brow bossing), nose, Adam’s apple, jaw, and chin, as the bony changes in this area do not feminize with hormones alone.

Additionally, women may wish to change their lips, cheeks, eyes, and neck. To find out what procedures would be most beneficial for each patient, Dr. Rodman conducts a thorough consultation with each patient.

The patient and Dr. Rodman decide on a plan together.

What are the most common procedures performed in Facial Feminization Surgery?

Forehead Reduction
This surgery reduces brow bossing. Dr. Rodman does a Type 3 forehead reduction for patients who qualify.

Hairline advancement and browlift.
These can be done in combination with forehead reduction.

Rhinoplasty
Makes the nose smaller and more refined. Usually by deprojecting and rotating the nose, often also removing a dorsal hump

Chin and jaw reduction
This narrows the chin and decreases the angle of the mandible

Renuvion Skin Tightening
Dr. Rodman recommends this be done with any jaw and chin reduction. The goal is to tighten the skin over the lower face to see the changes in the jaw.

Adam’s apple reduction
Reduces the thyroid cartilage prominence, otherwise known as the Adam’s apple.

Lip lift
This gives more vertical show to the upper lip and decreases the distance from the nose to upper lip.

Blepharoplasty
Reduces extra skin over the eyes, making them appear brighter.

Cheek augmentation
Implants can be placed to increase volume of cheeks.

Fat grafting
Fat is harvested from the abdomen and injected into cheeks, temples, and lips. Gives a softer more feminine appearance.

Buccal fat removal
Fat from the area under the cheekbones is removed through the mouth. This gives concavity to the lower face and helps the cheekbones look more defined.

Facelift
For patients with an aging face, this procedure can be done at the same time to give a rejuvenated appearance.

Skin resurfacing
Some patients may wish to undergo micro-needling, Renuvion laser skin tightening or microdermabrasion to resurface and renew the skin of the face.

Candidates for FFS

A few factors make some a good candidate for FFS.

Diagnosed with gender dysphoria
While Dr. Rodman does not require letters from a therapist to proceed with FFS, she does recommend that patients have a relationship with a licensed professional who has experience counseling patients with gender dysphoria.

Good health
The combinations of surgeries mean a long time under general anesthesia. Patients should be cleared by their primary care doctor and/or cardiologist, depending on age and past medical history. A healthy diet and good hydration will help patients to heal quickly.

Not smoking
Patients must quit smoking and using all nicotine products 30 days before surgery. All products with nicotine are (including gum, mints, and vape) constrict blood vessels and slow healing.

A strong support system
FFS is a positive change for patients, but there are still stressors with ups and downs along the path before and after. Having a support system of family and/or friends will help to get through the recovery period. Dr. Rodman recommends traveling with a close companion or staying in a recovery house in Houston so patients are not alone after surgery.

Hormone therapy
Dr. Rodman does not require patients to be on hormone therapy in order to get FFS. She understands that some patients may not want to take hormones for various reasons. For patients who do take hormones, she recommends being on them for at least 18 months before proceeding with surgery. Hormones will not change the bony structures of the face such as forehead and chin/jaw, but it will thin and soften the skin as well as add some subdermal fat. These changes may improve the results of rhinoplasty as well and cheek augmentation during FFS. Dr. Rodman also understands that some patients have such severe dysphoria they feel they cannot wait for 18 months. This can be discussed on a case by case basis in consultation.

Time spent living as a woman in your community.
Being able to “pass” depends on many factors in addition to facial features. The way a patient’s voice sounds, the way she walks and moves, her mannerisms, and other factors matter in how the public assigns gender. To transition to living full time as a woman, patients will need to be mindful of how they present themselves to the public. Some patients will need to speech therapy to help with their voice. The more time spent living as a woman, the more natural these behaviors become.

Realistic expectations.
Dr. Rodman can help you create a plan for your FFS process and help set expectations. Knowing what to expect is very important to mentally prepare for this transformation.

What can you do to prepare for FFS?

1. Quit smoking, vaping, or using any nicotine products.
2. Eat a healthy and balanced diet
3. Know it’s normal to be nervous!
4. Stay in touch with your therapist and your support system
5. Treat your skin with medical-grade skincare products (available from Dr. Rodman)
6. Stock up on soft foods like eggs, mashed potatoes, ice cream, and smoothies. Consider a meal service like Daily Harvest that will deliver and can be blended.
7. Make arrangements for aftercare to ensure all your needs are met. You will not feel like doing laundry or cleaning afterward, so get all that taken care of in advance.

What are the risks of FFS?

Risks vary depending on the procedure performed.

General possible risks of surgery on the facial skin and skeleton include bleeding, infection, poor healing or scarring, asymmetry, malposition, poor bone healing, unintended fracture of facial bones, contour abnormalities, dental injury, nerve injury (with facial numbness or weakness), injury to the brain or facial sinuses, and need for revision.

Every precaution is taken to minimize these risks.

Dr. Rodman gets a CT scan on every patient for pre-surgical planning. The CT helps map out where each patient’s important nerves are to ensure they are protected during surgery. The CT also helps Dr. Rodman plan where to make cuts in the bone to get the best outcome possible.

What is the recovery process?

Recovery time varies based on what surgeries are done and how physical the patient’s job is. Most patients take 3-4 weeks off of work to recover. Out of town patients should plan to stay 2 weeks in Houston.

The first week patients will be very sore and swollen. Patients need a lot of help the first week as the eyes swell and may even limit vision. Some patients have difficulty swallowing after surgery and need help to ensure they eat and drink enough.

The second week, swelling starts to go down and bruising starts to fade. Patients are able to walk around but will still feel very weak and low energy.

After two weeks Dr. Rodman will take out the last few sutures. Patients from out of town may travel back home after being in Houston for 2 weeks.

Most patients start to feel better at week three and are able to start going out in public. Small amounts of bruising may be covered with makeup.
Week four energy begins to return and many patients go back to work. Swelling in the face is still present but decreased to the point of being presentable

Swelling continues to fade over the first year. Patients will still notice subtle changes in the face for many months after surgery.

The amazing shift FFS can make in a woman’s life needs some planning, a lot of self-love and 2 – 4 weeks of time to recover. Be prepared to take this time.