Facial Feminization Surgery (FFS)

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In some cases, due to genetic or diseases that increase male hormones, women’s faces do not have the elegance and feminine beauty. And their face are masculine somehow. Too much facial hair growth, and skin changes such as thickening of the skin and changes in facial bone structure (such as augmented forehead, mandible, etc.) are changes that become apparent when male hormones increase in women.

On the other hand some of men, because of mental and emotional disorders, need to have Sex reassignment surgery. After legal procedures, and surgery, for marriage and a getting back to normal life in society as a woman, they need Facial feminization surgery.

Some of the actions that can be performed for Facial feminization are non-surgical or done by medicine. Unfortunately, in some cases these actions are not enough and do not have the desired result. In such cases surgical methods can solve the problem.
Facial feminization surgery is one of the surgeries with which pepole are not familiar. And often Surgeons do not provide information for patients.

What should we do for women who want to have a feminine face?

The first step is the diagnosis. This means that any factor which causes increase of male hormones level must be diagnosed and cured in a way that male hormones level will be reduced. Once hormonal changes of women are under control or cured, some male characteristics start to disappear spontaneously or become less obvious (for example, facial hair becomes thinner with less density). However, we know that some of the unwanted problems are still on the face and will not be resolved spontaneously (for example, changes of structure of the face). Therefore, in these cases we use other methods.

In this article, we try to point out some of the differences between men and women’s faces, and a brief description about Facial feminization of each part of face.

The forehead

Forehead and eyebrows are different in men and women. This area is one of the most important differences between men and women. The area of eyebrows in Men is augmented and the area between the eyebrows is flat. In the lateral view we can see a concave shape. But women’s forehead are convex and this can bee seen in different angles. The edge of the bone around the eye in men is more augmented and may need to be modified.


The distance between the eyebrows and Hairline for women is less than men. This difference can be seen even for men who have not experienced hair loss yet. The distance is about 5cm for women and 7cm for men. Big forehead is normal for men, but for women is not beautiful at all. Women know this and that is why they try to hide their big forehead by different hairstyles.

Bringing hairline forward

The purpose is to shorten the forehead and the distance between hairline and eyebrows. Then a big forehead woman looks younger and more feminine. One of supplementary actions that we can do during the surgery is to lift forehead and eyebrows simultaneously. This can help prople look younger.

In this surgery, we make an incision in front of hairline. There would be no trace after some time. But for patients who worry about this, we can transplant hair in the place of incision.

This can also be done without anesthesia, and the patient can be discharged on the same day.

The eyebrows

Eyebrows in women are naturally higher than men and the distance between eyes and eyebrows is more in women. In young women (who are not experiencing droopy eyebrows) eyebrows are higher than the edge of the bone above the eye. But in men it is placed right on the edge or a little lower than that. Masculine-face women can have a more feminine face by eyebrow lift.


The nose

In General, women have smaller nose. A big nose is a thing that makes the face masculine. In women the nose skin is thinner and the angle between nose and upper lips is wider. In men nose hump is normal but for women a nose with a nice arc shape is fine . Rhinoplasty is another method which help Facial feminization a lot.


The cheeks

Augmentation of cheeks is different for men and women. In men the skeleton of this area is more augmented and there is less soft tissue. In such case augmentation is in width and in fontal view is not obvious that much. This feature makes men attractive. But this is not true for women. In women soft tissues of face are more and cheeks are augmented in frontal view. Actually changing this feature can makes the face masculine or feminine. This should be considered when cheek augmentation by prosthesis is needed.

For cheek augmentation we can use prostheses or fat/filler injection. According to the above mentioned points, fat injection increases the soft tissue in face and hide the bones. That is why for Facial feminization fat injection is better than prosthesis.

Prosthesis implantation in cheeks is done under general anesthesia condition. But fat injection can be done with local anesthesia and sleep.


The chin

In women chin is narrower and its vertical length is less than men’s chin. But in men chin is broad and rounded and its vertical length is more than women’s chin. In lateral view, a man’s chin is more augmented. This makes men attractive. But this is not true for women. By changing chin dimensions (its height, width and augmentation) we can make chin more feminine. To do this removing a part of chin bone or implanting a special porsthesis is needed.


The angle of mandible

The angle of mandible in men is wider than women. And also the muscles are stronger in men. In fact, strong muscles in Mandibular Angle result in a growth outwards and this area in men is wider that women whose Mandibular muscles are more compact.

Changing the angle of the mandible plays an important role in Facial feminization. By decreasing the tissues of angle of the mandible, we can make the face more feminine. To do this, we remove a part of the bone and muscle of this area in a way that does not affect its normal activities. This is done through intraoral and without skin incision.

Nowadays in western countries, Augmentation of angle of the mandible is very common in men and women. Therefore in theses countries, contrary to the above mentioned point, some women want to augment the angle of the mandible. But in any case, this should not be exaggerated.


The laryngeal prominence (commonly referred to as Adam’s apple)

In men laryngeal cartilage is more prominent than in women. In most cases Laryngeal cartilage in women can not be seen at all. The laryngeal prominence has a negative effect on the beauty of a woman’s neck. If laryngeal prominence is too much, it can even decrease the beauty of the neck in men.

Chondrolaryngoplasty (commonly called tracheal shave) is a surgical procedure in which the thyroid cartilage is reduced in size by shaving down the cartilage through an incision in the throat, generally to aid those who are uncomfortable with the girth of their Adam’s apple. This can be done without anesthesia.


Feminization Laryngoplasty (Voice Change Surgery)

Finally after Facial feminization, the probable problem is a masculine voice for a woman. We know that the frequency of women’s voice is higher than men.

Some women, because of the form of the larynx and vocal cords, have a masculine voice. By some changes in the larynx, we can change the sound frequency in a way that the voice becomes feminine. This can be done without anesthesia and it can be done in a way that is reversible (i.e. If the patient is not satisfied with the new voice, we can bring the previous sound back)

Additional changes for Facial feminization

In addition to the above mentioned, we can do other things for facial feminization such as hair transplantation, fat injections in different parts of the face and neck, filler injecting and so on.

Finally, for choosing the best method of facial feminization, it is recommended that the person consults with an expert in this field and then selects the most appropriate way.

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