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Glossary: Gender-Affirming Facial and Aesthetic Surgery

Transgender healthcare is any and all healthcare that supports transgender people in their health and well-being. It can include primary care, as well as specialized medical care or gender-affirming care that supports their gender transition or gender affirmation goals. Transgender healthcare can include gender-affirming hormone therapy (GAHT, sometimes called HRT), gender-affirming surgery including facial feminization surgery (FFS), top surgery, breast augmentation and other surgeries, emotional support, mental health services, peer support, reproductive medicine, and other types of care.

Here are some common terms, definitions, and questions you may have about facial feminization surgery (FFS).

Facial surgery

Facial surgery is any surgery that alters the look of the head, face, or neck. This highly specialized field includes surgeries for the brow, cheeks, jaw, nose, chin, ears, lips, and other facial features.

Feminizing surgery

Any surgical procedure that makes someone look more feminine falls into this category of surgery. This can include breast augmentation, bottom surgery, orchiectomy, jaw shaving, certain types of facial fillers, liposuction, and other body sculpting procedures. Facial feminization surgery is also called “FFS” for short. FFS means the specific surgeries that create a more feminine appearance, such as rhinoplasty, laryngeal shave, or jaw shaving. Some of these procedures are covered by insurance as gender-affirming surgery, while others are considered cosmetic or aesthetic procedures. Reach out to your insurance company to learn more about your coverage.

Nonbinary facial surgery

Since every nonbinary person defines their own gender expression, there is no one-size-fits all surgery for nonbinary folks. Nonbinary facial surgery might include rhinoplasty, brow reduction surgery, and jaw shaving or jaw injections. Some of these procedures are covered by insurance as gender-affirming surgery, while others are considered cosmetic or aesthetic procedures. Reach out to your insurance company to learn more about your coverage.

Masculinizing surgery

Any surgical procedure that makes someone look more masculine falls into this category of surgery. This can include top surgery, bottom surgery, certain types of facial fillers, jaw injections, liposuction, and other body sculpting procedures. Some of these procedures are covered by insurance as gender-affirming surgery, while others are considered cosmetic or aesthetic procedures. Reach out to your insurance company to learn more about your coverage.

Types of facial feminization surgery (FFS)

Any surgical procedure that makes someone look more feminine falls into this category of facial feminization surgery (FFS). This can include jaw shaving, certain types of facial fillers, liposuction, rhinoplasty, and other facial sculpting procedures.

Nose job or rhinoplasty

Rhinoplasty, commonly known as a “nose job,” is a facial surgery that changes the shape or size of someone’s nose. The surgeon may break, reset, shave down, or otherwise sculpt the nose to look more feminine. The average cost of rhinoplasty is $5,483, according to the most recent statistics from the American Society of Plastic Surgeons.

Brow reduction surgery

Brow reduction surgery makes extremely subtle micro adjustments to the bones of the forehead and eye ridges to look more feminine. The surgeon may shave down or even reset these bones during the procedure.

Skin care for surgery

Preparing for surgery is more than just paperwork. While facial surgery happens below the skin level, you can take good care of your face and body to ensure that you are ready for your procedure. Healthy skin and bones heal faster, so think of your self-care routine as an investment in your future wellness! Proper hydration, using moisturizer, and taking a multivitamin can all help you get ready for your upcoming procedure. Learn more about skin care here.

Recovering from facial feminization surgery (FFS)

Facial feminization surgery is a major surgery, so recovering will take time—up to twelve weeks for some people. Many people sleep sitting up while they’re healing. It’s important to take a pause on physical activity, including exercise, cooking, or any activity that might cause you to break a sweat, including carrying your own groceries. Follow your surgeon’s guidance to get the most out of your healing and give your face a chance to settle into its new shape.

Pain medications after surgery

Since gender-affirming surgery is a major medical procedure, pain management is important to the healing process. Opioids, acetaminophen, ibuprofen, ice packs, and other comfort measures can help you get through the first week. Talk to your doctor about your pain needs to make a plan.

Activity limitations before and after facial surgery

Prior to facial surgery, there are no activity limitations unless specified by your surgeon. Obviously, you should try to avoid illness and injury prior to surgery—you don’t want to have to reschedule because you got hurt doing something! After surgery, you will need to rest and wait for your doctor’s approval before returning to gentle exercise, such as slow walking. If you’re a swimmer, ask your doctor when you can get back in the water!

How can I get FFS covered by insurance?

Every insurance plan is different, so check your plan’s coverage for gender-affirming surgery. You may also need to work with a primary care doctor, get a letter of support for the procedure you want, and find a surgeon who knows how to perform facial feminization surgery (FFS).

How much does facial feminization surgery cost?

There is no set price for facial feminization surgery (FFS). Each procedure is different and each surgeon may charge a different amount. However, the average cost of each procedure is fairly standardized. For example, the average cost of cheek implants is $3,669, the average cost of chin augmentation is $3,137 and the average cost of lip augmentation (without injectable fillers) is $2,299, according to the most recent statistics from the American Society of Plastic Surgeons. Laryngeal shaving costs $3,000-$4,000.

Some people use insurance to pay some or all of their surgery costs. Others crowdfund, pay out of pocket, or rely on gender-affirming grants.

How long do I have to be on hormones before I can get facial feminization surgery?

The short answer: it depends. Some surgeons require their patient to be on hormones for at least one year, since the body and facial features can change dramatically while using GAHT. If hormones are not appropriate for your gender identity, it is possible to bypass this requirement with a letter from your doctor.

The WPATH Standards of Care do not state criteria for surgical procedures such as feminizing or masculinizing facial surgery. In this way, FFS and other facial surgeries are different from procedures such as top surgery or bottom surgery. however, mental health professionals can play an important role in helping their clients to make fully informed decisions about the timing and implications of such procedures in the context of the overall coming-out or transition process.

What’s the difference between regular cosmetic surgery and FFS?

Facial feminization surgery (FFS) is a procedure that reshapes the face to align with someone’s gender expression. Often, surgeons make very subtle adjustments to the bones in someone’s jaw and brow, or they might use dermal fillers to create a softer appearance. They may also use laryngeal shaving to diminish the appearance of an Adam’s apple or “masculine” looking trachea or neck area.

FFS is a gender-affirming surgery and is considered life-saving for the people who need it. In comparison, regular cosmetic surgery is not life-saving. People get cosmetic surgeries purely for aesthetic reasons.

How long after facial feminization surgery will I feel normal?

Everyone’s healing process is different, which is why it’s important to communicate with your surgeon during your recovery. You may need up to one year to feel “normal” after FFS. It might also take up to a year to see definitive results from your surgery. Your body will need time to heal and “settle” into its new shape and that can take months. Know that this procedure is life-changing for many people, but it isn’t an overnight transformation. 

Beyond your physical recovery, you might need some time to get used to how other people respond to your new face! Your “before and after” FFS results may be dramatic or subtle, depending on your desired procedures and outcomes. Even minor FFS can be quite a transformation, so be gentle with yourself.

Does facial feminization surgery (FFS) hurt?

Facial feminization surgery is performed under anesthesia, so you will be unconscious during the procedure. The recovery period can be uncomfortable and even painful for some people. Your doctor will offer you medications to manage your pain. Some people say that the bandages, bruises, and general soreness are the most painful part. Luckily, the healing period for FFS is relatively short and most people are back to pain-free living within a month or two.

Can I make my face look more feminine without surgery?

If you’ve decided that FFS isn’t for you, there are plenty of safe, non-surgical alternatives. Makeup is the most popular choice. Some people also use dermal fillers, electrolysis or hairline treatments, and other non-invasive treatments to make themselves look more feminine.

About Plume

Co-founded by one of the leading voices in transgender healthcare, Dr. Jerrica Kirkley (she/her), Plume is the #1 gender-affirming healthcare provider in the world. Plume provides care and support for gender transition. Our services include gender-affirming hormone therapy (GAHT, sometimes called HRT or hormone replacement therapy) such as estrogen and testosterone prescriptions for transgender, nonbinary, and gender non-conforming individuals. Plume also provides specialized health care for the trans community that includes peer support and medications for treating anxiety and depression. To become a Plume Member, click here.

At Plume, we understand that your gender transition is deeply personal. We strive to provide the best care possible. We provide access to gender-affirming medications as well as resources that can help you understand the potential risks and benefits of your gender-affirming health care options. We also provide access to experts who can provide education and support throughout the process. We are committed to providing information about many types of information, from the clinical to the personal. While we strive to include a diverse range of voices and expertise, not everything will be for every person. Each individual’s experience is unique, and the information Plume provides is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always first seek the advice of your primary and/or specialist physician, the Plume Care Team, or other qualified health provider with any questions you may have regarding a medical condition or your health care needs regarding gender-affirming hormone treatment. Learn more about your options and start your customized care plan with Plume today!

 

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