Facial feminisation surgery (FFS) is a set of surgical procedures designed to reshape the male – typical facial features into more feminine – appearing ones. This type of surgery is often sought by transgender women, as well as some cisgender individuals who have a strong desire to modify their facial appearance to be more in line with female aesthetics.
The human face has distinct gender – related features. Male faces generally have more prominent brow ridges, a square – shaped jawline, and a larger, more angular nose. In contrast, female faces often have higher, more arched eyebrows, a smaller, more V – shaped jawline, and a smaller, more refined nose. Facial feminisation surgery aims to address these differences and create a more harmonious, feminine – looking face.
Common Procedures in Facial Feminisation Surgery
Brow Bone Reduction
The Purpose: The brow bone in males is typically thicker and more pronounced than in females. A prominent brow bone can give the face a more masculine appearance. Brow bone reduction surgery, also known as supraorbital ridge reduction, is aimed at reducing the projection of the brow bone. This procedure can make the forehead look smoother and more feminine, and it can also create a more natural setting for the eyebrows.
The Procedure: During the surgery, the surgeon makes an incision either in the hairline or inside the upper eyelid. Through this incision, the surgeon carefully removes or reshapes the excess bone using specialized surgical tools. The amount of bone removed depends on the individual’s facial structure and desired outcome. After the bone is adjusted, the incision is closed, and the area is bandaged.
Rhinoplasty
The Purpose: A male nose is often larger, with a more prominent bridge and wider nostrils compared to a female nose. Rhinoplasty in the context of facial feminisation surgery focuses on refining the nose to achieve a more delicate and feminine look. This may involve reducing the size of the nose, narrowing the nasal bridge, and refining the tip of the nose.
The Procedure: There are two main approaches to rhinoplasty: open and closed. In an open rhinoplasty, the surgeon makes a small incision on the columella, the strip of tissue that separates the nostrils. This allows for better access to the nasal structures and provides more precise control over the reshaping process. In a closed rhinoplasty, all the incisions are made inside the nostrils, leaving no visible external scars. The surgeon may use cartilage from the ear, nose, or rib to reshape the nose and achieve the desired feminine contours.
Mandible (Jaw) Surgery
The Purpose: The male jawline is usually more square – shaped and angular, while the female jawline is softer and more V – shaped. Mandible surgery in facial feminisation aims to reduce the width and angularity of the jaw, creating a more feminine contour. This can significantly enhance the overall femininity of the face.
The Procedure: There are different techniques for mandible surgery. One common method is mandibular angle reduction. The surgeon makes an incision either inside the mouth or along the lower jawline. Through this incision, the surgeon can remove a portion of the mandibular angle bone, which is responsible for the square – shaped appearance of the male jaw. Another technique is chin augmentation or reduction. A more prominent chin is a masculine feature, and in some cases, reducing the size of the chin can contribute to a more feminine look. Conversely, for those with a recessed chin, augmentation can help balance the face and create a more harmonious appearance.
Tracheal Shave
The Purpose: The Adam’s apple, or laryngeal prominence, is more prominent in males due to the larger size of the thyroid cartilage. A visible Adam’s apple can be a source of dysphoria for transgender women. A tracheal shave, also known as chondrolaryngoplasty, is a surgical procedure that reduces the size of the Adam’s apple, making the neck area look more feminine.
The Procedure: The surgeon makes a small incision in the front of the neck, just above the Adam’s apple. Through this incision, the surgeon carefully trims or reshapes the thyroid cartilage. The goal is to reduce the prominence of the Adam’s apple while minimizing the risk of damage to the underlying structures, such as the vocal cords. After the surgery, the incision is closed, and the patient may need to wear a compression bandage to reduce swelling.
The Pre – operative Process
Consultation
Initial Meeting: The first step in the facial feminisation surgery process is a consultation with a qualified plastic surgeon who has experience in performing these procedures. During this consultation, the patient can discuss their goals, concerns, and expectations. The surgeon will also evaluate the patient’s facial structure, taking into account factors such as bone structure, skin quality, and overall facial proportions.
Medical History and Tests: The surgeon will ask about the patient’s medical history, including any previous surgeries, allergies, and current medications. This information is crucial to ensure the safety of the surgery. The patient may also be required to undergo some medical tests, such as blood tests, electrocardiogram (ECG), and imaging tests (such as X – rays or CT scans) to assess the bone structure and overall health.
Psychological Evaluation
Importance of Evaluation: Given that facial feminisation surgery is often related to gender identity and body image, a psychological evaluation is an important part of the pre – operative process. A mental health professional will assess the patient’s psychological well – being, ensuring that they have a clear understanding of the surgery, its potential risks and benefits, and that they are emotionally prepared for the physical and psychological changes that come with the procedure. This evaluation also helps to rule out any underlying mental health conditions that could affect the patient’s ability to cope with the surgery.
The Surgical Process
Anesthesia
General vs. Local Anesthesia: Facial feminisation surgery can be performed under general anesthesia, which puts the patient to sleep during the entire procedure, or local anesthesia with sedation, where the patient is awake but relaxed. The choice of anesthesia depends on the complexity of the procedures being performed, the patient’s medical history, and the surgeon’s preference. General anesthesia is often used for more extensive surgeries that involve multiple procedures, as it allows the surgeon to work without the patient feeling pain or discomfort.
Duration of Surgery
Single vs. Multiple Procedures: The duration of facial feminisation surgery can vary widely depending on the number of procedures being performed. A single procedure, such as a tracheal shave, may take only an hour or two. However, if multiple procedures are combined, such as brow bone reduction, rhinoplasty, and mandible surgery, the surgery can last several hours, often 4 – 8 hours or more. The surgeon will carefully plan the sequence of procedures to ensure the best possible outcome.
The Post – operative Process
Recovery Time
Immediate Post – operative: After the surgery, the patient will be taken to a recovery area where they will be monitored closely. The patient may experience swelling, bruising, and pain in the surgical areas. Pain medications will be provided to manage the discomfort. The swelling and bruising are normal and will gradually subside over time.
Long – term Recovery: The initial recovery period usually lasts for a few weeks. During this time, the patient will need to follow the surgeon’s instructions carefully, which may include wearing compression garments, keeping the head elevated, and avoiding strenuous activities. The full results of the surgery may not be visible immediately. It can take several months for the swelling to completely subside and for the final results to become apparent.
Follow – up Appointments
Monitoring Healing Process: Follow – up appointments with the surgeon are essential to monitor the healing process. The surgeon will check the incisions for signs of infection, assess the progress of swelling reduction, and provide guidance on any necessary adjustments to the post – operative care. These appointments also give the patient an opportunity to ask questions and discuss any concerns they may have.
Risks and Complications
Surgical Risks
Infection: As with any surgical procedure, there is a risk of infection at the surgical site. This can be minimized by following strict sterile techniques during the surgery and proper post – operative care. Symptoms of infection may include redness, swelling, warmth, and pain at the incision site, as well as fever.
Bleeding: There is also a risk of bleeding during or after the surgery. Excessive bleeding can lead to the formation of hematomas, which are collections of blood under the skin. Hematomas can cause swelling, pain, and may require additional treatment to drain the blood.
Scarring
Visible Scars: Although surgeons take great care to minimize scarring, there will be some scarring as a result of the incisions. The location and visibility of the scars depend on the type of procedure. For example, scars from an open rhinoplasty or a tracheal shave may be more visible in the early stages, but with proper care and over time, they can fade significantly. In some cases, scar – revision techniques may be used if the scars are particularly prominent.
Nerve Damage
Sensory and Motor Nerve Damage: There is a small risk of nerve damage during facial feminisation surgery. Nerves in the face are responsible for both sensory functions (such as feeling touch, pain, and temperature) and motor functions (such as controlling facial muscles). Nerve damage can cause numbness, tingling, or weakness in the face. In most cases, nerve damage is temporary, but in rare cases, it can be permanent.
Conclusion
Facial feminisation surgery is a complex and specialized set of procedures that can have a profound impact on the lives of those who undergo it. It offers an opportunity for individuals to align their facial appearance with their gender identity or personal aesthetic goals. However, it’s important to approach this surgery with careful consideration, thorough research, and under the guidance of experienced medical professionals. Understanding the procedures, the pre – and post – operative processes, and the potential risks and complications is crucial for making an informed decision. With proper planning and care, facial feminisation surgery can help individuals achieve a more confident and authentic sense of self.
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