Facial feminization surgery (FFS) can help relieve gender dysphoria. The techniques can help transgender women transition physically to their self-affirmed gender. Facial feminization surgery is different for everyone. The process depends on the facial features you decide to change. It includes a wide range of reconstructive and aesthetic surgical procedures that reshape facial features to make them appear more feminine. Examples include moving the hairline to create a smaller forehead, augmenting lips and cheekbones, or reshaping and resizing the jaw and chin. Skin-tightening surgery, such as a facelift, is another option. Dr Kanhai will talk to you about your wishes and what goals are realistic to achieve.
What to expect
Pre-operative:
- Bring a list of your questions and concerns to your pre-operative visits. Understanding the expectations for recovery, based on your plan, is essential.
- You will need surgery referral letters from two qualified mental health professionals.
- You will be given guidelines on eating, drinking and adjusting current medications before the surgery can take place.
- Smoking is a relative contra-indication to subcutaneous mastectomy. Because of the increased risk of infection i.a., you are advised to stop smoking as soon as possible.
- After you have discussed which surgery technique is best for you, Dr Kanhai will draw up a plan for the operation.
- The anaesthesiologist will provide information on the anaesthesia, and doctor Kanhai about the type of the operation, and the follow-up procedures that might be necessary.
- Dr Kanhai will also ask about any risk factors for blood clotting issues (past deep vein thrombosis or pulmonary embolism), bleeding problems (like haemophilia), or family/personal history of issues with anaesthesia.
- You will undergo a physical examination to ensure readiness for the operation.
- Imaging scans might be done before facial feminization surgery. X-rays or CT scans take pictures of the bones and soft tissues of your face and skull. Dr Kanhai might also measure your face, take photographs and assess your skin quality.
Peri-operative:
- We will give you general anaesthesia through a vein in your arm. You will be asleep throughout the procedure and won’t feel any pain during surgery.
- Forehead contouring: In cisgender men, the bony ridge above the eye sockets tends to be more pronounced. In cisgender women, the outline of the forehead tends to be higher, smoother and more rounded. To make the forehead appear more feminine, part of the forehead bone is shaved and reshaped.
- Lowering the hairline: Feminine hairlines tend to be located lower than masculine hairlines. During hairline lowering surgery, an incision is made at the edge of the hairline. The scalp is raised, placed back and fixed to the bone. Excess forehead skin is removed.
- Eyelid modification: To feminise the upper eyelids, excess tissue can be cut away.
- Cheek augmentation:Cisgender women tend to have prominent round cheeks in the middle third of their faces. This is due to a greater concentration of fat in the area. To achieve a more feminine appearance, cheek augmentation can be done by lipofilling.
- Nose reshaping (rhinoplasty): To feminise the nose, rhinoplasty may include reducing the overall size of the nose and changing its angles.
- Lip lift and augmentation: Feminine faces tend to have shorter distances between the base of the nose and the border of the upper lip. Masculine faces have longer upper lips. A lip lift can shorten the distance between the lip and the nose and create a shorter, more curled lip. Lips can be enlarged with lipofilling.
- Chin width reduction: Masculine chins are taller than feminine chins and tend to be more square-shaped. To shorten and narrow the chin by shaving the bone.
Post-operative:
- As with any surgical procedure, there is a period of necessary healing and recovery. The time for healing varies among patients and depends on the type of FFS surgery.
- You will have gauze or bandages over your incisions for 1 to 2 weeks. You have to wear compression wraps around your forehead or jaw to reduce oedema.
- A surgical drain will stay in the incision site for a couple of days. A drain is a thin, plastic tube Dr Kanhai places under your skin. It helps to drain blood and fluids to prevent swelling.
- After the sutures are removed, your face will need weeks to continue the healing process until the final result is visible.
- Definitive and stable results might not appear until up to a year after facial feminization surgery. During your recovery period, you will continue to talk to specialists involved in your treatment about the evolution of your facial features and any concerns you might have.