The Facts About FFS and Transgender Cosmetic Surgery

The Facts About FFS and Transgender Cosmetic Surgery

The Facts About FFS and Transgender Cosmetic Surgery

Let’s face facts here, Estrogen and hormone replacement therapy will only get us so far with our body evolution. It’s a known fact that older you are before starting Estrogen and HRT the harder it becomes to reverse the ravages of either testosterone or Estrogen on pre-transitioned bodies.

Innate prominent male characteristics including wide noses, Adam’s apple, brow prominence, deep set eyes are just a few of the problems that us MTF trans girls wish to change. We turn to FFS or Facial Feminization Surgery, as a last resort, to correct a wide range of bothersome male attributes in an effort to realize our true and desired feminine appearance.

The transgender community inherently has issues surrounding body dysmorphia, I regrettably have to include myself here. During transition we all try to put or best faces forward and go about our everyday lives with varying degrees of confidence, we all know our physical flaws and we try and disguise them with makeup and clothes.

The trouble with body dysmorphia is that it is not helped by the images we now see every day on the media, Instagram, Facebook etc. of transgender idols that have amazing feminine faces and bodies whom we believe will never get “clocked”, they become our ideal poster girls or boys for facial surgery.

I guess for people that are undergoing a transition the difference between body dysmorphia and gender dysphoria is clear. It is surprising then that a few recent prominent trans articles on this subject seemingly confuse both terms, let me list the actual definitions below.

Body dysmorphia or Body Dysmorphic Disorder (BDD), is an anxiety disorder that causes the sufferers to spend a lot of time tormenting themselves about their physical appearance which leads to having a distorted view of how they look.

Gender dysphoria is a recognised medical condition where a person experiences emotional distress and anxiety because there is a complete disparity between their biological sex and their gender identity (Not a mental illness).

“It is important to your safety and wellbeing that for any surgery, facial or otherwise, that you seek a qualified professional accredited medical specialist for any or all procedures.”

The fact of the matter is that the majority of FTM or MTF trans individuals want so desperately to ‘pass’, the desire can easily consume our thoughts and actions (Read our article: Is passing really that important?). It is very common for us trans girls to see no other choice left open on our road of achieving femininity other than going under the knife for facial surgery.

When we lose sight of our health and take unnecessary risks, we have more than our dignity to pay. Back alley injections, unqualified surgeons, non-medical grade fillers and other substances have targeted the transgender community with any number of risks. “Silicone parties” have rendered too many of our community with varying degree of medical complications, lifetime consequences, and even deaths have resulted. Silicone injections are banned in the US by the FDA. Silicone should NEVER be injected into the body for any reason. It is a toxic substance and will lead to medical complications.

It is important to do your own research when deciding to have FFS, or any surgical procedure.

Just as there is the gender binary, no one person has an extreme feminine or masculine facial structure. We are all a blend of the typically associated features of females and males.

Classic Feminine Features:

High, arched tapered brows
Absence of frontal bone bossing
Large eyes, not deep set
Low straight hairline
Wide or narrow cheek and jaw bones
A more delicate nose
Short flat forehead
Short upper lip with well-defined philtrum complex
Full everted vermilion
Non-projecting thyroid cartilages (no “Adam’s Apple”)
Obtuse nasolabial angle (larger angle formed between nose and upper lip, nose tends upward pointing)

Classic Masculine Features:

Low, straight, heavy brows
Smaller, deeper, set eyes
Frontal bone prominence (“Forehead Dominance”)
High, curved hairline with “widows’ peaks”
Square, straighter teeth
Prominent chin
Adam’s Apple (Thyroid Cartilage)
High obtuse, often angled forehead
Prominent supraorbital rims (“Brow Bossing”)
Strong, long, prominent nose
Acute nasolabial angle (smaller angle formed between nose and upper lip, nose is parallel or downward protruding)
Prominent thyroid cartilage
Long upper lip
Narrow lip vermilion
Facial hair
Wide or narrow cheek bone and jaw

Common surgical procedures include:

Rhinoplasty Facial Feminization Surgery
Adam’s apple removal (“Tracheal Shave”)
eyebrow lift
Hair line adjustment
eye brow contouring
forehead contouring
chin contouring
cheek implants
Ear Pinning
Lip lift
jaw contouring
Before proceeding with any surgical procedure, understand the risks. With any surgery, there are inherent risks.

Some potentially dangerous risks surrounding FFS are:

Blood loss: especially dangerous if you are anaemic
Vision impairment
Blood clots
Allergic Reactions
Speech changes

Some ‘healing’ risks, many of which are expected and may not permanent:

Bleeding: Typically, only from suture sites and should not last more than a day. If longer or bleeding is profuse, see your doctor or get to an ER immediately.
Swelling and Bruising: A result of trauma from the surgery. These symptoms will dissipate with time.
General Pain: could be permanent due to malpractice or previous injury/surgery impact.
Numbness: General numbing after FFS is common, making it difficult to eat, drink, talk, and swallow. May last up to a couple months’ post-surgery.
Sore Throat: Resultant from the intubation tube.
Shocks: A result of severed nerves regenerating. These can last up to a couple of months after surgery.
Weakness and Fatigue (Mental and Physical): Activities can be more difficult for up to months following surgery. Being in good physical shape, quitting smoking and not drinking leading up to your procedure will drastically enhance recovery.
Nausea: A result of the anaesthesia is not uncommon.
Hypersensitivity: Some areas may permanently be ultra-sensitive to the touch.
Bed Sores: Resultant from not moving around, laying in one position for successive days.

There are certain cosmetic risks associated with FFS cosmetic surgery:
Graft Rejection or Mismatched Skin Tone: Tissue, even from one’s own body can be rejected, this is an early onset of necrosis and needs to be corrected immediately. Skin tones can become mismatched if blood flow is reduced from surrounding live tissue. This can also be dependent upon the area where the skin is grafted from.
Scarring: There will be a degree of scarring with any surgical procedure. Following the surgeon’s direction, NOT smoking, not drinking (to excess at least) will improve the chances for reduced scarring. There are topical cremes, natural vitamins and other healing remedies available when given the okay to use.
K Shape and Positioning: Often referred to as “botched” cosmetic procedures.
eloids: Raised dark and thick scars. Typically, more common on darker (sun tanned) and black skin tones

Psychological risks of FFS:

Regret: The patient typically feels regretful when the end results are not what they expected and now they have to live with a less than ‘perfect’ result.
Anxiety: Occurs immediately following surgery when the patient sees all the swelling, sutures, remaining surgical marks, dried blood, bruising, and any number of additional post-surgical consequences. It is important to remember the end result is not what you see hours and even days after surgery
Depression: Often occurs when the patient expects FFS to resolve problems not physical in nature. Be realistic with expectations and continue seeing your therapist, psychologist, counsellor before and after surgery.

It is important to do your own research when deciding to have FFS, or any surgical procedure. It is not unreasonable to request to see before and after photos of past patients. If you are referred to a surgeon by someone you trust, that is a great endorsement.

Voice Feminization:

Although surgery is available for some trans women to help with voice feminization it is more common that individuals choose vocal coacing over surgical interventions. You will find our ‘7 Transgender Voice Feminization MTF Coaching Tips‘ helpful if you want to acheive a passable female voice.

We hope that you have found this article useful, please be sure to check out our voice feminization article or visit our advice category for more articles on a wide range of transgender topics.

Recommended Reading: The Smart Woman’s Guide to Plastic Surgery by Jean Loftus (Amazon)

9 thoughts on “The Facts About FFS and Transgender Cosmetic Surgery

  1. Well written. I am currently looking into FFS and looking for a surgeon to do the work.Are there any GRS surgeons who can correct a botched labiaplasty that has no feeling/nerve sensitivity?

    1. OK, here goes Shelli, an FTM trans girl is a ‘Female to Male’ trans-girl, oops well spotted in fact that should read MTF trans girl 🙂 (Post Updated)

  2. Very informative article, but could we please refrain from calling these procedures “cosmetic” surgery. Both providers and insurance companies view cosmetic procedures as optional or frivolous.This allows the former to charge more and the latter to refuse coverage. For many transgender people dysphoria and dysmorphia make these procedures medically necessary.

    1. Thanks for the kind comment about the article being informative, and I definitely take your point on board about ‘cosmetic surgery’; I agree and so will make sure our editor knows so future related articles refrain from referring to same.

  3. What a good overview, this will really help people considering facial gender surgery. To add to Jessica´s comment which we agree with, since facial gender confirmation surgery is not a cosmetic treatment but should be considered a necessary, functional treatment that allows the patient to integrate in society in their chosen gender with confidence, with less discrimination and intolerance, and with less fear of being a target of violence given their appearance is no longer a trigger for embarrassing public rejection by strangers. As you can see, we are also beginning to use different terms than FFS, since the term in itself implies that it is aesthetically involved instead of a life-saving treatment for transgender women who identify with the binary and wish to be seen as females.

  4. Hi my name is Valerie Fox.
    I am currently on HRS for about 4 years now. I thought I would provide your readers a sm.all tidbit of information regarding voice therapy.
    I found that by doing karaoke or singing to the radio is a great way to traine your voice to sound more feminine without surgery. I have been doing this for several years and it’s working for me. I hope this will help you.

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