Top 10 Facial Feminization Procedures

April 28, 2023 | Facial Feminization

5 Minute Read:

Facial feminization surgery (FFS) includes a collection of cosmetic and reconstructive procedures plastic surgeons use to feminize facial features for trans women. While FFS is generally sought by trans women for gender affirming purposes, some cis women seek the procedures too.

Smiling transgender woman standing with her arms crossed.

While cis women seek these surgeries when they feel one or more of their features appear more masculine than feminine, trans women often combine several for a more comprehensive feminization.

While some trans women desire to undergo many or even all of the following FFS surgeries, others may only choose to address their top concerns.

1. Adam’s Apple Reduction

A tracheal shave or “trach shave” is used to reduce the size of a masculine Adam’s apple. This throat protrusion (typically more prominent in individuals assigned male at birth) is formed by the cartilage surrounding the thyroid gland.

Reducing thyroid cartilage involves a small incision above the Adam’s apple, allowing the surgeon to access the area and reduce the protruding cartilage.

2. Jawbone/Chin Contouring

The male jaw tends to be larger and more angled than a female’s. Jaw and chin contouring procedures are designed to reduce and reshape masculine jaw angles using a burr through tiny incisions inside the mouth.

An exceptionally large chin or jaw may require a wedge of bone to be removed for ideal results.

3. Forehead Shortening

A long forehead is generally considered a masculine feature. This is caused by a naturally high or receding hairline.

Hairline advancement is an excellent technique to shorten or feminize the forehead. This involves removing a section of skin at the top of the forehead and repositioning the hairline closer to the brow. The new hairline is secured to the skull, allowing the reshaped tissue to heal.

Some patients don’t need a hairline advancement and can achieve their forehead feminization goals with a brow lift and ridge reduction.

4. Brow Ridge Reduction

Brow bossing or forehead reduction refers to techniques used to reduce the prominence of the brow ridge. This facial feminization procedure is very popular as most trans women are concerned about brow ridge protrusion.

The following are the three traditional methods of brow ridge reduction:

Type 1 forehead reduction – Burring alone can reduce minimal brow bossing.
Type 2 forehead reduction – Burring the brow ridge and adding implants or fat grafts to the areas just above the ridge for a smooth transition between the brows and the forehead.
Type 3 forehead reduction (type 3 cranioplasty) – This approach requires cutting and repositioning the bone.

While Dr. Weinfeld frequently uses the type 3 cranioplasty, he also developed an endoscopic approach for women with a milder boney predominance who don’t want hairline advancement.

The Endoscopic Addition Subtraction Forehead Contouring (ASFC) Technique

Dr. Adam Weinfeld is a well-respected, board-certified plastic surgeon and female feminization surgery pioneer. He proudly provides FFS in Austin, Texas, and developed a less invasive approach called the Endoscopic Addition Subtraction Forehead Contouring (EASFC) technique.

EASFC is usually combined with fat grafting and performed endoscopically, eliminating the need for a coronal (across the top of the head) or pretrichial incision. A pretrichial incision is the same as the one used for hairline advancement (forehead shortening), but many FFS patients don’t want or need this procedure.

The endoscopic ASFC technique requires only tiny incisions hidden under the hair and an endoscopic burr to reduce the brow ridge and fat grafting to fill the depressions above the brow. When planning a lateral orbital bone reduction or hairline advancement, a pretrichial incision can be combined with the burring method.

5. Brow Lift and Eyelid Surgery

A brow lift can go a long way to reshape and reposition the eyebrows to reveal eyes that appear larger and more vibrant. Combining this procedure with hairline advancement offers a shorter, more feminine forehead and prettier eyes. The endoscopic approach can reduce the risk of numbness, a common complication with open surgery.

Trans women with droopy eyelids and tired-looking eyes may also benefit from eyelid surgery (blepharoplasty). This procedure tightens the skin and reshapes fatty deposits in and around the eyelids for more interested and alert-looking eyes.

6. Buccal Fat Pad Reduction

The buccal fat pad is located around and just under the cheeks to fill out the lower portion of the face. The lower portion of these fat pads is removed through tiny incisions inside the mouth to narrow the bottom of cheeks for thinner, more femininely defined cheek and jawline contours.

7. Rhinoplasty

Rhinoplasty can resize and reshape nasal structures for a desirable and feminine-looking nose. Rhinoplasty is a complex but very commonly performed cosmetic procedure. Choosing a reputable, experienced, and board-certified plastic surgeon for your FFS procedures, including rhinoplasty, is essential.

8. Liposuction to Smooth and Sculpt the Face

Liposuction is frequently used to reshape the body but can also sculpt and help feminize the face and neck. After the fat has been prepared with a tumescence solution to loosen the fat and minimize discomfort, a vacuum source suctions away unwanted fat.

The removed fat can also be processed and injected into facial areas that would benefit from additional volume.

9. Cheek, Lip, and Brow Augmentation With Fat Grafting

Fat grafting is a wonderful way to achieve permanent volume enhancement for facial sculpting in FFS. Unwanted fat can be removed from the abdomen, thighs, or hips.

After using liposuction to obtain fat, it is purified and then injected into the cheeks, lips, or above the brow.

10. Lip Lift

For women who desire luscious, plump, pouty lips, a lip lift shortens the space between the bottom of the nose and the top of the upper lip for a more youthful and feminine mouth.

You can choose to add a fat graft or dermal filler to the upper and lower lips for even more dramatic results.

Want to Learn More About FFS in Austin, TX?

Call South Texas’ leading gender-affirming plastic surgeon and Austin’s FFS expert, Dr. Adam Weinfeld, at (512) 580-3188 to learn how he can help you achieve your MTF gender-affirming goals.

Dr. Weinfeld loves to help trans women and men become more comfortable in their bodies by offering advanced and fully customized FTM and MTF services in Austin, Texas.