Facial feminization surgery FFS & body feminization procedures
Facial feminization is a set of cosmetic procedures done to soften typical male facial features and provide more classically feminine features to the face and neck. FFS is typically sought by the transgender population but can be performed for anyone seeking to soften their facial features. The selection of procedures is customized for each person based on their aesthetic goals. Some of the most popular procedures performed by Dr. Totonchi include:
Hair transplant (may require multiple sessions) – $10 per plug – 5-7 hours.
Hairline shortening – $4000 – 3 hours.
Frontal bossing shaving (forehead I) – $3000 – 2 hours.
Frontal bossing shaving & hairline shortening – $4500 – 2.5 hours.
Frontal bossing shaving w/forehead reconstruction w/plating (forehead III) – $4000 – 2 hours.
Frontal bossing shaving w/forehead reconstruction w/plating and hairline shortening – $6000 – 4 hours.
Facelift – $5000 – 5 hours.
Malar fat injections $1000 – 30 minutes.
Upper lip shortening – $2000 – 1 hour.
Upper and lower lip fat injections – $1500 – 30 minutes.
Fat injections to the upper eyelids – $500 – 30 minutes.
Mandibular angle shaving – $1500 – 1 hour.
Genioplasty (advancement and contouring) – $2500 – 1 hour.
Chin reduction osteoplasty – $3000 – 1.5 hours.
Tracheoplasty – $2500 – 1 hour.
Upper blepharoplasty – $2000 – 1 hour.
Four lid blepharoplasty – $4000 – 2 hours.
Rhinoplasty – $5000 – 2.5 hours.
Secondary rhinoplasty – $6000 – 3 hours.
Hairline advancement/forehead shortening
Scalp advancement is a procedure done to move the hairline forward, decreasing the prominence of the forehead. The procedure is used to decrease the distance between the hairline and the eyebrows giving a more youthful, feminine appearance.
Hair transplant involves moving hair follicles from one part of the scalp to another. ”Donor site” is the area where the hair follicles are taken from, which is generally the back of the head, and they are placed in the area to be treated, which is called the “recipient site.” Hair transplant is a minimally invasive procedure which is generally used to treat male pattern baldness. It can be done under local anesthesia but generally needs to be repeated for 2-3 sessions for optimal results.
Frontal bossing correction/Forehead bone contouring
Forehead contouring involves “shaving” down the frontal bone and altering its pronounced shape. Masculine foreheads have a heavy bony ridge above the eyes, just below the eyebrows. Forehead contouring typically removes this ridge and softens the appearance of the forehead and facial features.
The brow lift/forehead lift gives the most dramatic FFS results. The brow lift procedure moves the eyebrows to a higher set position on the forehead, giving a softer, wide eyed, feminine appearance. The brow lift can be used in combination with the scalp advancement procedure to give a more youthful feminine aesthetic outcome.
The facelift procedure is one of the most common plastic surgery procedures in the country. A traditional facelift incision begins in the hairline and continues around the ear, and ends in the lower scalp. All of these incisions are placed in the natural folds of the skin or in the hair line to conceal the scars. During a facelift procedure, excess skin is trimmed and sewn together to achieve a smoother, younger, more feminine facial contour. In cases where patients have an excessive amount of fat especially in the neck area, fat removal and neck muscle tightening, neck lift, can be performed in conjunction with a facelift for optimal results. Face and neck lift procedures are recommended for the transgender population over the age of 40 for optimal results of their FFS.
Rhinoplasty can be a key element in transgender facial feminization. The male nose, like the masculine chin, is typically longer, wider, and larger than the female nose which is generally shorter, narrower, and smaller in relation to female features. The nasal tip is generally adjusted to give a upward feminine appearance rather than the typical male downward nasal appearance.
The upper lip lift is generally done in combination with the rhinoplasty procedure. A small incision is made under the nose to lift the upper lip and decrease the distance between the nose and the upper lip. Decreasing the distance between the nose and upper lip gives a more feminine balance to the face.
Malar augmentation/fat grafting
Cheek augmentation can be achieved with fat grafting and/or implants. Cheek augmentation helps to round out the face giving it a feminine appearance. The incisions used to insert cheek implants or fat grafting are made through the mouth so there is no evident scar on the surface of the face.
Transgender chin contouring is performed to transform a wider, flatter, longer, and more squared masculine chin to a narrower, shorter, more rounded female chin. The chin plays a crucial role in the proportions and balance of facial features.
In cases where patients have an excessive amount of fat, especially in the neck area, fat removal and neck muscle tightening/neck lift, can be performed. Many times, a face and neck lift are done in combination to achieve a smoother enhanced look of the face and an elongated appearance of the neck.
A tracheal shave reduces the size of the Adam’s apple to achieve a smoother, more elongated appearance of the neck. A tracheal shave is done through a small incision on the anterior neck which Dr. Totonchi uses as an entry point to “shave” down the tracheal cartilage. Tracheal shave is one of the simplest surgeries done to obtain feminine features and can be performed under local anesthetic.
What about Hormone Replacement Therapy (HRT) and FFS?
The goal of HRT therapy for MtF reassignment is to cause development of feminine features such as: breast tissue, fat and muscle redistribution and hair reduction. Feminization is primarily done through the use of the hormone estrogen. HRT has a dramatic, positive impact with changes in body structure, making it more feminine. Hormones not only change your physical appearance, they also change the way you feel about yourself, which in turn improves self-esteem. Generally speaking, patients should be on hormone therapy and living in their preferred gender role for at least 1 year prior to facial feminization surgery or other reconstructive procedures.
What should I expect after facial feminization surgery?
Facial feminization surgery has a wide range of recovery time depending on the combination of procedures that are chosen. Generally speaking, the recovery time is approximately 2-3 weeks when involving one of these procedures or a combination of these: forehead contouring, hairline advancement, brow lift, rhinoplasty or genioplasty.
The combination of these procedures, however, does not increase the recovery time. The recovery time remains 2-3 weeks. When adding the rhinoplasty procedure, nasal splints and stents are kept in placed for 2 weeks before removal.
The tracheal shave procedure performed alone does not have any “downtime”.
While you are considering facial feminization surgery, make a plan for yourself. Determine what it is that you like or dislike about your look. What are the masculine features that you would most like to soften and make more feminine? At your consultation, Dr. Totonchi will meet with you and discuss your aesthetic goals openly and honestly, and explain what is possible and attainable for you. He will assist you in choosing the best surgical plan to attain your desired outcome.
Call and make your consultation appointment with Dr. Totonchi to discuss your FFS needs, call office at (440) 461-7999.