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Facial feminization surgery

Facial Feminization Surgery (FFS) refers to elective surgical procedures to alter a ‘masculine’ face to become a ‘feminine’ face. FFS comprises bony and soft tissue surgery of the face and trachea but is generally not regarded to include facial hair removal and hair transplants, though a case could be made for their inclusion as well.

The surgical techniques come from soft tissue plastic surgery, maxillofacial surgery, and reconstructive surgery. During the 1980s to 1990s, the field was pioneered by maxillofacial surgeon Douglas K. Ousterhout in U.S.A. Since 2000, it has also been developed independently by reconstructive surgeon Suporn Watanyusakul in Thailand. Apart from these practitioners who perform surgery nearly exclusively upon transsexual and transgender women, it has also been taken upon by other maxillofacial and plastic surgeons as part of their practice, notably by Frans Noorman van der Dussen in Antwerp, Belgium.

Though the skills required of this surgery are less esoteric than male-to-female genital sex reassignment surgery (SRS), there seems surprisingly fewer highly experienced and skilled surgeons than those practicing SRS. As of 2003, FFS has become an increasingly sought field of expertise by the international transgender community with many support groups worldwide.

Surgical procedures

Here is a short list of some of the more popular surgical procedures carried out during FFS. It is by no means a comprehensive list.

  • Brow lift
  • Temporal lift
  • Scalp advancement
  • Frontal bossing reduction osteotomy
  • Reduction osteotomy of the supra-orbital rims
  • Nasal tip refinement
  • Osteotomy of the bony pyramid of the nose
  • Dorsum reduction
  • Zygoma augmentation
  • Submalar augmentation
  • Sliding genioplasty
  • Lateral lower mandibular shave
  • Mandibular angle shave
  • Submandibular liposuction
  • Neck lift
  • Face lift (often SMAS)
  • Platysma banding elimination
  • Thyroid chondroplasty (see trachea shave)
  • Otoplasty

Many of these procedures are also commonly carried out as part of routine cosmetic surgery (face lift, neck lift, etc) while some of them are specific to feminization (mandibular angle shaving, brow bossing reduction).

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