What Is Facial Feminization Surgery?

Facial feminization surgery (FFS) includes surgical procedures that alter the structure of your face to create more feminine features. Specific areas of the face we focus on vary from person to person. These might include the:

  • brow,
  • nose,
  • cheeks, and
  • chin.

 We will discuss these in detail during your initial consultation.

Facial Feminization Services

 We offer the following services for facial feminization:

 *Only needed for older patients who have excess skin of face and/or eyelids 

Hairline Advancement & Reshaping

We will make an incision (cut) that hides just behind the hairline. We will lift and move the hairline forward to give it a rounder, more feminine shape and shorten the forehead.

Brow Bone Reduction & Contouring

We will access the bone of the forehead through an incision (cut) that hides behind the hairline. The technique we use for brow bone reduction depends on the severity of prominence of the bone and the results of the facial X-rays. During this procedure, we will remove and reposition a portion of the bone. We may even sand the bone down, if necessary. If we need to remove the brow bone and set it back, we  will use small titanium plates and screws to reposition the brow bone.

Direct Brow Lift

This procedure is also done using an incision that hides just behind the hairline. We will release the deep tissues that attach your eyebrows to the underlying bone, which allows us to raise the brows into a more feminine position. 

Corrugator Muscle Resection

The corrugator muscle adds bulk across the middle part of your brow bone and allows you to furrow your eyebrows. During this procedure, we partially remove the corrugator muscle to decrease the fullness over your brow giving a softer, more feminine look.

Fat Grafting

We perform fat grafts on your cheeks, lips, or temples. We will harvest fat from the abdomen through a gentle liposuction technique and inject it into the cheeks and lips through very small incisions (cuts). This  will increase the fullness of your cheeks, temples and lips to create a more feminine appearance of the face. 

Rhinoplasty

We will make an incision (cut) across the skin of your columella (part between the nostrils) and inside your nostrils to access the cartilage (soft tissue) of the tip and middle of your nose. We will generally narrow the bony base of your nose and refine the tip to feminize it. Your nostril size may need to be reduced as well to fit your new nose.

Upper Lip Shortening

Through an incision that hides around the base of your nose, the upper lip will be shortened to allow your upper teeth to show more when your mouth is at rest and to create increased fullness to your upper lip.

Mandible (Jawbone) Angle Reduction

We will make an incision on the inside of your mouth between the gums and the lower lip to remove any excess jawbone to create a more narrow lower jawline that is shorter.

Reduction Genioplasty

We will reshape and shorten your chin through an incision on the inside of the mouth between the gums and the lower lip. We will use small titanium plates and screws to secure the bone of the chin in its new position.This will create a more oval-shaped chin with a shorter distance between the lower lip and chin.

Tracheal Shave

During this procedure, we will remove any excess thyroid cartilage (your Adam’s apple) from your throat. This is done through an incision that hides in the crease between the underside of your chin and neck. We will place a camera down your breathing tube to locate your vocal cords and prevent any injury to them.

Facelift

We will remove any excess skin and tighten the skin of your lower face and neck.

Upper and Lower Blepharoplasty

We will remove excess skin and fat from your upper and lower eyelids.

Does Insurance Cover Facial Feminization Surgery?

Before your appointment, we advise that you contact your insurance carrier to determine whether transgender facial feminization is a covered benefit. However, most Utah payer plans do not cover facial feminization surgery. We are currently sending claims to the insurance companies to obtain data around how many denials we receive so we can advocate for facial feminization as a covered benefit.

After you have had your first appointment, we can contact them to obtain a pre-authorization prior to the surgery.  Insurance companies use the pre-authorization process to ensure that your surgery is covered. This process can take up to six months depending on your insurance provider. Our team will keep you in the loop as we receive status updates. However, you can always call your insurance for updates too.

For any questions about the pre-authorization process, please call us at 801-213-2195, option 1. If you reach our voicemail, please leave your:

  • name,
  • phone number, and
  • date of birth.

If our providers are not in-network, ask your insurance company if you would qualify for a gap exception. A gap exception can sometimes be granted as a covered service if there are no other in-network providers in the area that offer that service.

You can check our insurance information to verify whether University of Utah Health is in your network of coverage. If you do not have coverage, we will provide you with an out-of-pocket cost estimate.

What to Expect at Your First Appointment

How to Prepare

If you want bone work done (forehead, jaw etc.), you will need to get facial X-rays prior to your visit. Our team will schedule these X-rays for you when you set up your consultation appointment. If you have your letters of support, please bring them to your visit (however, they are not required for your initial consultation).

Your Appointment

The first appointment will take about 60 to 80 minutes. During this time, you will meet with the plastic surgeon and potentially a physician’s assistant and/or resident to discuss your goals for surgery. You will fill out a new patient intake form collect information for our staff  about your medical history, transition history, and areas of concern. We will also take pictures of your face to submit to your insurance for pre-authorization. Then, we will plan your surgery and provide you with an out-of-pocket price quote.

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Surgery Preparation

You should avoid any facial treatments (electrolysis, chemical peels, etc.) two weeks before your surgery date. You will need to call our surgery staff the day before your surgery and they will give you instructions for your surgery. Depending on the length of your surgery and your overall health, you may need to stay in observation over night after your surgery.

Length of Surgery

Surgery can range from 1.5 to eight hours, depending on how many procedures you chose. You may need more than one surgery. If this is the case you will need to wait at least three months in between each surgery to allow your body to heal. 

Facial Feminization Surgery Risks

We will discuss all side effects and risks with you during your initial consultation. Bruising and swelling are the most common. However, some rare risks may include:

  • bleeding
  • infection and wound healing,
  • numbness after surgery that does not improve with time,
  • bone healing problems,
  • infected titanium plates/screws that may need to be removed, and
  • potential for scarring. However, our surgeons are very careful about where scars are placed to hide the incision mark.

Facial Feminization Recovery

All post-surgical care will be discussed at your consultation depending on what procedure you have chosen. We will commonly prescribe you with medications for common post-surgical side effects such as  pain, nausea, and constipation. We recommend you take at least two weeks off from work to recover,  but  expect up to six to  eight weeks of decreased activity. Your scars may take up to a year to heal. 

You will have multiple follow-up appointments scheduled after surgery, most commonly: 

  • 1 to 2 weeks,
  • 6 to 8 weeks,
  • six months, and
  • one year.

If any concerns or complications arise, you may have additional follow-ups.

We Want Your Feedback

We are constantly evolving as a program and welcome any feedback from the community that will help us meet our mission to provide safe, gender-affirmative care at University of Utah Health. Please email us at transgenderhealth@hsc.utah.edu.