Facial Feminization Surgery (FFS)
The face is arguably one of the most important features of the human body. It provides to others the first clues to one’s identity and personality. It contains the features, such as the eyes, ears, and mouth, that allow us to communicate and interact with one another. And it offers the first visual cues that determine whether other people perceive us as male or female. For these reasons, facial feminization surgery (FFS) is a fundamental aspect of the male-to-female transition. In fact, the World Professional Organization for Transgender Health (WPATH) regards FFS as both medically necessary and essential to the well-being of transgender individuals. In a 2008 report, WPATH stated “these surgical interventions are often of greater practical significance in the patient’s daily life than reconstruction of the genitals”.
The term “facial feminization surgery” refers to a number of procedures that can be performed to give the face a softer, more traditionally feminine appearance. These can include both bony and soft tissue surgeries of the face, neck, and thyroid cartilage, often complimented by laser hair removal. While each patient will have unique needs, typical FFS procedures include brow lift with bossing, scalp advancement, nose reshaping, blepharoplasty, tracheal shave, cheek implants, lip lift, lip and cheek implants, cheek softening, and face/neck lift. Combined, these procedures can offer the transwoman a greater degree of harmony between her inside and outside self, increase her self-esteem, and allow her to “pass” more effectively.
There is no one feature that defines a “feminine” or “masculine” face. Rather, the degree of femininity expressed in a human face is typically the result of the combination of multiple facial features, and the ratio of feminine to masculine features. Facial features traditionally considered masculine include brow bone bossing, a prominent nose and chin, thick eyebrows, a square jaw, a long face, and a visible Adam’s apple. In short, men tend to have chiseled, more angular features. In contrast, women usually possess softer, rounder facial characteristics—a smooth forehead without bossing, a pointed chin, a more delicate nose, fuller cheeks, and an arched brow. Generally, facial feminization is achieved through bone reduction and changes to the skeletal framework.
Because every patient is unique, Dr. Antonetti doesn’t believe in a “one-size-fits-all” approach. Instead, we opt to work with each patient to design a unique treatment plan tailored to your individual needs. Dr. Antonetti is not only highly skilled technically, but has the aesthetic and artistic awareness to know what constitutes a feminine face. During a consultation appointment, he will meet with you to assess your facial structure, discuss your needs, and answer any questions you have about FFS and the recovery process. Most transwomen elect to have all facial feminization procedures performed at once, or in two phases (upper face and lower face). If performed all at once, FFS usually takes between 6-12 hours. In general, patients who undergo FFS will stay overnight after their procedure and return home the following day. Some swelling and discomfort is expected, but this typically resides after about 7 days, with full recovery expected within 3-4 weeks.
Nose Reshaping (Rhinoplasty)
While masculine noses are typically prominent with a bulbous tip, feminine noses are smaller and delicately curved, with a more defined tip. The angle between the forehead and nose is usually more vertical in females, while the angle between nose and upper lip is more accentuated. The goal of rhinoplasty within FFS is the creation of a feminine nose that matches the patient’s overall facial proportions. This is one of the most common and effective feminizing procedures available for the face. After rhinoplasty, a cast will be placed on the nose for about one week, along with absorbable sutures to close the surgical incisions. Some bleeding, bruising, and pain is expected. Definitive results of the procedure will be visible after about six months.
Male and female chins tend to differ greatly. The typical masculine jaw is full and chiseled, with a square shape and a higher position relative to the rest of the face. In contrast, female chins tend to be lower and less square-shaped. Chin softening is offered to provide a softer, more tapered lower face with a feminine, defined facial profile. During chin augmentation, which is also referred to as genioplasty, both the height and width of the chin is reduced using implants. As with other FFS, some swelling and pain is to be expected following the procedure.
A youthful, feminine face will have a short upper lip with good projection, less space between the top of the lips and the bottom of the nose, and good visibility of the teeth. During a lip lift, a small incision is made at the base of the nose and the lip area is lifted to expose the teeth and achieve more feminine proportions for the lower face. Patients who have undergone a lip lift will have dissolvable sutures placed. It is also common to experience some swelling and tightness around the mouth area for several weeks following this surgery
As we age, the skin tends to sag and lose its youthful contour. Because mature skin has less natural elasticity, it may not be able to rebound fully from the stretching that occurs during FFS. For this reason, older transwomen may require a face lift to fully experience the benefits of their other FFS procedures. In addition, face lift and neck lift procedures can be used generally to tighten aging, sagging skin, for a more youthful appearance. Face and neck lift patients will have stitches and plastic tubes placed under the skin. Post-surgery side effects include pain, swelling, and bleeding.
This procedure is often performed along with FFS to correct the aging process and lend a more youthful, beautiful look to the face. Blepharoplasty is used to remove eye bags and excess folds of skin from the corners of the eyes. Initial swelling and bruising is expected, but should subside within two weeks.
Contact Dr. Antonetti for a Facial Feminization Consultation Facial feminization surgery is a vital component of the male-to-female transition, offering many physical and psychological benefits for the transwoman. Because FFS is such an important procedure, it is paramount to work with only the most expert surgeons. We are proud to offer all of our services in a respectful, welcoming environment at our world-class surgical center in Dallas, Texas. We look forward to assisting you in achieving the very best possible results for all of your gender transition procedures. Contact us today to schedule a consultation at (972) 566-6677 .
Breast Augmentation for Transwomen
To many people, breasts represent beauty and femininity. Breast augmentation is a surgical procedure that can be used to enhance the size, shape, or fullness of the breasts. This procedure has a number of important benefits for the transwoman. It can provide a greater sense of congruence between her inner and outer selves, enhance her confidence and self-esteem, and help her to “blend in” more effectively in society as a woman. For these reasons, breast augmentation is a vital step in the male-to-female transition.
During the breast augmentation procedure, which is also known as augmentation mammoplasty, implants are placed either over (sub-glandular placement) or under (sub-muscular placement) the chest wall muscle. Placing the implant under the muscle can create a more natural look, but recovery time and pain tend to be a bit more with this method. In order to place the implant, the surgeon will make a small incision near the breast area, then create a pocket that will hold the implant. Possible locations for the incision include the areola, axilla (armpit), or the bottom of the chest muscle. Dr. Antonetti can help you to decide which technique is best suited for your unique anatomy.
Breast augmentation is a very common and safe procedure. Typically, the surgery takes about one to two hours to complete. It is usually performed on an outpatient basis using general anesthesia, which means that the patient is asleep during the procedure. Dissolvable sutures are placed during the surgery, and the patient will wear an ace bandage around the breasts until the first post-op appointment.
Several types of implants are currently available, including both saline and silicone options. Dr. Antonetti prefers to use smooth, round, moderate or high profile implants. Mentor, the maker of these implants, offers a 10-year warranty in case of rupture and guarantees them for life. While both saline and silicone implants can offer excellent results, silicone implants tend to look a bit more natural compared to saline implants. This type of implant can be a good option for transwomen, who tend to have less breast tissue. However, silicone implants do require a larger incision for placement, which means that any post-surgery scarring will also be more significant. Dr. Antonetti will work with you to weigh the pros and cons and choose the best implants for your needs.
Many breast augmentation patients have questions about what they’ll experience during the recovery period. Fortunately, recovery time tends to pass fairly quickly with this procedure. Most patients are able to return to work in about one week. During the first few days post-surgery, rest is extremely important. Use of the arms should also be limited during the first week, which means no driving, lifting, or reaching. The breasts will likely feel tender and swollen, but most patients report that their pain is mild to moderate. You’ll be sent home with a prescription for medication to address any pain issues. Breast massage is an important self-care technique that will improve your body’s ability to heal from the surgery—you’ll be taught this technique at your post-op appointment.
Because breast augmentation is such a safe procedure, complications are infrequent and tend to be minor. However, possible complications include hematoma (a collection of blood under the skin), sensory changes of the breast or nipple, firming of the breasts due to scar tissue, infection, poor healing (often related to tobacco use), and reactions to the anesthesia. Additionally, there is the potential for leakage or rupture of the implant itself—about a 1-2% chance of rupture per year.
While breast augmentation is similar for trans and cis gender women, transgender women do have some special considerations to keep in mind. Generally, the transgender woman has a broader chest and shoulders, so a larger implant may look more natural and proportional. Additionally, transwomen tend to have slightly lower nipples, which means that the natural breast crease may need to be lowered during surgery so that the nipple is properly centered on the implant. Finally, compliance with after-care measures is particularly important for the trans patient. Transwomen typically have a larger pec muscle that causes the implant to be held higher on the chest wall, but diligent breast massage and compression will allow the implant to “drop” into a more natural position.
In order to obtain the best possible results from surgery, the transwoman will ideally have taken hormone therapy for at least 12 months before undergoing breast augmentation. Initiating hormone therapy will result in nipple growth and the development of some breast tissue, which means that the surgery is likely to be more successful, with better cosmetic results.
As the patient, it’s very important to have realistic expectations going into breast augmentation surgery. While your breast augmentation will result in fuller, more feminine breasts, the results may not be perfect. Augmented breasts tend to look and feel somewhat different than natural breasts, particularly in transwomen who undergo breast augmentation in middle-age or beyond. The breasts may be firmer, rounder, and slightly further apart. Transwomen who are considering breast augmentation can try out implant sizers to get a better idea of how their breasts might look and feel after surgery. Additionally, patients should keep in mind that some scarring is inevitable with breast augmentation, as this procedure requires that a surgical incision be made. Good self-care measures after surgery can help to minimize scarring.
Contact Dr. Antonetti for your Breast Augmentation Surgery today!
Breast augmentation is a vital component of the male-to-female transition, offering many physical and psychological benefits for the transwoman. Because this procedure differs for transwomen, it is paramount to choose a surgeon with specialized knowledge and skill. We are proud to offer all of our services in a respectful, welcoming environment at our world-class surgical center in Dallas, Texas. We look forward to assisting you in achieving the very best possible results for all of your gender transition procedures. Contact us today to schedule a consultation at (972) 566-6677 .