FSS surgery (Facial Feminisation Surgery) is one of the fastest growing types of surgery among trans women, especially among those who started their transition at a more mature age. The female face has certain features that differentiate it from the male face. For this reason, trans women sometimes seek facial surgery to soften certain features of their face in order to feel more comfortable with their appearance. This type of operation is known as facial feminisation surgery.
What is FFS surgery?
Facial feminisation encompasses the set of treatments, techniques and surgeries whose aim is to transform or enhance the feminine features of a face. We need to understand that the bone structure and facial physiognomy differ considerably between men and women. For this reason, feminisation surgery must take these differences into account in order to deliver optimal and natural results. A person’s face is usually divided into three parts, which makes it easier to perform different facial operations on each part. However, techniques such as facelifts are treatments that are performed on the entire face. In the upper third of the face, the thickening of the bones above the eyebrows and the position of the hairline are features that give a harder and more masculine appearance to the face. This is why facial feminisation focuses on the features in this area. In contrast, in the lower third, attention is paid to the shape of the face, as surgery in this area is aimed at smoothing the angles of the jaw and chin. Emphasis is also placed on the importance of the lips in facial feminisation. 
Soften your features with these procedures
Hairline advancement
This is one of the foremost surgeries used to give the face a more feminine appearance. The reason for this lies in the differences between the two genders. While women tend to have a lower, rounder hairline, men’s hairline tends to be in the shape of an M. However, boys’ and girls’ hairline is identical during their childhood. It is in adolescence, with the influx of hormones, that the differences appear. There are currently two types of hairline feminisation for trans women: one is surgical and the other by transplant.
- Surgical technique: this consists of advancing the entire hairline. It will be performed through an incision of a few millimetres behind the natural hairline, which will be advanced by 1 to 2 centimetres. As a result, the distance between the eyebrows and hairline will be reduced.
- Transplant technique: this can be performed during forehead feminisation surgery or, subsequently, in a second operation. And, if the trans woman suffers from alopecia, a prior assessment will be carried out to prevent it. The surgery involves harvesting hair follicles from the scalp (1,000, 2,000 or more) and moving them to the frontal area in order to reduce the size of the forehead and achieve a more rounded frontal hairline.
Reduction angleplasty
Facial feminisation of the lower third of the face focuses especially on the jaw and chin. In this case, reduction angleplasty aims to round and soften the angles of the jaw, as well as decreasing the distance between chin and lip. During the procedure, the mandibular angle is reduced from the inside of the mouth using ultrasonic devices. This technology does not affect any adjacent tissues (such as teeth or the mandibular occlusion) and leaves no external, visible scars.
Chondrolaryngoplasty
One of the procedures most requested by trans women after vaginoplasty and breast augmentation is chondrolaryngoplasty. This consists of the reduction of the Adam’s apple, a thyroid cartilage that is much more prominent and visible in men than in women. This type of operation, always performed by an expert surgeon and in a hospital with medical-surgical guarantees, consists of making an incision in the area. The surgeon aims to make the incision in line with a crease or fold in order to conceal the scar. The cartilage is then reduced carefully so as not to affect the vocal cords.
Feminisation of the forehead
Women tend to have shorter, smoother and clearer foreheads. Generally, they also have less marked supraorbital arches and the ridge of bones above the eyebrows is less prominent. Their eyes tend to be rounder, larger and wider apart. And these are the objectives of the forehead feminisation technique. It is carried out by means of different incisions hidden in the scalp that allow access to the area that needs to be lowered. There are different techniques and the choice of one or the other will depend on the prior assessment and the results sought. In this video you can hear Lauren talking about her forehead feminisation surgery at IM GENDER. https://www.youtube.com/watch?v=JgQb3mJbqLw
Bichectomy
This consists of the removal of the Bichat balls, a procedure that helps to accentuate the cheekbones, refine and lengthen the face and soften the features. This is minor surgery, in other words, an outpatient, minimally invasive procedure. It takes about 30-45 minutes and is performed under local anaesthesia. It consists of removing the fat balls (Bichat balls) from the cheeks by means of an incision made inside the mouth that leaves no visible scar. This procedure makes it possible to define the cheekbones and stylise the facial contours.
Lip lift
The distance between the upper lip and the nose is longer in men and remains short, as in childhood, in women. A lip lift is the surgery that shortens this distance. This procedure is performed under local anaesthesia and the scar just below the nose is virtually unnoticeable. 
Feminising lipotransfer
The faces of mature men tend to have less fat than those of women as a result of the action of testosterone. This procedure consists of using the trans woman’s own fat to enhance her facial features, making them rounder and more voluptuous. For this, a mini-liposuction is performed on a donor area and the fat is then purified and prepared to be placed in strategic areas of the face to allow the plastic surgeon to achieve the desired facial features. There are other surgeries such as face lifts, chin feminisation, feminising rhinoplasty, cheek augmentation, etc, as well as aesthetic medicine treatments that facilitate feminisation of the face.
How should I prepare for FFS surgery?
When a trans woman has decided to go down the path of FFS surgery, it is very important that she chooses a specialised medical team. In other words, a plastic surgeon with experience in facial feminisation surgery for trans women. It is also important to resolve any doubts that may arise in relation to the preoperative stage, procedure, surgery or postoperative period with the specialist. You should also clearly explain your expectations to your surgeon, because he or she will be able to assess and advise you on the techniques that best suit your needs or the results you hope to achieve. Depending on your age and medical history, your surgeon may request certain tests to assess your health prior to any surgery. It is important to stop smoking for at least 4 weeks before surgery to avoid scarring problems. IM GENDER has specialists with more than 20 years of experience in gender surgery, both genital surgery and FFS surgery.
If you have more questions about what FSS surgery, make an appointment with the IM GENDER team and we will inform you.