Facial surgery

Facial surgery, sometimes commonly referred to as Facial Feminisation Surgery (or FFS), is the name for a whole range of different operations that can be done to the face and neck.

Facial surgery is primarily undertaken by trans women and AMAB gender diverse people to change the shape of their face to better fit how they want to be seen, and see themselves. There’s no right or wrong way to be or embody your gender, regardless of your surgical status. Not all trans people want, seek or can have surgery, and being trans doesn’t necessitate surgery either. Find out more about that here.

People under the age of 18 are not able to obtain facial surgery, and it is recommended that facial surgery is not done until the bones of their skull stop growing, which can be identified through successive xrays requested by your surgeon or doctor.

Information and resources to assist clinicians learn more about facial surgery can be found here.

The Standards of Care - 7th Ed (SoC7) is published by the World Professional Association for Transgender Health (WPATH) and offers guidance to clinicians working with trans patients all over the world, including criteria and recommended referral pathways for those seeking particular medical and surgical interventions.

The SoC7 does not specify an order by which surgeries should occur, if sought at all, and are guidelines, not legislated requirements.

WPATH states that surgeries modifying the face and/or neck, while often labelled as “purely aesthetic”, “these same operations in an individual with severe gender dysphoria can be considered medically necessary, depending on the unique clinical situation of a given patient’s condition and life situation. This ambiguity reflects reality in clinical situations, and allows for individual decisions as to the need and desirability of these procedures.”

WPATH also recommends that “although these surgeries do not require referral by mental health professionals, such professionals can play an important role in assisting clients in making a fully informed decision about the timing and implications of such procedures in the context of the social transition.”

There are several kinds of facial surgical options, and the procedures chosen will depend on the surgeon’s expertise as well as your body and needs.

Brow Lift (Browplasty)

Lifting or shaping the eyebrows.

Cheek Enhancement

Adds filler to the cheeks to create a rounder and smoother appearance.

Forehead reduction (and hairline lowering)

Reduces the size and shape of the forehead.

Lip lift and reshaping

Several possible procedures, depending on desired patient outcomes, including lip augmentation (or lip filling), lifting the corners of the mouth, or an upper lip lift.

Nasal surgery (Rhinoplasty)

Reduces the size, and changes the shape of the nose, by altering the nasal cavity, or reshaping the cartilage.

Scalp Advancement

Moves the hairline forward and creates a more rounded shape, sometimes alongside hair transplantation.

Tracheal Shave (Chondrolaryngoplasty)

Reduces the size of the thyroid cartilage, or ‘Adam’s apple’. A tracheal shave, or ‘trach shave’, is a fairly simple procedure and able to be done as an outpatient surgery under local anaesthesia, but it is often recommended to be performed under a general anaesthesia.

The type of hospital stay required and length of the recovery process will take depends on what procedures you undergo, and if you undertake more than one successively. Generally, the surgical site will be bandaged, with drains, or small tubes, placed to help fluid and blood drain from the site. It may take several weeks for swelling to go down, and scars from the surgeries can be expected to fade over the first year.

The specific instructions for your recovery will vary from surgeon to surgeon, and depending on where and what specific surgical techniques are used.

Facial surgery can cost between $5,000 - $40,000 out of pocket, and sometimes more, depending on the procedures, techniques and surgeon. Many people choose to travel overseas for facial surgery which can increase costs due to travel, accommodation, and other costs.

Facial surgery options in Australia are limited for trans people. The Australian Professional Association for Trans Health hosts a provider list of their members. It includes surgeons in Australia and is available here.

All surgeries carry some risk, including complications, infection, blood clots, and rarely death. It’s important to ask your surgeon about possible risks and how to avoid them.