Facial Feminization Surgery (FFS)
FFS is a suite of procedures designed to soften facial features that are perceived as masculine. It is highly customized to the individual's bone structure and goals. Common procedures include forehead contouring (reducing the brow bone), rhinoplasty (reshaping the nose), jaw and chin contouring (making them smaller and less square), and a tracheal shave (reducing the Adam's apple). FFS can have a profound impact on how a person is gendered by society, significantly reducing dysphoria.
Top Surgery: Masculinizing and Feminizing
'Top surgery' refers to procedures on the chest. For trans masculine individuals, this typically involves a subcutaneous mastectomy to remove breast tissue and create a masculine chest contour. For trans feminine individuals, it involves breast augmentation, using implants to increase breast size and create a feminine chest shape. This is often pursued after HRT has produced some breast growth but not to the desired size.
Vaginoplasty
Vaginoplasty is a type of 'bottom surgery' for trans feminine individuals that constructs a vagina, clitoris, and labia. The most common technique is the penile inversion vaginoplasty, which uses tissue from the penis and scrotum to create the new structures. The procedure is complex and requires a lengthy recovery period, including a lifelong regimen of vaginal dilation to maintain depth and functionality. The goal is to create genitals that are aesthetically and, in many cases, functionally female.
Phalloplasty and Metoidioplasty
These are two types of 'bottom surgery' for trans masculine individuals. Metoidioplasty uses the clitoris, which has grown due to testosterone, to create a small phallus (a 'meta-penis'). It is a less complex procedure with fewer risks. Phalloplasty is a more complex, multi-stage procedure that constructs a larger phallus using a tissue graft, typically from the forearm or thigh. It often includes urethral lengthening to allow for standing urination and the option for testicular and erectile implants in later stages.
WPATH Standards of Care
The World Professional Association for Transgender Health (WPATH) publishes the Standards of Care (SOC), which are clinical guidelines for the treatment of transgender individuals. Most surgeons and insurance companies adhere to these standards. For most genital surgeries, the SOC typically recommend that the patient be on hormone therapy for at least 12 months and have lived full-time in their affirmed gender role. They also generally require letters of support from qualified mental health professionals.
Recovery and Post-Operative Care
All gender-affirming surgeries are major operations that require significant downtime and careful post-operative care. Recovery can range from a few weeks for less invasive procedures to several months for complex surgeries like phalloplasty. Following the surgeon's instructions precisely is critical for proper healing and achieving the best possible outcome. This includes wound care, activity restrictions, and, in the case of vaginoplasty, a strict dilation schedule. Having a strong support system in place for the recovery period is highly recommended.