Forehead Contouring and Brow Lift
This is often considered the most impactful FFS procedure. Male foreheads typically have a bony ridge called the 'brow bossing' and tend to slope backwards, while female foreheads are smoother and more vertical. The surgery involves an incision at the hairline, peeling back the scalp, and using a burr to shave down the brow bone. In cases of a prominent frontal sinus, a more complex 'forehead reconstruction' is performed, where the front plate of the sinus is removed, reshaped, and set back into place. This is almost always combined with a brow lift to place the eyebrows in a higher, more arched, feminine position.
Rhinoplasty (Nose Reshaping)
Gender-affirming rhinoplasty aims to reshape the nose to be in harmony with the rest of the facial features. Feminizing rhinoplasty often involves reducing the overall size of the nose, narrowing the bridge, removing a dorsal hump, and refining and slightly upturning the nasal tip. Masculinizing rhinoplasty, conversely, might involve building up the bridge to be wider and straighter, sometimes using a cartilage graft.
Jaw and Chin Contouring
The lower third of the face is a key area for gendered features. For feminization, jaw contouring (mandible contouring) involves shaving bone along the angle of the jaw to reduce width and squareness. A genioplasty (chin surgery) can be performed to make the chin narrower, shorter, and more pointed. For masculinization, implants are often used. Jaw implants can be placed to create a wider, more angular jawline, and a chin implant can create a squarer, more prominent chin.
Tracheal Shave
A tracheal shave (chondrolaryngoplasty) is a procedure to reduce the size of the thyroid cartilage, or 'Adam's apple'. It is a relatively straightforward procedure performed through a small, discreet incision in a neck crease. The surgeon carefully shaves down the cartilage to create a smoother, flatter neck contour. Great care must be taken to not remove too much cartilage, which could affect the vocal cords.
Soft Tissue Procedures
In addition to bone work, many soft tissue procedures can be performed as part of FFS. A lip lift shortens the distance between the nose and the upper lip (the philtrum), which tends to be longer in males, and everts the lip for a fuller appearance. Cheek augmentation, either with implants or fat grafting, can create fuller, higher cheekbones. These procedures add the finishing touches to the feminization process by addressing the soft tissue envelope that drapes over the newly contoured bone structure.