Facial feminization surgery ( FFS) is a set of reconstructive that alter typically male facial features to bring them closer in shape and size to typical female facial features. FFS can include various bony and soft tissue procedures such as,,, and. Faces contain secondary sex characteristics that make male and female faces readily distinguishable, including the shape of the forehead, nose, lips, cheeks, chin, and jawline; the features in the upper third of the face seem to be the most important, but subtle changes in the lips can have a strong effect. Contents • • • • • • • • • • • • • Candidates [ ] For many women, FFS is medically necessary to treat. It can be just as important or even more important than genital forms of (SRS) in reducing gender dysphoria and helping trans women integrate socially as women; data on these sorts of outcomes are limited by small study size and confounding variables like other feminization procedures. While most FFS patients are transgender women, some cisgender women who feel that their faces are too masculine will also undergo FFS.

FFS is occasionally sought by and. FFS candidates should wait until the bones of their skull have stopped growing before undergoing FFS. The way to determine if the bones of the skull have stopped growing is to take successive of the and wrist bones to make sure that bone growth has stopped. Surgical procedures [ ] The surgical procedures most frequently performed during FFS include the following.

Upper third of face [ ] Some studies have shown that the shape of the forehead is one of the key differences between males and females. Hairline correction, forehead recontouring, eye socket recontouring, and brow lift are procedures are often performed at the same time, and with the rhinoplasty in mind. Hairline correction In males the hairline is often higher than in females and usually has receded corners above the temples that give it an “M” shape. The hairline can be moved forward and given a more rounded shape either with a procedure called a “” wherein the scalp is lifted and repositioned or with. Forehead recontouring Males tend to have a horizontal ridge of bone running across the forehead just above eyebrow level called the (or “brow bossing”), which includes the “supraorbital rims” (the lower edge, on which the eyebrows sit). Males also tend to have indented temples and a flatter forehead than females.

Jan 29, 2016. For patients with gender dysphoria undergoing male-to-female transformation, a stepwise approach to facial feminization surgery (FFS) leads to good cosmetic outcomes along with psychological, social, and functional benefits, according to a new study.

The brow ridge is usually solid bone and can simply be ground down. The section of bossing between the eyebrows (the ) sits over a hollow area called the.

Because the frontal sinus is hollow it can be more difficult to remove bossing there. If the bone over the frontal sinus is thick enough the bossing can be removed by simply grinding down the bone. However, in some people the wall of bone is too thin and it is not possible to grind the bossing away completely without breaking through the wall into the frontal sinus. FFS surgeons have taken two main approaches to resolving this problem.

The most conservative approach is to grind down the wall of bone as far as possible without breaking through and then build up the area around any remaining bossing with bone cement which can smooth out any visible step between remaining bossing and the rest of the forehead. In these cases some additional reduction in the bossing can sometimes be achieved by thinning the soft tissues that sit over it. Alternatively, FFS surgeons can perform a procedure called a forehead reconstruction or where the bone is taken apart, thinned and re-shaped, and reassembled in the new feminine position with small titanium wires or titanium and screws. The data on which approach is better is limited and does not provide guidance. The risks of cranioplasty include the skull not healing properly, movement of the bone fragments, and the formation of cysts; these can usually be corrected by another procedure. Brow lift Men tend to have lower eyebrows relative to the position of their when compared to women.

Men's eyebrows tend to be below their brow ridges while women's eyebrows tend to be above their brow ridges. Accordingly, FFS to raise the eyebrows results in a face with a more womanly appearance. Orbit recontouring In some studies the eye shape has been shown to be the key differentiating feature between males and females.

Female eye sockets tend to be smaller, located higher on the face, to have more sharply angled outer edges, and to be closer together at their inner edges (the ). Some FFS alter the orbit shape; data on outcomes is limited. Rhinoplasty [ ] Males tend to have larger, longer, and wider noses than females, and the tip of the female nose will often visibly point slightly upwards when compared to a male, so the procedure involves removing bone, cartilage and remodelling what remains.

In most cases this is performed in an open procedure, but endonasal procedures have been used; in all cases when reducing the nose there is a risk of interfering with function. Standard rhinoplasty procedures are generally used. There is limited data on outcomes. Cheek implants [ ] Females often have more forward projection in their cheekbones as well as fuller cheeks overall, with a triangle formed by the and the point of the chin. Planning of cheek contouring is done while planning reshaping of the chin. The cheeks are reshaped by and repositioning the facial bones. Augmenting the cheeks with implants or with fat harvested from other parts of the body is common.

Risks of implants include infection and the implant moving and becoming asymmetrical; fat can eventually be absorbed. Lips [ ] Subtle changes to the shape and structure of lips can have a strong influence on feminization.

The distance between the base of the nose and the top of the upper lip tends to be longer in males than in females and the upper lip is longer; when a female mouth is open and relaxed the upper incisors are often exposed by a few millimeters. An incision is usually made just under the base of the nose and a section of skin is removed. When the gap is closed it has the effect of lifting the top lip, placing it in a more feminine position and often exposing a little of the upper incisors. The surgeon can also use a lip lift to roll the top lip out a little making it appear fuller.

Females often have fuller lips than males so is often used in feminization. Injectable fillers are low risk but tend to absorbed after 6 months or so, and many implants have higher complication rates like infection or rejection. Use of fat harvested from the person can result in lumps and doesn't last long.

The longest lasting and least risky results appear to arise from use of products. Chin and jaw contouring [ ] Males tend to have longer and wider chins than females, with a more square base, and to project outward more than female chins. The male jawlines tend to extend outward from the chin at a wider angle than females and to have a sharp corner at the back. Thinking Socratically Ebook Store. The in length by either by bone shaving or with a procedure called a “” where a section of bone is removed.

The jaw can be reshaped through surgery; sometimes this is done through the mouth. The () can also be reduced to make the jaw appear narrower. The biggest risk in these procedures is damage to the that runs through the chin and jaw; other risks include damage to tooth roots, infection, nonunion, damage to the that controls the lower lip and is at the edges of the chin. Adam’s apple reduction [ ] Males tend to have a much more prominent than females following puberty. The Adam's apple can be reduced with a procedure called a; the goal of the procedure is to reduce the size without leaving a scar.

There are risks of damage to the vocal cords and destabilization of the. Associated procedures [ ] Beautification and rejuvenation procedures are often performed at the same time as facial feminisation. For example, it is common for eye bags and sagging eyelids to be corrected with a procedure called “” and many feminization patients undergo a. History [ ] FFS techniques are derived from and reconstructive surgery as well as general plastic and cosmetic surgery.

FFS began in 1982 when Darrell Pratt, a plastic surgeon who performed, approached with a request from a male-to-female transsexual patient of Pratt's; the patient wanted plastic surgery to make her face appear more feminine, since people still reacted to her as though she were a man. Ousterhout's prior practice had involved reconstructing faces and skulls of people who had suffered birth defects, accidents, or other trauma. Ousterhout was interested in helping but knew that he didn't know what a 'female face' was, so he investigated by first reading the from the early 20th century to identify what features were 'female', then by deriving measurements defining those features from a series of taken in the 1970s, and then by working with a set of several hundred skulls to see if he could reliably differentiate which were females and which were males using those measurements. Ousterhout then began working out what surgical techniques and materials he already used that he could apply in order to transform a male face into a female face; he pioneered most of the procedures involved in FFS and was involved in their subsequent improvements as well. As of 2006 there were about twelve surgeons globally who specialized in FFS. Cost [ ] In the US as of 2006, the procedure cost between $20,000 and $40,000, about twice the cost of.

In Europe prices are considerably lower. As of 2017 between €10.000 and €25.000 for a complete FFS. See also [ ]. • World Professional Association for Transgender Health. Page accessed June 20, 2016 • World Professional Association for Transgender Health.

2015-08-14 at the. • ^ Morrison SD, et al. Facial Feminization: Systematic Review of the Literature.

Plast Reconstr Surg. 2016 Jun;137(6):1759-70. • ^ Altman K Facial feminization surgery: current state of the art. Int J Oral Maxillofac Surg. 2012 Aug;41(8):885-94.

• ^ Ousterhout, D.K. Facial Feminization Surgery: A Guide for the Transgendered Woman. Omaha, Nebraska: Addicus Books, Inc. • Stan Monstrey, Gennaro Selvaggi and Peter Ceulemans. Surgery: Male-to-Female Patient. Chapter 6 in Principles of Transgender Medicine and Surgery (Human Sexuality series). Randi Ettner, et al.

Routledge 2007. Pages 105 and 111 • ^ Van de Ven, BFML (2008).

'Facial feminisation: why and how?' European Journal of Sexology. • Noureai, SA; Randhawa, P; Andrews, PJ; Saleh, HA (2007).. Archives of Facial Plastic Surgery. 9 (5): 318–20... • ^ Plemons ED.

Description of sex difference as prescription for sex change: on the origins of. Soc Stud Sci. 2014 Oct;44(5):657-79. • ^ Guthmann, Edward (April 26, 2006).. SF Chronicle.

Transgender healthcare and gender-confirming surgeries are becoming more readily available to transwomen, with facial feminization among the most common procedures. Facial feminization surgery (FFS) is a set of bone and soft tissue reconstructive surgical procedures intended to feminize the faces of male-to-female (MTF) transwomen.

The goal of FFS is to help individuals with gender dysphoria feel more comfortable in their bodies – and by extension, their lives – in the gender they actually identify with, rather than the gender of their birth. MTF patients can now choose from more than 30 gender-confirming surgeries, including FFS. Not surprisingly, many transgender people are opting to undergo these surgeries. One transwoman quoted in the 2014 landmark book, TransBodies, TransSelves, put it this way: “I consider facial feminization surgery one of my highest priorities – alongside getting my voice right. People don’t look at your genitals. Your voice and your face are how people judge you in face-to-face conversations, as well as what you see every day when you look in the mirror.” As, an assistant professor of plastic and reconstructive surgery with the Transgender Health Program at Oregon Health Sciences University in Portland, says, “If you think about it, not getting a job or having trouble going to [one’s preferred] bathroom is largely because of how people see your face.” So when a plastic surgeon performs FFS for a transwoman, s/he needs to be cognizant of anatomical differences between male and female faces. For example, women have fuller, shorter lips, a shorter distance from the base of the nose to the lip, and more teeth showing.

A woman’s chin is narrower and more pointed, with less projection. The jaw is more rounded and not as sharply angled. Men also have far more prominent Adam’s apples than women.

FFS involves modeling the face in thirds. The upper third encompanses the forehead, hairline and upper eyelids. The middle consists of the lower eyelid, nose, and cheeks while the bottom third is the chin, jaw, and sometimes the Adam’s apple. Facial reconstruction entails many bone and soft tissue procedures, but the most commonly performed are (including brow lift and eyebrow repositioning), hairline treatment or redefinition,, lower jaw and chin contouring, Adam’s apple reduction, and facial hair removal/electrolysis. Facial Feminization Surgery by Genioplasty is the most commonly performed procedure used to reduce the prominence of the chin. The jawline can be softened with a procedure known as mandibular angle reduction.

A mandibular reduction reduces the width and height of the lower edge of the jaw. Usually, these procedures are done at the same time. Cách Crack Game Popcap Plants Vs Zombies. The surgery is performed through the mouth on the inner portion of the lower lip. The chin is then cut away from the jaw and contoured. The procedure leaves no scar because manipulation is inside the mouth. Swelling and numbness of the lip and chin can last for two weeks.

A patient can usually return to work within ten days, with full recovery generally taking two-to-three weeks. Initially, patients won’t be able to chew their food and will need to go on a liquid or soft-food diet. An Adam’s Apple Reduction, also know as a tracheal shave or chondroplasty, will minimize a person’s Adam’s apple, as the name suggests.

This procedure makes a small incision just under the chin in the shadow of the neck, where it helps conceal any potential scarring. The Adam’s Apple reduction reshapes the cartilage and is typically performed in an outpatient setting. Preparation, Timing, and Recovery (W-PATH) is the widely accepted global authority that sets standards of care for FFS, as well as all aspects of transgender healthcare.

You will want to be sure that your provider is following their standards of care. These standards are still evolving, so keep an eye open for any changes to the present decorum. Before you contemplate FFS, Berli recommends you “recognize that the standard of care is that people should transition first, meaning come out to family and friends.

It’s also good to be on hormones for at least a year since it changes skin quality.” Evaluation by a primary care doctor and mental health professional are also recommended. Regarding surgery, one approach is to “perform the bone work initially, including forehead contouring, mandible contouring, and genioplasty. Then, six months later, soft tissue work can be done,” says, a well respected plastic surgeon with a busy San Francisco practice. “This may include facelift, blepharoplasty (to repair droopy eyelids), cheek implants, and lip lifts, etc.

Every surgeon will take the approach they feel most comfortable with and guarantees predictable results.” Facial Feminization Surgery by If a patient chooses to do the bulk of the bone work at once, it typically can take up to twelve hours in the operating room, according to Satterwhite. Additionally, he explains, patients should expect to spend one-to-two days in the hospital and plan on bedrest for at least one week, with no strenuous activity.

In the first week, they will be quite swollen and bruised. Patients will require pain medication medication for about ten days and they can go back to work in about two weeks. Within three months, 80% of the swelling will go down, and the final results will be clear in about a year. Cost, Insurance and Timing There are multiple approaches for facial feminization surgery, depending on patient preference, logistics, and insurance coverage.

“For a healthy patient, there is no reason why the majority of procedures cannot be done in one sitting,” says Satterwhite. “Because the majority of my patients are covered by insurance, getting insurance approval for multiple operations on multiple dates is exquisitely difficult.” What it comes down to are “logistics, insurance coverage, multiple times that a patient must travel, time off from work or school, and multiple recoveries, or one longer one,” Satterwhite adds. Patients paying out of pocket might select procedures in stages to keep costs down. Costs for a full facial feminization surgery range between $30,000 to $50,000 at Satterwhite’s practice.

Similar estimates are common across the United States. Satterwhite acknowledges that patient preference is paramount in deciding how to perform the surgeries. “I’ve had some patients who insist on staging the surgery because they don’t want drastic changes all at once,” he says. Their ability to pay also clearly impacts a patient’s choice. Patient Outcomes Dr. Tiffiny Ainsworth, surgeon at, and, plastic surgeon at co-authored a on quality of life in individuals with FFS or gender reassignment surgery. Using validated quality of life instruments and patient self-reports, considered the gold standard for such studies, they reported that mental health-related quality of life diminished in MTF transgender individuals without surgery.

Of the 247 patients in the study, those who had FFS or gender reassignment surgery reported better quality of life than those who did not. A Shift Towards Facial Gender-Confirmation Surgery The status of facial feminization surgery could soon rise, if evidence is used to update standards set by W-PATH. Review of standards of care for surgery is an ongoing process and changes are made based on the best available evidence and new studies. Many plastic surgeons who treat transgender people favor replacing the term “facial feminization surgery” with the more precise “facial gender-confirmation surgery,” which reflects the best evidence of value. In so doing, the surgery might earn its place as being medically necessary. In fact, as transgender healthcare becomes more accepted by the greater population, “gender confirmation” is rapidly replacing more surgeries formerly described as “gender reassigned”. Access Improving Statistics suggest transgender healthcare and gender-confirming surgeries are on the upswing.

For example, according to, gender-reassignment surgery (reshaping the genitals in the appearance of, and as far as possible, the function, to the gender a person identifies with) was covered by 43% of employers with at least 20,000 employees, a jump up from 29% in 2015. Mercer also reports that many smaller employers are considering covering it. Gender-reassignment surgery was covered by 43% of employers with at least 20,000 employees, a jump up from 29% in 2015. While several states have legislation in the works, transgender healthcare remains a fluid area. California’s MediCal (Medicaid) program covers hormone treatment, gender reassignment surgery, and other necessary procedures.

Additionally, seven states enforce laws and policy that insurers cannot exclude transgender health from insurance policies: Massachusetts, California, Oregon, Vermont, and the District of Columbia. Across the country, academic medical centers – especially in urban areas – are marketing new trans surgery programs or expanding older ones.

As a transwoman, you may have to work with your doctors to make a case for coverage, but in 2017 and beyond, you should have a far better shot of getting it covered than in previous years.