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Facial Feminisation

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Surgery for Facial Feminisation

Brian Musgrove has been performing Facial Feminisation Surgery for over 20 years. He has pioneered many of the operations used in FFS.

" It is important to have the knowledge and skills to analyse facial morphology and blend the different surgical procedures from both Maxillofacial Surgery and Plastic Surgery. I have spent many years drawing on my extensive training in both Maxillofacial and  Plastic Surgery to recommend a comprehensive analysis of your facial form and offer the most appropriate combination of operations to achieve your goals"

What is Facial Feminisation?

"It is estimated that 1% of the population have gender variance in some form. Gender variance knows no social, ethnic or religious or socioeconomic boundaries"

Facial Feminsation refers to surgical procedures designed to help individuals who have been assigned a male at birth but later identify as a woman. The operations have been popularised in the Transexual Community over the last twenty years.

What is the difference between a male face and a female face? To understand this consider what happens to the adolescent face at puberty. Under the influence of testosterone the male face grows faster compared to the female face and acquires secondary male sex characteristics. This includes facial hair and thickening of the skin. The voice box or larynx enlarges producing a prominent "Adam's Apple" and the voice deepens.

The most obvious changes occur in the bones of the face. The upper and lower jaws grow downwards and forwards and become heavier, the nose becomes larger and rapid growth of the frontal sinuses  produces frontal bossing of the brow.

The result is that the male face looks bigger and more angular compared to the female face which retains more of its adolescent character.

Of course there is great variability in facial appearance and some individuals are naturally androgynous. It is much easier for these people to pass as a female and they probably can manage with a change of hairstyle and makeup but for a large proportion of male to female transexuals it is necessary to resort to surgery.

The most common  operations for facial feminisation are :

Brow recontouring/reshaping

Rhinoplasty/Nose reshaping

Jaw reshaping/recontouring

Tracheal shave/thyroid chondroplasty

These facial plastic surgery operations  address the secondary sex characteristics affecting the face. However it is simplistic to employ the same operations for every FFS patient. It is important to consult a surgeon who can make a comprehensive analysis and offer a range of treatments which is best for you. In other words you need good advice. This is the most important part of your treatment.

Jaw Surgery:

The shape of the jaw and chin is very important in making your face appear feminine.The operation most commonly used to recontour the lower jaw is called "jaw recontouring" which entails shaving the lower border of the mandible. However this is not the best operation for every patient.

For example some individuals have a very long face, a common characteristic of the male face. It may be necessary to shorten the upper jaw as well as the lower jaw. Using maxillofacial surgery techniques it is possible to change the dimensions of upper and lower jaws, make the face shorter and more delicate, correct asymmetries, move the midface forwards if it is too flat, highlight the cheekbones and correct dental irregularities to give the face a more feminine and attractive appearance. 





These before and after images of a patient who attended for advice about FFS illustrate the power of surgery on the lower face in FFS. After requesting advice on how best to feminise her face and a careful analysis she realised that the most important issue for her was the length of her lower face. A bimaxillary osteotomy of the upper jaw was performed to shorten her face together with a lip lift. The lower jaw was recontoured together with a genioplasty to shorten her chin. This transformed her appearance, made her face more attractive and feminine. 




Brow recontouring:

A heavy brow particularly with heavy brow bossing is a strong gender cue. It is usually associated with large frontal sinuses. Brow reshaping can be carried out through an incision in the scalp and usually recontouring of the bony brow bossing together with augmentation with special bone cement. If the frontal sinus is very large then it may be necessary to reposition the bone with an osteotomy to achieve the surgical goal. Brow reshaping is often done in conjunction with hairline recontouring and brow lift.


This patient had prominent bossing of her forehead which required an osteotomy of the frontal sinus and recontouring together with a rhinoplasty to lengthen the nose and jaw recontouring with a genioplasty to advance the chin. 







The most frequently performed operations are brow recontoring, rhinoplasty and jaw recontouring.

Tracheal Shave or Thyrochondroplasty


Facial Feminising Procedures commonly include an opration to reduce the prominence of the thyroid cartilage. It can be done under local anaesthetic or general anaesthetic, both as a day-case. The reduction of the prominence is done through a small incision just above the prominence in a skin crease,  in order to keep the incision scar as inconspicuous as possible.

Other commonly performed operations include cheek augmentation, fat grafts, lip enhancement, hair transplants and grafting. In addition facelifts, blepharoplasty, liposuction can all be used to enhance the appearance but the most important key is to neutralize the male gender cues which are to do with the shape of he facial skeleton. The analysis and preoperative planning is paramount in reaching a desirable goal.


This patient had brow recontouring, a rhinoplasty, jaw recontouring and a tracheal shave to reduce the prominent "Adams Apple"

She then went on to have cheek implants to highlight her cheek bones and add more volume to her face.


From KA of South Wales:

“ I was very nervous for my consultation but Mr Musgrove made me feel at ease. His knowledge and manner was reassuring and the reason I chose him as my surgeon”.

“I had first class care at Spire Regency Hospital in Cheshire and follow up/after care all  went very well, so I now feel far more confident about my appearance & swelling has almost gone so I can see the results which I am very happy with”.