Are you satisfied with how you look? Are you sure of yourself and your body image? These are truly personal questions. Body image and self-confidence are important aspects of an individual’s persona and, to be sure, the two are intrinsically linked. Both men and women are often guided by these ingrained traits. Few people do not feel some pressure to primp, tidy or alter their appearance to be more attractive to others, more acceptable to an employer or more confident in themselves.

The staunch individualist may argue against this idea, however, taking an interest in self and self-care is ubiquitous in our society. Self-appearances drive industries and make or break success for countless people. The fields of plastic and cosmetic surgery have boomed for years. While the difference between applying makeup and physically changing one’s body form is severe, one can not deny the popularity and general availability of such surgery.

Many surgeons offer facial feminization surgery (FFS): surgically altering one’s head, face and/or neck in order to look more like a woman. This is often sought after by some transgender women who wish to obtain more female features so that they can more comfortably and successfully live as a woman. FFS is one stop on the vast spectrum of available elective body altering procedures, including breast augmentation, sexual reassignment surgery, hair removal and hormone therapy, for individuals who wish to enhance or create what are considered in our society to be female features. Vancouver ( British Columbia) Coastal Health has produced a general information guide on transitioning for transgender women, however, the following paragraphs will present information specifically on FFS.

Beyond the Facial

There are a variety of methods used by a variety of surgeons to create a more feminine appearance from the neck up. The following is meant as an overview and not as a detailed discussion or an endorsement of the procedures. There is risk involved in any surgical procedure.

The facelift is most familiar to the public. It can decrease or eliminate excess fat and tighten muscles below the surface of the skin leading to a smoother, more youthful appearance. Often done in conjunction with a brow lift (see below), a facelift can subtract years off facial appearance and create more feminine features by manipulating the deeper structures below the skin. Scarring is usually minimal, especially with endoscopic techniques, and post-operative bruising and swelling goes away in time. Forehead/brow lifts can have a marked effect on forehead shape and contour which, for many individuals, is strikingly male or female to begin with. This is often done with forehead bone surgery to modify underlying structures. Again, the result can be a more youthful appearance affecting the shape of the skin around the eyes and the contour of the eyebrows.

Few think about the trachea (wind pipe) initially, though it is a common surgery done for transgender women. Males have an “Adam’s Apple,” a protruding portion of the tracheal shaving trachea, which can be quite prominent in some men. It can be done to reduce the cartilaginous mass with minimal effect on function. Oftentimes, an individual may have concurrent surgery on the vocal cords (to change the pitch of their voice.)

The ears, if large or protruding, can be “pinned,” or surgically altered so that they lie more against the sides of the head. This is called otoplasty and can be done by most plastic surgeons. Complications are unusual and the procedure is considered permanent.

The jaw and chin may be distinctly female or male and can, in turn, present a major concern for transgender women. The shape and contour is more a function of the underlying bone rather than muscle. It is generally the practice to reduce bone by shaving and sculpting while keeping much needed muscles for chewing. Skin presents a unique challenge as females tend to have smoother skin and smaller pores. Along with moisturizing, eating well and not smoking one may decide that an extra step is needed to achieve a satisfactory feminine skin appearance.

Several techniques are used to alter the skin’s look and feel. These include microdermabrasion, topical preparations, chemical peels and laser resurfacing. Few features of the face stick out like the nose. Noses vary as widely as the people attached to them but if those attached are dissatisfied with the shape or function, a rhinoplasty can be done. The nose’s proportion to the eyes, cheekbones and ears can make the face seem delicate or noticeably distinct. Reducing the “flare” of the nostrils can also make the nose seem thinner. Nasal surgery can affect breathing, the sound of your voice, and often needs to be repeated to achieve the desired result. Complications are not uncommon.

Save Up Your Change for Your “Change”

Actual figures vary widely and one must shop around to find a responsible surgeon with reasonable fees. Much anecdotal information is available on the Internet detailing the costs certain individuals have incurred. Insurance may pay for certain procedures but only if there is a medical necessity (i.e., rhinoplasty which is also intended to correct a deviated septum). Some reports quote a total price tag for FFS somewhere between $22,000 and $40,000. Remember, there are hidden costs in operating room time, anesthesia, surgical materials and consultation time. It is not unreasonable to spend a year or so to research costs, meet several surgeons, obtain the finances and finally schedule surgery.

Is It For Me?

Facial feminization surgery, truthfully surgery of any kind, is an undertaking with inherent risk. Risks including blood loss, infection, unsatisfactory cosmetic results and even death (especially in cases requiring general anesthesia) should be included in the discussion one has with their surgeon planning to do the procedure. While untoward complications may be rare for some procedures, some degree of risk still exists. The patient/client should be made aware and given the opportunity to ask questions prior to consenting for the surgical procedure.

The high cost of the procedure, hospitalization and travel coupled with the likely permanence of cosmetic procedures provides food for thought; a feast, in fact! A person who identifies as a transgender woman and feels that they would be best served by getting surgery to look more feminine can find themselves wanting it so much. So much so that the arduous task of “shopping around,” saving funds and interviewing surgeons and other transgender folks about their experiences seems insurmountable. Clearly, it can be difficult but the end result is something you may need to live with (and pay for!) for a long time to come.