What you can expect

During the procedure

Facial feminization surgery might include:

• Forehead contouring. In men, the bony ridge above the eye sockets tends to be more pronounced. In women, the outline of the forehead tends to be higher, smoother and more vertical. There also might be a rounded protrusion. To make the forehead appear more feminine, part of the forehead bone is cut, removed, reshaped and put back into place.
• Eye and lid modification (blepharoplasty). To feminize the upper eyelids, excess tissue can be cut away.
• Cheek augmentation. Women tend to have prominent round cheeks in the middle third of their faces. This is due to a greater concentration of fat in the area. To achieve a more feminine appearance, cheek augmentation can be done with implants. It can also be done by fracturing and moving the cheekbones into a different position or by taking fat from another part of the body, such as the belly or thighs, and placing it in the cheeks to alter their size and shape.
• Nose reshaping (rhinoplasty). Rhinoplasty done on transgender women typically involves reducing the overall size of the nose and its angles.
• Lip lift and augmentation. Female faces tend to have shorter distances between the base of the nose and the border of the upper lip. Male faces also have longer upper lips. A lip lift can shorten the distance between the lip and the nose and create a shorter, more curled lip. Lips can be augmented through the use of implants or fillers or by taking fat from another part of the body and placing it in the lips.
• Mandibular angle reduction. Male jaws are typically larger and broader than female jaws. The jaw can be reduced and narrowed by sculpting or removing outer layers from the lower jaw.
• Chin width reduction (genioplasty). The male chin is taller than the female chin and tends to be more square-shaped. To shorten and narrow the chin, a horizontal cut is made along the chin bone and a small wedge of bone is removed. Then the chin bone is reattached.

Other possible head and neck procedures include:

• Tracheal shave. This is a procedure to minimize your thyroid cartilage or Adam's apple. During the procedure, a small incision will be made under your chin, in the shadow of your neck or in a skin fold to conceal the scar. Your surgeon will then reduce and reshape the cartilage.
• Lowering the hairline. Female hairlines tend to be located lower than male hairlines. During hairline lowering surgery, an incision is made at the meeting point of the hair-bearing and non-hair-bearing skin. The scalp is then raised, placed back and fixed to the bone. Excess forehead skin is removed.
• Hair transplantation. Men might experience hair loss. They also tend to have an M-shaped hairline that recedes at the temples, while women tend to have a rounded hairline. Hair transplantation can create a more feminine hairline. In this procedure, hair follicles from the back and side of the head are removed and transplanted to balding areas of the head and the temples.

You also might need skin-tightening surgery, such as a face-lift or other treatments.

After the procedure

After surgery, expect to experience pain, redness and swelling in your face, most noticeably in your eyes, nose, jaw and chin. Avoid overexertion for one month. You can begin moderate exercise within three to six months.

Chewing and swallowing might be difficult due to incisions and swelling. Your surgeon might recommend that you work with a nutritionist to make sure you get enough nutrients following surgery. A healthy diet is an important part of your recovery.