Facial Feminisation Surgery Sydney

Facial feminisation

Facial feminisation surgery, or FFS, is a group of procedures that alter the bone and soft tissue proportions of the face towards features more often read as feminine. It is planned around your face and your priorities rather than a template.

FFS may include brow and forehead reshaping, hairline advancement, rhinoplasty, cheek augmentation, lip procedures, jaw and chin contouring, and tracheal shave. Few people want all of them. The upper third of the face, meaning brow prominence, forehead slope and hairline shape, often matters most.

Dr Maryam Seyedabadi, Specialist Plastic Surgeon, MBBS FRACS, consults on facial feminisation surgery from rooms in Paddington, Sydney. Consultations are private.

Who it may suit

• You are transfeminine or non-binary and particular facial features cause dysphoria or lead to you being misgendered.
• You have had gender affirming hormone therapy and can see that soft tissue has changed while your brow, jaw and chin have not.
• You accept that surgery is usually staged across more than one operation, spaced months apart.
• You understand that your underlying bone structure sets limits on what can be changed.
• You are in reasonable general health and either do not smoke or will stop well before surgery.

What facial feminisation surgery involves

FFS is usually staged. Procedures in one region are often grouped into a single anaesthetic, while regions that heal differently, such as the nose and the jaw, are separated.

1. Planning: photographs and, where bone work is involved, a CT scan, so brow, orbital rims, jaw and chin are measured rather than estimated.
2. Upper face: brow and forehead reshaping through an incision at or behind the hairline, with hairline advancement where shortening the forehead is part of the plan.
3. Midface and nose: rhinoplasty to narrow and reshape the nose, and cheek augmentation with an implant or your own fat.
4. Lower face and neck: jaw contouring, chin reshaping, a lip lift, and tracheal shave to reduce prominence of the thyroid cartilage.
5. Review: oedema settles before the next stage is planned, usually a wait of several months.

Recovery

Timeframes depend on which procedures are combined, so treat these as a guide. Final contour is often not clear for six to twelve months.

• Bruising and oedema peak in the first few days, and after upper face work swelling tracks down towards the eyes.
• A tracheal shave alone is often a day procedure, while bone work usually means a night or two in hospital.
• Many people plan two to three weeks away from work or study after forehead or jaw surgery.
• Numbness of the scalp, forehead, chin or lower lip is common early and usually improves over weeks to months.

Risks and considerations

Risks include bleeding, haematoma, infection, delayed healing, and scars that widen, thicken or are followed by hair loss along a hairline incision. Nerve injury can cause lasting numbness or weakness, including the frontal branch of the facial nerve affecting brow movement and the mental nerve affecting the chin and lower lip. Forehead setback involves opening the frontal sinus. Cheek and chin implants can shift, become infected or need removal.

Asymmetry and contour irregularity are possible, and revision surgery is a separate operation with its own recovery and cost. Bone structure sets the ceiling: skull size, facial height and jaw width can be altered only within limits, and imaging is used at consultation to show what is realistic. General anaesthetic carries risks including blood clots.

Your consultation with Dr Maryam

Consultations are private and held at 2c Heeley Street, Paddington, with Dr Maryam, a female surgeon. Assessment in line with recognised standards of care forms part of the pathway and is discussed with you. Letters from a GP, endocrinologist or psychologist involved in your care are useful if you have them, and where you are up to with gender affirming hormone therapy is relevant to planning.

Where a procedure is classified as cosmetic surgery, a referral from a registered medical practitioner is required before consultation, and a cooling off period of at least seven days applies, or at least three months with an additional assessment for patients under 18. Some gender affirming procedures may attract Medicare item numbers and others do not, so out of pocket costs vary. Facial surgery is performed at St Luke’s Hospital in Potts Point or East Sydney Private Hospital. Call 1300 067 668.