Facial Feminization Surgery: Key Considerations in Choosing the Right Doctor
Among the numerous gender confirmation surgeries, facial feminization procedures are without a doubt some of the most influential—and the most demanding to carry out. "What I've discovered from my patients is that facial feminization can be even more significant than bottom surgery. They are clear about their identity—it's the external world that misidentifies their gender," remarks Dr. Jeffrey Spiegel, a board-certified plastic surgeon in Newton, Massachusetts. Other people don't frequently see your genitals, but they do see your face daily; modifying your facial characteristics so that they affirm your gender in a visible manner makes this a highly important surgery, he adds. (It's worth noting that gender-affirming facial surgery often involves feminizing the face for transgender or even cis women. Testosterone does an excellent job of making the face more masculine for female-to-male transgender patients, but estrogen doesn't have the reverse effect, as noted by Dr. Speigel.)
The prominence of the face also implies there's an extremely narrow margin for error. "If something goes awry with a surgery on the body, it's not ideal, but at least it can be concealed in public. That's clearly not the situation for the face," states Dr. Jordan Deschamps-Braly, a board-certified plastic surgeon in San Francisco. The point is, choosing the correct doctor is of utmost importance for any type of plastic surgery, but the risks are even greater when it comes to facial feminization. Ahead, expert advice on how to find the appropriate provider for you during the consultation process.
Inquire about Their Training
"Any plastic surgeon can assert to be an expert in facial feminization surgery, making it essential in this type of transgender surgery to find an experienced surgeon," cautions Beverly Hills, California-based board-certified facial plastic surgeon Dr. Toby Mayer. It's regarded as one of the most challenging types of plastic surgery, yet there's a growing number of doctors who claim they know how to perform it without having received proper training, adds Dr. Spiegel. Alongside the fact that the entire face needs to be taken into account, transgender women have distinct skin and tissue compared to cis women, demanding a different surgical technique. Consider it like this: "A person who can fly a small propeller plane probably isn't capable of flying a 747, even if they are an outstanding pilot," he analogizes. Be precise and ask the doctor you're considering exactly where and with whom they were trained, he suggests.
Apart from being board-certified, doctors who have undergone craniofacial surgery fellowships are typically well-prepared to be trained in facial feminization surgery, notes Dr. Deschamps-Braly. "A good question to pose is, 'How are you qualified to conduct this surgery, aside from your basic credentials?'" he says.
Ask How Many Transgender Surgeries They've Performed
Quality is important, of course, but so is quantity. The necessary expertise and skill can only be acquired over time. "Until someone has completed 300 to 400 cases, you truly run the risk of obtaining an inferior surgery," warns Dr. Deschamps-Braly. For reference, a surgeon who is very busy and performing FFS almost exclusively would likely carry out somewhere between 100 to 130 surgeries per year, he says, meaning it could be a solid three to four years before they are truly experienced. Dr. Mayer believes it takes even longer, advising that any facial feminization surgeon should have a minimum of five years of experience.
Pay Close Attention to Before-and-Afters
Look for a doctor who has a large collection of before and after photos they can present. (It's also a good notion to ensure these include patients of the same ethnicity as you, as feminizing facial features can vary significantly based on ethnicity, notes Dr. Deschamps-Braly.) It can be difficult for non-professionals to view these photos, however, because many people confuse beauty with a feminine gender, he adds. For this reason, ask the doctor to guide you through each photo and explain precisely what they did and why they did it as well as how it influences the ultimate goal of others perceiving that patient as a woman, he suggests. Similarly, consider requesting patient testimonials or ask to communicate with some of the doctor's previous patients, notes Dr. Spiegel.
However, there are a few specific aspects to watch for in the before-and-afters. "Ensure there are photos where the patient has her hair pulled back. Many doctors won't show the hairline because the way they perform hairline lowering surgery leaves a scar, which ultimately limits how the patient can style their hair," notes Dr. Mayer. You also want to make sure the noses don't have scoops or pinched tips and, ultimately, that the results appear both feminine and natural, he adds.
Discuss Your Entire Face
"Facial feminization surgery is all about integrating individual procedures to form an overall balanced, natural, and feminine outcome," says Dr. Mayer. That's why the fact that someone is proficient in rhinoplasty doesn't imply that they can perform a successful FFS, he adds, once again emphasizing the significance of finding specially trained surgeons. And there's no shortage of individual factors that impact the final result. This encompasses elements such as the hairline pattern and position; eyebrow position; shape of the orbital bone, forehead, chin, jaw and neck; the length of the lip; the presence of an Adam's apple; and many more, points out Dr. Spiegel. "Some patients come in and have only one very specific goal or aspect they wish to change. And that's fine, we can do that, but keep in mind that it might not change your perceived gender," he says. "It's valuable to be receptive to your doctor's recommendations and discuss your face from top to bottom and how each feature affects how people perceive you."
Ask the Doctor for Specifics
As you discuss your various features, insist your doctor provide exact figures. The top facial feminization surgeons understand the difference between female normative facial value and male normative facial value and will be able to quantify the changes they suggest, says Dr. Deschamps-Braly. If they can't tell you precisely how much smaller they'll make your chin or how much they'll modify the length of your upper lip and the reason for it, that's a major warning sign, he cautions.
