Facial feminization surgery (FFS) is a constellation of procedures that benefit patients who desire a more delicate and attractive face. These procedures are performed by world-renowned facial plastic surgeon Dr. Vartan Mardirossian at Mardirossian Facial Aesthetics, a fully licensed surgical suite in Jupiter, FL.
What is Facial Feminization Surgery (FFS)?
Facial feminization surgery (FFS) has developed within the field of facial plastic surgery and is defined as “a combination of surgical and non-surgical procedures that aim to increase the femininity and attractiveness of the face.” According to Dr. Mardirossian, however, FFS is not simply a group of procedures, but it is a new philosophy of how to perceive and transform the face in its harmony and balance. The objective of FFS is to sculpt feminine features out of preexisting masculine ones. During your visit, Dr. Mardirossian will evaluate your face and will recommend, in the order of their importance, the procedures that will make you look more feminine, and therefore, more beautiful. Some of the most popular, life-changing facial feminization procedures performed at our practice include:
- Forehead Contouring
- Feminization Rhinoplasty
- Mandible Contouring
- Tracheal Shave or Adam’s Apple Reduction
- Voice Feminization Surgery
- CBCT Scan
- FFS Surgery Recovery
- Hairline Advancement and Rounding
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What are Key Facial Differences Between Men and Women?
Men and women can have a distinct male or female face, but if not, you may be seeking gender-affirming surgery. In men, the hairline is often higher than in females and usually becomes even higher at the temples that give it an “M” shape. In men, the hairline is about 7 cm above the eyebrows, while in women, this distance is 5.5-6 cm. The hairline can be moved forward and given a more rounded shape either with a Hairline Advancement or with hair transplants, or a combination of both. During the Hairline Advancement procedure, the scalp is repositioned to the ideal feminine hairline. The incisions are made in an irregular fashion just behind the natural hairline. This is done because every time an incision is broken down in small segments of less than 5 mm, the human eye cannot perceive the incision. The cut is made in a fashion that results in hair growing through the incision line to further camouflage it. Three layers of closure guarantee minimum to no tension on the wound that therefore heals as a thin line. Hairline rounding can be performed along with a segmental Hairline Advancement that allows for the filling of the temporal recession with the hair-bearing scalp. The area of the scalp above the ear is rotated and advanced to replace the bald skin in the temporal recessions.
When hair transplantation is performed, a strip of hair-bearing skin is removed from the scalp and then transplanted to cover any areas of temporal balding and excess forehead (follicular unit strip or FUS technique). Alternatively, the hair follicles can be harvested one by one to avoid a linear scar on the scalp (follicular unit extraction or FUE technique). The hair follicles that have been harvested are then inset the desired location(s). The new grafts take about 6-12 months to populate the new hairline.
The forehead is the most gender-defining feature of the face. This is because the eyes are the most important feature of the female face, and a prominent forehead casts a shadow over the eyes, thus obscuring their inherent beauty. Men typically have a prominent ridge of bone in the center of the forehead and at the eyebrows called a brow ridge, which casts a shadow over the eyes (in an evolutionary sense, to maybe hide the direction of their gaze) while female foreheads tend to be smoother, flatter, and with no bossing. The bony rims that the eyebrows sit on are called supraorbital rims. The supraorbital rims are shaved down by a variable degree during a forehead contouring procedure. The prominent bone of the central forehead often serves as the anterior wall of a sinus cavity called the frontal sinus.
To achieve a perfect oval contour of the forehead, Dr. Mardirossian would actually set back the anterior wall of the frontal sinus (Type 3 reduction cranioplasty). The thickness of the anterior sinus wall is not reduced but it is simply placed in a more posterior position to give the forehead the desired smooth oval contour while maintaining its strength. A typical setback ranges between 1 and 2 cm. The formal name of this technique is Type 3 Forehead feminization or Group 3 reduction-recontouring after Osterhout. This is the technique that Dr. Mardirossian currently performs in 90-95% of his patients. This strategy does not apply only in the patients in which the frontal sinus is actually missing (3-5% of the population).
Eyebrows are usually horizontal in men while in women they are arched with the highest point corresponding to a line passing through the lateral edge of the iris of the eye. Along with advancing the hairline and contouring the forehead, Dr. Mardirossian performs a brow lift to elevate the brows above the orbital rims; this improves the appearance of the eyes and underlines their inner beauty.
Generally, men tend to have bigger and wider noses than women, and the nasal tip is bulbous and pointing down. The female nose is smaller, refined, and delicate compared to male noses. The attractive female nose has a slight scoop at the dorsum, and the tip is slightly turned up (or rotated) and less prominent (or less projected) than a male nose. The beautiful female nose is unnoticeable on the face – it is neither too big or too small, but just fits well with the rest of the facial features.
Women’s cheeks are fuller, with a more defined contour and projection than men. This is especially true for the area of the cheeks under the eyes. This portion of the cheeks is very important because, when fuller, it reflects light into the eyes to make them more attractive. Fillers, fat grafting and cheek implants are all viable options for cheek augmentation. Buccal fat removal will further define the contour of the face in select patients who tend to have a rounder and therefore less refined facial contour. The fat is accessed through two small incisions in the mouth with no visible incisions left, the procedure slims and refines the face of the patient. It is a procedure that we routinely combine with cheekbone reduction.
The Chin and the Jaw
Men tend to have longer and heavier chins than women. In men, the chin is often square whereas in women the chin is more refined and pointy, almost corresponding to the height of the upper and lower lip together. In addition, males have a more prominent body of the mandible (the area under the cheeks) and more prominent mandible angles. All these areas can be reduced very effectively by means of bone contouring.
The chin height can be reduced in several ways, including 3D bone shave-contouring, or a T-shaped narrowing sliding genioplasty where a central section of the chin bone is removed and the remaining fragments are moved and fixed together to refine and reduce the chin. The mandible contouring enhances feminine appearance, and narrows and reduces the length of the face, while good support for the soft tissue is preserved. There are two methods of mandible contouring: removing the cortex of the bone with the help of a powered instrument or removing the actual full thickness of bone as a fragment of the jaw angle and body, also known as angle and body osteotomy. Both of these are truly transforming procedures that Dr. Mardirossian has been safely performing for years.
The length of the philtrum (or area above the upper lip) is greater in men than in women and becomes longer with age. This process is contrasted and reversed, thanks to the lip lift procedure that lifts the upper lip to show several millimeters of the four upper teeth. Upper teeth show is perceived as very feminizing. It creates attractiveness to the lips and the lower face as a whole but also contributes to a shorter and more feminine face image. The incision is hidden underneath the nose and with meticulous closure becomes invisible in the vast majority of patients. To improve lips fullness for more attractive and kissable lips, we routinely use fillers, fat, dermal-fat grafts or soft silicone implants. These, as well as many other procedures, can be performed under local anesthesia as well as in conjunction with FFS.
Men tend to have a much more prominent laryngeal cartilage (aka Adam’s apple) than women. The Adam’s apple can be reduced with a procedure called a tracheal shave or Chondrolaryngoplasty. It is very important that your surgeon establishes the precise position of the attachment of the vocal cords to the laryngeal cartilage prior to removing the unwanted cartilage to avoid injury to the attachment of the vocal folds and changes in voice. This is not an in-office procedure and usually requires a one-night hospital stay. The incision is hidden under the chin to prevent it from being seen. The proper placement of the short 1 cm incision and its meticulous closure produce a very inconspicuous incision almost in all patients.
Women’s voices are more melodic while men’s voices are more monotonous. In speech training terms, this means that women have an overall higher voice frequency, and they change the frequency of their voice much more frequently than men. The voiced speech of a typical adult male will have a fundamental frequency from 85 to 180 Hz, and that of a typical adult female from 165 to 255 Hz. The voice feminization surgery by means of Vocal Fold Shortening and Retrodisplacement of the Anterior Commissure (VFSRAC) is a safe and reliable method, practiced by Dr. Mardirossian. In VFSRAC, the vocal folds are not only sutured together to create an anterior glottic web, but the entire anterior commissure of the vocal folds is moved posteriorly to create more tension and thinning of the vocal folds to increase their fundamental frequency. No skin incisions are necessary. The outer surface of the vocal folds is removed, and they are then sutured together tightly with a very fine permanent suture material to accomplish their tightening and the creation of a feminine geometry to the larynx.
Contact Mardirossian Facial Aesthetics today to schedule a consultation with Vartan Mardirossian, M.D., F.A.C.S., to see which procedures are the right solution for you. Our office is located in Jupiter, FL, but we offer facial feminization surgery to individuals all over the country and even internationally.