A Complete Guide to FFS Procedures and Choosing the Right Surgeon

Choosing the right surgeon for FFS is one of the most impactful decisions you’ll make in your transition journey.

The WPATH (World Professional Association for Transgender Health) Standards of Care Version 8 (its latest framework) emphasizes that anyone providing gender-affirming procedures should have appropriate training, demonstrated competence, and a commitment to ongoing education.

In other words, you deserve a surgeon who has made FFS a true specialty, not someone who treats it as an occasional cosmetic add-on.

To help you evaluate whether a surgeon is the right fit for your needs, here’s a checklist of what to look for:

Facial feminization surgery (FFS) is a collection of gender-affirming procedures that reshape facial features that may read as traditionally masculine, helping them align more closely with a feminine appearance.

FFS is part of the broader landscape of transgender surgical care, and for many individuals in the LGBTQ+ community, it can be a deeply meaningful part of their transition.

Unlike general cosmetic surgery, which focuses on aesthetics or restoring a more youthful look, FFS is centered on gender affirmation rather than simple beauty enhancement.

For instance, procedures like facelifts or neck lifts aim to rejuvenate aging features. Meanwhile, FFS aims to help ease gender dysphoria (the distress caused when physical traits don’t align with one’s gender identity).

For many people, the impact of FFS goes far beyond appearance.

Research consistently shows that FFS is linked to improvements in emotional well-being, social confidence, and day-to-day functioning.

A 2023 study published in Plastic and Reconstructive Surgery-Global Open found that transgender patients experienced reduced anxiety, depression, and overall distress in transgender patients after FFS.

Many transgender people seek medical care to help ease the distress that comes with gender dysphoria.

FFS is often an essential part of that care, and for some individuals, it may have an even greater impact than genital surgery when it comes to relieving their symptoms.

What Is Done in Facial Feminization Surgery?

Our FFS approach often combines several procedures to better align facial features and achieve a feminine appearance. While every patient’s plan is different, many FFS journeys include some of the following:

• Forehead contouring (type 3 cranioplasty)
  The surgeon reshapes the forehead by reducing a pronounced brow ridge and repositioning bone over the frontal sinus to create a smoother, rounder contour.
  If you want to soften the masculine projection of your upper face, consider forehead contouring.
• Hairline advancement (scalp advancement)
  The front of your scalp is carefully advanced forward to lower the hairline. This procedure helps reduce a high or receding hairline and creates a more traditionally feminine or nonbinary facial frame.
• Feminizing rhinoplasty
  The bones and cartilage of your nose are refined to narrow the bridge, slim the tip, and soften angles. The goal is a nose that looks delicate and harmonizes naturally with the rest of the face while preserving nasal function.
• Jaw contouring (mandibular angle reduction)
  Through incisions typically placed inside the mouth, the width and sharp angles of your jaw are reduced. Jaw contouring helps transition a broad or square jaw into a more tapered, feminine lower face.
• Chin reshaping (genioplasty)
  Your chin can be shortened, narrowed, or repositioned (such as with a sliding genioplasty) to create a softer, less angular contour.
• Tracheal shave (Adam’s apple reduction)
  A small portion of your thyroid cartilage is reduced through an incision placed in a natural neck crease, helping minimize the prominence of the Adam’s apple.
• Brow lift
  During this procedure, your surgeon lifts and gently reshapes your brows to create a higher, more arched position, opening the eye area and contributing to a softer, more feminine expression.
• Cheek augmentation
  Implants or fat grafting can add volume to your cheeks. This procedure enhances roundness and creates the fuller, lifted look often associated with a feminine facial structure.
• Lip procedures
  An upper lip lift can shorten the space between the nose and upper lip, while lip augmentation (using fat grafting or fillers) adds fullness for a more youthful, feminine appearance.
• Fat grafting
  Fat taken from another part of the body is used to soften transitions, add contour, and enhance features like the cheeks or lips.
• Eyelid surgery (blepharoplasty)
  Adjusting excess skin or repositioning fat around the eyelids can make the eyes appear more open and refreshed. This procedure often pairs well with a brow lift or forehead contouring.

Who Might Need Facial Feminization Surgery?

If you’re considering FFS, one of the first questions you might ask yourself is whether you’re the kind of person FFS is meant for. The truth is, it’s less about labels and more about how your facial features affect your sense of self.

FFS can support a wide range of people who want their features to better align with who they are on the inside. FFS may be a good fit for you if you are a:

• Transgender woman
  Many transgender women consider FFS when masculine facial features contribute to ongoing gender incongruence.
  This is especially common for those already living as women and often on hormone therapy, yet still experiencing distress related to facial characteristics that hormones cannot change.
• Nonbinary person seeking a more feminine appearance
  FFS is also an option for nonbinary people who want their features to appear more feminine.
• Cisgender women seeking feminization
  Some cisgender women pursue FFS procedures to refine or enhance the femininity of certain features, whether for gender expression, aesthetics, or personal comfort.
• Someone experiencing gender dysphoria
  For anyone whose facial features contribute to significant distress or a sense of mismatch between their gender identity and physical appearance, FFS may be a vital option to explore.

From a medical perspective, you can pursue FFS as long as you’re healthy enough for surgery, have stable mental well-being, and have goals that match what these procedures can realistically achieve.

Many people choose FFS not out of vanity, but because living with features that don’t align with your gender identity can create real emotional strain, including misgendering, anxiety, and persistent dysphoria.

Aligning your facial features with your identity can help bring relief, confidence, and create a greater sense of ease in day-to-day life.

Who Shouldn’t Have Facial Feminization Surgery?

Not everyone is ready for facial feminization surgery right now. And that’s completely okay.

FFS is a life-changing procedure, and ensuring you’re physically and emotionally prepared is part of keeping you safe.

You might hear surgeons talk about “contraindications,” which means factors that make surgery unsafe or not advised at the moment.

Here are some signs FFS may not be appropriate for you right now:

• Medical issues that make surgery unsafe
  If you have a health condition that increases your surgical risk, your surgeon may recommend waiting or addressing those issues first.
  These conditions can include heart disease, bleeding disorders, or complications related to general anesthesia.
  The goal isn’t to deny you care, but to ensure you’re not put in harm’s way.
• Significant or unstable mental health concerns
  You don’t need perfect mental health to pursue FFS. That said, if you’re in the middle of a crisis or struggling with symptoms that aren’t yet stable, it’s usually safer to pause.
  This precaution aligns with the WPATH (The World Professional Association for Transgender Health) Standards of Care, which emphasize making sure you’re mentally ready for transformative surgery and the recovery that follows.
• Expectations that go beyond what surgery can deliver
  If you’re hoping FFS will solve every problem in your life, guarantee social acceptance, or completely erase dysphoria overnight, you may need more time to explore what these procedures can realistically achieve.
  FFS can help tremendously, but it can’t rewrite every part of your experience.
• Being underage or not developmentally ready
  FFS is generally performed in adults. In most cases, you should be over 18 before undergoing these procedures.
  FFS for trans teens remains highly controversial. Most guidance emphasizes legal adulthood and informed decision-making before moving forward.
  Other than that, there’s no “perfect” age beyond adulthood. Readiness is personal and depends on your health, timing, and goals.
• Limited support or not enough readiness for recovery
  FFS recovery can be demanding. You’ll need time, help, and emotional support.
  If you don’t yet have a safe environment, reliable caregiving, or the space to recover comfortably, your surgeon may encourage you to build those supports first.

At FFS Institute, Dr. Chen and our entire team take a safety-first approach aligned with standards set by reputable organizations, such as the WPATH.

That means we look at the whole picture, not just your anatomy, but your health, your mental well-being, and the support you have around you.

We want to ensure you’re stepping into surgery at the right time, with the right expectations, and with the resources you need to heal well.

The cost of facial feminization surgery can vary widely depending on how many procedures you’re having and which areas of the face you want to address. For patients paying out of pocket, prices typically range from $5,000 to $100,000.

Here’s a simple breakdown of non-insurance, out-of-pocket estimates by facial region:

• Upper third (hairline, forehead bone, brow): $10,000 to $50,000
• Middle third (nose, cheeks): $6,000 to $30,000
• Lower third (lips, jaw, chin, neck): $5,000 to $50,000

Specialized FFS surgeons and institute-level centers often fall on the higher end of these ranges because of their advanced training, high case volume, and the technology they use to plan and perform surgery.

What Factors Affect the Cost of FFS Surgery?

Your final cost can vary based on these factors:

• Surgeon experience: Board-certified surgeons with deep, gender-affirming expertise usually charge more due to their specialized training and skill.
• Facility quality: Centers in areas like Beverly Hills often operate with hospital-grade equipment, accredited operating rooms, and concierge-level care, all of which are reflected in the price.
• Facility fees: These cover nursing staff, medications, surgical supplies, and the cost of running a safe, accredited operating suite.
• Anesthesia: Full FFS requires general anesthesia, and working with a dedicated anesthesia provider adds an additional fee.
• Geographic location: Major medical hubs — especially Beverly Hills — tend to have higher fees due to cost of living, strong demand, and expectations for premium care.
• Number and type of procedures: Each procedure you add (forehead reduction, rhinoplasty, jaw or chin reshaping, tracheal shave, and lip work) increases surgical time and, in turn, facility and anesthesia costs. More procedures mean a higher overall total.

These factors together shape your final price, and your surgeon’s team can help you understand how each piece applies to your specific plan.

Does Insurance Cover Facial Feminization Surgery?

Insurance may cover facial feminization surgery, but coverage varies by plan and what your insurer considers medically necessary.

Many gender-affirming procedures, including FFS, are now recognized as medically necessary for trans and nonbinary patients, especially in states like California.

When the right documentation is submitted, private insurance plans in these states often approve at least part of the surgical plan.

Major organizations support this shift in coverage.

As early as 2016, the WPATH Board of Directors has been urging U.S. insurers to remove exclusions for transgender patients and cover medically necessary gender-affirming care.

The University of California, San Francisco (UCSF) echoes this advocacy, noting that a wide range of gender-affirming procedures are officially defined as medically necessary.

Unfortunately, most insurers don’t publish a list of “covered FFS procedures,” which can make the process confusing.

In practice, insurers are most likely to cover procedures that are clearly tied to treating gender dysphoria.

That’s why documentation is necessary, and why you may need to submit letters for each procedure rather than for FFS as a whole.

Here’s what the insurance process often involves:

• Working with your mental health provider to obtain a support letter
• Submitting that letter along with your surgeon’s treatment plan
• Checking your policy for any exclusions related to gender-affirming care
• Expecting some back-and-forth before receiving a final decision

Navigating this process can feel overwhelming, but you don’t have to do it alone. At FFS Institute, we can help organize paperwork, understand requirements, and work toward obtaining approval.

How Do I Pay for FFS?

There’s no single “right” way to prepare financially. The best approach is the one that feels realistic and sustainable for you.

Some people save gradually, while others combine savings with financing so they don’t have to wait years to move forward. You might:

• Save a portion of the cost and finance the rest to help keep monthly payments manageable.
• Factor in travel, time off work, and follow-up visits if you’re coming from out of town.
• Create a flexible timeline, saving steadily while gathering any insurance documentation you may need.

Whatever path you choose, plan in a way that supports both your goals and your financial well-being.

FFS is more than a cosmetic change. For many people, it’s a lifeline, a step toward living in a face that finally feels like yours.

And throughout every stage of your recovery, our team is here to support and empower you.

How Much Discomfort Follows After FFS?

It’s completely normal to wonder how much discomfort you’ll feel after FFS.

Every surgery comes with some level of pain, but what you experience depends mainly on how many procedures you’re having at once and how your body personally responds to healing.

If you’re having a minor, focused procedure, your discomfort may be relatively mild and manageable with over-the-counter medications like Advil or Tylenol.

But if you’re having multiple areas addressed—such as forehead work combined with jaw contouring and rhinoplasty—the first few days will likely feel more intense.

Existing data can help give you a clearer picture. In a multicenter study of 74 FFS patients, the average reported pain was 4.3 out of 10 in the early postoperative period.

Interestingly, the study didn’t find significant differences between patients who had a “partial” FFS versus those who had full-face procedures.

For most people, the pattern looks something like this:

• The first few days usually bring moderate discomfort, but it’s typically well controlled with our pain-management protocol.
• Stronger medications (like short-term narcotics) are generally only needed for the first four to five days.
• After this early healing phase, most patients switch to lighter options and notice the pain steadily improving.

Some procedures, such as a tracheal shave, can cause temporary hoarseness or throat discomfort. This kind of irritation is usually associated with swelling and almost always resolves over time.

Overall, your level of discomfort can vary depending on:

• The number of procedures you’re having at once
• The amount of bone work involved
• Your personal pain tolerance, age, and overall health
• How closely you follow post-op instructions, such as wearing compression garments, resting, icing, and keeping your head elevated

At FFS Institute, we won’t leave you to manage post-op discomfort on your own.

You’ll receive a personalized pain-management plan based on the exact procedures you had—nothing generic, and nothing more demanding than you truly need.

We also structure your follow-up visits early and often: a check-in the day after surgery, suture or dressing removal around day seven, and regular visits after that.

Those touchpoints allow Dr. Chen and our team to keep a close eye on your healing and adjust your care right away if discomfort or swelling feels like more than you expected.

Throughout the entire process, our goal is straightforward: to help you stay as comfortable and supported as possible while your face heals.

When to Call the Doctor

FFS is generally safe when performed by a qualified surgeon, but, like any procedure, it still carries risks.

Here’s a good rule of thumb: If something feels off, trust your instincts and reach out. That said, here are the specific signs you should never ignore:

• Infection

  Call your surgeon if you notice:

  • Redness, swelling, or soreness around an incision that’s getting worse instead of slowly improving.
  • Unusual drainage (anything cloudy, foul-smelling, or pus-like).
  • Fever, chills, or feeling unwell
• Bleeding, hematoma, or wound opening

  These signs deserve an immediate call:

  • Bleeding that doesn’t stop with gentle pressure or bleeding that starts again after stopping.
  • Sudden or rapidly growing swelling—especially if it feels tight, firm, or painful—can signal a hematoma (blood pooling under the skin) or a fluid collection.
  • An incision that appears to be opening, pulling apart, or losing sutures (wound dehiscence).
• Abnormal pain

  Some discomfort is expected, but reach out if:

  • Your pain isn’t improving day by day, or it suddenly gets worse.
  • The pain feels sharp, throbbing, or “different” from what you’ve felt before.
  • Your prescribed medication isn’t helping, or the pain returns after it seemed to be getting better.
• Systemic or Unusual Symptoms

  FFS can involve several regions of the face and neck, so complications don’t always show up directly on the incision line. Call right away if you experience:

  • Shortness of breath, chest pain, or irregular heartbeat.
  • Worsening hoarseness, trouble swallowing, or sudden neck swelling
  • Unexpected numbness or nerve symptoms that feel severe or worsening

At FFS Institute, we see ourselves as your partner in healing.

You’re never bothering anyone by asking questions, especially after a complex facial surgery.

Even if you’re unsure whether something is serious, it’s always better to check in—whether you need reassurance or something truly needs attention.

Modern facial feminization surgery is far more sophisticated than simply “eyeballing” bone or soft tissue.

Today’s FFS combines surgical expertise with high-resolution imaging, computer-based planning, and minimally invasive tools, many of which are already built into our workflow at the FFS Institute.

• Virtual Surgical Planning (VSP) and 3D Facial CT Scanning
  One of the foundations of advanced FFS is Virtual Surgical Planning (VSP).
  With a detailed face scan, we can study your bone structure, your forehead, orbital rims, jaw, and chin, down to the millimeter.
  This step lets us map out where contouring should happen long before you’re in the operating room.
  VSP gives you the advantage of a “plan first, then operate” approach.
  Instead of estimating shape changes during surgery, Dr. Chen can visualize the problem areas, explore different solutions, and choose the path that will give you the most natural, balanced result.
  Across craniofacial and aesthetic surgery, it’s now routine to gather imaging using CT (computed tomography), MRI (magnetic resonance imaging), ultrasound, laser scanning, and 3D photography.
  At FFS Institute, these tools support the detailed preoperative evaluation that makes your surgical plan completely customized, and not a template or one-size-fits-all approach.
• 3D Medical Printing
  Three-dimensional printing has become an essential component of modern craniofacial surgery and integrates seamlessly into FFS.
  What once lived only on a screen can now become something your surgeon can hold, study, and use with remarkable precision. With 3D printing, your surgical plan can be transformed into physical, customized tools, such as:
  • Custom 3D-printed guides for forehead or jaw contouring
  • 3D-printed implants crafted specifically for your chin or cheeks
  • Physical skull models that help your surgeon rehearse the procedure and explain each step clearly
• Endoscopic, Minimal-Scar Techniques
  Endoscopic methods use a small camera and slim instruments inserted through tiny incisions, often hidden along natural creases. In FFS, this approach is especially helpful for:
  • Brow lifts
  • Certain scalp or hairline procedures
  • Select soft-tissue repositioning With smaller incisions and less visible scarring, you get a cleaner, more natural result, which is especially crucial if you want your face to look feminized without apparent signs of surgery.
• Robotic and Automation-Assisted Tools
  Robotics isn’t yet a standard part of FFS, but the technology is advancing rapidly in the broader field of craniomaxillofacial surgery.
  Early robotic systems show real promise, from helping shape surgical hardware to assisting with incredibly precise, digitally guided tasks. Dr. Chen keeps a close eye on these developments, ensuring that as the field grows, you benefit from the safest and most advanced options available.
• Computer-Assisted “Morphing” and Predictive Visualization
  At FFS Institute, you’ll also experience another modern tool: photo-based morphing.
  It gives you a visual sense of what might be possible and helps create a clear, shared starting point for conversations about your goals, so you feel understood, supported, and truly involved in shaping your outcome.