FFS Owners Manual: Preface

FFS Owners Manual: Preface

Whether you identify as a man, a woman, or prefer not to play into our bi-gendered society, you still remain a product of your hormones.

Without medical intervention, female assigned at birth (faab) people will grow breasts, grow fuller hips etc.

Male assigned at birth (maab) people will grow more coarse body hair as well as facial hair. Their voices will also drop and their hairlines will eventually recede.

There are many other properties, but this article is only making the basis for an understanding of FFS.

If you are a trans person, you are probably aware that hormones can help to adjust these differences and will function stronger the younger you are. Faab person can take testosterone and many of the male characteristics experienced during puberty will happen. Faab people taking testosterone (trans men) will develop a lower voice and begin growing facial hair. They will experience rougher skin and an ability to gain muscle. The aim of hormone replacement therapy (HRT) is to bring your hormones in line with your target gender.

Trans women (maab) on HRT will take Estrogen, and an anti-Androgen, to nullify the production of Testosterone. Breasts, a reduction in body hair, and softer skin are a few of the benefits of HRT. Unfortunately, maab puberty and aging is rough on a trans woman’s face. The older a trans woman is after puberty, the less hormones will show their effects.

Breasts tend to grow to one size smaller than your closest relative, but have better results the earlier you start. Receding hairlines are also very much a product of genetics, but the older you are, the less hair you may have. Bone structure is genetic, but the longer testosterone is active, the more masculine a face will become. Puberty causes the first obvious change to the bone structure. Basically, puberty is the beginning of a man or woman face from a less gendered child face.

FFS – Facial Feminization Surgery

A masculine face has a strong angular jaw line, a protruding orbital/browbone, an Adam’s Apple, a downward-turned nose, a M hairline, and usually no Cupid’s Bow on the upper lip. While many plastic surgery techniques can address these issues individually, some bone structure procedures do not fall into the repertoire of many surgeons. FFS is a combination of plastic surgery and maxillofacial surgery that aims to bring the dimensions and appearance of the face into the female range. FFS is not the term for the surgery, but a combination of surgeries that will help the specific individual.

Anyone considering FFS whether in Europe or elsewhere should visit Dr Bart van de Ven’s excellent site. From my consultation, I was sure I wanted him as my surgeon. He is very professional and treats the facial proportions as a science. His website includes many before and after photos and details which procedures were performed.


See below for a comparison from early November 2013 (when I decided I would transition) and photos taken from the same angle today, 5 weeks since my FFS in Antwerp, Belgium.

My personal procedures were: forehead recontouring, hairline lowering, brow lift, lip lift, jaw angle reduction, genioplasty and mid facelift. It is normal for after pictures to be taken 3 months post surgery and I am at less than half that recovery time. I will post updates when I reach 3 months of healing time.

The two last things to take into consideration are my weight loss since living full-time in May (15 kilos) and that I have been on estrogen and anti-Androgens since July. Both have had an effect on my face, but nothing compared to FFS.

November 7, 2013 and October 17, 2014

Dr van de Ven noted, in my consultation, that my nose was upturned and that I lacked an Adam’s Apple. I would, therefore, not need surgery to alter these. I was happy to hear this, as both could have interfered with my singing.

The forehead recountouring can be best seen in the profile shots as well as the front-facing shot. One function of this is to give a round silhouette from nose to hairline and make the profile of the browbone less aggressive. The second aim is reduce the shadows cast on the eyes. The eyebrows tend to sit on or above, rather than below, the browbone. This procedure really opens up the entire face and makes it softer. In my opinion, this should be one of the first procedures considered when looking into FFS. The older you are, the more this surgery, along with a brow lift, will revitalize and feminize your face.

Here is a great explanation of forehead recontouring: http://facialfeminization.eu/procedures/forehead-recontouring/

Hairline lowering is taking the M and turning it into an upside down U. In my case, though my hairline does not appear lower, it suits the shape of my face and features much better. This procedure takes away the skin from the temples and lowers the hairline to produce a more pleasing, feminine shape. This is done together with a brow lift to lay the eyebrows in a good position on the orbital bone. In the November photos, my forehead has two very distinct lines due to me over-opening my eyes on a regular basis to see better. This is a condition called ptosis, which is a drooping of the upper eyelid. Some elderly patients have this and have a correctional operation, but not typically people under 60. My lines had some filler injected and seem to be healing nicely. They are almost completely invisible now. The feeling of my stretched scalp feels weird on the top of my head, but it feels great on my forehead and on my eye area and I don’t have to raise my eyebrows anymore to see the world 🙂 !

The lip lift takes the length of the upper lip and makes it that of a natal female. Best seen in the front facing picture, my top lip is now about 4mm shorter. This upturns the lip and exposes the Cupid’s Bow. This also tends to make the mouth stay open more. This has been the most difficult thing to get used to. I have to rehydrate more often and always have to keep some lip balm or lipstick in my purse to keep my lips from chapping. It is very feminizing and I don’t mind dealing with those small negatives.

I would still get every one of these procedure done now knowing how it looks and feels.

The genioplasty (chin surgery) is more visible now than the jaw angle reduction, but both will be more visible after the 6-12 month recovery time. It takes a long time for skin and bone to realign and settle together. This is also true of heavy dental surgeries. My chin was reduced 5mm in height and sits slightly back now. This is best seen in the profile shots, but the distance between my nose and chin is clearly smaller in today’s spread. I am very happy with it, but I am waiting for the skin to adjust to the jawline which should be about 6 months. This can temporarily be made less visible with chin contour shading, but is not featured in this spread.

The mid-face lift can best be seen in the photo which I am looking down. The surgery performed gave me rounder more feminine cheeks. My cheeks, eyes, forehead, and lips are what make me read as female.

When walking in the street my 100 kilo, 180cm frame is still looked at because I’m no small girl, but when people look to my face they get their female confirmation and go about their day instead of giving me questioning or disapproving looks. I am almost exclusively read as female in public after this surgery, whereas before I was not.

I cannot say that this will be as effective for everyone, as your own results may vary, but I am very happy with mine and enjoy watching it heal everyday.

For more info check out: http://facialfeminization.eu/



PS. let me know any questions and I would be happy to answer them.


5 thoughts on “FFS Owners Manual: Preface”

  1. Lucia,

    I’m am in awe of your bravery and willingness to be open and share your experince with the world. I know by doing so you are helping many people. I am very happy for you and so glad you are finally able to be your true self. I wish you the best in your life and hope your journey is joyful and makes you feel whole inside and out.

    If I may ask, I am just curious about how this has affected your marriage and your relationship with your family and close friends? I know physically changing must be a difficult adjustment at times, but how has this affected you and your loved ones emotionally?

    I hope it is not too personal of a question and of course I totally understand if you rather not share.

    I wish you continued success and happiness in your career and personal life.

    All the Best!

    1. Dear Ashley,

      Thank you for reading and for commenting. Of course it is a big shift for anyone in my life. The longer one has known a person before coming out, the more they have to undo years of pronouns and names.

      My wife and I have been together for 11 years as of this month. It’s been about and year since we talked and agreed that I must go further in my journey of transition. With her and I, it has always been somewhat of a question if I would ever feel the need to transition. Back in the first year of our relationship a good friend at the time “warned” her about my halloween costumes and other times I went out dressed up during undergrad.

      She has been wonderful and 10 years of a relationship can weather large life changes easier than a shorter relationship. It’s a big public adjustment, but just because I have been out since only May does not mean that it was a surprise to her in May. She is my favorite person in this world and I am thankful for her everyday. She is my best advocate and defender. It is easier for us in public now, but before ffs, she was always looking out for me.

      It took my mother a few months to get comfortable with the idea, but now she is very supportive. We are closer than ever and I speak to her at least a couple of hours a week.

      My two step sisters in CA have been friendly and supportive. I am not really close with other family people, but the people who have contacted me have been supportive.

      My work has been extremely supportive and and all of my colleagues. I have tried to make myself available to them to speak individually and open to any questions they may have. I cannot thank my bosses enough for their friendly response. I love my job here and would love to continue singing opera with Badisches Staatstheater Karlsruhe.

      I think for a parent of a trans person coming out later in life the question is always “what did I do?” or ” what did I miss?” With youtube and other forms of social sharing you can see so many successful trans people living healthy productive lives. Speaking with my mother it was important to express how different the world is now. It was simply a different time and the only examples of transwomen were exploitative talk shows and gags on sitcoms. Although I felt like a girl since about 5-6 years old, taking puberty blockers then hormones was not something I could find while researching on the internet. I was fortunate enough to have a computer with Internet in about 1988. Despite having Internet at such a young age, the information was not out there…. yet.

      I don’t like the idea of fate, but if I choose to believe things happen for a reason, transitioning after beginning my career has made me more visible as a trans woman. If I had transitioned before college or in college I would have done computer science and went to work for Intel or some similar company. Going through puberty was rough emotionally but it gave me my singing voice and through that my career. Singing about 50 shows a year exposes about 1000 people per show to a working trans woman. I hope that this alone makes people a little more thoughtful when dealing with trans people.

      I hope that through writing and simply doing my job I can be one more successful and visual trans person to show others that it is not a choice between transition and a “normal” life. Being a trans person does not mean jobless, homeless, friendless or all the other terrible things the media would lead you to believe.

      Hopefully this answers your question and a bit more.

      Thank you again for reading.



  2. Fascinating, courageous blog! Very curious to know to what extent, if any, your facial surgeries have affected the timbre of your voice. and your technique. (A friend of mine who had reconstructive facial surgery after an accident told me that his placement sensations were totally different afterwards.)

    1. Hi Tom,

      I am a little hesitant to say exactly what, but the sensations are different. I did my first show back based on muscle memory and actually every show that is not a new premiere. Everything feels different and I’m pretty sure sounds slightly different.

      Right now I am working on a song recital and the sensations are new. There are small parts of my face still slowly regaining feeling and all the nerves get going again. My lower jaw and tongue feel very different than before and are creating different overtones than I’m used to.

      The top of my voice coming out of the passaggio feels way more free than before. One of my singer friends thinks its the emotional weight being lifted off my chords, but shaving my orbital bone I’m sure has affected my sound. I continue to record my voice and see improvement, but there have been alot of things that could have an effect on my voice.

      There was an old piano tuner in my undergrad that would remove braces off french horns. It actually made them alot easier to play. It could be that the reduction of certain bone has freed up my sound, but probably not.

      I have sound samples on youtube of 3 audition arias I recorded after my hormonal levels stabilized to that of a natal female. Once my Lieberabend is done on November 23 I will find some time to record those same pieces to catalogue them after ffs recovery. 3 months of healing seems like a reasonable time to record as post ffs. If there is a significant difference, a multimedia blog may be worth doing explaining how the sound differs and possible physical reasons why.



Leave a Reply

Your email address will not be published. Required fields are marked *