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.
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.