Facial Feminization

Our Clinical Practice in Facial Feminization Surgery

In our practice, we require a routine pre-operative health check-up to exclude serious underlying medical illness that may cause some complications during or after the operation.

Facial feminization surgery (FFS) is a series of procedures intended to reconstruct the male face to make it look more feminine which includes various bony and soft tissue procedures. FFS techniques are derived from maxillofacial and reconstructive surgery as well as general plastic and cosmetic surgery.

FFS is a series of major aesthetics reconstructive surgeries done under general anesthetics in our affiliated hospitals in Phuket, not at the clinic. You will be admitted in the hospital’s private room and operated on the same day. Full payment of the operating expenses must be paid in full before the operation.

Get Educated in Facial Feminization Surgery

The Surgery: Facial Feminization Surgery is generally regarded as an important step in the transition from male to female. Gender identity refers to a person’s internal, deeply felt sense of being male or female. Because gender identity is internal and personally defined, it is not visible to others. The complete intervention normally lasts between 4 and 8 hours depending on its extensiveness.

Procedures involve in facial feminization surgery

Brow ridge contouring, Brow and forehead lift with Hairline Lowering where the incision is made just inside the hairline in an irregular way to avoid a straight scar. The feminizing effect of the combination of these procedures is massive.

  • Brow ridge contouring: The forehead skin is pulled forward to reveal the bone. The bone plate over the frontal sinuses is removed, thinned until it becomes slightly translucent, and reshaped. Then the orbital rims are shaved. Finally, the thin bone plate is put back and fixed with titanium micro screw. The heads of the screws are cut so they cannot be felt or seen through the skin.
  • Brow and forehead lift: The forehead skin is turned back to the forehead and pulled upward to bring the brows in their desired position a little bit over the supra orbital rims. The forehead skin is fixed to the bone using small re-absorbable devices.
  • Hairline lowering: The scalp will be mobilized over the galea (a fibrous plate connecting muscles of the forehead and the back of the head) to the back of the head and pulled forward as needed. However when a greater advancement is required, an expander may need to be inserted under the scalp for about 8 weeks before the advancement which will inflated 2-3 times a week to expand the hair baring skin. The inflation is easy and can be done by one of your friends or relatives or sometimes even yourself.

Jaw Contouring and Chinplasty
The incisions are made inside the mouth so it will not be visible

  • Jaw contouring: The bone at the mandibular angles that is flaring laterally and posteriorly is trimmed off. The Masseter muscle is reduced on its inner aspect.
  • Chinplasty: When the chin is not too heavy, trimming off the corners could be enough. However when it is very wide or too high, a sliding osteotomy is necessary. The chin is cut from back to front on both sides, separating a horseshoe-shape of bone. A second cut parallel to and a few millimeters over the first one can be made, and a slice of bone removed. This will reduce the height of the chin. The middle part of the horseshoe-shaped bone can be removed to make the chin more pointed. The bone parts are fixed using titanium mini-plates and screws. These will never be removed.
  • Adam apple or trachea shaving An incision of about 2 cm is placed under the chin, if possible inside a crease. From there, a tunnel under the skin is made up to the thyroid cartilage. With a bur, its prominence and upper rim are trimmed. The muscles that run along and over the cartilage are united in the middle to cover the remaining prominence. Usually a reduction of the Adam’s apple is necessary for feminization.
  • Lip lift The only way to permanently show more of the lip mucosa is by making an incision along the vermilion border (this is the edge between red and white parts of the lip) and excising a small slice of skin. Skin excisions immediately under the nose have only temporary effects on the volume of the lip mucosa.
  • Malar augmentation High prominent cheekbones are frequently associated with feminine beauty. Malar augmentation or cheek implants usually made of synthetic material are used to make cheek bones more prominent and give better definition to the face.
  • Reduction rhinoplasty Generally, the dorsum and tip of the nose need to be made smaller and the tip lifted. The extent of tissue reduction required to feminize a nose is usually bigger than that normally required in a standard rhinoplasty. The volume of the nostrils can be reduced by alar base excision. Correction of the frontal bossing will add a lot to improving the angle between the nose and the forehead.
  • Facelift and neck lift with sub-mental liposuction After jaw contouring and chinplasty, the amount of skin can easily become excessive, requiring reduction. In these cases, we perform a face lift or neck lift, with limited undermining of skin and SMAS (sub dermal layer) to avoid high costs and risk of damaging the facial nerve. With very thin suction tubes, sub mental fat can also be removed after injection of a solution that disconnects the fat cells.
  • Dental feminization In a patient with healthy teeth, this would involve orthodontics, prosthetic dentistry making crowns, and maybe even orthognatic surgery. For most patients, this would be far too extensive treatment for the relatively small feminizing effect it would have. In patients wearing full dentures or patients with a desolate natural dentition, a feminizing effect can be achieved by new dentures or fixed bridges on implants.
  • Otoplasty and Blepharoplasty can also be done when you have very big earlobes and sagging eyelids.

Get Ready For The Big Day (Before, During & After)

Before Operation

  • Weeks Before: Stop smoking well in advance of surgery. Stop taking Aspirin, Herbal or diet supplements and certain anti-inflammatory drugs as taking these substances can cause increase bleeding.
  • On Consultation Day: Prepare for medical check up, physical exam and discuss expectations, your medical history such as any drug or food allergies, underlying medical conditions and on-going medical treatments to the plastic surgeon. The surgeon may take photographs before and after surgery and keep the photos in your medical record.
  • 24 hours and 12 hours Before: Use anti-bacterial soap on operative area for 10 minutes on the night before and in the morning of your surgery.
  • 8 hours Before Operation: No food or drink, take off jewelries, nail colors on hands & feet

During Operation:

  • The facial feminization surgery usually takes 4-8 hours depending on how extensive your operation will be as required. Moreover, you will be observed in the recovery room for an hour or two until stable before being moved back to your private room.
  • During the first postoperative hours a mask with a constant temperature of 15 degrees Celsius will cool the skin of your face and keep bruising and swelling to a minimum. This will add to your comfort and assist you to more rapidly recover from surgery.
  • After your surgery, you will be given a potent intravenous painkiller continuously. Some patients are sensitive to the painkiller and might develop nausea so please inform our nursing staff once you wake up feeling sick in the room.

After Operation

You will be encouraged to ambulate as soon as you can manage.

On the 2nd Day: Your wound will be dressed, drains and intravenous painkillers will be taken out and you will be discharged when you are feeling well.

On Discharge: You will be given a written instruction on when to take your antibiotics, anti-inflammatory and analgesic pills and you’ll be advised on the date of your follow-up visit.

5 - 7 days After: Your follow-up visit and removal of sutures and staples.

You are expected to stay in Phuket for at least 10 – 14 days to recuperate well.

The Facial Feminization Surgery Package

Full payment of the operating expenses must be paid in full before the operation. This package is applicable for elective, uncomplicated patients only. When any underlying abnormality is detected during the pre-operative check-up, special investigations and consultations must be required to avoid risk at your additional expense.

Package Includes:
Doctor’s fee, anesthetics, operating theater charges, medical supplies and special equipments, hospital private room accommodation and routine in-patient medications related to the procedure, regular food menu, nursing and room services, basic preoperative check-up (routine blood test, EKG, Chest X ray), home medications and doctor’s fee on follow-up visit.

Package Excludes:
Charges for excess in-patient stays, charges for intensive care, when necessary, outpatient expenses incurred before admission, telephone charges and guest meals, any other charges for laboratory profiles and medications not related to the procedure, other specialist consultation and charges related to underlying condition such as Diabetes, Asthma, Hypertension, Drug Allergy and Heart Disease.

The Long Term Outcome of Facial Feminization Surgery

It is highly recommended for patients to stay in Phuket or nearby places for at least 10-14 days because facial feminization surgery is an aesthetic reconstructive procedure rather than purely aesthetics. Since this is a complex operation requiring highly technical skills which have variable presentations in each patient with high chances of developing early post-operative complications, it would be beneficial when our surgeon could closely follow-up and monitor your recovery while you’re still in Phuket. There are no promises for the results as the outcome varies in each individual patient and it will take many months to see the result. In the event that the patient requires additional operations, there will be no doctor’s fee; however, the patient must pay for the operating room charges, anesthesia and hospital fee.

Like any surgical procedure, facial feminization surgery is also associated with certain number of risks and complications despite maximum care. Possible complications include asymmetry, permanent numbness in areas of the face and unsatisfactory result. Our Team takes every precaution possible to prevent and minimize the risks of surgery. However, much of the responsibility for risk avoidance rests with you as well.

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For appointment booking and inquiry, please feel free to contact us at consultdr.p@gmail.com

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