Facial Feminization Surgery Procedures (FFS)

Facial Feminization Surgery Procedures (FFS)


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Tracheal Shave – Thyroid Cartilage Reduction (Procedure I & II): involves a fine 1.0 cm external horizontal incision to shave or cut the Adam’s Apple cartilage. This is usually done under general anesthesia in the hospital.
Scalp Reduction (also known as ‘scalp advancement’): involves advancing forward the scalp between 2.0 cm to 3.0 cm to correct the receding masculine pattern hairline and to approximate, when possible, a more feminine ‘oval’ pattern hairline.

Forehead Lift: involves an across-the-scalp incision in front of the hairline or behind-the-scalp to lift the forehead to reduce the horizontal age lines and lift the eyebrows to a more feminine shape (brow lift).

Facial Feminisation Surgery (FFS) terminology for reduction of bone, bony cartilage, soft cartilage
Procedure I (shaving/grinding) | Procedure II (cutting) | Procedure III (reconstruction/osteotomy)

Forehead Reconstruction (Procedure III): this technique (referred to as ‘Forehead Type III’ in Ousterhout) is indicated when the brow bossing is prominent and the air cavities are large (evidenced by x-ray radiographs) with a consequent thin anterior wall. This involves removing and reconstructing the anterior wall of the frontal sinus with titanium microplates and screws.

Forehead Contouring/Resetting (Procedure I & II): this technique (referred to as ‘Procedure Type II’) involves: (I) contouring via shaving across the forehead and brow bossing/orbital rims followed by (II) controlled fracturing of the anterior wall to realign (reset) it to a more posterior position. This technique, developed in 2002, is applied in the majority of cases in 2003.

Forehead Augmentation: in selected cases, the forehead can also be simultaneously augmented with Dermalive injections. The effect of Dermalive treatment is guaranteed to last over 5 years and likely between 7 to 10+ years.

Upper blepharoplasty: involves recreating the upper eyelid to correct for a sagging upper eyelid.

Lower blepharoplasty: involves reducing the age lines and tightening the saggy skin and bags under the eyes.

SMAS/Platysma (deep plane) Rhytidectomy: involves lifting the face, jowls, jawline, and neck and their underlying muscles (including liposuction, if necessary).

Cheekbone Reduction (Procedure I): involves shaving/grinding the bony structure via an intra-oral incision or/and lower blepharoplasty incision which requires an extended recovery period (with severe facial swelling/bruising for about 10 days).

Reconstructive Rhinoplasty (Procedure III): involves breaking the nose at 3 positions (median line and lateral points), resetting the bone to a radically smaller size, reducing the cartilage, repositioning closer the nostrils (alarplasty), and improving the left-right symmetry.

Feminising Rhinoplasty (Procedure I & II): involves aggressive shaving of the bone, straightening the nose, cutting the cartilage, contouring via a fine sheet of hard silicone implant for a juvenile effect, repositioning closer the nostrils (alarplasty), and improving the left-right symmetry. Minor cases of a deviated septum can be corrected to improve the airflow, but major cases should be done by an ENT (Ear-Nose-Throat) surgeon. Most cases of rhinoplasty are done under general anesthesia in the hospital.

Upper Lip Lift: (referred to as ‘upper lip reduction’ in Ousterhout) involves a shallow ‘v’ incision below the nose to reduce the distance between the base (underside) of nose to the upper lip. This also has the effect of slightly lifting the upper lip upward and outward giving a fuller and juvenile effect.

Otoplasty: involves pinning back prominent ears and reducing the lower earlobes if necessary.

Jaw Reduction (Procedure I & II): involves an extensive intra-oral incision from the back of jaw forward to the chin (‘U’-shaped incision around the entire mandible). A fine extra-oral incision of 0.5 cm remains necessary to drain the excess fluid.

Chin Reconstruction (Procedure III): this technique (also known as ‘sliding genioplasty’) involves an intra-oral incision and sliding forward or backward the lower section of chin or/and sectioning out the mid-section of chin and joining the upper and lower sections via titanium screws.

Chin Reduction (Procedure I & II): involves an intra-oral incision to shave/grind/cut down the chin. It is usually done together with jawline reduction for the best result.

Chin Advancement: involves an intra-oral incision to advance a short or/and receding chin up to 1.0 cm with a feminising contouring hard silicone implant. This can advance forward the chin without increasing its vertical length.

Vertical or Horizontal Cleft Chin Correction: involves an external incision (‘z-plasty’) to lift the deep crease above to a higher plane to the surrounding surface.

Dermalive: semi-permanent collagen-substitute injection (per 0.6 cc/ml). These injections can be used to augment the forehead, lips, remove creases, and occasionally replace a rhytidectomy. To produce a slight juvenile ‘pout’ in the lips requires 4 injections usually done under general anesthesia. Dermalive is guaranteed to last over 5 years and likely between 7 to 10+ years.