Facial surgery

This page provides a brief summary of gender affirming facial surgeries and offers guidance to help you support your trans patients if they undergo these surgical interventions.

Facial surgery, commonly referred to as Facial Feminisation Surgery (or FFS), includes a variety of surgical procedures undertaken to feminise the appearance of the face and neck. Facial surgery is typically sought by trans people who were presumed male at birth (PMAB), including women and non-binary people, to change the shape of their face to better fit how they see themselves, and want to be seen.

Not all trans people want, seek or can have surgery, and being trans doesn’t necessitate surgery either. Find out more about that here.

Information for community members about FFS is available here.

The Standards of Care - 7th Ed (SoC7) is published by the World Professional Association for Transgender Health (WPATH) and offers guidance to clinicians working with trans patients all over the world, including criteria and recommended referral pathways for those seeking particular medical and surgical interventions.

The SoC7 does not specify an order by which surgeries should occur, if sought at all, and are guidelines, not legislated requirements.

WPATH states that surgeries modifying the face and/or neck, while often labelled as “purely aesthetic”, “these same operations in an individual with severe gender dysphoria can be considered medically necessary, depending on the unique clinical situation of a given patient’s condition and life situation. This ambiguity reflects reality in clinical situations, and allows for individual decisions as to the need and desirability of these procedures.”

WPATH also recommends that “although these surgeries do not require referral by mental health professionals, such professionals can play an important role in assisting clients in making a fully informed decision about the timing and implications of such procedures in the context of the social transition.”

There are several kinds of surgical options, and the procedures chosen will depend on the surgeon’s expertise and the physical capacity, and needs, of the patient.

Facial surgeries include:

Brow Lift (Browplasty)

Lifting or shaping the eyebrows.

Cheek Enhancement

Adds filler to the cheeks to create a rounder and smoother appearance.

Forehead Reduction (and hairline lowering)

Reduces the size and shape of the forehead.

Lip lift and Reshaping

Several possible procedures, depending on desired patient outcomes, including lip augmentation (or lip filling), lifting the corners of the mouth, or an upper lip lift.

Nasal surgery (Rhinoplasty)

Reduces the size, and changes the shape of the nose, by altering the nasal cavity, or reshaping the cartilage.

Scalp Advancement

Moves the hairline forward and creates a more rounded shape, sometimes alongside hair transplantation.

Tracheal Shave (Chondrolaryngoplasty)

Reduces the size of the thyroid cartilage, or ‘Adam’s apple’. A tracheal shave, or ‘trach shave’, is a fairly simple procedure and able to be done as an outpatient surgery under local anaesthesia, but it is often recommended to be performed under a general anaesthesia.

Before surgery

At appointments in the lead up to surgery, your patient might like to discuss their expectations and concerns, as well as their hopes and fears. It will be important to have an open conversation about what surgery can and cannot do. They may have been waiting many years for this particular surgery and feel that they have a lot riding on it. They may not be part of a supportive network or could be the centre of a thriving friendship circle. They might be clear about what they need from you, or really unsure. 

Your patient will also need to be referred to a mental health professional for support and assessment to confirm readiness for surgery.

Finding comprehensive, evidence-based information about gender affirming surgical processes can be a challenge, and so your patient might benefit from your additional research, including contacting a specific surgeon, if requested, or connecting with other health professionals to better understand and explain the process, possible complications, risk factors and outcomes. 

It’s also likely that a patient’s GP will be the first point of contact for any post-surgical care and complications, so having a sense of what might be happening, and being able to engage with additional clinician peer networks could prove advantageous. 

Surgery location

If your patient is contemplating surgery in Australia, it is prudent to encourage them to obtain private health insurance when and if they can afford it. This will help cover some of the costs such as the hospital stay. Their surgeon will be able to provide the applicable MBS Item Numbers that can be checked with the health insurer. 

If a patient is considering having surgery overseas, they will very likely appreciate a discussion about the benefits and risks of travelling overseas for surgery. This can be complex, especially if the surgery they’re seeking is not performed, or widely available, in Australia. 

For some patients, benefits can include cost saving, particularly if they’re not able to access private health insurance or Medicare in Australia, having greater choice of surgeons and being connected to a global community of trans people (we do a great job of offering comprehensive surgical reviews to the community).

Risks tend to arise from a lack of access to post-surgical care, including being able to effectively, and efficiently treat complications. Additional complications can arise if a patient is not being able to take the requisite time off work or study, and inadvertently damaging the surgical site. 

Around surgery

Around the point of surgery, the surgeon and their staff will typically be supporting the patient through any fears and complications.

Some surgeons require patients to decrease hormones, particularly estrogen, for a period of time in the lead up to, and immediately following, surgery. Your patient may want to discuss time-frames, expectations, and potential side effects from this. 

After surgery

As well as providing regular post-surgical care for your patient, you might find yourself supporting them through learning how their body now functions and feels.

Even if a surgical outcome is affirming for people, it can still be confronting. Discuss with your patient that it is normal to feel excited, but also very normal to feel overwhelmed, uncomfortable, to grieve, and to take time to become used to their body again. This isn’t an indication that they have made a mistake, or regret their decision, but a normal part of reconnecting with how their body appears and functions.

It can also be valuable to discuss how sensation may change, and what this might feel like. Having an honest conversation about how your patient will need to learn this for themselves over time can be helpful too. Refer to peer networks or a mental health professional, as needed.