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 trans 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 on our ‘Am I trans enough?’ page. 

Information for community members about FFS is available here. 

Standards of Care (SOC8)

The Standards of Care – 8th edition (SOC8) are published by the World Professional Association for Transgender Health (WPATH) and offer 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 SOC8 does not specify an order by which surgeries should occur, if sought at all, and are guidelines, not legislated requirements.  

The SOC8 highlight the benefits of facial surgeries for trans & gender diverse patients requesting it. WPATH state that surgeries modifying the face and/or neck ‘significantly improves both mid- and long-term quality of life’ and that ‘while gender-affirming facial surgery for AFAB individuals is an emerging field, current limited data points toward equal benefits in select patients.’

WPATH also highlight the need for aftercare and post-operative follow-ups. While the Standards of Care 7 mentioned the benefits of mental health support, the Standards of Care 8 state that ‘we recommend health care professionals should not make it mandatory for transgender and gender diverse people to undergo psychotherapy prior to the initiation of gender-affirming treatment, while acknowledging psychotherapy may be helpful for some transgender and gender diverse people’.

What happens during facial surgery 

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/or 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 general anaesthesia. 

Supporting your trans patient through surgery

Before surgery

At appointments in the lead up to surgery, your client 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.  

Finding comprehensive, evidence-based information about gender affirming surgical procedures can be a challenge, so your client 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 client 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 trans or gender diverse person 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 people, 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 person is not 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 person through any fears and complications. 

Some surgeons require clients to decrease hormones, particularly oestrogen, for a period of time in the lead up to and immediately following surgery. Your client may want to discuss timeframes, expectations, and potential side effects.  

After surgery

As well as providing regular post-surgical care for your client, 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 take time getting used to. Discuss with your client that it is normal to feel excited, but also very normal to feel overwhelmed or 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 client will need to learn this for themselves over time can be helpful too. Refer to peer networks or a mental health professional, as needed. 

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