Facial feminisation surgery (FFS) involves a combination of procedures designed to alter facial features in a way that aligns more closely with cis-female characteristics. This type of gender affirming facial surgery is highly individualised and tailored to each person’s goals and unique facial anatomy.

One of the most critical aspects of planning any facial procedure is understanding the specific facial feminisation anatomical landmarks that define the masculine and feminine facial structures. Surgeons must evaluate bone shape, tissue depth, and proportions to determine what procedures might be suitable. The approach is medical and structured—not cosmetic or artistic—and rooted in surgical science and anatomical precision.

In this article, we’ll explore the key anatomical features assessed in facial gender surgery planning, how these assessments guide surgical decisions, and what individuals might expect throughout the process, including risks and recovery considerations.

Understanding Anatomical Landmarks in Facial Feminisation

In the context of facial bone structure feminisation, surgeons consider a range of craniofacial measurements and bone contours. Facial landmarks serve as reference points for assessing how various procedures may affect overall balance and proportion.

Some of the most commonly evaluated areas include:

• Forehead and brow bone / orbital operatives
• Hairline
• Cheekbones
• Jawline and chin
• Nose
• Lips
• Adam’s apple

Each of these landmarks plays a distinct role in perceived facial gender, and not all individuals will require modifications in every area.

Forehead and Brow Area: A Central Consideration

One of the most defining differences between male and female facial structures is the shape of the forehead and brow ridge. Typically, male foreheads feature a more prominent supraorbital ridge (brow bone) and forehead slope. Female foreheads are often smoother with a more vertical angle between the forehead and nose bridge.

Forehead contouring surgery may involve reduction of the brow bone and reshaping of the underlying bone to achieve a softer forehead profile. In some cases, a frontal sinus setback may be required. This is a significant surgical procedure that requires careful pre-operative planning, including bone scans or CT imaging in some cases.

Jaw and Chin: Balancing the Lower Face

Jaw reshaping in facial feminisation is another key aspect of the surgical plan. A wider, square jaw and prominent chin are typically associated with male anatomy. Feminisation may involve narrowing the jaw, softening angles, and reducing the size or projection of the chin.

This can be done through techniques such as mandibular angle reduction or chin osteotomy / genioplasty. While these are complex surgeries, they are considered medically appropriate options in gender-affirming care when planned and performed by a qualified surgeon.

Nose and Midface Structure

While rhinoplasty (nasal surgery) is common in many settings, in the context of gender affirming facial surgery, it focuses on adjusting nasal angles, width, rotation and projection to create a profile more consistent with the patient’s goals. Midface evaluation also includes the cheeks, where volume may be added or bone structure adjusted to create balance with other facial features.

Tracheal Considerations

The appearance of the Adam’s apple (thyroid cartilage) is another anatomical consideration in FFS. A procedure called tracheal shave (chondrolaryngoplasty) may be considered to reduce the prominence of this cartilage. This must be done with caution to preserve vocal cord function.

Individualised Facial Gender Surgery Planning

No two people have the same facial anatomy or desired outcomes, which is why facial gender surgery planning must be highly tailored. A comprehensive medical evaluation will assess your general health, surgical goals, and whether certain procedures are clinically appropriate for you.

The following points are commonly reviewed in planning:

• Bone thickness and position (evaluated via imaging)
• Facial planes and jaw positioning relative to the base of the skull and each other.
• Dental integrity and positioning / relative to facial / jaw planes
• Soft tissue characteristics
• Hairline shape and density
• Dental occlusion (bite)
• Skin elasticity and healing capacity

During your consultation on the facial feminisation surgery, the medical practitioner will also review your medical history and discuss surgical risks in detail.

Risks and Considerations

It is important to understand that any surgical procedure carries risks. These may include:

• Bleeding or haematoma
• Infection / mucoceole
• Nerve damage (temporary or permanent)
• Scarring
• Changes in sensation
• Dissatisfaction with aesthetic outcomes / asymmetry
• Swelling and bruising that may last for weeks
• Requirement for revision surgery in some cases

Recovery times vary, but patients are generally advised to allow for several weeks of reduced activity, especially for procedures involving bone. Swelling can take months to fully settle, and final results are typically assessed around 6-12 months post-operatively.

Compression garments, medication, and specific aftercare instructions will form part of your recovery plan. Downtime from work and daily responsibilities will depend on the extent of the surgery and should be discussed during your consultation.

Setting Realistic Expectations

The goal of FFS is to support gender congruence and align external features with an individual’s identity. However, it’s essential to understand that outcomes can vary depending on surgical response, healing, and individual anatomy.

Surgery is not a guaranteed or exclusive solution to concerns around identity or appearance. It is one option within a broader medical and psychosocial framework of gender-affirming care.

Also, it is important to weigh in Cultural Factors in Gender Affirmation Surgery.

Final Thoughts

Facial feminisation anatomical landmarks play a critical role in evaluating suitability for gender affirming facial surgery. From forehead contouring surgery to jaw reshaping in facial feminisation, each element must be assessed in relation to the whole face, underlying anatomy, and patient preferences.

Understanding the medical basis behind facial bone structure feminisation helps support informed decision-making and realistic expectations. If you are exploring options, always consult a qualified practitioner who provides a full clinical assessment and discusses both the potential outcomes and the associated risks.