Cosmetic Surgery -Let’s Face It

Jahn Westbrook

by jahn westbrook

Estrogen alone will not fully reverse the damage testosterone inflicted on our bodies. Inherent masculine features are revealed in characteristic brow prominence, hairline issues, wider noses, deep set eyes, high foreheads, and the dreaded bulge of cartilage known as the Adam’s apple. Facial Feminization Surgery or, FFS, is often the last and most drastic resort to achieving our true femininity.

Our body dysmorphia challenges us to put our best face forward. When we see flaws in ourselves, they are magnified by degrees. Speaking for myself, I would, and in some instances still do, over compensate in an effort to draw attention away from my (glaring?) masculine features. None of what I did allayed my inner gender dysmorphia.


Our drive for beauty runs askance of our cisgender sisters. We both strive to attain beauty associated with “Aphrodite syndrome,” that mythical moniker of ideal beauty. Where we dramatically differ is in that us transfemales want so desperately to ‘pass’, that that becomes a laser focus consuming all thought and action. Physiology and biology make up part of this human condition. We have to physically modify our appearance in order to achieve, or at best diminish the masculine affects of our chromosomal make up.

When we lose sight of our health and take unnecessary risks, we have more than our dignity to pay. Back alley injections, unqualified surgeons, non-medical grade fillers and other substances have targeted the transgender community with any number of risks. “Silicone parties” have rendered too many of our community with varying degree of medical complications, lifetime consequences, and even deaths have resulted. Silicone injections are banned in the US by the FDA. Silicone should NEVER be injected into the body for any reason. It is a toxic substance and will lead to medical complications.


Just as there is the gender binary, no one person has an extreme feminine or masculine facial structure. We are all a blend of the typically associated features of females and males.

Classic Feminine Features:

  • Low straight hairline
  • Short flat forehead
  • High, arched tapered brows
  • Absence of frontal bone bossing
  • Large eyes, not deep set
  • Short upper lip with well defined philtrum complex
  • Full everted vermilion
  • Non-projecting thyroid cartilages(no “Adam’s Apple”)
  • Wide or narrow cheek and jaw bones
  • A more delicate nose
  • Obtuse nasolabial angle(larger angle formed between nose and upper lip, nose tends upward pointing)

Classic Masculine Features:

  • High, curved hairline with “widows peaks”
  • High obtuse, often angled forehead
  • Low, straight, heavy brows
  • Frontal bone prominence(“Forehead Dominance”)
  • Prominent supraorbital rims(“Brow Bossing”)
  • Smaller, deeper, set eyes
  • Strong, long, prominent nose
  • Acute nasolabial angle(smaller angle formed between nose and upper lip, nose is parallel or downward protruding)
  • Long upper lip
  • Narrow lip vermilion
  • Square, straighter teeth
  • Prominent chin
  • Prominent thyroid cartilage
  • Adam’s Apple(Thyriod Cartilage)
  • Facial hair
  • Wide or narrow cheek bone and jaw

Common surgical procedures include:

  • Hair line adjustment
  • Rhinoplasty
  • Ear Pinning
  • Lip lift
  • eye brow contouring
  • forehead contouring
  • chin contouring
  • eyebrow lift
  • cheek implants
  • jaw contouring
  • Adam’s apple removal(“Tracheal Shave”)

Before proceeding with any surgical procedure, understand the risks. With any surgery, there are inherent risks.

Some potentially dangerous risks surrounding FFS are:

  • Blood loss: especially dangerous if you are anemic
  • Blood clots
  • Infection
  • Pneumonia
  • Necrosis
  • Paralysis
  • Allergic Reactions
  • Vision impairment
  • Speech changes

Some ‘healing’ risks, many of which are expected and may not permanent:

  • Weakness and Fatigue(Mental and Physical): Activities can be more difficult for up to months following surgery. Being in good physical shape, quitting smoking and not drinking leading up to your procedure will drastically enhance recovery.
  • Numbness: General numbing after FFS is common, making it difficult to eat, drink, talk, and swallow. May last up to a couple months post surgery.
  • General Pain: could be permanent due to malpractice or previous injury/surgery impact.
  • Hypersensitivity: Some areas may permanently be ultra sensitive to the touch.
  • Bleeding: Typically only from suture sites and should not last more than a day. If longer or bleeding is profuse, see your doctor or get to an ER immediately.
  • Sore Throat: Resultant from the intubation tube.
  • Shocks: A result of severed nerves regenerating. These can last up to a couple of months after surgery.
  • Swelling and Bruising: A result of trauma from the surgery. These symptoms will dissipate with time.
  • Nausea: A result of the anesthesia is not uncommon.
  • Bed Sores: Resultant from not moving around, laying in one position for successive days.

There are certain cosmetic risks associated with FFS cosmetic surgery:

  • Scarring: There will be a degree of scarring with any surgical procedure. Following the surgeons direction, NOT smoking, not drinking(to excess at least) will improve the chances for reduced scarring. There are topical cremes, natural vitamins and other healing remedies available when given the okay to use.
  • Graft Rejection or Mismatched Skin Tone: Tissue, even from one’s own body can be rejected, this is an early onset of necrosis and needs to be corrected immediately. Skin tones can become mismatched if blood flow is reduced from surrounding live tissue. This can also be dependent upon the area where the skin is grafted from.
  • Keloids: Raised dark and thick scars. Typically more common on darker(sun tanned) and black skin tones
  • Shape and Positioning: Often referred to as “botched” cosmetic procedures.

Psychological risks of FFS:

  • Depression: Often occurs when the patient expects FFS to resolve problems not physical in nature. Be realistic with expectations and continue seeing your therapist, psychologist, counselor before and after surgery.
  • Anxiety: Occurs immediately following surgery when the patient sees all the swelling, sutures, remaining surgical marks, dried blood, bruising, and any number of additional post-surgical consequences. It is important to remember the end result is not what you see hours and even days after surgery
  • Regret: The patient typically feels regretful when the end results are not what they expected and now they have to live with a less than ‘perfect’ result.

It is important to do you own research when deciding to have FFS, or any surgical procedure. It is not unreasonable to request to see before and after photos of past patients. If you are referred to a surgeon by someone you trust, that is a great endorsement.

The field of Facial Feminization Surgery is filled with professionals who are out for their patient’s best interests. There are equally as many charlatans out for themselves. Use your wits and your intuitive judgement. If something doesn’t feel right, move on. Why take a chance on what is your life for impatience and rash decisions? What is in front of your today will be there tomorrow, even not month. Additional information on FFS

Stay BEAUTIFUL, sisters,

mir, irini, peace, amn,



TU Articles