For many transgender women, their transition if often facilitated by having undergone Facial Feminization Surgery and will often be undertaken prior to bottom surgery. The effects from this series of operations work by altering the masculine features of the face to bring out a softer and more delicate feminine appearance.

If you are a transgender woman, Dr. Christopher Salgado and his team of multidisciplinary specialists are here to help facilitate the process of facial transition.

Feminization of the Face

Facial Feminization Surgery oversees a number of procedures that surgically alters the entire area of the face, from the hairline all the way down to Adam’s apple or thyroid cartilage. It is imperative to remember that the results from FFS may vary due to possible co-morbidities but overall complications are very low from these procedures. Factors such as age, length of time on hormonal replacement therapy (HRT) and ethnicity will all be considered when determining which procedure would be right for you.

Tracheal Shave

Popularly known as the removal and/or reduction of Adam’s apple, this procedure reduces the thyroid cartilage through an incision in upper neck skin so that it is concealed when looking straight on at another person.

Forehead Reduction/Contouring

The masculine features around the forehead and eyebrows are altered by shaping the contours of these features to a softer more feminine appearance. The surgery will require Dr. Salgado to reshape the frontal bone and orbital rims to sculpt a more feminine ridge along the hairline. The procedure would be done open or endoscopically depending on the frontal bone anatomy.

Jawline/Chin Contouring

Through intraoral incisions, the jawline and chin are modified so that a softer more refined feminine contour is achieved.


A reduction rhinoplasty is commonly performed together with Jawline/Chin Contouring and frontal bone reduction. The features of the nose are reshaped by shortening the distance from the nasion region to the nasal tip and narrowing the width of the nose if necessary.

Voice Surgery

Clinically known as a feminization larygoplasty, is a which surgically narrows the anterior commissure of the vocal cords so that your pitch is raised allowing for a more softer tone to your voice. This procedure is referred to our ENT colleagues.

Other Procedures:

Hair Transplant – Reverses the impact of male pattern hair loss by replanting hair in the area of affected areas in your scalp such as the widow’s peak.

Botox – This injectable allows your face to look younger and smoother by stopping muscles to prevent the formation of wrinkles and other fine lines.

Dermal Fillers – This injectable increases the natural fullness of your lips and cheeks, reversing any signs of aging. It also may be used to fill the labia majora following gender affirmation bottom surgery

Facelift – Enhances the appearance of the lower half of your face. This works by surgically lifting the tissue to restore and rejuvenate the youthful appearance of your face.


The total costs of your Facial Feminization Surgery will be determined by the staff of the University of Miami. As much as possible, Dr. Salgado will do what he can to keep costs at a minimum. Some insurance providers to provide coverage for facial feminization surgery and we will attempt to receive an approval for the procedures from insurances following your visit. The total cost will depend on factors, such as:

  • Medical Center and its facility fee costs
  • Anesthesia and other medications that will be administered before and after surgery
  • Physician surgeon fee

Insurance Issues & Financing

Unfortunately, not every insurance company covers Facial Feminization Surgery, unless deemed to be a medical necessity. On our part, every effort will be made to ensure you get the best coverage possible.

The FFS Procedure

Before you begin surgery, you will meet with Dr. Salgado. At this time, he will listen to your concerns, and you will watch of video so that you are informed of any consenting procedure you may choose and for your education about the surgeries. Then the exam will take place, photos taken and you will then discuss with Dr. Salgado the procedure which is best for you.

If you are a heavy smoker it is crucial that you stop for at least one month before and after your procedure to decrease the already increased risks of complications during your recovery period.

If you are under any medication, including aspirin, ibuprofen, and blood thinners, Dr. Salgado may recommend refraining from taking these medications, unless otherwise specified. All hormonal medications should be stopped for 4 weeks prior to surgery.

You must not eat or drink anything past midnight the day of your surgery.

General anesthesia will be used for this procedure to ensure you remain unconscious during the operation. Local anesthesia via IV sedation is also possible.


As with any form of surgery, Facial Feminization Surgery will come with a number of risks including:

  • Numbness
  • Acute and possibly chronic pain
  • Wound separation
  • Nerve damage
  • Asymmetry
  • Mucocele (frontal bone set back)
  • Alopecia
  • Hoarseness (thyroid cartilage reduction)

You will also experience scarring as an after-effect from surgery. It will take one year before the scars mature entirely. While they will never truly fade, Dr. Salgado will ensure that it is well hidden along sections of your skin.

Recovery and Results

It is essential to get plenty of rest and keep your head elevated for the first two days after surgery. The application of a cold compress every day on your forehead, cheeks, and jaw is strongly recommended for the best recovery possible.

You may enjoy a light diet that is rich in fiber and nutrients. You must refrain from consuming sodium as it may leave you vulnerable to swelling.

Always be mindful of your bandages. They must regularly be changed, and it is best to avoid showers and take baths with the bandages on instead. And should you undergo a rhinoplasty, you will be instructed to breathe through your mouth and to avoid any strenuous activities to protect the nose’s soft tissues.

After a week, you can expect the casts to be removed, and despite swelling, you will see visible signs of improvement.

Depending on the number of procedures you undergo, it will take your body roughly six weeks for gain in wound tensile strength.


Facial Feminization Surgery eases the distress many transgender women experience from Gender Dysphoria by adjusting the features of the face in order to bring out the softer, feminine details underneath. We have researched that the frontal bone region is one area in particular where transgender women feel that it is important for their passing more than others.

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