FFS can include various bony and soft tissue procedures such as brow lift, rhinoplasty, cheek implantation, and lip augmentation.
[3][4] It can be just as important or even more important than genital forms of sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women; data on these sorts of outcomes are limited by small study size and confounding variables like other feminization procedures.
[5] In males, the hairline is often higher than in females and usually has receded corners above the temples that give it an "M" shape.
[5] Cisgender males tend to have a horizontal ridge of bone running across the forehead just above eyebrow level called the brow ridge (or "brow bossing"), which includes the "supraorbital rims" (the lower edge, on which the eyebrows sit).
The section of bossing between the eyebrows (the glabella) sits over a hollow area called the frontal sinus.
Alternatively, FFS surgeons can perform a procedure called a forehead reconstruction or cranioplasty where the glabella bone is taken apart, thinned and re-shaped, and reassembled in the new feminine position with small titanium wires or titanium orthopedic plate and screws.
[5] The risks of cranioplasty include the skull not healing properly, movement of the bone fragments, and the formation of cysts; these can usually be corrected by another procedure.
[8] In some studies, the eye shape has been shown to be the key differentiating feature between cis males and females.
When the gap is closed it has the effect of lifting the top lip, placing it in a more feminine position and often exposing a little of the upper incisors.
Injectable fillers are low-risk but tend to be absorbed after six months or so, and many implants have higher complication rates like infection or rejection.
For example, it is common for eye bags and sagging eyelids to be corrected with a procedure called "blepharoplasty" and many feminization patients undergo a face and neck lift.
[5][8] FFS began in 1982 when Darrell Pratt, a plastic surgeon who performed sex reassignment surgeries, approached Douglas Ousterhout with a request from a transgender woman patient of Pratt's; the patient wanted plastic surgery to make her face appear more feminine, since people still reacted to her as though she were a man.
[12] Ousterhout's prior practice had involved reconstructing faces and skulls of people who had had birth defects, accidents, or other trauma.