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I'm getting facial feminization surgery!

Let’s talk faces! As I’ve discussed before, there are a few significant surgeries that trans women commonly (but nowhere near universally) undergo as part of our transition. The one that the fewest people seem to be aware of is actually the first one I’m going to get: Facial Feminization Surgery, or FFS. And I’m getting it on April 24th!

For the squeamish among you, I will be avoiding any graphic images or descriptions of the surgical methods. This post is much more focused on the what and the why, not the how.

Me, in late March, 2024.

What is FFS?

In short, it’s a collection of procedures, commonly done on cisgender women, which make the face appear “more feminine.” Different trans people will get different things done and do them differently.

But what does that even mean? If you’re like me three years ago, you probably could only name a couple major differences in a feminine and masculine face. Those might be:

• Hairline (receded hairlines, and the “M” shape of it, are more common to masculine faces than feminine ones)

• Beard (many adult men have one, or at least a shadow of one, while few adult women actually embrace a bearded look, though they may still have hair or shadow, which is actually quite common).

• Noses maybe?

But here’s the crazy thing - your brain actually knows a lot more. Specifically, it’s capable of seeing a face and almost instantly gendering it one way or the other. And most of the time that’s fine. But not always.

In early childhood, there’s little distinction between the faces of boys and girls. Think of all the comedy about someone asking a new mom “oh how old is she” and the mom is like “um… he.” This continues all the way to the onset of puberty. At that point, differentiation happens - this is driven by the increased testosterone production in those assigned male at birth. There’s no “DNA” that does this - the whole XX vs. XY chromosome thing really only affects things early in embryonic development - everything after that is hormones. That’ll be important in a moment.

But either way, when I hit puberty, my body started making testosterone, which had a number of effects beyond just sexual maturity: I grew a beard and body hair, I got taller and my voice got lower. My bone structure became more masculine instead of becoming more feminine.

Some of those are truly irreversible. I’m 6’2”, and nothing’s going to change that except for aging. My hands are probably bigger than a 6’2” cisgender woman’s hands. My collarbone might be wider, my hips narrower, etc. All of that is bone structure, which is a one-way trip. Hormone Replacement Therapy only has minimal effect once testosterone has done its thing.

So what does your brain see? First - it’s important to note that nearly everyone doesn’t fit neatly into masc/femme on every single one of these. And most people have at least one feature more typical of the “other”. If you read this and are like “oh noooo my nose is…” or something, don’t worry about it! And also - that’s like a tiny version of gender dysphoria - you feeling some amount of stress by a feature that you feel conveys a gender other than the one you know you are. Now imagine most of your body was like that. But seriously, don’t worry about it - next time you watch a movie, pay attention to how many movie stars don’t fit neatly into the same box for every attribute.

• Hairline - masculine hairlines tend to have more of an “M” shape, with receded peaks on the sides, while feminine hairlines are more on the left and right.

• Forehead - Masculine foreheads are more angular, frequently more verticle, then turn back sharper (like the grill/hood of a truck). Feminine foreheads are typically more rounded (like the bumper/hood of a small car)

• Brow bone - Masculine brow bones tend to be much more pronounced, and lower toward the eyes. Feminine brow bones tend to be unpronounced, and higher, giving more of a “big eyes” look.

• Cheek bones - Feminine faces have a higher cheek bone, whereas masculine faces have a more rounded face. This is actually due to fat distribution, not bone structure, so estrogen has actually already helped me a lot there.

• Nose - Masculine noses are longer, wider, and the bottom of the nose tends to be at about a 90-degree angle from the face. Feminine noses frequently tip upward slightly. Masculine noses are more likely to have “hump” look on the bridge, whereas feminine noses tend to be a little straighter or even curve “in” a little, though in my observation that’s much rarer on white faces that haven’t had plastic surgery. (Side note: ethnicity can affect many of these a lot!)

• Lips - higher and fuller on feminine faces, lower and narrower on masculine faces. The fullness difference is likely exaggerated these days by people using lip plumpers and fillers.

• Chin/Jaw - feminine chins are less pronounced, and the whole chin/jaw-line is more V-shaped, whereas a masculine chin-jaw is more U shaped. The back corner of the jaw bone itself is typically squarer on masculine faces, and more rounded on feminine faces.

• Trachea - masculine faces may have the so-called “Adam’s apple” (and yes, many trans women refer to theirs as an “Eve’s apple”.

Remember - all of those are the result of hormones during puberty.

It’s easier if you just go look at faces and look for what I’m referring to - you’ll see it quickly and then not be able to unsee it!

So FFS is the collection of surgeries meant to transform the face from one that was masculinized by testosterone into one that the individual might have been more likely to have without that. On me, they are going to:

• Pull my hairline forward and attempt to make it more rounded.

• Contour my forehead into a more rounded look

• Reduce or remove the prominence of my brow bone

• Shave the upper orbital rims above the eyes down/up to give the eyes more space

• Pretty much redo my nose. It was broken as a teenager but I never noticed because by then I was rarely looking in mirrors. They’ll straighten it, shorten it, narrow it, and give it the right curves.

• Lip augmentation - they’ll make my lips look a little fuller.

• Chin/Jaw-line work to give me more of that “v-shaped” look.

And that’ll be it for this round. Later I may still have more work to do:

• Additional work on hairline (hair transplants, where they take hairs from the back of your head and put them into the spot that needs them)

• Possible face/neck lift.

• Possible tracheal shave (reduce Eve’s Apple).

• Any revisions from the initial surgery that are required.

The surgery I’m having first will take 6-8 hours, be under general anesthesia (obviously), and recovery will take:

• 3-4 days until I’m able to pretty much be ok on my own

• 1 week until they take the bandages/sutures out

• 2-3 weeks for swelling/brusing to reduce to “you look like a normal person” levels.

• If I was working, they’d want me to take 3-4 weeks off.

• 3-4 months for full settling of forehead

• ~6 months for full settling of chin/jaw

• ~12 months for full settling of nose and healing of scars

If you have a question, feel free to ask anything below! I’ll do my best to answer anything anyone asks!

Ok but why?

First, not all of us do this. A face is a very personal thing, and some people love theirs. Moreover, many just can’t afford it (it’s still not covered by insurance for most) or can’t afford the time off work. And few people do everything that could possibly be done.

But I do want this. I want it more than almost anything else in my entire life. People ask me “why do you need to feminize your face if you’re already a woman”? And for that, we go back to that lower-brain mechanism which quickly genders people. While it’s not the whole story (again, people misgender kids or even adults all the time - that doesn’t mean they’re right), it is a real thing. And the fact is: unless I’ve done my hair/makeup really well, I regularly get called “sir” or “he”, both of which are painful. But there’s one person who misgenders my face more than anyone else: me.

My brain genders faces the same as anyone else’s brain does. There’s not much I can do about that. And the fact remains that when I look in the mirror, I see him looking back at me. With hair/makeup and a cute outfit, sometimes I get to see her, but it’s rare and non-permanent. If you found that you saw someone else in the mirror looking back at you all the time, you’d be unsettled, too.¹

With FFS, I will, for the first time in decades, if ever, have a chance to see me in the mirror. I always tell people, this isn’t like a typical nose job where someone just wishes their feminine nose was a little more stereotypically “pretty”. This is taking a masculine face and making it feminine - I don’t need stunning results to be elated with the results. Again, as I’ve told people: the problem isn’t what my face is. It’s what my face means.

And most of that is about what this means for me.

My expectations

A recurring thought in my life has always been, “I wish I was a woman because I wish I could be beautiful.” Now, I have a chance at that. And honestly, I’m well aware that cisgender women of every shape, size, ethnicity, and ability can be stunning. I don’t know what I’ll look like. I don’t expect to be a “10” or whatever societal beauty standards would rate me. But I do expect that when I’m done, when someone glances at a my face, they will see “feminine.” That’s the goal. That’s the prize. If I end up pretty on top of that? I’ll take it. My surgeon is highly regarded in the trans community and there’s every reason to think he’s going to do fantastic work.

But truly, I can’t wait until that first time I look in the mirror, and, for the first time in my adult life, see myself looking back.

The next couple months

I know I haven’t written much lately. I’ve spent much of the last couple months prepping for this surgery, as well as trying to write an essay in the wake of the death of Nex Benedict and another wave of anti-trans bills and hateful statements by politicians, church leaders, and more. I’ll continue to be a little sparse here as I try to keep my stress levels down before and after surgery.

I’m thankful to have a number of local and online friends who will be supporting me through this, and look forward to sharing the results with all of you on the other side.

Don’t forget to subscribe (free) to make sure you see my photos once I’m ready to share!

Love y’all,

Celeste

1. Yes, I’m loosely pulling this language from Abigail Thorn’s amazing coming out video, which you should absolutely watch if you have not already.