This is an early study of facial feminization surgery (FFS) from 1996. At that time FFS was new and there were no standards or studies. The doctors at the Free University Hospital in the Netherlands had to devise surgeries they believed would make the trans women’s faces more feminine.
Without exception, all patients were convinced that their faces had become more feminine…it is impossible to consider this as the only reason for success. Make-up and hairdo were obviously changed over this period as well and, in time, most persons became more adapted to their life as a member of the opposite gender.
Looking at the before and after pictures in the article, I would agree. In the after pictures, the patients are wearing make-up and jewelry and their hair styles have changed. It is hard to tell whether they look more feminine due to the surgery or the other changes.
The authors conclude that the results thus far are promising and call for more research:
More research is needed on several aspects of the subject. There is a need for a more objective standardization of the differences in the facial features of the two sexes, thus facilitating the process of planning facial corrections. Objective follow-up on the appreciation and the effects of the facial surgery on psychosocial functioning also needs to be carried out. Finally, the long-term effect of these surgical interventions, with regard to function and cosmetics, await
The authors of the study talk about the importance of facial features for passing in public as a member of the opposite sex, but they also state that not everyone will need FFS:
Facial esthetic surgery of the soft tissues or the bone is not indicated in many patients. Make-up, changing the hairdo, and using depilating procedures usually give satisfying cosmetic results. Occasionally, additional surgery in the head and neck region is carried out. Blepharoplasty, rhinoplasty, and chondrolaryngoplasty may be of help.
This is a good early report on reasons and potential strategies for FFS.
Facial Corrections in Male to Female Transsexuals: A Preliminary Report on I6 Patients, by ALFRED G. BECKING, DDS, D. BRAM TUINZING, DDS, PHD, J. JORIS HAGE, MD, PHD,AND LOUIS J.G. GOOREN, MD, PHD, published in J Oral Mzdlofac Surg, 54:413-418, 1996.
Note: This study includes photos of surgery.