Facial feminization surgery: current state of the art – Review

This is an excellent overview of the current (2012) state of the art in facial feminization surgery (FFS). It provides detailed descriptions of the various surgeries, how they are done, and some possible complications. It seems to be aimed at surgeons, but would be useful to someone who is in the process of planning facial feminization surgery with a doctor.

The article goes into detail about the average differences between male and female faces; this might cause dysphoria for some people.

As with many articles in this area, the before and after pictures are confusing. Women in the after picture often have new hairdos and more make-up and jewelry. In one before picture, you can see a five o’clock shadow. This makes it harder to evaluate the effectiveness of the surgeries.

The author of the study is a surgeon who performs FFS. He is therefore an expert in the area, but he might also have a bias in favor of believing that FFS works.

The article provides some history of FFS. Altman states that Dr. Douglas Ousterhout popularized and pioneered the procedure in the 1980s and 1990s. Ousterhout analyzed an anthropological skull collection at the University of San Francisco to understand average facial shapes of men and women. (This article does not mention the work in the early 1990s at the Free University Hospital in the Netherlands. Becking et al wrote in the early 1990s that only Farkas had done anthromorphometric work on the differences between male and female faces.)

Altman discusses the purpose of FFS and how it fits into the process of transition. He offers some advice on discussing surgeries with patients.

Altman concludes with an extremely important call for more research in this area:

In terms of clinical effectiveness, there are no large studies looking at this aspect of care, but the author’s experience suggests that patient satisfaction is generally high following these procedures.


The future of FFS depends on further development of the procedures currently undertaken and possible changes in approaches to funding. For public funding to become available, clinical effectiveness will have to be audited and presented to health authorities to justify the health gain and requirement for patients undergoing this type of surgery.

Original Article: Facial Feminization Surgery: Current State of the Art by K. Altman in International Journal of Oral & Maxillofacial Surgery, 2012-08-01, Volume 41, Issue 8, Pages 885-894.

Note: This article contains photos of surgery and graphic descriptions of surgical techniques.