Facial feminization surgery, or FFS, describes a set of complex procedures designed to “feminize” the face. The concept and treatments were developed with transfeminine patients in mind in the 1980s, led by a San Francisco–based surgeon who devised measurements for a “normal” female appearance by surveying anthropological skeletal records. Despite its origins, FFS as it’s performed today is very similar to other facial procedures adopted by cisgender women. The surgery changes the size of bones and the distribution of fat to bring a patient’s appearance more in line with conventional ideas of beauty, femininity, and “normalcy.”
FFS has changed substantially since its initial development. Different practitioners, aesthetic preferences, and ideas about what it means to be beautiful, feminine, and normal have all impacted the field, making it increasingly popular and desirable for transfeminine people with varied transition goals. Among many of them, it is considered a matter of life or death, or, at least, a gateway to a much better quality of life. The procedure makes the difference between someone passing and someone being targeted for anti-trans harassment, and it helps alleviate the dysphoric discomfort associated with being scrutinized and misgendered.