Facial feminization surgery

I had facial feminization surgery in 1996, and it still remains the best investment I have ever made. Period. Since I had it, many other women have come forward to share their experiences and results. I’m very proud to have raised awareness of the life-changing potential of this option.

My surgeon Dr. Douglas Ousterhout wrote a first-rate consumer guide to FFS, Facial Feminization Surgery: A Guide for the Transgendered Woman. It’s an excellent 185-page overview of available procedures, with many illustrations and images. I highly recommend it for anyone considering these procedures, as it is the definitive consumer guide. It includes an introduction by Donna Rose, who, like me, had life-changing results from these procedures. Both of us are among the many patients who consented to having our results included in the book.

facial feminization book

This is a follow-up to materials in his medical book Aesthetic Contouring of the Craniofacial Skeleton.

Dr. Ousterhout retired in 2014. His successor, Dr. Jordan Deschamps-Braly, is a brilliant maxillofacial and craniofacial  surgeon who trained directly with Dr. O before taking over his practice. I recommend making Dr. Deschamps-Braly your primary consideration for any work you’d like to have done.

I never would have gone to San Francisco if I hadn’t written to Dallas Denny in 1996, who mentioned two surgeons on the west coast. So those who write to thank me should also thank Dallas!


If being accepted as female is your goal, one of the most important things to consider is facial feminization surgery. I feel that it can have a major impact in the quality of your day-to-day life, far more so than other aspects of transition. It’s not enough by itself to make you be accepted as female, but for some, it’s a necessity. I feel the key to being accepted as female is from the neck up. That means hair removal, voice, and face are vital. If you’re serious about having a smooth transition and the option of stealth, you should read my section on how to prioritize.

Due to problems from trolls, some transwomen have removed their FFS photos from the web, including me. I apologize for this inconvenience.

Generally speaking, bony work will have a far more dramatic effect on face shape, which is necessary in some cases in order to be accepted as female. Men and women have basic differences in skull shapes, and if you have a skull shape outside of female range, it might make being accepted as female more difficult.

Soft tissue work can be enough for some women to be accepted as female. Soft tissue work may be necessary to get the full result of bony work for some women. In general soft tissue work will smooth and tighten areas, making you look younger and by extension more feminine. There are masculine and feminine aging patterns, and getting rid of certain soft tissue traits can make a significant difference in your ability to be accepted as female.

In this section:

Procedures available

  • Forehead
  • Trachea
  • Jaw and chin
  • Nose
  • Ears
  • Injections
  • Facial implants
  • Facelift
  • Skin resurfacing

Information and recommendations

  • Complications
  • Choosing a surgeon
  • Costs
  • Opinions on facial surgery (pros and cons)
  • Letter to HBIGDA on medical necessity of FFS
  • FFS and insurance submission

My experiences with Douglas Ousterhout

  • Dr. Ousterhout and Cocoon Guest House:
  • Frequently-asked questions
  • My surgical journal: forehead/trachea
  • My surgical journal: jaw/nose
  • My surgical journal: my chin revision
  • Other patient experiences with FFS and/or Douglas Ousterhout
  • Appendix: Metro hotel

Related web resources

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Facial Feminization | Facial Masculinization