Full Facial Feminization Surgery: What This Study Means for You
Mirco Raffaini, Raffaella Perello, Carlo Tremolada, Tommaso Agostini · Journal of Craniofacial Surgery · 2018
Nine patients had complete facial changes in one surgery
Researchers at a specialized center in Italy studied a new approach to facial feminization surgery (FFS). They reviewed records from nine transgender patients who had their entire facial transformation done in a single operation. This "all-in-one" approach combines bone reshaping, nose surgery, and fat grafting into one procedure. Patients ranged in age from 19 to 33 years old, with an average age of 21.
Fat tissue grafting helps create softer, feminine contours
An important part of this surgery involves "lipomodelling" or lipofilling. This technique uses processed fat tissue from your own body to enhance soft tissue areas. The surgeons harvest fat, process it carefully, and then inject it into specific areas of the face. This creates the softer, fuller appearance typically associated with feminine facial features. Because the fat comes from your own body, there is no risk of rejection.
Surgery took about four and a half hours with no major complications
The average surgery time was 281 minutes (roughly four hours and 40 minutes). None of the nine patients experienced wound infections, wound opening, or damage to nerves or blood vessels. Patients were able to leave the clinic the day after surgery. Most returned to work within 30 days. These results suggest the all-in-one approach can be both safe and efficient.
Combining procedures may reduce costs and recovery time
Traditional facial feminization often requires multiple separate surgeries over many months or years. Each surgery means additional anesthesia, hospital stays, and recovery periods. By combining all procedures into one session, patients may benefit from lower overall costs. They also avoid the stress of multiple operations and recovery periods.
Careful planning ensures realistic expectations
Before surgery, each patient went through a detailed evaluation process. This included psychological assessment and orthodontic evaluation. The surgical team used CT scans and photographs to create a "virtual facial feminization" plan. Surgeons then discussed this plan with each patient to make sure their expectations were realistic. This careful preparation helps ensure patients are satisfied with their results.
What this means for your treatment options
This study shows that comprehensive facial feminization can be achieved safely in a single surgery. The use of your own fat tissue (autologous tissue) for soft tissue enhancement is a key part of creating natural-looking results. Technologies like Lipogems® process fat tissue to preserve its natural healing properties. This includes pericytes (cells that support blood vessel healing) and mesenchymal stem cells (regenerative cells). These cells may help the grafted fat survive better and integrate naturally with your facial tissues.
If you are considering facial feminization, this research suggests that modern techniques can deliver meaningful results with manageable recovery times. The combination of bone reshaping and fat grafting addresses both the underlying structure and the soft tissue appearance of your face. Speaking with a qualified surgeon about how regenerative fat tissue processing might fit into your treatment plan could help you understand all available options.
Source: Raffaini et al., Journal of Craniofacial Surgery, 2018.
Original Publication
Evolution of Full Facial Feminization Surgery: Creating the Gendered Face With an All-in-one Procedure
Mirco Raffaini, Raffaella Perello, Carlo Tremolada, Tommaso Agostini · Journal of Craniofacial Surgery · 2018
Facial feminization surgery (FFS) has recently gained popularity to enhance the female facial profile and promote transformation of the male to female face in transgender patients. FFS involves overlapping surgical procedures that modify both hard and soft tissues through reductive and augmentative techniques, representing a unique dual and reversible procedure in plastic surgery. This study describes a novel approach to full FFS (F-FFS) performed in a single surgery termed "all-in-one," representing its most recent evolution. Forty-nine consecutive nonrandomized patients underwent FFS at a private clinical practice between January 2003 and December 2017. Following retrospective review, nine patients aged 19 to 33 years (mean age 21 years) who underwent all-in-one F-FFS were identified. Patients were discharged the day after surgery with written postoperative instructions. No wound infection, dehiscence, or nerve/vessel damage were recorded. Patients typically returned to work within 30 days following surgery. Mean operative time was 281 minutes (range 245-305 minutes). The evolved all-in-one F-FFS provides a further technical step by overlapping several procedures, resulting in higher satisfaction rates, reduced overall costs, and low morbidity. This approach addresses modifications of the upper third (frontal bone), mid face (nose, eyes), lower face, and neck through various techniques including scalp shifting, lipomodelling, mandibular reshaping, and thyroid cartilage chondroplasty.