Facial Masculinization Surgery (FMS): A Comprehensive Guide

Medically reviewed by Jennifer Richman on July 21, 2024.

Facial masculinization surgery (FMS) is a specialized set of procedures designed to augment and accentuate masculine facial features for transgender, non-binary and gender non-conforming patients. This gender-affirming surgical process aims to create greater harmony between a patient’s appearance and their gender or internal sense of self.

If you are interested in undergoing surgery, you can request a free virtual or in-person consultation with Dr. Zara Ley (she/her/they) or Dr. Alex Facque (he/him).

What is Facial Masculinization Surgery?

FMS refers to a series of procedures that patients can choose from to modify any of the three following parts of the face:

• The lower third of the face and the neck: the neck, chin and jaw
• The middle third of the face: the nose, lips and cheek
• The upper third of the face: the eyebrows, forehead and hairline

The procedures that patients can choose from are very similar to the options for Facial Feminization Surgery (FFS). In most cases, FMS procedures seek to augment and/or make features more angular and pronounced, as opposed to giving the face a softer, more conventionally feminine appearance.

The following procedures are most commonly associated with FMS. That said, patients can choose to undergo any of the gender-affirming facial surgery procedures we offer and will not be limited to just the following list:

Brow Bone Augmentation & Hairline Repositioning

The presence of a prominent, protruding brow bone is a common effect of a first, testosterone-dominant puberty. Patients who have a flat forehead or brow bone can elect to have the shape of their forehead augmented with implants. Augmenting the brow bone can result in a more conventionally masculine look. This procedure can be done by creating an incision at the hairline or the scalp. The hairline incision may create a visible scar at the top of the forehead, but this incision location can allow your surgeon to bring down a receding hairline. Creating an incision further up in the scalp, on the other hand, does not leave a visible scar on the forehead, but limits your surgeon’s ability to alter your hairline.

Rhinoplasty

A rhinoplasty can augment the size of the nose bridge and give the tip of the nose a more prominent position. Cartilage grafts, most often taken from the ribs, may be required in order to enlarge the nose. Rhinoplasties can also help patients achieve a more symmetrical nose and alter its structure to correct any functional (i.e., breathing) issues.

Jaw and Chin Augmentation

Patients can opt to have the jaw and/or chin augmented through the placement of implants. Your surgeon will create incisions inside of your mouth, at the base of your bottom gums, to insert the implants.

Once you have healed from surgery, these will give the jaw a larger, more prominent and more angular appearance. If you have preferences about the specific shape or angles you would like your jawline to have, you can communicate them to your surgeon in a free consultation.

Buccal Fat Removal

By removing the fat pads in the cheek using small incisions in the mouth, patients can achieve a more sculpted and angular contour to the cheeks. This may be a good option for patients wishing to reduce the fullness in their midface region.

Tracheal Augmentation

A thyroid cartilage enhancement (also known as Adam’s Apple Augmentation) is a technique that involves making the appearance of an Adam’s Apple. This is achieved by taking cartilage from the ribs to create a natural Y-shaped cartilage implant that mimics the appearance of an Adam’s Apple. In some cases, a silicone implant may be used. This procedure is performed in a way to not alter the vocal cords. Also, this procedure often involves creating a small incision in the neck or under the jaw. The latter creates a far more concealable scar.

Facial Surgery Consultation

In the video below, Dr. Facque discusses how you can make the most out of your free facial surgery consultation:

Which Facial Masculinization Procedures Should I Choose?

Given the number of options available for facial surgery patients, it can sometimes be overwhelming to figure out which ones would be right for you. Our practice offers the following tips for patients who are having difficulty deciding which procedures they would like to undergo:

• Many of our patients find it helpful to come into the consultation with pictures of people whose facial features they would like to have–for example, a family member. Having a visual representation can help your surgeon figure out which surgical options can best help you accomplish your goals.
• Some patients find it helpful to reflect on what features of their face bring them dysphoria and/or what changes would bring gender euphoria. Having a sense of which parts of your face you would like to alter can help your surgeon figure out which options might best suit your unique needs.
• After a consultation, some surgeons offer their patients the option of creating a 3-D digital rendering of what your facial surgery results could look like. Digital renderings are never completely accurate, but they can help you gain a sense of what facial surgery can do for you.
• If cost is a limiting factor for you, you can request a cost-specific breakdown of each procedure after your initial consultation to see which procedures will fit in your budget.

Surgical Eligibility

Both Dr. Ley and Dr. Facque use the informed-consent model to determine surgical eligibility for legal adults. Informed consent determines eligibility based on a patient’s ability to make a decision about whether or not surgery is the right choice for them once they have had the proper education about its risks and benefits.

Hormones Therapy and Facial Masculinization

We have no HRT requirements for facial surgery candidacy as many of our patients do not undergo HRT. That said, per WPATH’s Soc 8 recommendations, most insurance providers that cover gender-affirming facial surgery will require that patients be on testosterone for a continuous 12 months prior to surgery.

Patients who have undergone testosterone HRT may see changes in the shape of their jaw and the volume of their cheeks, for example. This could influence their decision about which FMS procedures would be right for them.

Costs and Insurance Coverage 

The total price for FMS can range from $4,500 to $100,000 for cash-pay patients. For a more detailed cost-breakdown of gender-affirming facial surgery, click here.

The good news is, insurance has been covering gender-affirming facial surgery more than ever before. In the video below, Dr. Facque describes how you can figure out if your plan will cover the costs of surgery.

Recovery from Facial Masculinization Surgery

Recovery from facial surgery can vary greatly from patient to patient, depending on the specific procedures they undergo. We generally tell patients that they will need to wait 12 months after facial surgery to see their final results.

Below are some general guidelines you can keep in mind for the FMS procedures listed above. For a more detailed guide on recovery, click here.

Leaving the Hospital

While FMS can be an outpatient procedure for some patients, others might need to stay the night in a hospital after surgery. Regardless of when you are discharged, you will need to be picked up by someone who will take care of you.

Around-the-Clock Care

Generally speaking, for the first 72 hours after surgery, you should be accompanied by someone around-the-clock. You will need help administering medications and icing your face every hour to keep down inflammation.

Pain and Inflammation

Pain and inflammation will be at its peak during the first week after surgery. Your care team will prescribe and recommend medications to help you manage the pain as time goes on.

We recommend keeping your head elevated at all times, especially while you sleep, and keeping snug compression garments or bandages on the face as much as tolerable for the first week after surgery.

Diet

We recommend that patients follow a low sodium diet to reduce swelling during the recovery period. If there are any incisions in the mouth–from a jaw or chin augmentation–you will need to maintain a soft food diet for at least two weeks. Eating hard or sharp foods can pre-maturely open the incisions and delay healing.

Emotional Recovery

Facial surgery not only involves an intense recovery process, but also requires great patience as you wait for one of the most visible parts of your body to heal. The physical toll and long healing timeline sometimes give patients temporary feelings of post-operative depression and even regret. For this reason, we encourage patients to lean on their loved ones and mental health professionals for the emotional hardships that may come up during recovery.