Facial feminization surgery includes a range of procedures designed to align facial features with a patient’s gender identity. For medical coders, these services present unique challenges due to the number of anatomical areas involved and the variety of CPT codes that may apply. This overview identifies commonly performed facial feminization procedures—including forehead, hairline, nasal, cheek, lip, jaw, chin, and tracheal interventions—while highlighting key procedural components, potential codes for reporting and authoritative references to support accurate, compliant code assignment.
Facial feminization surgery is often performed for patients with gender dysphoria whose gender identity differs from their sex assigned at birth. In facial feminization, surgery helps align facial features to better match this identity by changing the shape of the face so it looks more female. Many facial features reflect sex differences and there are different procedures that change the look of the cheekbones, brow, lips, jaw and chin. Additional procedures for feminizing the face include hair transplant, moving the hairline to make the forehead smaller and skin-tightening surgery such as a face-lift. The procedures listed below are some of the more commonly performed procedures. These are not exclusive to men undergoing gender reassignment as women who want a more feminine appearance may also have these procedures performed.
Source: https://my.clevelandclinic.org/health/treatments/21574-facial-feminization-surgery
Males tend to have a higher hairline than females, and they also may have receded corners that give the hairline an “M” shape. To correct this, the hairline can be advanced forward and the shape of the hairline changed to a more rounded, feminine shape by repositioning the scalp or with hair transplantation.
Procedures to alter the hairline include:
Forehead procedures are done to contour the forehead. This is accomplished by shaving down hard angles and reducing the prominence of the brow bone. For a larger brow protrusion, the front of the brow bone may be removed entirely, contoured and replaced. A brow lift can be done to elevate the eyebrows to a more feminine position and appearance, and an eyelid lift removes excess tissue to help feminize the eyes. Orbital contouring alters the shape of the orbit as female eye sockets tend to be smaller, located higher on the face, more sharply angled at the outer edges and closer together at the inner edges.
Procedures to alter the forehead include:
A rhinoplasty contours the nose so it will fit with more feminine features and maintain its proportion with other facial features by reducing the nose’s width and re-shaping the masculine angles for a softer look.
Procedures to alter the nose include:
Females tend to have more forward projection in their cheekbones as well as fuller cheeks compared to males, so cheek augmentation can be done using implants or fat harvested from other parts of the body to create more feminine appearing cheeks. Lip procedures such as lip filling are done because females often have fuller lips than males. Males also tend to have a greater distance from the base of the nose to the top of the upper lip compared to females, so a lip lift may be performed to shorten this distance so it looks more feminine.
Procedures to alter the lips include:
Procedures to alter the cheeks include:
The male chin tends to be taller, wider and more squared-off at the front and the jawline larger, thicker and wider compared to a female. The chin can be reduced with recontouring to make it shorter, narrower, and rounder. This is accomplished by shaving and smoothing down bone and protrusions or with a sliding genioplasty where a section of chin bone is removed via osteotomies and the remaining bone is retracted and reattached at this new position. The jaw can also be reduced by contouring the angle of the mandible, narrowing and softening the lower jaw to make it appear more feminine.
Procedures to alter the chin and jawbone include:
Males tend to have a more prominent Adam’s apple than females and this can be minimized with a procedure called a chondrolaryngoplasty or tracheal shave.
Procedure to alter the trachea includes:
In summary, these are just some of the procedures that may be performed to achieve facial feminization when a patient is undergoing gender reassignment, also known as gender-affirming, surgery. Other feminization surgery may involve procedures on other parts of the body that help align a person’s physical appearance with their gender identity and for a patient transitioning from male to female these may include procedures such as breast augmentation and vaginoplasty.
References
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