How effective is facial feminization surgery? The effect of facial feminization surgery on your passing

Posted on November 26, 2018 by Aaricia

Facial Feminization Surgery can act as a real catalyst for positive change. We were lucky enough to acquire data from 118 of our own patients to do a study on the effect of Facial Feminization Surgery on their passing. Since ‘being able to pass’ is the biggest goal that is reported amongst our patients, we wanted to see whether this is something that could truly be achieved.

How effective is FFS in relation to passing

How effective is FFS in relation to passing

How was the study performed?

  • 118 patients filled out a survey before and a survey after their FFS. We accumulated and analysed this data (SPSS), and noted it was statistically relevant (P=0.000***). This means that the improvement (or not) in passing that was reported, could only be attributed to the surgery.
  • We asked patients to grade their passibility, about whether or not they went out using make-up, whether or not they lived as a woman full time, etc.
  • This data was collected between June 2014 and December 2015.

What are the 3 most important results of our study?

1. Good passing increased from 35% to 75% after facial feminization surgery

  • These are the results of the question: “How would you grade your passability at this moment?” in the pre-operative stage, in comparison to the answers during the post-operative stage. As you can see, “good passing” increased from 35% to 75%. “Bad passing” dropped from 30% to 8%.

How would you grade your passibility at this moment?

How would you grade your passibility at this moment?

2. Need for heavy makeup reduced by 50%

  • Another question was: “What kind of make-up do you need to be able to pass?” As you can see below, the level of make-up to achieve a feeling of passing greatly decreased after Facial Feminization Surgery. The amount of individuals needing heavy to medium makeup was reduced by over 50% after their FFS. The amount of people not using any makeup, more than doubled.

What kind of makeup do you need to be able to pass?

What kind of makeup do you need to be able to pass?

3. Never experienced any doubt increased from 15% to 35%

  • One of the other questions we asked: “In recent times, how often did you feel people were doubting your gender?” also showed a very significant difference. The number of patients that never experienced that people were doubting their gender, doubled from 15% to 35% after the FFS. But it is important to note that the main cause for doubt is only half attributed to the face, and that body and especially voice are very important factors as well. And self-confidence is also a contributing factor.

In recent times, how often did you feel people were doubting your gender?

In recent times, how often did you feel people were doubting your gender?


What can we conclude from the results of this passibility survey?

The results undeniably show the positive effect of Facial Feminization surgery on passing. It can be concluded that FFS can be critical in helping trans women going about their everyday life without interference.

  • Quote from one of our patients:
    • “I still worry a bit about my passability because I got into a pattern of doing it, but that is fading away with time as everything that happens reinforces that I don’t need to. In fact the last time I came out to someone they refused to believe me and thought I was joking. I even got a lecture on how its not nice to make a joke out of being trans and trans people, which was very affirming.”



How would the clinic deal with an emergency if serious complications were to arise during the procedure?

If a patient needs hospitalisation we would transfer her to the Middelheim hospital which is 8 minutes or 3,5km from our clinic.

We have had this situation 2 times in more than 700 surgeries. In case this would be because of a mistake from our side we have an insurance that covers the cost. More likely is that it happens without anyone having made a mistake. In that case most health insurances cover these costs.  If you don’t have a health insurance it’s your (financial) risk.

When can I judge the final result?

After three weeks you would look presentable but it takes at least 4 months to get a good impression of the final result. Sometimes after chin and jaw work it can take up to a year for the swelling to completely disappear. Scars take about a year to fully mature.

What type of care is needed after the treatment? Will I require check-ups in my own country?

All care in Antwerp is provided. In general no extra care is needed in your home country. Check-up with Dr Bart is after 4 months and can be in any city where Dr Bart van de Ven provides consultations.

What happens if there are complications after the procedure and is this covered?

We will correct the complication if surgically possible, without charging any surgical fees. Hospital, material and traveling costs are for the expense of the patient.

How long is the waiting time to book an operation?

The average waiting time for an operation at the moment is 3 months. For big surgeries it can be a bit more, for small surgeries less. You can check availability through our online operation planner.

Is FFS painful?

There is no complete answer to this. It depends entirely on the pain threshold of the patient, and the operation procedures performed.Most procedures will involve the need for some incisions, and closure with sutures. Inevitably these will lead to some level of discomfort for some period post-operation. Mostly patients describe it as ‘uncomfortable’ rather then ‘pain’.

Can I loose feeling permanently in some areas following FFS surgery?

Some temporary numbness in any of the areas where bone work is done is an absolute certainty. That could include the scalp, forehead, chin, jaw or even cheek areas depending on where the surgery has been done. This is simply because the flesh is detached from the bony area. Several thousand minor nerves are severed, and it will obviously take some while for those areas to heal. Up to 18 months is not unusual, but less than that is more common.

I am interested in a surgery, in which country do you perform FFS and BFS?

Dr Bart van de Ven (FFS) travels to different European cities for consultations twice every month, but surgery is only performed in Antwerp, Belgium. Dr Maarten Doornaert (BFS) on occasion also travels for consultations, but also only performs surgery in Antwerp.

How long do you need to stay in the hospital after an FFS?

When you’ve had an FFS you will most likely stay at our guesthouse for a week to recover. You arrive one day before your surgery, and you stay for six days afterward. So if you’d arrive on Monday, you would be leaving again on Monday.

What if there are post-op complications?

It doesn’t happen often, but should there be a complication during your stay, you can notify Petra (our permanent resident) or one of the night nurses and they will get in contact with the surgeon if they can’t help you themselves. There will always be someone by your side.

When you leave our clinic, you will receive the phone number of the surgeon in case a complication were to arise later on.

Do the pictures sent for the online FFS quote/simulation have to be taken with a professional camera?

If you have a professional camera, definitely use it. The better the quality, the better the simulation can be. If you don’t own a professional camera, don’t worry. Just make sure you don’t take the pictures like you would take selfies. Prop up your camera against something, use a tripod, or even better: have someone else help you take your pictures.

How long will it take for the sensation in my face to return back to “normal”? What can be done to help?

Facial stiffness and a lack of sensitivity are both common factors after a Facial Feminization Surgery. Recovery time is different from patient to patient, but it can be expected that one will recover to “normal” parameters within six months to two years.

Is it safe to perform an MRI after FFS?

Yes, we use very small titanium screws and plates which are never a problem for an MRI. Also the bonecement does not contain metal.

I’m a bit overweight. What is the maximum BMI for elective surgery?

In principle the maximum BMI is 30. If your BMI is between 30 and 35 but you are in good health, your case is considered on an individual basis by our anaesthesiologist (fill out the anesthesiology form) and we also need Cardiopulmonary Exercise Test (CPET). If your BMI is higher then 35 we don’t operate, so you would need to lose weight.

I only speak English. Will they understand me in Belgium?

In Belgium as good as everyone can speak English. Hence our entire staff speaks English as well, so you will always be able to communicate whatever you feel or need!

Can I get this surgery if I’m a cis woman?

Yes, of course. We perform Facial Feminization Surgery on all women. Every woman is welcome at our clinic!

When should I stop my HRT treatment?


You can continue your HRT treatment before, during and after your FFS. You will receive an anti-thrombotic injection the day before surgery to prevent blood clotting. We prefer you to continue taking your hormones because FFS is emotionally already perturbing enough without messing with your hormone balance.


Only for implant surgery of the buttock and hips we ask to stop one week before the surgery. The day after surgery you can continue your HRT treatment. This because this type of surgery implies some immobilisation (obliged) after the surgery. In this case the risk for blood clots is higher.

Which language does the FFS surgeon speak?

Dr Bart van de Ven speaks Dutch, English and German!

Can I get in contact with one of your former patients?

Yes, you can. You can find a picture (due to spam) of the email address on the before and after FFS picture page of most patients (those that gave us permission). For example on the before and after FFS page of Maya, you can find the following:

What does this procedure cost?

There are 3 options to receive a financial and operative proposal. You can either send us pictures and receive a quote and an FFS simulation, or you can book a Skype or a live consultation with Dr Bart van de Ven during which you will also receive a quote and FFS simulation.

How do I get my FFS price request?

Click here if you want to get a general idea of FFS prices.

Will I have numbness?

The treatment areas will feel numb in the beginning. It will take 3-6 months to recover feeling, and you may not regain the same level of feeling as before.

Should I wait with FFS until I have taken hormones long enough?

The hormones will have their effect on the soft tissues of your face: the fat will redistribute and the muscles will atrophy a bit. Also the facial hair will diminish and hair to the scalp will become denser and thicker. All this will make your face look softer and more feminine.
Dr van de Ven will try to make your face as feminine as possible and there is no negative effect to your face becoming even more feminine after your FFS due to the hormones. Those last changes will be very subtle. Therefore Dr van de Ven does not see a reason to postpone FFS if you have only started taking hormones recently.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.

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