Written By: Erin Storm, PA-C
Published: March 19, 2021
Last updated: October 07, 2021
The Skinny
Gender confirmation surgery or gender reassignment surgery can be a major component of a transgender individual’s transition. There are numerous surgical procedures from head to toe for female to male (FTM) transgender patients. Plastic surgery procedures are usually used in unison with medical and hormone therapies being administered under the guidance of a healthcare provider. You can also consult our male to female (MTF) gender confirmation guide.
All individuals planning to undergo a gender confirmation or gender reassignment transition are evaluated for physical, emotional, and mental health. These evaluations are used to provide whole patient considerations and maintain standards of care for transgender health and gender dysphoria. Multiple international and national organizations exist to advocate, educate, and cultivate a transgender community. The World Professional Association for Transgender Health (WPATH), American society offshoot USPATH, and GLAAD are just a few of these institutions.
The Specifics
Who is a candidate for female to male gender confirmation surgeries?
Candidates for female to male (FTM) gender confirmation surgery are individuals identified as female at birth who are seeking to fully embody their authentic male gender identity. The decision to pursue medical and/or surgical treatments as part of a transition journey is entirely unique to each individual transgender person. Anyone considering a gender confirmation surgery should consider their overall health, expectations of the procedure, and ability to commit to recovery times prior to pursuing treatments.What can you expect from female to male gender confirmation surgeries?
FTM gender confirmation surgeries vary greatly depending on an individual transgender candidate’s needs. There are both surgical and non-surgical treatment options for gender reassignment.- Facial Masculinization: These procedures address the hair, face, and neck. There are surgical modalities to alter bony and soft tissue structures and also less invasive non-surgical options like fillers, thread lifts, and Botox.
- Transmasculine Top Surgery: Typically a surgical breast removal (mastectomy) is used. The nipples and areola are also usually altered to create a more male appearing chest.
- Transmasculine Bottom Surgery: These are typically surgical procedures to alter the buttocks, hips, legs, and genitals.
- Body Contouring: Liposuction is a minor surgical procedure, although other body contouring procedures may be less invasive and involve phototherapy or freezing techniques.
Generally, surgical procedures are more involved, but also permanent, and will necessitate weeks to months of recovery. Non-surgical options usually provide less permanent results, but are also less invasive, and possibly changeable. Some hair procedures may take many months to years to achieve full, lasting results. Medical and hormone therapies may possibly affect surgical procedures. There use should be discussed with your providers.
When should you consider female to male gender confirmation surgeries?
The decision to pursue any gender confirmation surgery is unique to each individual transgender patient. Considerations for physical and mental health are important components in deciding the appropriate time to pursue procedures. Additionally, candidates concurrently utilizing medical and hormone therapies will need to discuss the timing of surgical procedures with their plastic surgeon and medical provider.What is the youngest age someone can have female to male gender confirmation surgeries?
Guidelines for pediatric candidates (those under age 18) seeking to pursue gender affirming surgeries state transgender individuals should not undergo genital reconstruction procedures such as phalloplasty (penile construction), scrotoplasty (scrotum construction), vaginoplasty (labia, clitoris, and vaginal construction), oophorectomy (ovary removal), or hysterectomy (uterus removal) until they reach age 18.Certain top FTM procedures may be considered at age 16. A consultation with a certified medical provider is necessary to determine the best timing of all gender affirming procedures and therapies. Additionally, parental consent and full physical and mental health evaluations are required.
Facial Masculinization Procedures
A combination of surgical and non-surgical procedures that address the forehead, hairline, nose, lips, cheeks, chin, neck, and more may be employed for facial masculinization.Forehead Contouring & Hairline Advancement
- Brow Lift
- Overview: A surgical procedure to alter the appearance of the forehead and brow, there are numerous approaches including Combination Midbrow Incision with Endoscope Brow Lift, Coronal Brow Lift, Direct Brow Lift, Endoscopic Brow Lift, Pretrichial Brow Lift, and a Traditional Midbrow Lift. A non-surgical Chemical Brow Lift is also available.
- Cost: $3,000 - $14,000
- Recovery & Results: Swelling, pain, and bruising for a few weeks to months. The results are permanent.
- Surgical Hair Restoration
- Overview: To preserve and augment scalp, eyebrow, and eyelash hair, procedures like Follicular Unit Transplantation (Strip Harvesting), Follicular Unit Extraction (FUE), Neograft, Accugraft, and ARTAS Robotic Hair Transplantation are available.
- Cost: $4,000 - $18,000
- Recovery & Results: Pain, swelling, and bruising will resolve within a week or two. The results are permanent and hair growth will begin after several months.
Rhinoplasty
- Surgical Rhinoplasty
- Overview: There are numerous approaches to refine the size and shapr of the nose and nostrils, including Open Rhinoplasty, Closed Rhinoplasty, Endoscopic Rhinoplasty, Ultrasonic Rhinoplasty, and Alarplasty.
- Cost: $3,000 - $15,000
- Recovery & Results: The results are permanent and may continue to heal for up to 18 months, but most activities can be resumed within six weeks.
- Non-Surgical Rhinoplasty
- Overview: Liquid Rhinoplasty with dermal fillers or Muscle Paralysis Rhinoplasty with Botox® are less invasive and less permanent options.
- Cost: $500 to $2,000
- Recovery & Results: Results last six months to a year and are immediate. Activity can generally be resumed the same day.
Cheek Augmentation
- Surgical Cheek Augmentation
- Overview: Cheek augmentation with fillers, cheek augmentation with implants, and cheek augmentation with fat transfer can all change the contour and definition of the cheeks.
- Cost: $500 - $6,000
- Recovery & Results: Tenderness, swelling, and bruising will resolve within a week or two. Results may be temporary or permanent depending on the procedure.
Lip Augmentation
- Surgical Lip Augmentation
- Overview: V-Y mucosal advancement of the lip, lip implants, and lip reduction surgery can provide permanent solutions to re-shape and size the lips.
- Cost: $1,000 - $5,000
- Recovery & Results: Tenderness, swelling, and bruising will resolve within a few weeks. The results are usually permanent.
- Non-Surgical Lip Augmentation
- Overview: Cosmetic Lip Tattoo, Temporary Lip Fillers, and Permanent Lip Fillers are less invasive treatment options, but they can still provide dramatic improvements to the appearance of the pout.
- Cost: $500 - $4,000
- Recovery & Results: Tenderness, swelling, and bruising will resolve within a few weeks. The results are usually temporary and require maintenance.
Chin Surgery
- Surgical Chin Augmentation
- Overview: Osseous Genioplasty for Chin Deformity, Chin Reduction, and Surgical Correction of Chin Ptosis can help to define the chin and jawline area.
- Cost: $5,000 - $15,000
- Recovery & Results: Some procedures will require a liquid diet for one week with activity limitations for multiple weeks. The results are permanent and usually finalize within one year.
Neck Procedures
- Adam's Apple Enhancement
- Overview: Harvesting of rib cartilage for implant over the trachea increases the protuberance and size of the Adam’s apple.
- Cost: $3,500 - $6,000
- Recovery & Results: The average patient recovers within two weeks, and the results are permanent.
Transmasculine Top Procedures
Breast removal and chest augmentation are the goals of transmasculine top procedures.- Mastectomy + Nipple & Areola Surgery
- Overview: A mastectomy with a nipple reduction and areola reduction can be used to completely remove the female breast tissue.
- Cost: $2,500 - $6,000
- Recovery & Results: The average patient recovers within a few weeks, and the results are permanent.
- Pectoral Implants
- Overview: Placement of silicone implants or saline implants to augment and contour the chest.
- Cost: $3,800 - $8,500
- Recovery & Results: Pain, swelling, and bruising will last for a few weeks. Full recovery takes about six weeks. The results are permanent.
Transmasculine Bottom Procedures
Transmasuline bottom procedures can be used to remove female sex organs and create a penis and scrotum.- Male Genital Construction
- Overview: Also known as a phalloplasty or metoidioplasty, this procedure involves creating a penis, scrotum (scrotoplasty), and lengthening the urethra. Patients may also elect for a vaginectomy, hysterectomy, and oophorectomy to remove the internal female sex organs.
- Cost: $3,000 - $10,000
- Recovery & Results: The average patient recovers within a few weeks to months, and the results are permanent.
Body Contouring
There are both surgical and non-surgical treatment options to shape and contour the body.- Non-Surgical Body Contouring
- Overview: An alternative approach to classic liposuction that may also have skin tightening benefits. Procedures include truSculpt®, Emsculpt®, and BodyTite™.
- Cost: $1,000 - $10,000
- Recovery & Results: The average patient recovers within a few days to weeks, and the results are permanent, but will evolve with aging and weight gain.
- Liposuction
- Overview: Lipodissolve, Laser-Assisted Liposuction, Power Assisted Liposuction, Radiofrequency-Assisted Lipolysis (RFAL), SmartLipo, SlimLipo, Tumescent Liposuction, Ultrasound Assisted Liposuction, Water Jet Assisted Liposuction, SculpSure, and PrecisionTX can be used to alter and redistribute fatty tissue deposits.
- Cost: $1,000 - $8,000
- Recovery & Results: The average patient recovers within a few days to one week, and the results are permanent, but will evolve with aging and weight gain.
- Calf Augmentation via Implant
- Overview: Gel or solid silicone implants are placed within the contours of the calf muscle.
- Cost: $3,600 - $8,000
- Recovery & Results: Bruising, pain, and difficulty walking for about three weeks. Permanent and immediately noticeable improvement.
The Takeaway
For transgender individuals considering integratin gender confirmation surgeries into their transition, there exists a wide array of procedures to further refine, define, and create their desired aesthetic. A plastic surgeon will assist with both sex reassignment surgeries and cosmetic transgender surgeries in unison with medical and hormone therapies administered by a healthcare provider. Candidates should also consider discussing with their insurance companies possible coverages for some of these procedures in the treatment of gender dysphoria.
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Source List
- American Society of Plastic Surgeons Gender Confirmation Surgeries plasticsurgery.org
- Karel E Y Claes Chest Surgery for Transgender and Gender Nonconforming Individuals PubMed.gov; 2018-07-02
- Hoyos, A, and M Perez Arm Dynamic Definition by Liposculpture and Fat Grafting Oxford Academic; 2012-11-01
- GB Forbes Body Fat Content Influences the Body Composition Response to Nutrition and Exercise PubMed.gov; 2000-05-01
- Paul Cohen, Bruce M Spiegelman Cell Biology of Fat Storage PubMed.gov; 2016-08-15
