Is Your FFS Surgeon Craniofacial/Maxillofacial Trained?


Facial Feminization Surgery is a big step in transitional process. And a very important one. It’s more important than bottom surgery for many.

Because your face is visible to everyone. It is not something that can be easily hidden. Even with makeup.

The right FFS surgeon becomes even more important for AMAB individuals seeking to feminize their face.

Think all you need is a plastic surgeon? Think again. Because most plastic surgeons are capable of only performing the sum of the soft tissue procedures.

But what about bone work? Forehead contouring involves the reshaping the bones of the skull to a more feminine shape.

Now that’s a skill. Even a specialty. Performed by a highly skilled surgeon. Dr. Keojampa or Dr. Deschamps-Braly, for example.


“Forehead reduction surgery (AKA forehead reshaping and contouring) is a craniofacial surgical procedure requiring the highly advanced surgical skill set of a cross-trained surgeon who is skilled in both general plastic surgery AND craniofacial surgery. A high level of skill is needed because the surgeon will not only be altering the soft tissues of the face (plastic surgery) but also the skeletal (bony) structure of the skull” Dr. Deschamps-Braly.


Craniofacial/Craniomaxillofacial Surgery is a shared subspecialty of Otolarygology-Head & Neck Surgery (ENT), Plastic Surgery, and Oral & Maxillofacial Surgery, Dr. Keojampa says.


“Each of those specialties all has fellowship or additional training pathways to further obtain craniomaxillofacial surgery experience. Facial Feminization Surgery for transgender patients is interesting in that a great surgeon needs to have knowledge in all 3 of those specialtiesDr. Keojampa.


Here is a catch. Additional training in craniofacial/maxillofacial training in no way makes a surgeon competent to perform FFS. Because training is mostly focused on pediatric craniofacial surgery. And unless you need cleft lip, palate, and craniosynostosis repair, a Craniofacial surgeon may have no prior experience performing the common procedures needed for adult FFS surgery. Additional training, specifically in FFS surgery with another expert FFS surgeon is encouraged.

Your FFS surgeon must have craniofacial/maxillofacial training AND experience working with transgender patients.

Dr. Keojampa, one of the few surgeons in the world with extensive experience in aesthetic craniomaxillofacial surgery and Facial Feminization Surgery, recommends asking the following key questions when choosing FFS surgeon:

1. Where and with whom did you receive training to perform Facial Feminization Surgery? This can be through an official fellowship such as offered with Dr. Jeffrey Spiegel at Boston University, informal observerships, or continuing medical education courses.

2. How often do you perform Forehead Feminization Cranioplasty? Rhinoplasty? Jaw Reduction Surgery? Sliding Genioplasty?

If newly finished with training, it would be important to ask how many of those procedures you were involved in during your training?

3. Do you have hospital privileges to perform those surgeries? Can I see your clinical delineation of privileges from your hospital?

4. What percentage of your practice involves the care of transgender patients? And if the staff are trained in caring for transgender patients such as correctly addressing patients by their identified gender.

Curious to hear Dr. Keojampa answers to his own test?

1. I trained with Dr. Jeffrey Spiegel in specifically Facial Feminization Surgery and Craniomaxillofacial surgery.

2. I perform over 100 major Facial Feminization Surgery cases a year with approximately 1000 individual procedures and average 2-3 full Facial Feminization Surgeries involving the Upper, Mid, and Lower Craniofacial structures every week.

3. I have hospital privileges in Otolaryngology, Head & Neck surgery, and Complex Craniofacial Surgery.

4. 70% of our practice involves the care of transgender patients and all staff is trained in LGBTQ sensitivity and care.

For a successful and long-lasting FFS that includes ‘bone work’ on the facial skeleton, having a highly skilled surgeon with craniofacial/maxillofacial training is paramount!