Updated September 28, 2026

Facial masculinization surgery, or FMS, refers to a group of surgical procedures that modify facial features to create a more masculine appearance. FMS is highly individualized. Some patients choose one procedure, while others combine several procedures during one operation or undergo surgery in stages.

Facial masculinization can address both the facial skeleton and soft tissues, including the forehead and brow, nose, cheeks, jaw and chin. The goal is not to create one particular type of masculine face, but to develop a treatment plan that reflects each person's anatomy, identity and goals. Fan Liang, M.D., of the Johns Hopkins Center for Transgender and Gender Expansive Health reviews what patients should know.

What is facial masculinization surgery?

Facial masculinization surgery is a group of procedures that can reshape the face and its features to create a more masculine appearance.

Testosterone therapy can produce significant changes in facial appearance, including growth of facial hair and changes in skin, facial fat and muscle. However, the extent of these changes varies from person to person, and testosterone generally does not substantially change the dimensions of the adult facial skeleton.

For patients who desire additional changes, facial masculinization surgery can alter both skeletal and soft-tissue features.

The procedures included in FMS vary considerably from person to person. Your surgeon will evaluate your facial anatomy and discuss which features are most important to you before developing an individualized treatment plan.

Who may consider facial masculinization surgery?

Facial masculinization surgery may be appropriate for transgender men, nonbinary people and other individuals who desire a more masculine facial appearance.

For some people, facial appearance can be an important component of gender affirmation and how they are perceived by others. Other people are satisfied with the facial changes that occur with testosterone or do not desire facial surgery.

The decision to undergo facial masculinization surgery is personal, and there is no single set of procedures that is appropriate for everyone.

Facial Masculinization Surgery (FMS) | Q&A

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Facial Masculinization Surgery Procedures

Masculine and feminine facial characteristics vary widely among individuals and across populations. Rather than applying a single definition of a masculine face, facial masculinization surgery focuses on the features that are most important to each patient.

Depending on your anatomy and goals, your surgical plan may include one or more of the following procedures.

Forehead and Brow

The forehead and brow contribute to the overall proportions and contour of the upper face.

For patients who desire greater prominence of the brow or forehead, the surgeon may augment selected areas using an implant, bone or other techniques. The appropriate approach depends on the existing facial skeleton and the degree and location of augmentation desired.

Rhinoplasty

Rhinoplasty reshapes the nose and can change its size, projection and relationship to other facial features.

Depending on your anatomy and goals, masculinizing rhinoplasty may increase projection or width, alter the nasal bridge or tip, or change other aspects of nasal shape and proportion.

Surgery may involve reshaping existing bone and cartilage or adding structural support using cartilage grafts or other materials.

An important goal of rhinoplasty is to achieve the desired appearance while preserving or improving nasal breathing.

Cheek and Midface Contouring

Masculinization of the middle third of the face may involve changing the distribution or projection of the cheek and surrounding soft tissues.

Depending on your anatomy and goals, treatment may involve fat grafting or implants to change facial volume and contour.

The goal is to create balance between the midface and other facial features rather than simply making the cheeks larger or smaller.

Chin and Jaw

The chin and jaw are important components of lower facial shape and proportion.

For patients who desire a broader, longer or more prominent chin, genioplasty can reposition or reshape the chin bone. In other patients, a chin implant may be appropriate.

The width and projection of the lower jaw can also be increased using implants or other surgical techniques. Jaw angle augmentation can create greater width or definition along the lower face.

Some patients may benefit from a combination of skeletal repositioning and augmentation.

Many chin and jaw procedures can be performed through incisions inside the mouth, although the surgical approach depends on the specific procedure.

Your surgeon may recommend dental evaluation or imaging when necessary to evaluate the teeth, jaw and surrounding structures before surgery.

Facial Implants

Facial implants can be used to increase the projection, width or definition of selected facial features. Common locations can include the brow, cheeks, chin and jaw.

Implants may be manufactured from biocompatible materials for which patient-specific implants may be designed to fit an individual's facial skeleton.

Implants can provide substantial and lasting changes in facial contour, but they require surgery and have risks including infection, implant movement or malposition, asymmetry, changes in sensation, visibility or palpability of the implant, and the possibility that the implant may need to be removed or revised.

Adam's Apple Augmentation

The prominence at the front of the neck commonly called the Adam's apple is formed by the thyroid cartilage of the larynx. Its size and shape vary naturally among individuals.

Testosterone started after puberty may deepen the voice and produce other changes but does not reliably create a prominent thyroid cartilage.

For patients who desire a more prominent contour in this area, augmentation of the thyroid cartilage may be considered. 

Techniques can involve cartilage or other implant materials. Because the thyroid cartilage surrounds and supports structures involved in voice production and swallowing, careful surgical planning is important.

Your surgeon will discuss whether this procedure is appropriate for you as well as potential risks, including scarring, infection, implant-related complications, swallowing discomfort and changes in the voice.

Nonsurgical Options for Facial Masculinization

Not everyone seeking a more masculine facial appearance requires surgery. Nonsurgical treatments can be used alone or in combination with surgical procedures.

Options can include:

• Injectable fillers to increase projection or definition of the chin, jaw or other facial features
• Botulinum toxin in selected applications
• Facial hair treatments or transplantation when appropriate
• Other individualized skin and soft-tissue treatments

Injectable fillers are temporary and generally require repeat treatment to maintain their effect.

Although fillers do not require surgery, they are medical procedures and can cause complications. Rare but serious complications can occur if filler enters or compresses a blood vessel. Treatment should therefore be performed by an appropriately trained clinician with a detailed understanding of facial anatomy.

Testosterone and Facial Masculinization

Testosterone can produce significant changes in facial appearance. These may include facial hair growth, increased skin thickness and oil production, changes in facial fat distribution and changes in muscle mass.

The extent and timing of these changes vary among individuals.

Testosterone generally does not substantially enlarge or reshape the adult facial skeleton. For patients who desire changes beyond those produced by hormone therapy, surgical or nonsurgical facial procedures may be considered.

Testosterone is not a prerequisite for facial masculinization surgery. Decisions about hormone therapy and surgery should be based on each person's goals and medical needs.

First Consultation for Facial Masculinization Surgery

Your first consultation is an opportunity to discuss your goals and identify which facial features are most important to you.

Your surgeon will evaluate your facial proportions, skin and soft tissues, facial skeleton and other relevant anatomy. Together, you can discuss which surgical and nonsurgical options may help achieve your goals.

Standardized photographs are commonly obtained for surgical planning. In some cases, your surgeon may recommend a CT scan or other imaging to better understand the facial skeleton or plan a specific procedure.

Preparing for Facial Masculinization Surgery

Facial masculinization surgery is highly individualized. Some patients undergo several procedures during one operation, while others benefit from surgery performed in stages. Factors such as the procedures being performed, anticipated length of surgery, overall health, recovery considerations and patient preference help determine the safest and most appropriate approach.

During Your Procedure

How long does facial masculinization surgery take? 

The length of surgery depends on the procedures being performed. A single procedure may take a few hours, while an operation combining several facial procedures may take considerably longer.

Will I stay in the hospital? 

Some facial masculinization procedures can be performed as outpatient surgery, while more extensive or combined procedures may require overnight observation. Your surgeon will discuss what to expect based on your surgical plan.

When is the first follow-up visit? 

Your first follow-up visit will typically occur 7-10 days after surgery.

Recovery After Facial Masculinization Surgery

Recovery varies depending on the procedures performed and the extent of surgery.

Swelling and bruising are common after facial surgery and are often most noticeable during the first several days. Bruising generally improves substantially during the first few weeks. Swelling can take longer to resolve, particularly after surgery involving the facial bones or implants.

Patients undergoing jaw or chin surgery may initially find soft foods more comfortable. Patients undergoing rhinoplasty may temporarily have splints over their nose, and within the nostrils. 

Temporary numbness or altered sensation is common after some facial procedures. Sensation often improves over time, although recovery can take several months and some sensory changes can be permanent.

Your surgical team will provide individualized instructions about incision care, bathing, diet, sleeping position, returning to work and resuming exercise.

Although you may notice changes soon after surgery, the final result cannot be judged immediately. Facial swelling continues to improve over several months, and the final contour after skeletal surgery may take several months or longer to become apparent.

Risks and Possible Complications of Facial Masculinization Surgery

Facial masculinization surgery is generally safe when performed by an appropriately trained surgical team, but all surgery involves risks. The specific risks depend on which procedures are performed.

Potential complications can include:

• Bleeding or hematoma
• Infection
• Scarring
• Delayed wound healing
• Temporary or permanent numbness
• Facial asymmetry or contour irregularities
• Injury to nerves, teeth or other nearby structures
• Nasal breathing problems after rhinoplasty
• Implant infection, movement, visibility or extrusion
• Problems with implanted hardware
• Blood clots or complications related to anesthesia
• Dissatisfaction with the aesthetic result
• Need for additional or revision surgery

Certain procedures have additional risks that your surgeon will discuss with you.

Contact your surgical team promptly if you develop symptoms such as fever, worsening redness, increasing drainage, sudden or severe swelling, difficulty breathing, severe or worsening pain, or other concerning symptoms after surgery.

What Results Can I Expect From Facial Masculinization Surgery?

The goal of facial masculinization surgery is not to create one particular type of masculine face. Facial characteristics vary widely, and surgery should be individualized to preserve facial harmony and reflect each patient's identity and goals.

Changes from surgery continue to evolve as swelling resolves and tissues heal. Some differences are apparent soon after surgery, while the final results of skeletal procedures may take several months or longer to become apparent.

Research specifically examining outcomes after facial masculinization surgery is still limited compared with research on facial feminization surgery. Available experience supports the use of individualized surgical and nonsurgical techniques to alter facial gender-related characteristics, but additional research is needed to better understand long-term patient-reported outcomes.

It is important to discuss your priorities and expectations openly with your surgeon. Understanding what surgery can and cannot accomplish is an important part of deciding which procedures are right for you.

Medically reviewed by Fan Liang, M.D.