If you’ve been considering Facial Feminization Surgery (FFS), you’ve likely searched everything about it on the internet and probably have read many opinions about who should perform your surgery. Should it be a plastic surgeon? What about a craniofacial surgeon? How about an oral & maxillofacial surgeon? Would a general surgeon suffice or perhaps a dermatologist who took a course in plastic surgery? The latter may be easy to rule out when it comes to facial feminization surgery. But, the others require that the patient be more informed in order to avoid being led down the primrose path.
You could probably guess that if a surgeon wants to start performing FFS, he might declare that his specialty is the only one you should consider and that the training that came along with it makes him perfectly suited to perform such a complex set of procedures. Many of these surgeons are hoping that you won’t ask how long and how often they have been performing FFS.
So, what do all of these various titles refer to? Let’s review them:
Plastic Surgeons are MD specialists who perform medical procedures designed to alter or restore the body’s shape or form. Though cosmetic or aesthetic surgery is the most well known kind of plastic surgery, plastic surgeons are also trained in reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and in the treatment of burns. In most countries, plastic surgeons must complete medical school followed by a residency in general surgery and finally a residency in plastic surgery. Due to these two separate residency requirements, a doctor can’t be a board-certified plastic surgeon until several years have passed after medical school. It’s a long and tedious process.
Oral & Maxillofacial Surgeons specialize in treating both the hard and soft tissues of the mouth, jaws, and face. In the United States and Canada, oral and maxillofacial surgery is considered to be a subspecialty of dentistry. Oral surgeons are most familiar to Americans as the doctors who surgically remove wisdom teeth and implant certain types of dental hardware. But, they are also trained in other procedures such as treating the misalignment of the jaws & teeth as well as correcting cleft lips & palates. Doctors who pursue this specialty must first complete dental and/or medical school, depending on the country, followed by an oral & maxillofacial residency program. In the United States, both dentists and doctors may train to be board-certified oral & maxillofacial surgeons.
Craniofacial Surgeons treat deformities of the jaws, head, neck, face, teeth, and associated areas. These surgeons are typically plastic surgeons, oral & maxillofacial surgeons, or otolaryngologists (ENT’s). Once they are board-certified in one of these specialities, they then choose to practice as a “fellow” under another surgeon or surgeons who already specialize in craniofacial surgery. The length of the fellowship varies and most countries do not have a board that oversees this.
Cosmetic Surgery is a procedure done for aesthetic or cosmetic purposes rather than for a functional or reconstructive reason. Many of the surgical specialities that we just reviewed deal with cosmetic surgery in some way. But, what about doctors who call themselves cosmetic surgeons? The truth is that any licensed doctor can offer procedures meant to improve one’s appearance. This is not prohibited in most countries, including in the United States. For this reason, you’ll sometimes find general surgeons, dermatologists, and general practitioners using the cosmetic surgeon title and offering common procedures like liposuction and breast implants. These types of doctors would be very unlikely to offer specialized surgeries such as FFS.
How do these different medical specialties and titles relate to Facial Feminization Surgery and which type of surgeon should you choose? First and foremost, you should realize that FFS is a rare specialty performed by a very small percentage of global surgeons. The vast majority of plastic surgeons and oral/maxillofacial surgeons are not likely to have gained much experience with FFS during their residency programs. By the same token, most craniofacial surgeons are unlikely to learn FFS during their fellowships. This is because only a small handful of teaching surgeons from any of these specialities performs Facial Feminization Surgery. More often than not, experience in FFS is gained by interested surgeons after he or she is in well into private practice and begins exploring more advanced procedures while pulling from everything learned and experienced in the operating room. The surgeon slowly gains experience and progresses to more advanced and difficult procedures, often consulting with other surgeons and medical literature along the way. This is how the late Dr. Stanley Biber got his start performing Sex Reassignment Surgery in a small town in Colorado.
So, how does one choose when so may surgeons claim to be the most qualified? You should begin by verifying that any surgeon you are considering is board-certified as a plastic surgeon or as an oral & maxillofacial surgeon. If they cannot direct you to an independent website for the appropriate boards, move on. More importantly, you should find out just how much experience the surgeon has performing Facial Feminization Surgery. Would you want a surgeon with any of the above specialties who has just a couple of years of FFS experience?
In short, verify experience with FFS as well as training. One doesn’t mean all that much without the other.