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Facial feminization surgery (FFS) refers to surgical procedures that alter the human face to bring its features closer in shape and size to those of an average female human. FFS includes various bony and soft tissue procedures (see below) though the term "FFS" is generally not regarded to include facial hair removal. FFS techniques are derived from maxillofacial and reconstructive surgery as well as general plastic and cosmetic surgery. Douglas Ousterhout pioneered what is now called FFS During the 1980s and 1990s in the U.S.A. There are only a small number of surgeons globally who specialise in FFS.

FFS has become increasingly sought after by transsexual women and many feel that it is just as important or even more important for them than sex reassignment surgery (SRS) because it helps them integrate socially as women. While most FFS patients are transsexual women, some non-transsexual women who feel that their faces are too masculine will also undergo FFS. FFS is occasionally sought by other transgender people such as cross-dressers and drag queens.

In males the hairline is often higher than in females and usually has receded corners above the temples that give it an “M” shape. The hairline can be moved forwards and given a more rounded shape either with a procedure called a “scalp advance” where the scalp is lifted and repositioned or with hair transplantation. Hair transplants can also be used to thicken up hair that has been thinned by male pattern baldness. If too much hair has been lost, it will not be possible to correct hairline problems.

Males tend to have a horizontal ridge of bone running across the forehead at eyebrow level called the brow ridge or “brow bossing” while female foreheads tend to smoother and flatter and have little or no bossing. The outer segments of the bossing that the eyebrows sit on are called the “supraorbital rims”. These are usually solid bone and can simply be ground down. The section of bossing between the eyebrows (the glabella) sits over a hollow area called the frontal sinus and because it is hollow it can be more difficult to remove the bossing here. If the wall of bone sitting over the frontal sinus is thick enough the bossing can be removed by simply grinding down the bone, however if the wall of bone is thin it may not be possible to grind the bossing away completely without breaking through the wall into the frontal sinus. FFS surgeons have taken 3 main approaches to resolving this problem:

1. Most FFS surgeons can perform a procedure called a forehead reconstruction where the wall of bone is taken apart, thinned, re-shaped and put back together in the new feminine position with titanium wires or titanium screws and microplates.

2. Some surgeons grind down the wall of bone as far as possible without breaking through and then build up the area around the remaining bossing with bone cement. The bone cement smooths out any visible step between the remaining bossing and the rest of the forehead to give a smooth and feminine appearance. In these cases some additional reduction in the bossing can also be made by thinning the soft tissues that sit over it.

There is a great deal of heated debate in FFS circles about whether it is best to remove the bossing with a reconstruction or to use the build-up method to disguise it. Some feel that a reconstruction is too invasive and that disguising the bossing is just as good as removing it; others feel that disguising the bossing is an unacceptable compromise and that it can sometimes leave the forehead with an unnatural bulge - these patients would rather have the bossing completely removed with a reconstruction.

3. Some FFS surgeons now offer a compression technique in appropriate cases where the wall of bone is first weakened and then compressed into place. It then heals in the new position.

Male foreheads also often have various indented areas. For example, the centre of the forehead is often slightly indented. These areas can be filled with bone cement during surgery to smooth everything out.