This is a rather sensitive topic but ignoring the harm done by these surgeries wouldn’t be ethical at all, trying to sweep these things under the rug isn’t helpful.

Facial Feminization Surgery (FFS)

Facial Feminization Surgery, when done correctly, can create valuable changes to facial aesthetics - correcting masculine features or assymetries.

Facial feminization surgery (FFS) is a type of plastic surgery that is designed to make the face look more feminine. FFS involves reshaping the face, including the forehead, brow, nose, cheeks, chin, and jaw. It can also involve facial hair removal, lip augmentation, and eyelid surgery. The goal of FFS is to create a softer, more feminine look that is in line with a feminine identity. FFS is a complex and delicate procedure that requires a skilled surgeon, as the results are permanent. It is important to consult with a reputable plastic surgeon before deciding to undergo FFS, as the results may vary from person to person - no results are guaranteed.

FFS Providers & Results

In many cases radical surgery can increase “passability”.

Subtle FFS makes minor changes to the face, this is the by far most common type of FFS performed.

Aggressive FFS is radical surgery that makes significant changes. For this you have to find the right doctor, and might come with more risks/complications.

Make sure you know what you are getting; It is questionable if paying a lot of money for subtle FFS actually makes sense since it’s unlikely to significantly help someone pass to their own expectations.

Popular and well-reviewed surgeons in the US are Keojampa, Deschamps-Braly, Dr Toby Mayer (Subtle, Aggressive), Mardirossian (Subtle, Aggressive), Jumaily and Harrison Lee.

Popular and well-reviewed Korean clinics are EverM, EUdental, JK, and The Face Dental. They all do double jaw and are good with genioplasty.

Tracheal Shave

A tracheal shave reduces the size of the Adam’s apple. The procedure can be performed under either local or general anesthesia, but it is often done on an outpatient basis. A minor incision is made on the chin, and then cartilage is scraped or “shaved” away and restructured to reduce its size. The results of a tracheal shave are very noticeable - the neckline will be smoother, and the patient’s Adam’s apple will be much less prominent.

It’s important to speak with your doctor about the results you’re hoping to obtain. A tracheal shave isn’t done to raise or change voice pitch permanently - if a higher-sounding voice is part of your feminization goal, a separate procedure known as voice cord or voice feminization surgery may help. While increasing aesthetics, tracheal shave is not a miracle cure, and some patients have not been entirely satisfied with the outcome.

Genital SRS

Because of higher risk of dissatisfaction with current SRS methods Transmaxxing does not recommend any form of currently available SRS

To a very large degree the issue is simply bad clinics/surgeons butchering people. Most SRS results you can find when looking them up online are very bad but there are a few exception.

If you look at actual studies you will find that it’s not surgeries trans people benefit from. Only HRT has a significant positive association with quality of life in multivariate regression.

If your SRS is a failure there will probably not be any way to fix it later, it’s irreversible.

The following study did found that the “mental health” metric increased temporarily after SRS only to fall back to the level it was prior to the surgery.

Quality of life after SRS

In-addition SRS generally require regular dilation, otherwise the pseudo-vagina will gradually shrink as the body tried to heal.

Another option to consider is penile preserving vaginoplasty (PPV). This is mostly experimental.


It is hard to see any real benefit with this when injections or ethinyl estradiol alone supresses testosterone enough to the level of castrated men.

Suggested HRT

This will also make you permanently infertile and thus the only way for you to have children will be via sperm you have backed up. See About Sperm Banking

Breast Augmentation

If you look at natural vs enhances breasts you will see a very clear difference, you can tell it’s fake when it’s fake (few exceptions) and it doesn’t look right. A proper HRT regimen is effective in achieving mature breast development. If BA is desired be informed of the risks which include infection - which may even result in mastectomy. Proper surgical precautions are essential.

Teardrop/Gummybear BA

This type of breast enhancement focuses on maximizing the natural shape of the breast when in an upright position - including a more natural “sideboob”.

Comparing Teardrop vs Round

Teardrop BA

Due to their strength, gummy bear implants are less likely to rupture and leak compared with other silicone gel and saline forms. The risk, however, is that if gummy bear implants do leak, it’s harder to detect the leak than with saline implants. This is why screenings are important to detect any problems. For silicone implants, the U.S. Food and Drug Administration (FDA) recommends surveillance MRIs 3 years after they are placed and every 2 years thereafter.

Safety Info