How many facial feminization procedures has Facialteam performed?

Since 2008, Facialteam has treated 3,582 patients across 11,151 facial feminization procedures (through 2025), with patients travelling from 64 countries.

How is a surgical complication defined in Facialteam's registry?

A complication is any objective negative consequence of surgery, of any severity, excluding subjective aesthetic dissatisfaction and elective touch-ups. Frequencies are calculated as post-operative cases over procedures performed (2020–2024), and every complication is recorded and tracked as part of the follow-up protocol.

What are the most common complications of forehead feminization (FOREContour®)?

For forehead feminization, the most frequent complications by incidence are Impaired wound healing (0.9%), Asymmetry (0.8%), Facial nerve weakness (0.7%), followed by bone contour irregularity (0.5%), fixation hardware issue (0.4%), hair loss / shock loss (0.2%) and pain / headache (0.2%). Revision rate is 0.92% (2020–2024).

What are the most common complications of feminization rhinoplasty?

For feminization rhinoplasty, the most frequent complications by incidence are Palpable bump (1.2%), Asymmetry (1.0%), Infection (0.7%), followed by impaired nasal breathing (0.5%), impaired wound healing (0.4%), bone contour irregularity (0.2%) and nasal crusting / odor (0.1%). Revision rate is 5.55% (2020–2024) — the highest of the portfolio.

What are the most common complications of jaw and chin feminization (JAWContour®)?

For lower-third (jaw and chin) feminization with JAWContour®, the most frequent complications by incidence are Soft-tissue excess / sagging (2.1%), Local pain (jaw / chin / teeth) (0.6%), Altered sensation (0.5%), followed by asymmetry (0.2%), suture reaction (0.1%), facial nerve weakness (0.1%), hematoma / bleeding (0.1%) and suture dehiscence (0.1%). Revision rate is 0.82% for the jaw and 1.55% for the chin (2020–2024).

What are the most common complications of tracheal shave (TContour®, Adam's apple reduction)?

For tracheal shave (TContour®), the most frequent complications by incidence are Impaired wound healing (0.7%), Temporary hoarseness (0.5%), Palpable bump (0.3%), followed by permanent hoarseness (0.2%), vocal cord injury (0.1%) and suture dehiscence (<0.1%). Revision rate is 1.93% (2020–2024).

What is the revision rate for facial feminization surgery at Facialteam?

Revision rates (2020–2024) by procedure: jaw 0.82%, forehead 0.92%, hair transplant 1.06%, chin 1.55%, tracheal shave 1.93%, lip lift 4.41% and rhinoplasty 5.55%. A revision is a second surgical intervention to refine an outcome.

How satisfied are Facialteam's facial feminization patients?

One year after surgery, 98.8% of patients (n=600) rated their outcome as expected or better than expected — 59.8% as expected and 39% better than expected — while only 1.2% rated it worse than expected.

Where is Facialteam located and who can be treated?

Facialteam is based in Marbella, Spain, and treats patients from around the world — to date from 64 countries across every inhabited continent (Europe 64%, North America 20%, Oceania 11%).

How much published research supports Facialteam's facial feminization surgery?

Facialteam's approach is supported by 38 peer-reviewed publications, book chapters and official recommendations (2013–2026), including the foundational forehead and lower-jaw technique papers and contributions to the WPATH Standards of Care, Version 8.

When did Facialteam start performing facial feminization surgery?

Facialteam has performed facial feminization surgery since 2008 — 18 years of specialised practice — making it one of the most experienced single FFS teams worldwide.

Facialteam · Transparency Hub · 2008 — 2025

Facialteam Facial Feminization Surgery — outcomes, complications & revisions in open data

Eighteen years of facial feminization surgery (FFS), in numbers. Facialteam, based in Marbella, Spain, openly publishes every procedure performed, per-procedure complication frequencies, revision rates and patient-reported outcomes. This is the machine-readable summary of that registry; the interactive version requires JavaScript.

Overview — the practice at a glance

Patients (2008–2025): 3,582
Procedures (2008–2025): 11,151
Countries of origin: 64
Years of practice: 18
Patient satisfaction (1 yr, n=600): 98.8% as expected or better
Peer-reviewed publications: 38

A complication is defined as any objective negative consequence of surgery, of any severity, excluding subjective aesthetic dissatisfaction and elective touch-ups. Frequencies below are calculated as post-operative cases over procedures performed (2020–2024). Percentages shown are per-complication incidence, not the global per-procedure complication rate. A revision is a second surgical intervention performed to refine an outcome; revision rates use a five-year follow-up window (current cohort 2020–2024, each case with at least one full year of post-operative follow-up).

Procedures & their most frequent complications

Forehead feminization FOREContour®

Anterior wall osteotomy (Type 3) via coronal approach. Reduces brow bossing, contours frontal bone, and repositions the supraorbital ridge for a feminine profile.

2,891 procedures since 2008 · revision rate 1.37% (2018–2022) → 0.92% (2020–2024)

Forehead feminization (FOREContour®) — most frequent complications, 2,891 procedures, revision rate 0.92% (2020–2024)
Incidence	Complication	Description
0.9%	Impaired wound healing	Delayed or altered healing along the coronal incision.
0.8%	Asymmetry	Minor side-to-side differences after bone contouring.
0.7%	Facial nerve weakness	Temporary weakness of the brow from traction on the frontal nerve branch.
0.5%	Bone contour irregularity	A palpable or visible step in the reshaped frontal bone.
0.4%	Fixation hardware issue	Discomfort or palpability of the titanium plates or screws used to fixate the bone.
0.2%	Hair loss / shock loss	Temporary shedding along the scar line that recovers as follicles regrow.
0.2%	Pain / headache	Persistent headache or scalp discomfort beyond the usual recovery.

Simultaneous hair transplant Simultaneous Hair Transplant

Oval hairline reshaping via simultaneous hair transplant during forehead feminization, customized to each face.

1,342 procedures since 2008 · revision rate 1.2% (2018–2022) → 1.06% (2020–2024)

Simultaneous hair transplant (Simultaneous Hair Transplant) — most frequent complications, 1,342 procedures, revision rate 1.06% (2020–2024)
Incidence	Complication	Description
1.7%	Folliculitis / pimples	Small inflamed bumps around grafts and transplanted follicles, usually self-limiting.
0.7%	Impaired wound healing	Delayed or altered healing along the trichophytic scar.
0.3%	Asymmetry	Minor side-to-side differences in the reshaped hairline.
0.3%	Dandruff / dryness	Temporary flaking or dryness of the scalp during healing.
0.2%	Shock loss	Temporary shedding triggered by surgical trauma; follicles regrow.
0.1%	Altered growth direction	A few grafts growing at an unintended angle.

Redoing forehead (revision) FOREContour® Redoing

A corrective procedure for patients seeking revision after a forehead feminization performed elsewhere: rebuilding the frontal sinus wall with a cranial bone graft, removing prior implants or cement, and refining the upper third.

84 procedures since 2008 · revision rate 2.4% (2018–2022)

Redoing forehead (revision) (FOREContour® Redoing) — most frequent complications, 84 procedures
Incidence	Complication	Description
0.9%	Impaired wound healing	Delayed or altered healing along the coronal incision.
0.8%	Asymmetry	Minor side-to-side differences after bone contouring.
0.7%	Facial nerve weakness	Temporary weakness of the brow from traction on the frontal nerve branch.
0.5%	Bone contour irregularity	A palpable or visible step in the reshaped frontal bone.
0.4%	Fixation hardware issue	Discomfort or palpability of the titanium plates or screws used to fixate the bone.
0.2%	Hair loss / shock loss	Temporary shedding along the scar line that recovers as follicles regrow.
0.2%	Pain / headache	Persistent headache or scalp discomfort beyond the usual recovery.

Rhinoplasty (nose feminization) REVONose®

Narrows the bridge, reshapes the tip and adjusts the profile to harmonize with the feminized forehead and chin.

1,904 procedures since 2008 · revision rate 4.66% (2018–2022) → 5.55% (2020–2024)

Rhinoplasty (nose feminization) (REVONose®) — most frequent complications, 1,904 procedures, revision rate 5.55% (2020–2024)
Incidence	Complication	Description
1.2%	Palpable bump	A small palpable irregularity along the bridge as tissues settle.
1.0%	Asymmetry	Subtle side-to-side differences in the bridge or tip.
0.7%	Infection	Localized infection, managed with targeted antibiotics.
0.5%	Impaired nasal breathing	Reduced airflow; persistent cases point to the valve or septum.
0.4%	Impaired wound healing	Delayed or altered healing at the incision.
0.2%	Bone contour irregularity	A visible or palpable step along the reshaped nasal bone.
0.1%	Nasal crusting / odor	Temporary crusting or odor during the first weeks of healing.

Jaw feminization JAWContour®

Ultrasonic piezosurgery cuts bone only, preserving soft tissue, with individual 3D CT planning per patient.

1,261 procedures since 2008 · revision rate 0.85% (2018–2022) → 0.82% (2020–2024)

Jaw feminization (JAWContour®) — most frequent complications, 1,261 procedures, revision rate 0.82% (2020–2024)
Incidence	Complication	Description
2.1%	Soft-tissue excess / sagging	Loose soft tissue over the new bone contour as the envelope readapts.
0.6%	Local pain (jaw / chin / teeth)	Persistent local pain in the jaw, chin or teeth beyond the usual recovery.
0.5%	Altered sensation	Reduced lower-lip or chin sensation from mental nerve traction.
0.2%	Asymmetry	Minor side-to-side differences after bone contouring.
0.1%	Suture reaction	Local reaction to a stitch, resolved once it is removed.
0.1%	Facial nerve weakness	Temporary weakness from traction on the marginal mandibular nerve.
0.1%	Hematoma / bleeding	Bleeding in the floor of the mouth — observed overnight as protocol.
0.1%	Suture dehiscence	Tension-related opening of the incision, managed with local wound care.

Chin feminization JAWContour®

3D planning combined with ultrasonic piezosurgery provides millimeter-level accuracy of the chin.

1,419 procedures since 2008 · revision rate 0.91% (2018–2022) → 1.55% (2020–2024)

Chin feminization (JAWContour®) — most frequent complications, 1,419 procedures, revision rate 1.55% (2020–2024)
Incidence	Complication	Description
2.1%	Soft-tissue excess / sagging	Loose soft tissue over the new bone contour as the envelope readapts.
0.6%	Local pain (jaw / chin / teeth)	Persistent local pain in the jaw, chin or teeth beyond the usual recovery.
0.5%	Altered sensation	Reduced lower-lip or chin sensation from mental nerve traction.
0.2%	Asymmetry	Minor side-to-side differences after bone contouring.
0.1%	Suture reaction	Local reaction to a stitch, resolved once it is removed.
0.1%	Facial nerve weakness	Temporary weakness from traction on the marginal mandibular nerve.
0.1%	Hematoma / bleeding	Bleeding in the floor of the mouth — observed overnight as protocol.
0.1%	Suture dehiscence	Tension-related opening of the incision, managed with local wound care.

Tracheal shave (Adam's apple reduction) TContour®

Thyroid cartilage reduction through a hidden submental incision, leaving no scars on the front of the neck.

1,228 procedures since 2008 · revision rate 1.08% (2018–2022) → 1.93% (2020–2024)

Tracheal shave (Adam's apple reduction) (TContour®) — most frequent complications, 1,228 procedures, revision rate 1.93% (2020–2024)
Incidence	Complication	Description
0.7%	Impaired wound healing	Delayed or altered healing at the submental incision.
0.5%	Temporary hoarseness	Short-lived voice change that recovers with observation.
0.3%	Palpable bump	A small palpable irregularity over the cartilage as tissues settle.
0.2%	Permanent hoarseness	A lasting change in the voice — exceptional in our series.
0.1%	Vocal cord injury	Injury near the vocal cords from over-reduction of cartilage.
<0.1%	Suture dehiscence	Tension-related opening of the submental incision.

Lip lift Lip Lift

Shortens the nose-to-lip distance and exposes more vermillion, creating a fuller upper lip and a more youthful proportion.

563 procedures since 2008 · revision rate 5.04% (2018–2022) → 4.41% (2020–2024)

Lip lift (Lip Lift) — most frequent complications, 563 procedures, revision rate 4.41% (2020–2024)
Incidence	Complication	Description
0.3%	Asymmetry	Subtle side-to-side differences in lip elevation.
0.3%	Impaired wound healing	Delayed or altered healing at the subnasal incision.

Revision rates by procedure (2020–2024)

Procedure	Technique	2018–2022	2020–2024
Forehead feminization	FOREContour®	1.37%	0.92%
Simultaneous hair transplant	Simultaneous Hair Transplant	1.2%	1.06%
Redoing forehead (revision)	FOREContour® Redoing	2.4%	—
Rhinoplasty (nose feminization)	REVONose®	4.66%	5.55%
Jaw feminization	JAWContour®	0.85%	0.82%
Chin feminization	JAWContour®	0.91%	1.55%
Tracheal shave (Adam's apple reduction)	TContour®	1.08%	1.93%
Lip lift	Lip Lift	5.04%	4.41%

Patient-reported satisfaction

One year after surgery every patient receives a follow-up questionnaire. Asked “how would you rate your satisfaction with the results up until now?” (Question 4, n=600):

39% — Excellent, better than expected
59.8% — As expected
1.2% — Worse than expected

98.8% of patients rated their outcome as expected or better than expected.

Where patients come from

Europe: 64%
North America: 20%
Oceania: 11%
South America: 3%
Asia: 1%
Africa: 1%

Procedure volume per year (2008–2025)

Year	Patients
2008	3
2009	22
2010	23
2011	35
2012	57
2013	74
2014	60
2015	100
2016	141
2017	178
2018	251
2019	281
2020	206
2021	284
2022	383
2023	476
2024	490
2025	518

Selected publications (38 total, 2013–2026)

Capitán L, Simon D, Bailón C, et al. (2026). Facial Gender-Affirming Surgery: A State-of-the-Art Overview Based on 18 Years of Specialised Practice. British Journal of Oral and Maxillofacial Surgery.
Pérez de Perceval M, Penedo Á, et al. (2025). Telescopic Genioplasty: A novel technique for chin feminization in facial feminization surgery. Journal of Stomatology Oral and Maxillofacial Surgery.
Simon D, Capitán L, et al. (2025). Combined orthognathic surgery and jaw contouring to improve long face stigma: Lessons learned from facial feminisation. British Journal of Oral and Maxillofacial Surgery.
Kaur MN, Rae C, Morrison SD, et al. (2025). Development and Assessment of a Patient-Reported Outcome Instrument for Gender-Affirming Care. JAMA Network Open.
Bellinga RJ, et al. (2025). Simultaneous Chondrolaryngoplasty and Platysmaplasty in Male-to-Female Facial Gender-Affirming Surgery: A Surgical Technique. Facial Plastic Surgery & Aesthetic Medicine.
Capitán L, Bailón C, et al. (2024). Advanced Surgical Techniques in Forehead Feminization and Hairline Redefinition. Annales de Chirurgie Plastique Esthétique.
Capitán L, Simon D, et al. (2024). Soft Tissue Complications after Facial Feminization Bone Surgery. Journal of Cranio-Maxillo-Facial Surgery.
Bellinga RJ, Capitán L, et al. (2024). Structured Open Rhinoplasty in Facial Feminization Surgery: Lessons Learned After 1422 Consecutive Cases. Revista Española de Cirugía Oral y Maxilofacial.
Capitán L, Penedo Á, et al. (2023). Facial Feminization. In: Hopper RA, ed. Plastic Surgery, 5th ed. Elsevier.
Simon D, Bailón C, et al. (2023). Secondary Facial Gender Surgery: Causes of Poor Outcomes and Strategies for Avoidance and Correction. Plastic and Reconstructive Surgery.
Bailón C, Capitán L, et al. (2023). Facial gender confirmation surgery. In: Purohit RS, Djordjevic M, eds. Atlas of Operative Techniques in Gender Confirmation Surgery. Elsevier.
Coleman E, Radix AE, Bouman WP, et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health.
Simon D, Capitán L, Bailón C, et al. (2022). Facial Gender Confirmation Surgery: The Lower Jaw. Description of Surgical Techniques and Presentation of Results. Plastic and Reconstructive Surgery.
Simon D, Penedo Á, et al. (2024). Shaping the Lower Jaw Border with Customized Cutting Guides: Development, Validation, and Application in Facial Gender-Affirming Surgery. Facial Plastic Surgery & Aesthetic Medicine.
Özer M, Toulabi SP, Fisher AD, et al. (2022). ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”. Sexual Medicine.
Coon D, Berli JU, Oles N, et al. (2022). Facial Gender Surgery: Systematic Review and Evidence-Based Consensus Guidelines from the International Facial Gender Symposium. Plastic and Reconstructive Surgery.
Simon D, Capitán L, et al. (2021). Masking Gender: The Impact of Facial Coverings on Gender Recognition. Plastic and Reconstructive Surgery.
Martin SA, Morrison SD, Patel V, et al. (2021). Social Perception of Facial Feminization Surgery Outcomes: Does Gender Identity Alter Gaze? Aesthetic Surgery Journal.
Capitán L, Simon D, et al. (2021). Reply: Facial Gender Confirmation Surgery: A Protocol for Diagnosis, Surgical Planning, and Postoperative Management. Plastic and Reconstructive Surgery.
Morrison SD, Capitán-Cañadas F, Sánchez-García A, et al. (2020). Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study. Plastic and Reconstructive Surgery.
Capitán L, Simon D, et al. (2020). Facial Gender Confirmation Surgery: A Protocol for Diagnosis, Surgical Planning, and Postoperative Management. Plastic and Reconstructive Surgery.
Capitán L, Simon D, Bailón C, et al. (2019). The Upper Third in Facial Gender Confirmation Surgery: Forehead and Hairline. Journal of Craniofacial Surgery.
Bailón C, Simon D, et al. (2019). Facial Feminization Surgery and Facial Gender Confirmation Surgery. In: Unger C, ed. Comprehensive Care of the Transgender Patient. Elsevier.
Penedo Á, Bailón C, et al. (2019). Técnicas y procedimientos de modificación del óvalo facial. In: López Cedrún J, ed. Atlas de Procedimientos y Técnicas Quirúrgicas. SECOM.
Bailón C, Capitán L, et al. (2018). Cirugía de Feminización Facial. In: Casado JC, Maraví E, eds. Feminización de la voz. Hospitales Quirónsalud.
Capitán L, Bailón C, et al. (2017). Facial Gender Confirmation Surgery: A New Nomenclature. Plastic and Reconstructive Surgery.
Bellinga RJ, Capitán L, et al. (2017). Reply: Role of Rhinoplasty in Transsexual Patients. Plastic and Reconstructive Surgery.
Bellinga RJ, Capitán L, Simon D. (2017). Ethnic Considerations for Rhinoplasty in Facial Feminization — Reply. JAMA Facial Plastic Surgery.
Bellinga RJ, Capitán L, Simon D, et al. (2017). Technical and Clinical Considerations for Facial Feminization Surgery with Rhinoplasty and Related Procedures. JAMA Facial Plastic Surgery.
Berli JU, Capitán L, Simon D, et al. (2017). Facial Gender Confirmation Surgery – Review of the Literature and Recommendations for Version 8 of the WPATH Standards of Care. International Journal of Transgenderism.
Capitán L, Penedo Á, et al. (2017). Facial Feminization Surgery: Simultaneous Hair Transplant during Forehead Reconstruction. Plastic and Reconstructive Surgery.
Capitán L, Simon D. (2016). Facial Feminization Surgery: A Global Approach. In: Salgado C, Monstrey S, Djordjevic M, eds. Gender Affirmation. Thieme.
Capitán L, Simon D. (2016). Intervenciones quirúrgicas: la Cirugía de Feminización Facial. In: Astudillo M, ed. La feminización de la voz de la mujer transexual. Círculo Rojo.
Capitán L, Penedo Á, et al. (2015). Reply: Facial Feminization Surgery: The Forehead. Surgical Techniques and Analysis of Results. Plastic and Reconstructive Surgery.
Capitán L, Simon D, et al. (2014). Facial Feminization Surgery: The Forehead, Surgical Techniques and Analysis of Results. Plastic and Reconstructive Surgery (Best Paper Award).
Capitán L, Simon D, Bailón C. (2013). Facial feminization surgery: surgical techniques and analysis of results in 200 patients. International Journal of Oral and Maxillofacial Surgery.