# Facialteam Facial Feminization Surgery — Full Transparency Data # Source: Facialteam (SICAP Healthcare), Marbella, Spain. Clinical CRM (Salesforce) + 1-year patient questionnaire. # Coverage: 2008–2025. Complication frequencies: 2020–2024 window. Last generated: 2026-06-08. ## DEFINITIONS A complication is any objective negative consequence of surgery, of any severity, excluding subjective aesthetic dissatisfaction and elective touch-up. Per-complication incidence = post-operative cases / procedures performed (2020–2024). A revision is a second surgical intervention to refine an outcome. ## TOTALS Patients (2008–2025): 3,582 Procedures (2008–2025): 11,151 Countries of patient origin: 64 Years of specialised practice: 18 Peer-reviewed publications & official recommendations: 38 ## PATIENT SATISFACTION (1 year, Question 4, n=600) 39% — Excellent, better than expected 59.8% — As expected 1.2% — Worse than expected Combined "as expected or better than expected": 98.8% ## PATIENT ORIGIN (% of total cases) Europe: 64% North America: 20% Oceania: 11% South America: 3% Asia: 1% Africa: 1% ## PROCEDURES & COMPLICATIONS ### Forehead feminization — FOREContour® Body location: Forehead Procedures since 2008: 2,891 Revision rate: 1.37% (2018–2022) -> 0.92% (2020–2024) Description: Anterior wall osteotomy (Type 3) via coronal approach. Reduces brow bossing, contours frontal bone, and repositions the supraorbital ridge for a feminine profile. Most frequent complications (incidence | complication | note): 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 Body location: Hairline / scalp Procedures since 2008: 1,342 Revision rate: 1.2% (2018–2022) -> 1.06% (2020–2024) Description: Oval hairline reshaping via simultaneous hair transplant during forehead feminization, customized to each face. Most frequent complications (incidence | complication | note): 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 Body location: Forehead Procedures since 2008: 84 Revision rate: 2.4% (2018–2022) -> 1.8% (2020–2024) Description: 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. Most frequent complications (incidence | complication | note): 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® Body location: Nose Procedures since 2008: 1,904 Revision rate: 4.66% (2018–2022) -> 5.55% (2020–2024) Description: Narrows the bridge, reshapes the tip and adjusts the profile to harmonize with the feminized forehead and chin. Most frequent complications (incidence | complication | note): 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® Body location: Jaw / mandible Procedures since 2008: 1,261 Revision rate: 0.85% (2018–2022) -> 0.82% (2020–2024) Description: Ultrasonic piezosurgery cuts bone only, preserving soft tissue, with individual 3D CT planning per patient. Most frequent complications (incidence | complication | note): 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® Body location: Chin Procedures since 2008: 1,419 Revision rate: 0.91% (2018–2022) -> 1.55% (2020–2024) Description: 3D planning combined with ultrasonic piezosurgery provides millimeter-level accuracy of the chin. Most frequent complications (incidence | complication | note): 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® Body location: Thyroid cartilage / neck Procedures since 2008: 1,228 Revision rate: 1.08% (2018–2022) -> 1.93% (2020–2024) Description: Thyroid cartilage reduction through a hidden submental incision, leaving no scars on the front of the neck. Most frequent complications (incidence | complication | note): 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 Body location: Upper lip Procedures since 2008: 563 Revision rate: 5.04% (2018–2022) -> 4.41% (2020–2024) Description: Shortens the nose-to-lip distance and exposes more vermillion, creating a fuller upper lip and a more youthful proportion. Most frequent complications (incidence | complication | note): 0.3% | Asymmetry | Subtle side-to-side differences in lip elevation. 0.3% | Impaired wound healing | Delayed or altered healing at the subnasal incision. ## PROCEDURE VOLUME PER YEAR 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 ## PUBLICATIONS (38 total; selected, 2013–2026) 2026 Apr [article] Capitán L, Simon D, Bailón C, et al. — Facial Gender-Affirming Surgery: A State-of-the-Art Overview Based on 18 Years of Specialised Practice. British Journal of Oral and Maxillofacial Surgery. https://www.sciencedirect.com/science/article/abs/pii/S0266435626001117 2025 Oct [article] Pérez de Perceval M, Penedo Á, et al. — Telescopic Genioplasty: A novel technique for chin feminization in facial feminization surgery. Journal of Stomatology Oral and Maxillofacial Surgery. 2025 May [article] Simon D, Capitán L, et al. — Combined orthognathic surgery and jaw contouring to improve long face stigma: Lessons learned from facial feminisation. British Journal of Oral and Maxillofacial Surgery. 2025 Apr [article] Kaur MN, Rae C, Morrison SD, et al. — Development and Assessment of a Patient-Reported Outcome Instrument for Gender-Affirming Care. JAMA Network Open. 2025 Apr [article] Bellinga RJ, et al. — Simultaneous Chondrolaryngoplasty and Platysmaplasty in Male-to-Female Facial Gender-Affirming Surgery: A Surgical Technique. Facial Plastic Surgery & Aesthetic Medicine. https://pubmed.ncbi.nlm.nih.gov/40261764/ 2024 Nov [article] Capitán L, Bailón C, et al. — Advanced Surgical Techniques in Forehead Feminization and Hairline Redefinition. Annales de Chirurgie Plastique Esthétique. 2024 Nov [article] Capitán L, Simon D, et al. — Soft Tissue Complications after Facial Feminization Bone Surgery. Journal of Cranio-Maxillo-Facial Surgery. 2024 Nov [article] Simon D, Penedo Á, et al. — Shaping the Lower Jaw Border with Customized Cutting Guides: Development, Validation, and Application in Facial Gender-Affirming Surgery. Facial Plastic Surgery & Aesthetic Medicine. 2024 [article] Bellinga RJ, Capitán L, et al. — Structured Open Rhinoplasty in Facial Feminization Surgery: Lessons Learned After 1422 Consecutive Cases. Revista Española de Cirugía Oral y Maxilofacial. https://www.revistacirugiaoralymaxilofacial.es/rinoplastia-abierta-estructurada-en-cirugia-de-feminizacion-facial-lecciones-aprendidas-tras-1422-casos-consecutivos852 2023 Nov [chapter] Capitán L, Penedo Á, et al. — Facial Feminization. In: Hopper RA, ed. Plastic Surgery, 5th ed. Elsevier. 2023 Aug [article] Simon D, Bailón C, et al. — Secondary Facial Gender Surgery: Causes of Poor Outcomes and Strategies for Avoidance and Correction. Plastic and Reconstructive Surgery. 2023 Apr [chapter] Bailón C, Capitán L, et al. — Facial gender confirmation surgery. In: Purohit RS, Djordjevic M, eds. Atlas of Operative Techniques in Gender Confirmation Surgery. Elsevier. 2022 Sep [recommendation] Coleman E, Radix AE, Bouman WP, et al. — Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health. 2022 Apr [article] Simon D, Capitán L, Bailón C, et al. — Facial Gender Confirmation Surgery: The Lower Jaw. Description of Surgical Techniques and Presentation of Results. Plastic and Reconstructive Surgery. 2022 Feb [recommendation] Özer M, Toulabi SP, Fisher AD, et al. — ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”. Sexual Medicine. 2022 Jan [article] Coon D, Berli JU, Oles N, et al. — Facial Gender Surgery: Systematic Review and Evidence-Based Consensus Guidelines from the International Facial Gender Symposium. Plastic and Reconstructive Surgery. 2021 Sep [article] Simon D, Capitán L, et al. — Masking Gender: The Impact of Facial Coverings on Gender Recognition. Plastic and Reconstructive Surgery. 2021 Sep [article] Martin SA, Morrison SD, Patel V, et al. — Social Perception of Facial Feminization Surgery Outcomes: Does Gender Identity Alter Gaze? Aesthetic Surgery Journal. 2021 Apr [article] Capitán L, Simon D, et al. — Reply: Facial Gender Confirmation Surgery: A Protocol for Diagnosis, Surgical Planning, and Postoperative Management. Plastic and Reconstructive Surgery. 2020 Jun [article] Morrison SD, Capitán-Cañadas F, Sánchez-García A, et al. — Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study. Plastic and Reconstructive Surgery. 2020 Apr [article] Capitán L, Simon D, et al. — Facial Gender Confirmation Surgery: A Protocol for Diagnosis, Surgical Planning, and Postoperative Management. Plastic and Reconstructive Surgery. 2019 Jul [article] Capitán L, Simon D, Bailón C, et al. — The Upper Third in Facial Gender Confirmation Surgery: Forehead and Hairline. Journal of Craniofacial Surgery. 2019 Mar [chapter] Bailón C, Simon D, et al. — Facial Feminization Surgery and Facial Gender Confirmation Surgery. In: Unger C, ed. Comprehensive Care of the Transgender Patient. Elsevier. 2019 Jan [chapter] Penedo Á, Bailón C, et al. — Técnicas y procedimientos de modificación del óvalo facial. In: López Cedrún J, ed. Atlas de Procedimientos y Técnicas Quirúrgicas. SECOM. 2018 Feb [chapter] Bailón C, Capitán L, et al. — Cirugía de Feminización Facial. In: Casado JC, Maraví E, eds. Feminización de la voz. Hospitales Quirónsalud. 2017 Nov [article] Capitán L, Bailón C, et al. — Facial Gender Confirmation Surgery: A New Nomenclature. Plastic and Reconstructive Surgery. 2017 Oct [article] Bellinga RJ, Capitán L, et al. — Reply: Role of Rhinoplasty in Transsexual Patients. Plastic and Reconstructive Surgery. 2017 May [article] Bellinga RJ, Capitán L, Simon D. — Ethnic Considerations for Rhinoplasty in Facial Feminization — Reply. JAMA Facial Plastic Surgery. 2017 May [article] Bellinga RJ, Capitán L, Simon D, et al. — Technical and Clinical Considerations for Facial Feminization Surgery with Rhinoplasty and Related Procedures. JAMA Facial Plastic Surgery. 2017 Apr [article] Berli JU, Capitán L, Simon D, et al. — Facial Gender Confirmation Surgery – Review of the Literature and Recommendations for Version 8 of the WPATH Standards of Care. International Journal of Transgenderism. https://www.tandfonline.com/doi/full/10.1080/15532739.2017.1302862 2017 Mar [article] Capitán L, Penedo Á, et al. — Facial Feminization Surgery: Simultaneous Hair Transplant during Forehead Reconstruction. Plastic and Reconstructive Surgery. 2016 Nov [chapter] Capitán L, Simon D. — Facial Feminization Surgery: A Global Approach. In: Salgado C, Monstrey S, Djordjevic M, eds. Gender Affirmation. Thieme. 2016 May [chapter] Capitán L, Simon D. — Intervenciones quirúrgicas: la Cirugía de Feminización Facial. In: Astudillo M, ed. La feminización de la voz de la mujer transexual. Círculo Rojo. 2015 Oct [article] Capitán L, Penedo Á, et al. — Reply: Facial Feminization Surgery: The Forehead. Surgical Techniques and Analysis of Results. Plastic and Reconstructive Surgery. 2014 Oct [article] Capitán L, Simon D, et al. — Facial Feminization Surgery: The Forehead, Surgical Techniques and Analysis of Results. Plastic and Reconstructive Surgery (Best Paper Award). 2013 Oct [article] Capitán L, Simon D, Bailón C. — Facial feminization surgery: surgical techniques and analysis of results in 200 patients. International Journal of Oral and Maxillofacial Surgery. https://www.ijoms.com/article/S0901-5027%2813%2900571-7/abstract