Facial feminization is also sought by Cross dressers and drag queens. Suitable candidates for FFS are the ones whose bones have stopped growing and are physiologically ready to undergo this change. The surgeon will take radiographs of the mandible of the wrist bones to determine if the one growth has stopped or not.

Facial feminization is all about creating a more harmonious and still a natural looking female look. The number and types of procedures needed to complete the look is decided by the surgeon on the examination of the patient. The point to keep in mind that it takes only a fraction of a second for an eye to decide the gender of the face and of all the features of the body the face is what everybody will notice. Therefore facial feminization is a carefully thought out process.

The face is made of two parts the bony structure and the soft tissues. While the soft tissue (skin, fat and muscle) is subject to many external factors such as age, stress, health, environment etc. the bony structure remains the same. Therefore the effect of surgery in a long term on the soft tissues is difficult to predict but changes in the facial skeleton will remain unchanged.

Therefore considering this difference is important for the facial feminization procedure. A good surgeon in India like Dr Debraj Shome understands the difference between make and female facial skeletons and is able to redefine the skeleton to give a more natural looking feminine face. The male is distinguished from the female by through some specific features such as forehead, nose, jaw and chin and distribution of facial fat.

Therefore this is no laid down protocol for facial feminization surgery but instead the procedures are selected on the basis of the requirement of final results. The face is usually categorized in two parts the primary and secondary areas that need work to get the final results. The surgeon works with the patients to get a clear idea of the final results that are expected.