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Facial Feminization Surgery (FFS) in Bellevue — Craniofacial Expertise, Affirming Care

Your face is the most visible expression of who you are. For transgender women and non-binary individuals seeking facial feminization surgery in the Bellevue and Seattle area, Dr. Kristopher M. Day offers something rare: a fellowship-trained craniofacial surgeon whose specialized bone and soft tissue expertise is precisely matched to what FFS requires. At Pacific Sound Plastic Surgery, you’ll receive compassionate, affirming care in a boutique practice where every detail of your surgical plan is tailored to your unique anatomy and goals.

Double Board-Certified (ABPS + ABS)

Ivy League Trained

Highly Rated Bellevue Plastic Surgeon

Proudly Serving Bellevue, Seattle, Kirkland, Redmond, Mercer Island, Issaquah, Renton

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(425) 818-8991

What Is Facial Feminization Surgery?

Facial feminization surgery (FFS) is a collection of surgical procedures designed to reshape masculine facial features to reflect a more traditionally feminine appearance. For many transgender women and non-binary individuals, FFS is a medically necessary step in gender transition — recognized by the World Professional Association for Transgender Health (WPATH) as part of the evidence-based Standards of Care.

Unlike purely cosmetic procedures, FFS addresses the underlying bone and soft tissue structures that create gender-specific facial differences. The forehead, nose, jaw, chin, throat, and hairline are the primary targets — each requiring a distinct level of surgical precision.

FFS Procedures Performed at Pacific Sound

Dr. Day customizes every FFS plan to the individual. Commonly performed procedures include:
  • Forehead Contouring & Brow Bone Reduction (Frontal Cranioplasty) — Reduces brow bossing and creates a smoother, more feminine forehead profile. This is the most technically demanding FFS procedure and requires advanced craniofacial training.
  • Feminizing Rhinoplasty — Narrows the bridge, refines the tip, and adjusts the overall nasal profile for feminine harmony with the rest of the face.
  • Jaw & Chin Contouring (Mandibular Angle Reduction / Genioplasty) — Reduces the squareness of the jaw and softens the chin to create a more tapered, V-line facial shape.
  • Tracheal Shave (Chondrolaryngoplasty) — Minimizes the visibility of the Adam's apple through a small, discreetly placed incision.
  • Hairline Lowering (Scalp Advancement) — Reduces the height of the forehead and creates a hairline that better reflects feminine proportions.
  • Lip Lift, Brow Lift & Cheek Augmentation — Complementary procedures that enhance overall facial femininity and can often be combined in a single surgical session.
Not every patient needs every procedure. During your consultation, Dr. Day will evaluate your facial anatomy and listen carefully to your goals — then design a staged or single-session plan that prioritizes safety and achieves the most meaningful results.

Benefits of FFS?

What FFS Can Achieve for You

Facial feminization surgery offers benefits that go far beyond the cosmetic. For many patients, the impact is deeply personal and profoundly life-changing:

  • Reduced gender dysphoria — aligning external appearance with internal identity
  • Greater confidence in everyday life, at work, and in social settings
  • Natural, harmonious results — FFS should make you look authentically feminine, not 'surgically altered'
  • Bone-level changes that no amount of makeup, contouring, or non-surgical treatment can replicate
  • Procedures that are often covered by insurance — including Washington Apple Health (Medicaid)
  • Long-lasting results for bony procedures; soft tissue results that settle beautifully with time
  • A surgical plan designed around your goals and anatomy — not a template

"Doctor day is a very experienced cranial facial and plastic surgeon. I quoted ffs at other surgeons he was the only one that looked at all my health and split it into smaller chunks for my safety. He respected my wants, listened to me. Specifically told me they have my back, if anything shifts over next year, would not drop me... My scarring is so unnoticed, people comment on how it looks like no surgery marks at all. Sophia the receptionist was always kind to me."

— Sarah B., FFS Patient • Google Review

Am I a Good Candidate for FFS?

  • IDEAL CANDIDATES
  • Transgender women or non-binary individuals seeking facial feminization
  • Adults in stable overall health with realistic expectations
  • Patients who have completed or are undergoing gender transition planning
  • Those with masculine facial features that cause gender dysphoria
  • Individuals who have discussed surgical readiness with a mental health provider
  • Patients prepared for staged procedures and full recovery commitment
  • CONSIDER WAITING IF
  • Facial bone structure has not finished developing (typically under age 18)
  • Significant uncontrolled medical conditions affecting surgical safety
  • Active smoking or nicotine use within 4–6 weeks of planned surgery
  • Unrealistic expectations about what FFS can achieve
  • Insufficient support network for the recovery period
  • Insurance documentation (letters, HRT timeline) not yet in place

WPATH Requirements & Documentation

Washington State and most insurers follow WPATH Standards of Care for FFS approval. Generally, you’ll need:

  • One or two letters from a licensed mental health provider confirming gender dysphoria diagnosis
  • Documented history of hormone therapy (duration requirements vary by insurer and procedure)
  • Surgeon's consultation notes and surgical necessity documentation

Our team assists with the documentation and insurance pre-authorization process. You do not need to navigate this alone. Call (425) 818-8991 to discuss your situation.

Not Sure If You're a Candidate?

Ready to Take the First Step? Schedule Consultation Now

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The Process And Recovery

Your FFS Journey at Pacific Sound

Facial feminization surgery is a process — not a single event. Dr. Day’s approach begins well before surgery and extends through your full recovery. Here’s what you can expect:

Step 1: Consultation

Dr. Day does not offer virtual consultations for FFS — he believes that evaluating bone structure and facial tissue requires an in-person examination. During your consultation, he will assess your facial anatomy, discuss your goals, review your health history, and develop a detailed surgical plan. He will explain each recommended procedure, the rationale behind the staging approach (if applicable), and realistic expectations for your results.

Step 2: Planning & Pre-Authorization

Once your plan is established, our team begins the insurance pre-authorization process. We assist with gathering the required documentation and coordinating with your insurer. This phase can take 2–6 weeks depending on your carrier. We keep you informed throughout.

Step 3: Pre-Surgical Preparation

In the weeks before surgery, you will receive detailed instructions covering medications to avoid, nutritional guidelines, and arrangements for your post-operative care. If you smoke or use nicotine, cessation is required at least 4–6 weeks before surgery for optimal healing.

Step 4: Day of Surgery

FFS procedures are performed under general anesthesia at an accredited surgical facility. Surgery duration depends on the number of procedures — a single-procedure session may last 2–3 hours; comprehensive multi-procedure FFS may require 5–8 hours. Dr. Day personally performs every aspect of the surgery.

Step 5: Recovery & Follow-Up

Detailed recovery timeline below. Dr. Day calls personally to check in after your procedure and remains available throughout your recovery. Follow-up appointments are scheduled at regular intervals to monitor healing and address any concerns.

Recovery Timeline

Days 1-3

Rest at home. Swelling and bruising at their peak — this is normal and expected. Head elevation and cold compresses help manage discomfort. Most patients report pain is manageable with prescribed medication.

Week 1

Gentle walking is encouraged starting the day after surgery. Swelling prominent. Sutures in place. Avoid any activity that causes grimacing, straining, or sweating.

Many patients begin to feel more comfortable by days 5–7. Patients with sedentary or desk-based work can often return within this first week. Liquid or soft diet if jaw work was performed.

Weeks 2–3

Sutures removed. Bruising begins to fade. Begin gradual return to light exercise — start at 50% of your pre-operative baseline and increase by approximately 5% per day. Visible swelling continues to improve.

Weeks 4–6

Significant improvement in visible swelling. Surgical contours become more apparent. Full return to pre-operative activity level, including higher-impact exercise, by weeks 4–6 as directed by Dr. Day.

Month 3

Soft tissue swelling largely resolved. Rhinoplasty results beginning to settle. Most patients feel comfortable in social situations without heavy makeup.

Month 9–12

Final results visible. Bony structures fully healed. Rhinoplasty tip refinement continues through month 12. This is when before/after photos best capture your outcome.

Does Insurance Cover FFS in Washington State?

Insurance coverage for facial feminization surgery has expanded significantly in recent years — and Washington State is among the most favorable in the country for FFS patients.

Washington Apple Health (Medicaid)

Washington Apple Health (Medicaid) covers facial feminization surgery as a medically necessary gender-affirming procedure. This includes procedures such as forehead contouring, rhinoplasty, jaw and chin reshaping, and tracheal shave when documented as medically necessary for the treatment of gender dysphoria. Our team has experience navigating Apple Health pre-authorization and can guide you through the process.

Private Insurance

Many private insurance plans in Washington now cover some or all FFS procedures when properly documented as medically necessary. Coverage varies significantly by carrier and plan. Procedures more commonly covered include:
  • Forehead contouring and brow bone reduction
  • Rhinoplasty (when documented as medically necessary)
  • Jaw and chin contouring
  • Tracheal shave

Soft tissue procedures and hairline lowering are more likely to be classified as cosmetic and may require out-of-pocket payment. Dr. Day’s team will review your specific plan and provide documentation to maximize your coverage.

Our Insurance Navigation Support

The pre-authorization process for FFS can feel overwhelming. We assist patients with:

  • Reviewing your specific insurance plan's trans health coverage
  • Preparing and submitting the surgical necessity documentation
  • Coordinating with your mental health provider for required letters
  • Following up with your insurer on the status of your pre-authorization
  • Providing detailed itemized quotes for coverage appeals if needed

Call (425) 818-8991 to speak with our team about your insurance situation before your consultation. We will let you know what to expect.

What FFS Results Look Like

When You'll See Results

The most important thing to understand about FFS results: the goal is that you look authentically like yourself — feminine, natural, and undeniably you. Not ‘surgical.’ Not a different person. A more complete version of who you already are.

Bony procedures (forehead contouring, jaw contouring, genioplasty) produce permanent structural changes. Soft tissue results remain highly stable when weight is maintained. Final results for rhinoplasty are typically visible by 12 months as swelling fully resolves.

Dr. Day’s approach to FFS emphasizes facial harmony above all. No single procedure exists in isolation — each decision accounts for how the final face will look as a complete whole.

FFS Cost in Bellevue & Seattle

The cost of facial feminization surgery varies widely depending on which procedures are included, the complexity of your anatomy, whether surgery is staged across multiple sessions, and what your insurance plan covers. Rather than listing a starting price that may not reflect your plan, we discuss cost in full detail during your consultation — at which point Dr. Day can provide an itemized estimate based on your specific goals.

💰What Affects Your FFS Investment

  • Number and type of procedures selected
  • Single-session vs. staged approach
  • Anesthesia fees and surgical facility fees
  • Post-operative care requirements
  • Insurance coverage (which can significantly reduce out-of-pocket cost)

✨What's Included in Your Investment

  • Surgeon’s fee
  • Facility / operating room fee
  • Anesthesia (administered by a board-certified anesthesiologist or certified registered nurse anesthetist)
  • Enhanced Recovery After Surgery medication (Exparel)
  • High-end compression garment (Isavella) — ⚠️ Dr. Day: please confirm applicability for FFS (chin strap / head wrap may apply)
  • High-end scar ointment (Biocorneum)
  • Swelling and bruising ointment (Arnica)
  • All scheduled post-operative follow-up visits
  • Insurance pre-authorization documentation and support

Flexible Financing Options

For procedures or portions not covered by insurance, Pacific Sound Plastic Surgery offers financing through:

  • CareCredit — 6-month financing available
  • Alphaeon Credit — flexible credit lines designed for healthcare

The Craniofacial Fellowship Difference

Choosing the right surgeon for FFS is one of the most important decisions of your transition journey. Facial feminization involves reshaping bone — and not all plastic surgeons have the same level of training in craniofacial bone surgery.

Why Craniofacial Training Matters for FFS

Craniofacial surgery is a subspecialty that focuses specifically on the bone and soft tissue structures of the skull and face. Dr. Day’s craniofacial fellowship gave him advanced training in:
  • Frontal cranioplasty — the forehead procedure that often defines FFS outcomes
  • Orbital rim contouring — affecting the eye socket appearance
  • Maxillary and mandibular bone work — jaw and mid-face reshaping
  • Rhinoplasty — from a craniofacial perspective, not just soft tissue
  • Virtual surgical planning for complex bone repositioning

The Only Craniofacial-Fellowship-Trained FFS Surgeon in the Bellevue Market

Dr. Day holds craniofacial fellowship training from one of the most selective programs in the country — and he is the only surgeon in the Bellevue market with this specific credential. For FFS patients, this means your surgeon understands the anatomy at the bone level that defines gender-distinguishing facial features.

Trans-Affirming Care at Pacific Sound

Pacific Sound Plastic Surgery is a welcoming practice for all patients. Our team uses preferred names and pronouns, handles all documentation with discretion, and understands the unique medical and emotional journey that FFS represents. Dr. Day is a WPATH-compliant provider and works collaboratively with your mental health team throughout the process.

Additional Credentials Relevant to FFS

  • Double Board-Certified: American Board of Plastic Surgery + American Board of Surgery
  • Ivy League Trained
  • 30+ peer-reviewed publications in craniofacial and plastic surgery
  • Active member of national professional societies including leadership roles
  • Surgical Facilities: Accredited surgical facilities in the Bellevue area

Conveniently Located in Bellevue

Pacific Sound Plastic Surgery is centrally located in downtown Bellevue, making Dr. Day’s fellowship-trained expertise accessible to families throughout the Eastside — without the stress of navigating Seattle traffic.Our patients enjoy a private, boutique surgical experience with on-site parking, just minutes from the communities they call home.

Seattle

~15 minutes

World-class plastic surgery results without the downtown Seattle parking hassle. A quick drive across SR-520 or I-90 to our private Bellevue office.

Serving Seattle residents

Kirkland

~10 minutes

Just minutes from downtown Kirkland and the Juanita waterfront via I-405 or surface streets.

Serving Kirkland residents

Redmond

~10 minutes

Convenient for the Redmond tech community via SR-520 or surface streets.

Serving Redmond residents

Mercer Island

~10 minutes

A quick drive across I-90. Our discreet, private environment is ideal for discerning Mercer Island residents.

Serving Mercer Island residents

Issaquah

~10 minutes

Convenient for Issaquah Highlands and Gilman Village area families via I-90.

Serving Issaquah residents

Renton

~5 minutes

Easy access from Renton and the Landing via I-405 North. Boutique care and personalized attention just minutes away.

Serving Renton residents
Get Directions to Our Bellevue Office

Frequently Asked Questions

What is facial feminization surgery and is it right for me?
Facial feminization surgery (FFS) is a collection of surgical procedures that reshape the bone and soft tissue structures of the face to create a more feminine appearance. It is most commonly sought by transgender women and non-binary individuals as part of their gender transition. Whether FFS is right for you depends on your specific anatomy, goals, and overall health. A consultation with Dr. Day will give you a personalized assessment.
Yes — Washington State is one of the most favorable states for FFS insurance coverage. Washington Apple Health (Medicaid) covers FFS procedures when documented as medically necessary for the treatment of gender dysphoria. Many private insurers also cover some or all procedures. Our team assists with pre-authorization and documentation. Call (425) 818-8991 to discuss your specific plan before your consultation.
HRT is not a strict medical requirement for most FFS procedures from a surgical safety standpoint. However, many insurance plans and the WPATH Standards of Care recommend documented HRT history as part of the pre-authorization process. Dr. Day will review your individual situation during consultation — some patients pursue surgery on their own timeline for personal or medical reasons.
Most insurance plans and WPATH guidelines require one or two letters from a licensed mental health professional confirming a gender dysphoria diagnosis and recommending surgical intervention. Some carriers require one letter; others require two from different providers. Our team will guide you on exactly what documentation your specific plan requires.
FFS often involves reshaping bone — particularly in the forehead, jaw, and chin. Craniofacial surgeons receive fellowship training specifically focused on the bone and soft tissue structures of the skull and face. Dr. Day’s craniofacial fellowship gave him advanced expertise in the exact procedures that define FFS outcomes. He is the only craniofacial-fellowship-trained surgeon offering FFS in the Bellevue market.
Recovery varies by the number and type of procedures performed. Most patients with sedentary work can return within the first week. Visible bruising and swelling typically resolve by weeks 4–6. Bone-level healing continues for several months, and rhinoplasty results continue to refine through month 12. Dr. Day provides a detailed, personalized recovery timeline at your consultation.
Yes — the goal of FFS is not to change who you are, but to let the face you see in the mirror better reflect who you have always been. Dr. Day approaches FFS with a philosophy of facial harmony: each procedure is evaluated in the context of your complete face, your individual anatomy, and your specific goals. The result should feel authentic and natural, not overdone.
Both approaches are possible and common. Many patients choose a staged approach for safety (limiting anesthesia time) or to prioritize procedures with insurance coverage in one session while self-paying for others in a subsequent session. Dr. Day will recommend a staging plan based on the procedures you need, your health, and your goals. He will always prioritize your safety over convenience.
Incision placement in FFS is carefully planned to minimize visible scarring. Hairline incisions are positioned within the hair, or at the natural hairline. Jaw and chin incisions are placed inside the mouth or under the chin where they heal discreetly. Tracheal shave incisions are small and hidden in a natural skin crease. Many patients report that scarring becomes virtually undetectable within 6–12 months.
Call (425) 818-8991 or use our online consultation request form to schedule your in-person consultation with Dr. Day. Bring any insurance documentation, a list of your goals and questions, and any photos you’ve saved as reference. Dr. Day does not conduct virtual consultations for FFS — an in-person exam is required to properly assess bone structure and tissue. We look forward to meeting you.

Schedule Your Consultation Now

You deserve to feel confident in your body again. Dr. Day and the Pacific Sound team create personalized transformation plans tailored to your unique goals.
Schedule Your Consultation
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(425) 818-8991

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