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
What Is Facial Feminization Surgery?
Facial Feminization Surgery 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.
- Hairline Lowering (Scalp Advancement) — Reduces the height of the forehead and creates a hairline that better reflects feminine proportions.
- Tracheal Shave (Chondrolaryngoplasty) — Reduces the prominence of the Adam’s apple by carefully shaving down the thyroid cartilage through a small, well-concealed incision.
- 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
- 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
- Under 19 years of age (Pacific Sound Plastic Surgery follows the ASPS position that gender-affirming facial surgery is appropriate at age 19 or older)
- 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 letter from a licensed mental health provider or primary care doctor confirming gender dysphoria diagnosis
- Hormone therapy is not required to undergo FFS. Some insurers may request documented HRT history as part of pre-authorization — our team will let you know if this applies to your specific plan.
- 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?
Schedule a consultation with Dr. Day to discuss your goals and options.
Your Facial feminization surgery Journey
Your FFS Journey at Pacific Sound
Facial feminization surgery is a process — not a single event. For patients pursuing a comprehensive facial transformation, multiple procedures are often staged across two or more surgical sessions to prioritize safety, manage anesthesia time, and align with insurance coverage timing. Dr. Day’s approach begins well before surgery and extends through your full recovery. Here’s what you can expect:
Step 1: Consultation
We offer both virtual and in-person consultations. A virtual consultation can be a convenient first step to discuss your goals, review your health history, and develop a preliminary surgical plan. An in-person examination is required prior to surgery, however, because evaluating bone structure and facial tissue accurately depends on a hands-on assessment. During your consultation, Dr. Day will explain each recommended procedure, the rationale behind any staging approach, 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.
Recovery Timeline
Days 1-3
What to Expect
Rest at home. Swelling and bruising at their peak. Head elevation and cold compresses help manage discomfort.
Week 1
What to Expect
Gentle walking the day after surgery. Sutures in place. Sedentary work return often possible by days 5–7. Liquid/soft diet if jaw work was performed.
Weeks 2-3
What to Expect
Sutures removed. Bruising begins to fade. Gradual return to light exercise.
Weeks 4-6
What to Expect
Significant improvement in visible swelling. Full return to pre-op activity by Weeks 4–6.
Month 3+
What to Expect
Soft tissue swelling largely resolved.
Month 9–12
What to Expect
Final results visible. Bony structures fully healed. Rhinoplasty refinement continues through Month 12.
Step 5 — Follow-Up Care
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.
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.
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, by plan, and by procedure — and the decision ultimately rests with the insurance company, not the practice. Any out-of-pocket figures discussed during your consultation are approximate and can vary substantially based on whether in-network or out-of-network approvals are obtained. Dr. Day’s team will review your specific plan, identify which procedures may be eligible for coverage, and provide the documentation needed to support your pre-authorization.
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.
"I went to Dr. Day's office for facial feminization surgery, and I don't think I could be happier with the results! During our initial consult, he took the time to understand my wants, but also helped me understand some of the anatomical differences between 'male' and 'female' faces and some of the surgical options we had for addressing my face. I would highly recommend Dr. Day, especially to any of my trans sisters who may be having a hard time finding someone covered by insurance in a reasonable timeframe."
— Michelle Douglas, FFS Patient • Google Review
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 FFS Investment
Your surgical fee covers all of the following at Pacific Sound Plastic Surgery:
- 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)
- Cosmetic surgery insurance coverage (Cosmetasure)
- High-end compression garment (Isavella)
- High-end scar ointment (Biocorneum)
- Swelling and bruising ointment (Arnica)
- Clara Recovery Supplements
- Chlorhexidine Anti-Septic Scrub Cloths
- Post-operative recovery and follow-up care
Financing Options
Pacific Sound Plastic Surgery accepts CareCredit (6-month financing) and Alphaeon Credit, two of the most widely used healthcare financing programs. Both allow patients to begin their journey without paying the full cost upfront.
Pricing is discussed in full detail during your consultation so there are no surprises. Call (425) 818-8991 to get started.
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 Bellevue
Dr. Day holds craniofacial fellowship training from one of the most selective programs in the country — and he is the only surgeon in Bellevue 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: Swedish Medical Center, Virginia Mason Franciscan Health, Carillon Point Surgery Center, Sound Plastic Surgery Center
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 Bellevue and the greater 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.
Kirkland
~10 minutes
Just minutes from downtown Kirkland and the Juanita waterfront via I-405 or surface streets.
Redmond
~10 minutes
Convenient for the Redmond tech community via SR-520 or surface streets.
Mercer Island
~10 minutes
A quick drive across I-90. Our discreet, private environment is ideal for discerning Mercer Island residents.
Issaquah
~10 minutes
Convenient for Issaquah Highlands and Gilman Village area families via I-90.
Renton
~5 minutes
Easy access from Renton and the Landing via I-405 North. Boutique care and personalized attention just minutes away.
Frequently Asked Questions
What is facial feminization surgery and is it right for me?
Do I need to be on hormone therapy (HRT) before FFS?
No — hormone therapy is not required to have FFS. Some insurance plans may request documented HRT history as part of pre-authorization, but it is not a surgical requirement. Dr. Day will review your individual situation during consultation, and patients are welcome to pursue surgery on their own timeline for personal or medical reasons.
What letters do I need for FFS surgery?
WPATH guidelines require one letter confirming a gender dysphoria diagnosis and recommending surgical intervention. The letter can be provided by a licensed mental health provider or your primary care doctor. Insurance carrier requirements may vary — our team will guide you on exactly what documentation your specific plan requires.
Why does craniofacial training matter for FFS surgery?
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 Bellevue.
How long is the recovery after FFS?
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 within 1–2 weeks. 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.
Will I still look like myself after FFS?
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. Incisions are placed and closed with techniques that optimize and conceal the appearance of scars as they mature over 6–12 months.
Can FFS procedures be done in a single surgery, or does it need to be staged?
Will FFS leave visible scars?
How do I get started with FFS at Pacific Sound Plastic Surgery?
Call (425) 818-8991 or use our online consultation request form to schedule a consultation with Dr. Day. We offer both virtual and in-person consultations. Bring any insurance documentation, a list of your goals and questions, and any photos you’ve saved as reference. An in-person exam is required prior to surgery to properly assess bone structure and tissue, but a virtual consultation is a great way to start the conversation. We look forward to meeting you.
Schedule Your Consultation Now
You deserve a face that reflects who you are. Dr. Day and the Pacific Sound team create personalized FFS plans tailored to your unique anatomy and goals — with compassionate, affirming care every step of the way.