Skin Tightening (Face or Neck Lift)

A face and neck lift, also called a rhytidectomy, is a procedure that lifts and repositions the skin and deeper soft tissues of the lower face and neck. The goal is to reduce sagging along the jawline, soften deep creases, and redefine the neck and chin profile. For transgender women and nonbinary individuals undergoing FFS, this helps accentuate the jaw contour, lift jowling, and expose the full impact of the skeletal changes beneath.

This surgery does not feminize the face through bone modification—it enhances and reveals what has already been accomplished through procedures like jaw contouring, chin reduction, and tracheal shave.

The surgery is tailored to each patient’s anatomy and goals, but generally includes the following steps:
Incisions are made in natural creases around the ears, extending into the hairline behind the ears. A small incision under the chin may also be made if significant neck tightening is needed.

• The skin is gently lifted and separated from the underlying SMAS (superficial musculoaponeurotic system).
• The SMAS layer is tightened and repositioned, allowing for long-lasting structural improvement rather than just surface skin tightening.
• If necessary, fat deposits under the chin or along the jawline may be removed or repositioned for contour.
• Excess skin is trimmed, and the remaining skin is redraped in a natural, tension-free manner.
• A drain is typically placed, especially for combined face and neck lifts, and is usually removed the following day.

Face and neck lifts are ideal for transfeminine and nonbinary individuals who:

• Are undergoing facial bone contouring procedures and have sagging, heavy, or loose soft tissue that will obscure the results
• Experience jowling, lower face drooping, or a poorly defined neck contour
• Are noticing age-related skin laxity or have had significant weight fluctuations
• Are seeking refinement and final harmonization of their feminized features
• Are in good overall health, nonsmokers, and have realistic expectations

This procedure is particularly valuable for patients in their 30s or older, when skin elasticity begins to decline and can mask the changes made during bone-focused FFS procedures.

The first step in facial feminization (FFS) is to meet with Dr. Marano or Dr. Keith for a private consultation at GAMMA in New York City or New Jersey. During this time, you will discuss your goals and medical history with our team, who will then create a customized treatment plan according to your unique anatomy, comfort levels, and goals. Prior to consultation, you should ensure the following:

• Provide Mental Health Letter – Many insurance providers and surgical guidelines require a letter from a qualified mental health professional confirming a diagnosis of gender dysphoria and the patient’s readiness for surgery. This letter should follow WPATH (World Professional Association for Transgender Health) standards and address the patient’s understanding of the procedure and its implications. Our team will assist in ensuring the proper language is used and the provider is appropriately credentialed
• Quit Smoking – Nicotine constricts blood vessels and significantly increases the risk of complications, including poor wound healing and tissue loss. Patients must stop using all nicotine products—including cigarettes, vapes, nicotine patches, and gum—at least 4-6 weeks before and after surgery.
• Manage Medications – You may be asked to discontinue certain medications that increase surgical risks.
• Well-Controlled Medical or Mental Health Issues / Medical Clearance – To ensure safe surgery and recovery, patients with underlying medical conditions such as diabetes, high blood pressure, or psychiatric conditions should have them well-managed. Medical clearance from a primary care provider or specialist is required.
• BMI Cutoff – There is no strict BMI cutoff for FFS at GAMMA. Every patient is evaluated individually, considering overall health and surgical goals rather than BMI alone.
• Insurance Coverage – GAMMA works with various insurance providers to help patients access gender-affirming surgery. Our team assists with insurance verification, prior authorization, and necessary documentation. Patients should check with their insurance carrier regarding coverage criteria, including mental health letters and medical clearance requirements.
• Complete Your Consultation – You will undergo a detailed consultation with Dr. Marano or Dr. Keith to ensure your expectations are realistic and your health supports the treatment process. Our team will discuss the risks and benefits, recovery and results, of FFS.

On surgery day, you will arrive at the surgical center, meet your care team, and review the surgical plan. General anesthesia is typically used. The face and neck lift procedure usually takes 3–4 hours, depending on complexity and whether it’s being done in combination with other surgeries.

After surgery, you’ll wake up in a recovery suite with a soft compression dressing and one or more small drains to help prevent fluid accumulation. Most patients stay overnight in the hospital, particularly if additional procedures are performed.

Drains are typically removed the day following surgery. Before discharge, you will receive detailed instructions for incision cleaning, post-operative restrictions, and medication management.

Recovery from face and neck lift is manageable but requires dedicated downtime:

• Swelling and bruising are expected and most noticeable in the first 7–10 days
• Drains are usually removed the day following surgery
• Sutures and staples (if used) are removed at the 1-week follow-up
• You should sleep with your head elevated for the first two weeks to help with swelling
• Strenuous activity, heavy lifting, and bending should be avoided for 3–4 weeks
• Most patients feel comfortable returning to work or social activities in 2–3 weeks
• Numbness, tightness, and mild asymmetry are common during the healing phase and gradually resolve
• Final results may take several months as swelling subsides and the skin fully settles

Insurance carriers will typically cover gender affirmation surgery, including facial feminization surgery, when it is performed to treat gender dysphoria, a condition in which the patient’s outer traits do not reflect their authentic gender identity. You’ll need a letter from a mental health provider detailing your decision to undergo FFS. Our team can go over the insurance requirements in greater detail during your consultation.

• Resources – For patients traveling to NYC for surgery, GAMMA provides recommendations for LGBTQ+ friendly accommodations, post-op caregivers, and recovery services. Our team can also assist with logistics such as medical transport and aftercare arrangements.
• Requirements – Out-of-town patients must plan to stay in NYC for at least two weeks after surgery to ensure proper healing and attend necessary post-operative appointments. We encourage having a trusted friend, family member, or professional caregiver for the first few days post-surgery.

Our team at Gender Affirming Medical and Microsurgical Associates (GAMMA) in New York City and New Jersey is known for providing the highest-level care in an affirming environment. We utilize today’s most progressive and cutting-edge techniques to provide the highest level of service possible. Our goal is to help transgender, nonbinary, and gender nonconforming individuals achieve their unique appearance goals and thrive with confidence, security, and peace of mind.

Dr. Drew Marano

Dr. Drew Marano is an accomplished, board- certified, and fellowship-trained plastic and reconstructive surgeon who has devoted his career to the art of gender affirmation surgery. He graduated from Rutgers New Jersey Medical School at the top of his class, receiving AOA honors before embarking on a competitive six-year Integrated Plastic and Reconstructive Surgery Residency at Columbia University/Cornell University in New York City. Following his residency, Dr. Marano was selected as the first-ever Harvard University Complex Gender and Microsurgery Fellow, during which time he underwent advanced training in groundbreaking and innovative surgical techniques. He is a prolific author, researcher, and lecturer who has contributed to over 40 publications and presentations at regional and national meetings. Dr. Marano offers ongoing support for transgender patients as they navigate their unique and rewarding journey of transitioning.

Dr. Jonathan Keith

Dr. Jonathan Keith is a renowned, fellowship-trained, board-certified plastic surgeon known for his progressive approach to microvascular surgery. He is an active member of the World Professional Association for Transgender Health and the founder of the Rutgers Center for Transgender Health. In 2018, Dr. Keith created the first multidisciplinary clinical program for transgender patients in New Jersey and was the first surgeon in the state to perform a female-to-male phalloplasty for gender affirmation. Regarding his extensive educational background, Dr. Keith completed a demanding seven-year residency at the University of Pittsburgh, one of the nation’s most elite and well-regarded plastic surgery training programs. As a testament to his skill and artistry, in 2012, he received the Stephen S. Kroll Fellowship in microsurgery at the University Hospital of Gent, Belgium. Today, Dr. Ketih performs a range of complex and delicate procedures to assist transgender and nonbinary individuals in achieving their ideal appearance, including DIEP flaps for breast reconstruction, vaginoplasty, and phalloplasty.

While complications are uncommon, especially with experienced surgeons, all surgery carries some risk. These may include:

• Bleeding or hematoma
• Infection
• Nerve injury (temporary or, rarely, permanent)
• Asymmetry
• Poor wound healing or unfavorable scars
• Skin irregularities or dimpling
• Hair loss along incision lines

Your surgical team will provide thorough guidance on how to minimize these risks and support your healing every step of the way.