Dr. Keojampa is one of the few surgeons in the world with extensive experience in facial feminization surgery with forehead reduction cranioplasty Type 3, hairline lowering, jaw and chin contouring, facial implants, fat grafting, eyelid surgery, rhinoplasty. and tracheal shave. He was trained by Dr. Jeffrey Spiegel (www.drspiegel.com), an internationally renowned facial plastic surgeon and the foremost expert in facial feminization surgery in the world. This experience translates to intricate knowledge in some of the most advanced surgeries performed anywhere in the world. As one of the few experts in Facial Feminization Surgery, Dr. Keojampa is able to provide a unique perspective in understanding feminine and masculine characteristics. This unique skill set allows him to create dramatic but natural appearing results. His extensive training and experience ensure the safest surgery even with the most complex craniomaxillofacial, plastic, and cosmetic procedures with superior results.
Dr. Keojampa is one of the busiest facial feminization and craniomaxillofacial surgeons in the world, performing on average three full feminization surgeries weekly. Facial feminization surgery is a collection of procedures for both cisgender women and transgender women looking to soften and remove masculine features.
In 2020, Dr. Keojampa was named as Outstanding Alumni in Healthcare by Pepperdine University for his international medical work and world-renowned aesthetic craniofacial surgery practice along with Top Doctors by Los Angeles Magazine.
We provide Skype consultations for patients who are not local to our office for the initial consultation. We routinely have patients throughout the United States and Internationally travel to our center for Facial Feminization Surgery (FFS).
We have had success obtaining insurance coverage for FFS for the treatment of gender dysphoria from health plans of large technology companies such as Apple, AT&T, Amazon, T-mobile, Dell, Boeing, Oracle, Google, along with select health insurance plans from Massachusetts. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. Insurance coverage for FFS is NOT common outside the above-mentioned companies. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval. Your insurer must sign a letter of agreement to guarantee payment for services.
We believe in the utmost privacy for our transgender patients and do NOT publish identifying patient pictures online. Before and after photos can be viewed during the in-office consultation only. Consults can be requested using the online forms below. Appointments are offered both in the San Francisco Bay Area and Los Angeles
Consult Request Form – In-Office and Videoconference
FFS Frequently Asked Questions
What to expect during your FFS Consultation
FFS Insurance Coverage
Facial Feminization Surgery Videos
Dr. Keojampa explains Facial Feminizing Forehead Reduction Cranioplasty Type 3 and Hairline Feminization
Dr. Keojampa discusses feminizing mandible contouring and V-line Jaw Surgery
Dr. Keojampa is certified to perform plastic and reconstructive surgery of the face, eyelids, nose, head, and neck by the American Board of Otolaryngology -Head and Neck Surgery, one of the two boards of the American Board of Medical Specialties (ABMS) to certify physicians in plastic surgery within the head and neck. Additionally, Dr. Keojampa is a Fellow of the prestigious American College of Surgeons (FACS) and previously served on the clinical teaching surgical faculty at both Boston University and Harvard Medical School for 5 years as a Clinical Assistant Professor and a Clinical Instructor. He was an attending surgeon at the Massachusetts Eye & Ear Infirmary and Boston Medical Center.
Dr. Keojampa has surgery privileges and performs facial plastic surgery & facial feminization surgery in Los Angeles and the San Francisco Bay area.
Comprehensive Guide for Facial Feminization Surgery
The goals of facial feminization surgery are to uncover feminine and remove masculine features. Many procedures are performed such as reducing the forehead prominence, contouring the hairline, repositioning the eyebrows and shape, enlarging the appearance of eyes with orbital bone reduction, cheek augmentation, lip lift, reducing the size of the nose and chin, and removing the prominence of the Adam’s apple (Tracheal shave). These procedures when combined can transform a face which was distinctly masculine to one that is unambiguously feminine. Our patients report the dramatic change of being correctly gendered after surgery which is life-changing. Learn more about facial feminization surgery by reviewing more detailed descriptions of procedures below:
Forehead Feminization (Type 3 Cranioplasty) and Contouring
The forehead is the facial region most important for gender identification. Males tend to have a horizontal ridge of bone running across the forehead just above eyebrow level called the brow ridge or “brow bossing” while female foreheads tend to be smoother, flatter and have less bossing. The outer segments of the bossing that the eyebrows sit on are called the “supraorbital rims”. The supraorbital rims are usually solid bone and can simply be shaved down. The section of bossing between the eyebrows (the glabella) sits over a hollow area called the frontal sinus. Because the frontal sinus is hollow it can be more difficult to remove bossing there. The vast majority of patients, about 95% require a Type 3 forehead cranioplasty to completely feminize and setback the forehead bone. The best way to determine the optimal approach is with 3D CT imaging which is performed during your in-office consultation with Dr. Keojampa.
Dr. Keojampa has been trained in and routinely performs Type 3 Forehead Feminization Reduction Cranioplasty which involves a craniotomy and creating an osteoplastic flap to maximally set back the forehead without compromising the integrity of the frontal sinus bone. Many surgeons may simply shave down the forehead bone and are unable to provide the maximal reduction and setback. However, if the wall of bone is too thin it may not be possible to shave the bossing away completely without breaking through the wall into the frontal sinus.
Hairline Feminization Surgery and Hair Transplants
In males, the hairline is often higher than in females and usually has receded corners above the temples that give it an “M” shape. The hairline can be moved forward and given a more rounded shape either with a procedure called a “scalp advancement.” The scalp is repositioned to the ideal feminine hairline. Incisions can be made either behind the hairline to be completely invisible or at the hairline. Some patients elect to have hair transplants placed to lower and feminize the hairline. For this technique, a strip of hair is removed from the coronal incision and then transplanted to cover any areas of temporal balding and excess forehead. 2000 to 3000 hair grafts can be placed in one session. Hair transplants can be performed during your full facial feminization surgery simultaneously. The new grafts take about 6 months to populate the new hairline. For the scalp advancement technique, the incision is placed at the hairline and advance to lower and remove any excess forehead skin. The scalp advancement technique does offer immediate hairline feminization.
Simultaneous hair transplants
Brow Lift
Men tend to have lower eyebrows relative to the position of their brow ridges when compared to women. Men’s eyebrows tend to be below their brow ridges while women’s eyebrows tend to be above their brow ridges. During Forehead Facial Feminization Surgery, we raise the eyebrows to a more feminine appearance.
Rhinoplasty
Males tend to have larger and wider noses than females, and the nasal tip is prominent and straight. The female nose is smaller, refined, and delicate compared to male noses. Many women prefer a slightly up rotated tip and less prominent nasal bridge than a man’s.
Cheek implants and Facial Fat Grafting
Females often have a more forward projection in their cheekbones as well as fuller cheeks overall. Sometimes cheek implants are used to feminize cheeks. They come in different sizes and can be placed in different positions depending on the needs of the patient. Sometimes a fat transfer is performed where fat is removed from another part of the body and injected into the cheeks to make them fuller.
V-Line Jaw Reduction and Feminization
Males tend to have taller chins than females and while female chins tend to be rounded, male chins tend to be square with a flat base and two corners. The chin can be reduced in height either by bone shaving or with a procedure called a “sliding genioplasty” where a section of bone is removed. The square corners can usually be shaved down. Liposuction is also used to remove some fat underneath the chin. Males’ jaws tend to be wider and taller than female jaws and often have a sharp corner at the back. The back corner can be rounded off in a procedure called “mandibular angle reduction”; bone can also be shaved off along the lower edge of the jaw to reduce width and height and the chewing muscles (masseter muscles) can also be reduced to make the jaw appear narrower. A sliding genioplasty can be performed to narrow, project, or change the vertical height of the chin to feminize the lower third of the face.
Zygoma Reduction
Overly wide faces can be slimmed and narrowed with reduction of the Zygoma bone which provides the lateral prominence to the face. This area can be reduced with osteotomies of the Zygomatic body and arch to slim the midface. Titanium plates are used to stabilize the cheekbone in the new medialized position. This can be performed through either a hairline incision or a hidden internal upper lip incision
Lefort 1 Osteotomy for treatment of “Long Face Syndrome”
Lefort 1 osteotomy can be used to shorten the midface due to vertical maxillary excess (VME) by removing intervening bone. Correction decreases the vertical position of the maxilla and the amount of gingival show along with shortening the mid-face
Lip Lift
The distance between the opening of the mouth and the base of the nose tends to be longer in males than in females. When a female mouth is open and relaxed the upper incisors are often exposed by a few millimeters. To feminize a mouth an incision is usually made just under the base of the nose and a section of skin is removed. When the gap is closed it has the effect of lifting the top lip, placing it in a more feminine position and often exposing a little of the upper incisors. The incision is hidden underneath the nose and becomes near invisible in the vast majority of patients.
Lip Augmentation
Females often have fuller lips than males so lip augmentation is often used in facial feminization surgery. There are many methods of lip augmentation from injecting fillers and dermal fat grafts. We often will use subcutaneous tissue from the scalp to provide long-lasting lip augmentation if performed the same time at forehead facial feminization surgery.
Adam’s apple or Thyroid Cartilage reduction
Males tend to have a much more prominent Adam’s apple than females. The Adam’s apple can be reduced with a procedure called a “Tracheal shave” or “Chondrolaryngoplasty”. It is very important that your surgeon visualizes the attachment of the vocal cords to the thyroid cartilage endoscopically during tracheal shaving. This safety measure ensures the vocals are not injured. Injury to the vocal cords during thyroid cartilage shaving can cause permanent hoarseness. The incision also should be hidden under the chin and not directly over the thyroid or tracheal cartilage. Typically, a small 1cm incision is made. For extremely motivated patients who want to avoid any visible incision, we offer scarless tracheal shave or Adam’s apple reduction with Jaw reduction surgery. Incision is hidden inside the mouth and performed with transoral endoscopic surgery.
When is endoscopic scarless Tracheal shave recommended?
If you have a history of keloids or hypertrophic scarring, this guarantees that you will not have a visible scar from a Tracheal shave. African Americans, Asians, and Middle Eastern patients have the highest incidence of keloids. This is also indicated for any patient who is concerned about having a visible incision or scar after surgery. We can also perform platysmal corset sutures to tighten the neck line during the procedure and perform submental lipectomy to remove stubborn neck fat. Incisions are hidden inside the mouth.
Our practice has been performing scarless Tracheal Shave since 2019 and one of the first to describe our scarless endoscopic technique.
Key questions to ask your surgeon are:
How will you confirm the location of the attachment of the vocal cords?
We confirm the location using a fiberoptic laryngoscope and marking the location with a needle. The needle is pierced into the tracheal cartilage and airway. Real-time visualization is performed with the fiberoptic scope to determine the exact location of vocal cord attachment.
Where will the incision be made and how long? The incision does not need to be any longer than 1cm and should be above the tracheal cartilage, hidden underneath the chin. Making an incision directly on top of the cartilage is easier but will always leave signs that surgery was performed there. For extremely motivated patients who want to avoid any visible incision, we were one of the first in the world to offer scarless tracheal shave or Adam’s apple reduction with Jaw reduction surgery. Incision is hidden inside the mouth and performed with transoral endoscopic surgery.
Voice Feminization Surgery
This incision less technique is the safest way to raise the fundamental vocal pitch. The vocal folds are shortened by retrodisplacement of Anterior Commissure using permanent microsutures. Suspension microlaryngoscopy is used to perform voice feminization surgery.
This technique changes the features of male vocal cords to those of females by removing 1/3 of the anterior portion of vocal fold outer lining and then suturing them together with permanent sutures using microlaryngeal instruments.
We have also partnered with Pryde Transgender Voice & Speech Therapy in Los Angeles. Eryn Gitelis, MS-CCC, specializes in Transgender/Gender Spectrum Voice Modification without surgery. Patients can additionally receive pre and post voice surgery therapy to optimize voice results.
Custom Facial Implants
Custom facial implants can offer superior results to generic alternatives as they are designed to intimately fit the contours of your unique anatomy and facial structures. We use state-of-the-art 3D Imaging systems to plan and digitally design custom jaw, forehead, mid-face, and facial implants. With unlimited sizes and shapes, we can customize your treatment to achieve the best results.
Revision or Redo Facial Feminization Surgery
We commonly perform and revise another surgeon’s work. Facial Feminization Surgery has become very popular recently with many plastic surgeons with minimal experience in facial feminization surgery offering and performing FFS. The most commonly revised surgery we perform is forehead reduction cranioplasty. Many novice surgeons may offer or attempt to only burr or shave the forehead and unable to completely setback the forehead using the Type 3 Cranioplasty technique.
Many patients are unaware of the level of complexity involved in facial feminization surgery and the specific training required to perform at an expert level. We offer cutting-edge technology to precisely diagnose why a previous surgery did not achieve the desired result. We offer specifically:
3D Facial CT scans to diagnose issues with your prior surgery and to develop a plan to correct them.
Real-time Stereotactic CT Imaging Guidance: We are one of the few practices in the world that offer this advanced technology to pinpoint within less than a millimeter of precision critical areas of the skull and brain to perform the most accurate osteotomies and bone contouring. This gives us immediate feedback during surgery to ensure desired results are achieved.
3D Virtual Surgical Planning. We are one of the few practices in the world to use extensive 3D virtual surgery planning along with mapping of critical nerves and important structures. Shown below is the path and location of the inferior alveolar nerve and mental nerve. This advanced technology allows us to be maximally aggressive but also maximally safe when performing osteotomies and bone contouring.
Ultrasonic Scalpel for Bone Contouring. We use the Sonopet Ultrasonic Bone Scalpel to perform osteotomies and bone contouring with the highest precision and safety. The Sonopet is the most advanced Ultrasonic scalpel used by craniofacial and neurosurgeons as it selectively targets bone without injuring the surrounding nerves and soft tissue.
Using a high-speed rotary drill must be done with care as it is very easy to have a high-speed spinning burr inadvertently grab onto adjacent soft tissues like nerves and create injury. The Sonopet Ultrasonic system allows for fine bone dissection and contouring with prevention of damage to adjacent soft tissues. Sonopet burrs will only engage the hard bone but not the soft tissues since it has no spinning or rotary movement. The ultrasonic energy allows for better control and eliminates the concern about collateral damage to soft tissue from the bone work.
3D Printed exact anatomical models. Our practice employs extensive use of 3d medical printing to plan Craniofacial, Orthognathic, and Facial feminization surgery cases. We have an in house 3d medical printing lab that can generate exact anatomical models the same day. The future of healthcare is now. We can practice and plan surgery before to ensure the actual surgery goes smoothly and accurately. You would expect nothing less from a world-leading Surgical practice.
We use the highest quality materials and instruments during our surgeries and can offer custom treatment along with custom planned facial implants to fit your exact facial anatomy.
Where our patients come from
What are the differences between the male and female craniofacial anatomy?
Female Skulls
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Male Skulls
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Facial Feminization Surgery FFS Patient Testimonial
Ashley C.
I started reviewing all photos from every Dr that does FFS. After reviewing many reviews, photos , and videos.I decided my main concern is forehead. I want that ideal female forehead. I wanted to make sure I choose a surgeon that does Type III forehead reconstruction I wont go in to details about the types and why, there is enough on here about that topic. So I contacted the facial surgeons that preform Type III or work on foreheads alot.
I had a scheduled consultation with five different surgeons.
My first visit with Dr Keojampa was 1-24-17. The staff( Alyssa and Jessica) was great and helpful from the very beginning, first consultation until my last follow up. The first time meeting we just talked, then went over what I didnt like and what he thought was best procedures to make my face more feminine. He took X-rays and went over measurement and took regular pictures of me. Explained in detail alot about female feature and how the are different in male and female. He also went over in detail how he does the procedures. You wont find pictures online anywhere. But he does have alot in his office FYI. We decided type III forehead slight hairline advancement, brow lift, rhinoplasty, lip lift, and neck chin liposuction. Then I returned home and a day or two after that I received my quote. I feel it was reasonable. I wont post price. I left it at that for a few weeks. Then a talked to the other surgeons listed above. After contact other surgeons I had more questions , so I contacted the office. Dr Keojampa emailed back and forth a few times until all my questions were answered. After that I knew he was the Dr for me. So I went ahead paid my deposit for surgery . Then I had to change it like two day later because my help was able to get off that day. So the big day was 4-14-17 at 10:00. I had to be there 4-12-17 to go over pre-surgery and before pictures. We went over procedures again but we went over what he planned to do with my nose and hairline. He showed me pictures of past procedures that were similar to my face and how they cam out. Night before I was getting nervous, I have never had surgery so I was ready by a little nervous. I dont believe that I sleep the night before I woke up early. But really missed my morning coffee. So wore comfy cloths glad I did because when I got out that night thats what I slept in. So I arrived at the office. Just sitting there talking to staff. They made me feel comfortable which is good because I was nervours. I meet the staff that will be assisting nurse and surgery tech , and anesthesiologist we took some picture right before. The thats all I remember. Then I woke up, I was just out of it. No pain just head and face felt different. Went back to hotel and ice down my face and took a pain pill. I didnt want to eat or drink but I had to because the pain pill are hard on my stomach. I didnt sleep much. It just felt more unreal that it was finally over. Something I have wanted for so long was finally done. Woke up and eat little bit of eggs so I could take a pain pill. Next day I went to follow up with Dr Keojampa. He changed the wrap on my head and showed me how to clean and maintain he incision for the next week. He Checked everything out. He gave me the green light to go home, next appointment was 1 week after. So we drove back to Phoenix after that. I was swollen. But not much pain I took a couple pain pills(2 each day and a few Tylenol )the first two days and then Tylenol two day following that. Sunday( 48 hours after surgery) I was really swollen need alot of ice that day. After that you can see swelling going down. I was given the green light to bath and wash my hair. This was hard for me the first time. I was more nervous about opening up the incision. There was a lot of blood and hair. It is different touching you head and not really feeling it? After the first day. I could have pretty much been on my If need be. I had a person come with me for the first two days. I did have help the first time bathing which really helped clean my hair that first time.
Following days were very long. Hard to sleep with your head elevated. For the next four-five days I just laid down and watched alot of tv. I would walk around my house or go get the mail. Day 5 most of the swelling went down were I could really see the difference. Day 7 I went back to LA for follow up. Staff was great and helpful as usual. He went ahead and pulled the splint cast thing of my nose and removed all stitches and staples. There was some bleeding but I didn’t feel any pain. i was amazed how my lip lift stitches were very much healed. I did see my nose when he pulled it off and iI am really excited and happy how it came out. But sad to say it has been swollen since then. But that is to be expected. I cleaned my hair best I could at the office. It is very hard to wash all the blood out of you hair with all the stitches and staples in it. 9 days out of surgery very surprised how good my incision of hair line is healing. After that I came back to Phoenix. Still resting and taking it easy.
I read a lot about finding the best or right surgeon. You have to find the right one for what you want. Also the one that you feel comfortable with. Dont be afraid to voice your concern, make sure that you both are on the same page.
I didn’t have any mental break downs or crying episodes. Which I hear happens. I feel that It is life changing I am extremely excited for the week and months to come. I am still swollen, and hair still shorter then I would like. Before surgery I would get missed gender 50% easy. I have only really been out 4 days. But I can tell you I didn’t get missed gendered at all. I am extremely happy with everything. I know it will only get better I am still swollen around my nose. But I can see the difference. I feel that there were big changes to my face. But My family and I feel that I didn’t completely lose my old face. I still have similar facial features there just way more feminine. My eyes look the sam just way more brighter.
I am starting to feel back to normal after surgery. I will be posting pictures and try to keep it updated at month, 3, 6. I can tell you I dont feel that I take very good pictures and they dont true show how good The results came out. This is my review hopefully it helps you when making a life changing decision. I definitely feel that if your looking into facial feminization surgery Dr Kyle Keojampa should be on your list of surgeons to consider or at least have a consultation. Thank you for reading and best of luck on your journey. Ashley C
Ashley C