“Craniofacial surgery will become very useful for cosmetic surgery” – Douglas Ousterhout, 2015   Facial feminisation surgery (FFS) is a set of Cranio-Maxillo-Facial reconstructions aiming to change masculine facial features into feminine ones. Combined with the ‘aesthetic’ in ‘reconstructive’ minds, FFS provides ‘softening’ and ‘harmony’ as more feminine looks. FFS is a combination of surgical procedures that are mainly aimed at transwomen and cis-women who prefer a more feminine facial appearance. The primary procedures involved in FFS include forehead feminisation, nose reduction (rhinoplasty), jaw surgery (orthognathic), and Adam's apple contouring (tracheal). Dr Douglas Ousterhout pioneered the first FFS operation in 1983. It is well-known that trans-sexual hormonal therapy can cause significant soft tissue alterations in the body. However, the effects of this therapy on bony parts are much more subtle. Recent data has shown that crossed-sex hormonal treatment has minimal effects on altering the shape and contour of bones, especially in the craniofacial regions. Therefore, craniofacial reconstruction surgery remains the best option for addressing undesired cis-gender facial appearances.