Facial feminization surgery (FFS) refers to surgical proceures that alter the human face to bring its features closer in shape and size to those of an average female human. FFS includes various bony and soft tissue procedures (see below) though the term "FFS" is generally not regarded to include facial hair removal. FFS techniques are derived from maxillofacial and reconstructive surgery as well as general plastic and cosmetic surgery. Douglas Ousterhout pioneered what is now called FFS During the 1980s and 1990s in the U.S.A. There are only a small number of surgeons globally who specialise in FFS.