Douglas Ousterhout

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Douglas K. Ousterhout, MD, DDS, is a retired[1] craniofacial surgeon who practiced in San Francisco, CA, United States.[2][3] His specialty was facial feminization surgery for trans women, and he was widely considered the foremost facial feminization surgeon in the United States.[4] He also offered facial masculinization surgery for trans men, and other aesthetic craniofacial and maxilliofacial procedures.[5]

Facial feminization surgery (FFS) began in 1982 when Darrell Pratt, a plastic surgeon who performed sex reassignment surgeries, approached Ousterhout with a request from a male-to-female transsexual patient of Pratt's; the patient wanted plastic surgery to make her face appear more feminine, since people still reacted to her as though she were a man.[6] Ousterhout's prior practice had involved reconstructing faces and skulls of people who had suffered birth defects, accidents or other trauma.[6] Ousterhout was interested in helping but knew that he didn't know what a "female face" was, so he investigated by first reading the physical anthropology from the early 20th century to identify what features were "female", then by deriving measurements defining those features from a series of cephalograms taken in the 1970s, and then by working with a set of several hundred skulls to see if he could reliably differentiate which were females and which were males using those measurements.[6][7] Ousterhout then began working out what surgical techniques and materials he already used that he could apply in order to transform a male face into a female face; he pioneered most of the procedures involved in FFS and was involved in their subsequent improvements as well.[7]

FFS generally involves advancing the hairline, making the forehead smaller and rounder, reducing the brow ridge, shortening and narrowing the nose, shortening the upper lip, shortening the chin, narrowing the jaw, and reducing the laryngeal prominence.[8] As of 2006 there were only about twelve surgeons in the world performing FFS.[4]

Notable Ousterhout patients who have written about their surgery include Lynn Conway,[9] Andrea James,[10] and Nicole Hamilton.[11]


Ousterhout and wife Nancy also own and manage Ousterhout Wine and Vineyards. The wines have won compliments and awards, with Vinography writing "you can't go wrong with Ousterhout",[12][13] and Wine & Spirits magazine selecting their wines among the best Zinfandels and the best California wines.[14][15]

Personal life[edit]

Ousterhout lives in the Mrs. Doubtfire home, which he bought in 1997. The title character in the movie, played by Robin Williams, is a divorced man who pretends to be an older female nanny so he can be around his children. Ousterhout briefly knew Williams and liked the connection, explaining, "I turn boys' faces into girls' faces. It seemed only natural."[16] In 2015, a disgruntled former patient tried to set the front door on fire.[17]


  • Ousterhout, Douglas K., editor (1991). Aesthetic Contouring of the Craniofacial Skeleton. Lippincott Williams and Wilkins. ISBN 0-316-67410-9. 


  1. ^ Kron, Joan (June 12, 2015), "A Look at Caitlyn Jenner's Facial Feminization Surgery", Allure, Condé Nast, retrieved June 15, 2016 
  2. ^ Scurlock, James D. (2012). King Larry: The Life and Ruins of a Billionaire Genius. Scribner, a Division of Simon & Schuster, Inc. pp. 171–175. 
  3. ^ Van Marie, Karin (1006). Sex, Gender, Becoming: Post-apartheid Reflections. Pretoria University Law Press. p. 12. 
  4. ^ a b Guthmann, Edward (April 26, 2006). "Facing facts". SF Chronicle. Retrieved 29 June 2014. Ousterhout, who practices at the California Pacific Medical Center's Davies campus on Castro Street, is widely considered the country's foremost facial feminization surgeon. 
  5. ^ Oustherhout, Douglas. "Cosmetic Surgery San Francisc , Breast Augmentation Oakland, Ca >>Oustherthought Douglas (". 
  6. ^ a b c Plemons ED. Description of sex difference as prescription for sex change: on the origins of facial feminization surgery. Soc Stud Sci. 2014 Oct;44(5):657-79. PMID 25362828
  7. ^ a b Altman K Facial feminization surgery: current state of the art. Int J Oral Maxillofac Surg. 2012 Aug;41(8):885-94. PMID 22682235
  8. ^ Morrison SD, et al. Facial Feminization: Systematic Review of the Literature. Plast Reconstr Surg. 2016 Jun;137(6):1759-70. PMID 27219232
  9. ^ Conway, Lynn (2011-11-16). "Lynn's Facial Feminization Surgery (FFS)". University of Michigan. Retrieved 13 July 2016. 
  10. ^ James, Andrea (January 16, 1997). "My surgical journal: Scalp Advancement, Brow Shave, Brow Lift, and Trachea Shave". Retrieved 13 July 2016. 
  11. ^ Hamilton, Nicole (April 8, 2013). "My Experience with Facial Surgery". Retrieved 13 July 2016. 
  12. ^ Yarrow, Alden (January 24, 2015). "Vinography Unboxed: Week of January 18, 2015". Vinography. Retrieved 13 July 2016. 
  13. ^ Mobley, Esther (September 2, 2015). "Tasting Notes: The spectrum of rosé wine recommendations". San Francisco Chronicle. Retrieved 13 July 2016. 
  14. ^ Sykora, Luke. "Wines of the Month: Zinfandel: National Zinfandel Day: US: California: Sonoma Ousterhout 2012 Alexander Valley Nance’s Vineyard Zinfandel". Wine & Spirits. Retrieved 13 July 2016. 
  15. ^ Sykora, Luke (2014). "Wines of the Month: Zinfandel: California Wine Month: US: California Ousterhout 2011 Alexander Valley Nance’s Vineyard Zinfandel". Wine & Spirits. Retrieved 13 July 2016. 
  16. ^ Redell, Bob; Fernandez, Lisa (August 12, 2014). ""It Seemed Only Natural": Plastic Surgeon Owns "Mrs. Doubtfire" Home". NBCUniversal Media, LLC. Retrieved June 20, 2016. 
  17. ^ Sernoffsky, Evan (January 6, 2015). "'Mrs. Doubtfire’ home in San Francisco singed by arsonist". SFGATE.