Facial Feminization Surgery (FFS)

• Every face is unique and has facial features that are both recognized as feminine and masculine. Facial features and appearance are influenced by hormones in our body. Faces contain secondary sex characteristics that can be perceived as male, female, or androgynous including the shape of the forehead, nose, lips, cheeks, chin, and jawline.
• For trans feminine people on hormone replacement therapy (HRT), these hormones can soften facial features but cannot change the underlying bone structure.  Facial Feminization Surgery (FFS) can reduce the impact of past testosterone exposure on bone structure. Nonbinary individuals may desire a different combination of what would be considered facial masculinization or feminization. Discussing these considerations with your navigator prior to surgical consult can yield a more successful consultation.
• FFS is a group of surgical procedures that specifically manipulate the bone and soft tissue in one’s face and neck. These procedures are tailored to an individual’s needs and desired outcome. Surgeons may perform FFS in two stages, first stage for bone contouring and second stage for soft tissue work if needed. Although we often refer simply to FFS, the is a collection of different surgeries—tailored to a patient’s specific goals.

• Hairline advancement
• Brow lift Brow/forehead
• Orbital rim contouring
• Eyelid surgery
• Chin and jaw modification
• Cheek augmentation
• Rhinoplasty
• Upper lip shortening
• Face-lift
• Neck lift
• Tracheal shave

• Fat transfer
• Fillers
• Hair reduction

Patients who understand the surgical and non-surgical procedures for facial surgery often have a more successful consultation experience. Your navigator will provide surgical education and help you prepare for consult. Talking through your expectations, desired outcome, and concerns can be helpful practice prior to seeing a surgeon.

It is essential that you and your surgeon agree on a surgical plan that will be gender affirming to you. Special considerations to your personal ideas about femininity, racial & ethnic identity, as well as inherited familial or cultural features should be discussed in consultation prior to surgery. It is important to note that desired outcomes may not be surgically possible due to anatomy and surgical limitations, please discuss possible limitations with surgeon for best understanding.

Bring a list of questions to ask your surgeon at the consultation to help you plan for your surgery and set expectations. If you don’t understand something, it’s okay to ask your surgeon to repeat or explain it in a different way.

Expectations

• Will I need multiple surgeries, and how common are revisions?
• What are the possible complications of this surgery?
• What can I expect healing to look/feel like?

Planning

• What choices do I have with FFS surgery procedures and what is best for me?
• What is your surgical approach to FFS?
• Will I have scarring?
• How long will I need to take off work/school?
• How long will I be in the hospital to recover?
• Will I need to eat certain foods during recovery?

Your PCP, surgeon, and Gender Health Navigator can help you achieve optimal surgical outcomes by actively preparing for your surgery and making sure expectations are surgically possible.

PHYSICAL HEALTH

• Maintain a healthy body weight, high body weight can increase complications and interfere with wound healing.
• Although there is not a strict Body Mass Index (BMI) requirement, your surgeon may discuss specific anesthesia risks or considerations, depending on your BMI. It is beneficial to reach your own personal sustainable goal weight prior to surgery

MENTAL HEALTH/WELLNESS

• Having surgery takes both physical and mental preparation.  Surgery is stressful, some people feel an increase in depression or anxiety after surgery. 
• If you notice any changes in your mood or sleep, especially with anesthesia, please discuss with your care team.
• If you struggle with mental health, reach out to your mental health provider or navigator for support.

SMOKING

• Nicotine intake by smoking, patches, chewing gum, or vaping may interfere with wound healing. If you use nicotine, you should discuss a quit date with your PCP and surgeon. Surgeons require patients to stop nicotine prior to surgery and may test for confirmation.
• If you inhale cannabis, it’s important to find another way to use it, for example, topical, edibles, and tinctures, or to stop altogether.

SUPPORT

Build your network of support with providers, family, and community to help you plan and organize your recovery prior to and after surgery

• Transportation to and from appointments 
• Meal planning and preparation
• Providing a calm and supportive healing space

Everyone heals differently. The more you know what to expect in your recovery process the happier you will be with your surgical experience and outcome. You may experience some of these common post-op issues—pain, numbness, tingling, swelling, or bruising for weeks or even months after surgery.

FFS has a long healing process until final results are fully visible, talk to your surgeon and care team if you have questions about post-op care. You will be advised to follow the surgeon’s aftercare instructions for the best outcome possible. Your surgeon will cover post-surgery topics, such as:

• Healing process & pain management
• The dos and don’ts during recovery
• When to resume exercise and physical activity
• Complications

• Medicare A&B
• Full Scope Medi-cal
• San Francisco Health Plan (Medi-cal, Healthy Workers and Healthy Families)
• Anthem (Medi-cal)
• Healthy San Francisco (Health Access Program)