Facial Feminization Surgery in San Francisco

Medical illustrations shows the different parts of the face that can be altered through FFS

Medically reviewed by Lin-Lin Liu, PA on August 27, 2026.

The Gender Confirmation Center offers free consultations for facial feminization surgery (FFS) in San Francisco. Four of our board-certified surgeons––Dr. Zara Ley (she/her/they), Dr. Alexander Facque (he/him), Dr. Efstathios Karamanos (he/him) and Dr. Ari Wes (he/him)––have provided facial surgery to patients for years. Our surgeons are committed to working with patients on an individual basis to provide personalized surgical plans to address the unique gender embodiment goals and needs of patients of a diversity of ethnicities and age groups.

Why Choose San Francisco for Facial Feminization Surgery?

San Francisco is one of the most traveled-to cities for gender-affirming surgeries generally, and FFS in particular. Due to our inclusive clinical policies and surgical expertise, patients travel internationally, from other parts of the US, California and the greater San Francisco Bay Area––such as Mountain View, San Jose, Berkeley, Oakland and Walnut Creek––to undergo surgery with our board-certified surgeons. As a result, we have plenty of experience helping patients find affordable accommodations and resources for their stay in San Francisco for gender-affirming surgery.

What is Facial Feminization Surgery?

Facial Feminization Surgery (FFS) is a set of gender-affirming procedures patients can choose to experience greater gender congruence with their facial features. Transgender women, non-binary folks and gender non-conforming patients can choose between procedures that alter the upper (hairline, brow bone & eyebrows), middle (nose & cheeks) and/or lower (lips, chin, jaw & trachea or Adam’s Apple) thirds of the face.

Each FFS procedure is different. If you have questions about which procedures would be right for you, you can request a free consultation, commitment-free, in San Francisco or remotely with any of our facial surgeons.

Meet Your San Francisco FFS Surgeons

GCC is highly sought out for FFS in San Francisco for several reasons. Our clinical inclusion policies make surgery more accessible to patients of older ages and with higher BMIs. Not to mention, our free insurance concierge service has a 90% success rate of securing coverage for interested patients. Likewise, our administrative team has plenty of experience supporting patients that travel to San Francisco from out-of-town for surgery.

Our surgeons have years of experience providing a variety of personalized facial surgery techniques to patients of a variety of ethnic backgrounds. Additionally, the advantage of having four surgeons that offer gender-affirming facial surgery means that we can often be more flexible with scheduling patients––for example, those that are trying to get a sooner date.

Dr. Zara Ley (she/her/they)

Dr. Ley is a board-certified surgeon, animal lover and one of the only trans women of color to provide gender-affirming surgery. Dr. Ley is a recognized expert with vast experience and knowledge, having undergone three plastic surgery fellowships after her medical school residency. Her patients often express appreciation not only for her skill level, but also for her ability to empathize with patients as a trans person herself. In consultations, she creates the space for patients to voice their individual preferences and goals and is open to giving her professional opinion when crafting a surgical plan.

Dr. Alexander Facque (he/him)

Dr. Facque is certified by the American Board of Plastic Surgeons and has 8 years of experience in gender-affirming care. He is a member of the LGBT+ community devoted to improving the quality of care for trans, nonbinary, and gender diverse communities. In his professional formation, he was valedictorian of his graduating class in medical school, recipient of the Dean’s Scholars Award and finished his training in the Gender Surgery Fellowship under the guidance of Dr. Loren Schecter. He is deeply committed to centering his patients’ needs in the creation of surgical plans and is an advocate for the inclusion of non-binary, high BMI and patients of color in gender-affirming surgical care.

Dr. Efstathios Karamanos (he/him)

Dr. Karamanos is a board-certified plastic and reconstructive surgeon with expertise in microsurgery, breast reconstruction, body contouring, and facial surgery. He has trained at leading institutions in both the United States and Europe and currently serves as Assistant Professor of Surgery at the California University of Science and Medicine. Dr. Karamanos is known by his patients for being highly personable. When we asked about what brought him into plastic surgery, he talked to us about being born and raised in Greece, “a place that is full of history, culture and art. I was classically trained and spent my early years looking at statues and learning about the principles of symmetry and beauty.”

Dr. Ari Wes (he/him)

Dr. Wes is a plastic and reconstructive surgeon at the Gender Confirmation Center specializing in gender-affirming facial surgery and top surgery. Over the past decade, his training and clinical practice have focused extensively on gender-affirming care, with dedicated experience in facial feminization and chest surgery and a sustained commitment to transgender, nonbinary, and gender-diverse patients. He is committed to clear communication, thoughtful planning, and meticulous technique so patients feel informed and supported throughout their surgical care. Dr. Wes is known for taking the time to listen to patients and explain––with photos, sketches and plain language––to make sure that they fully understand their options for surgery and have realistic expectations of what can be accomplished.

The FFS Procedures

Patients can choose between the following procedures for one or two stages of facial surgery:

Are You a Candidate for FFS?

At the GCC, we only offer FFS to legal adults who are capable of participating in the informed consent process. At the GCC, we are generally able to provide facial surgery to patients who have a BMI under 60, depending on other underlying medical conditions.

Having a support letter from a licensed mental health professional and undergoing at least 12 continuous months of feminizing hormone replacement therapy (HRT) are requirements for insurance coverage, but not for surgical candidacy with the GCC. Still, for patients on HRT, we generally recommend that you wait 1.5-2 years on hormones to see how your facial structure changes before undergoing surgery.

The Surgical Process and Recovery

FFS Surgical Process

  • Pre-Operative Preparation: Once your procedure is scheduled, your surgeon will likely order a CT scan or X ray of your cranium to help them prepare for the operation. Likewise, the GCC requires that patients pay their full financial responsibility six weeks prior to their surgery date. If you need financial assistance or help getting insurance coverage for your FFS, you can click on the hyperlinks previously listed.
  • The Surgery: FFS is always performed under general anesthesia. This means that patients are fully unconscious and will not feel anything during the procedure. You will wake up in a post-operative care room under the supervision of a nurse, and may need to stay the night in the hospital after. Once you are discharged, you will need to be picked up by a loved one to be taken home.
  • Post-Operative Care: FFS can be one of the most intense gender-affirming procedures to recover from. During the first 72 hours post-op, you will likely need a support person with you 24/7 to help you change ice packs, assist you with meals and more.

FFS Recovery Timeline

FFS is notorious for having an emotionally and physically draining recovery process. This is because pain and inflammation concentrated in the face–where most of our sensory organs are located–can be particularly difficult to deal with. For more detailed recovery instructions, click here.

That said, recovery from FFS varies greatly by the number and type of procedures you undergo. Generally speaking, especially if you are traveling from out of town, know that you will need 24/7 care for the first 72 hours after surgery. Afterwards, you will likely still need support with changing bandages, bathing, caring for incision sites, meals and daily household tasks. Patients who come in from out of town can usually return home 1-2 weeks after surgery, with approval of their surgeon in the first post-operative appointment. It is important that you stay in-town for at least that long to deal with any urgent complications in the rare case that they do arise.

FFS Recovery Supplies

The following is a list of recommended supplies for FFS recovery:

Item Purpose
Face-shaped ice packs or packages of frozen vegetables Icing the face is essential to manage inflammation
Small to medium-sized towels To prevent ice burns by creating a barrier between ice and the face
Extra pillows Maintaining your head in an elevated position for the first month post-op can significantly help with inflammation management.
Button-down shirts, blouses, sweaters and jackets You should avoid pull-over shirts, sweaters or tops of any kind during the first three weeks post-op
Antibiotic ointment (Bacitracin or Neosporin) To prevent infections in incision sites during the first week after surgery
4” thick Ace bandage wraps To manage inflammation and pain through facial compression during the first 2 weeks post-op. Necessary if any procedures are done to the upper or lower thirds of the face. 
Vaseline or Aquaphor To keep incision sites hydrated once they have closed, usually after your first post-op visit.
Tissues Patients that undergo a brow bone reduction with frontal sinus setback or a rhinoplasty will be on sinus precautions for the first month after surgery. During this time, you will not be able to blow your nose, only wipe.
Saline spray To keep nasal passages hydrated after a rhinoplasty.
Gentle mouthwash and children’s toothbrush Patients who undergo jaw and/or chin contouring will need these materials to keep their mouth clean without opening incisions.
Saline solution or hydrogen peroxide If patients experience crusting around incision sites as they heal, saline solution or hydrogen peroxide can help keep them clean.
Gentle face wash and/or neutral or baby shampoo A gentle face cleanser and/or shampoo (if you have incisions on your scalp) will be necessary to keep your face and scalp clean after surgery without causing further irritation.
Blender, food processor and/or flexible straw Patients that undergo jaw and/or chin contouring will be on a soft food diet for at least two weeks after surgery. These items can help you prepare and ingest soft foods and drinks.
Antacid Some patients experience acid reflux from taking several medications to manage pain and inflammation. Antacid can help you manage these symptoms.
Arnica Montana Taking Arnica Montana and other herbal supplements prior to surgery is generally not allowed because it can cause complications with anesthesia. After surgery, however, arnica supplements can help with managing bruising and inflammation.
Stool softeners or fiber Prescription pain medications can cause constipation in some patients. These medications and supplements can help manage this symptom.
Probiotics Patients are sometimes prescribed antibiotics after surgery to reduce the risk of infection. Taking probiotic supplements after you finish your antibiotic treatment can help restore your microbiome.

Cost and Insurance in California

The cost of facial surgery in California varies greatly as so much is dependent on the number and type of procedures you undergo. Besides the specific procedures, patients are billed for surgeons fees, facility fees, anesthesia fees, hospital fees and/or any medical exams you need to undergo prior to surgery.

After your surgical consultation, your surgeon’s office can provide you with a precise quote for your procedure, which can fall anywhere from $4,500 to over $100,000. Costs vary due to factors like surgeon experience, the amount of time you will need to be put under anesthesia and whether or not you will need to spend a night in the hospital after surgery.

With the help of our insurance concierge, many of our patients are able to seriously reduce the costs of surgery by securing insurance coverage for their medically necessary, gender-affirming procedure. Regardless of whether or not you have health insurance coverage, we have a variety of grant and medical financing resources you can consult on this page.

Traveling to San Francisco for FFS

San Francisco has one of the most expensive costs of living of any city in the United States. Still, many patients choose to travel to the San Francisco Bay Area for FFS because of the natural-looking, high-quality results and state-of-the-art medical technology that surgeons offer.

After years of experience helping patients, we have devised a series of strategies to help them reduce the cost of their stay. We have compiled a free travel guide with resources and tips to help you save costs on travel, lodging and more. Likewise, if you’re interested in doing some sight-seeing before your operation, you can find tourist recommendations there as well.

Conclusion

FFS is a highly personalized gender-affirming surgery. Remotely and in-person, out of our San Francisco office, Dr. Facque, Dr. Ley, Dr. Wes and Dr. Karamanos offer complimentary consultations to prospective patients.