For patients who have decided to undergo facial feminization surgery or who want to learn more about the process, these are the general steps that one must take from consultation through the early stages of recovery. To read more about recovering from FFS, head to the post-op section.
Schedule a virtual or in person consultation to learn about FFS, discuss any facial features that you might want targeted, and ask questions. This is also a good time to bring up any concerns you might have about risks and benefits, recovery, aesthetics, or any other issues that come to mind. Dr. Facque will work with you to help figure out what procedures can best suit your needs. Before your consultation, you may be asked to send us photos of your face. Please follow this guide to taking facial surgery photos.
Your consultation may be in-person or virtual, and will go over a large amount of information to help you better understand the facial feminization surgery process. You will learn about the different techniques used in facial feminization and which may be appropriate to meet your needs. You will learn about the incisions involved in each procedure, how the procedure is performed, and the important risks and benefits specific to that procedure. Patients will have the opportunity to discuss their ideal surgical outcomes, the recovery/healing process, go over paperwork, and discuss insurance or self-pay options. If your appointment is in person, you will be photographed to help with pre-surgical planning.
Note: This consultation can be overwhelming, which is why we recommend coming prepared with any questions you’d like to discuss. If you have specific results in mind, bringing inspiration photos or making a “wish list” collage can help us get a better sense of which procedures will help you achieve your goals. If you don’t have specific results in mind yet, that’s ok too! Dr. Facque may give you homework to help review any gaps in your resources regarding payment, social support, or other needs you’ll need filled throughout this process.
Patients will need a preoperative CT scan in order to finalize their surgery plan. The CT scan will help Dr. Facque to learn more about your face shape and will help determine what procedures could be a part of your surgery plan. Our office will order your CT scan, and we will do our best to help you find a radiology clinic that is covered by your insurance company. There are alternative options available for patients who cannot get a CT scan.
Because the first consultation can be lengthy and covers a lot of information, some patients may have another phone, virtual, or in-person consultation with Dr. Facque to ask questions and review any new information that may have come up since the first appointment. If your CT scans were completed after the first consultation, the CT scans will be reviewed at this appointment. After the secondary consultation, you should have a good idea of what your surgical plan will be and a general timeline for all the milestones that follow, including how long you may need to stay in town for if you don’t live in the San Francisco Bay Area.
If you are hoping to have insurance pay for your surgery, you’ll need to get approval. Our office uses the informed consent model and therefore doesn’t require letters of support from therapists, but the insurance approval process requires provider support letters. We have a dedicated Insurance Advocacy Team that handles the entire process of insurance approval for patients; we send all your documents to your insurance providers and work with them to try and secure coverage to the fullest extent. We can’t guarantee insurance coverage but we can guarantee to try our hardest!
Once surgery has been approved by your insurance or you have decided to pay out-of-pocket, you can schedule a surgery date! If you are traveling for surgery you can plan travel, book airfare, request time off work for recovery, and if necessary, find accommodations ahead of time.
COVID-19 and facial surgery: Patients should quarantine (remain in their household and interact only with others in their germ bubble) for 2 weeks before surgery. Patients will need to be tested 3-5 days before their scheduled surgery date, and they must have a negative test result in order to move forward with having surgery. If the patient returns a positive test for COVID-19, we will wait 2-3 months until we reschedule surgery depending on how severely their illness was.
About 3 weeks before surgery, you will have a preoperative visit where you can ask any final questions you may have of Dr. Facque, and you will sign consent forms (part of the informed consent process). This visit can be either virtual for patients who don’t live in the San Francisco Bay Area or in person if you live locally. If your visit is in person, photographs may be taken at this time if they haven’t been already (see below, for those coming from out of town). At this visit, you’ll receive lots of information regarding what to expect around surgery, how to stay comfortable, what conveniences you should put in place to be ready for your recovery, medication instructions, and your recovery milestones after surgery. At the conclusion of this visit, you should feel 100% comfortable with all of the details surrounding the surgical process.
For patients who don’t live in the Bay Area and have had their consultation and preoperative visits virtually, there will be an in-person visit with Dr. Facque one or two days before surgery. Our staff will take your photographs at this visit and Dr. Facque or one of the members of his team will conduct a detailed physical exam to make sure everyone is on the same page regarding the goals of the procedure and the operative plan..
Our staff will tell you exactly when to arrive at the surgery center. Many of Dr. Facque’s facial feminization surgery patients stay overnight in the hospital or recovery unit after surgery and are usually discharged the following morning.
Dr. Facque will check in with patients the day after their surgery. For patients that spend the night in the hospital, this includes seeing them to change dressings. For patients that are not, he will check in via phone call or video chat.
During this first week after surgery, you’ll take it easy, keep comfortable, and ideally maintain a low sodium diet with soft foods to allow any incisions in your mouth to heal properly. Your body knows how to heal, so find ways to allow that process to unfold. If you have any questions you can reach out to Dr. Facque. He will give you a work hour and after hours phone number to get in touch with him if you need. It’s extremely important that you keep your first in-office postoperative appointment visit, which is usually 7-10 days after surgery.
Around 7-10 days after surgery, you will have an appointment to see Dr. Facque in our office. If you had rhinoplasty, sutures on the nose will be removed in the office at this visit, as well as the interior and exterior nasal splints. You’ll also receive instructions about what to do next, including care for simple dressings, if needed.
After that first visit, once your sutures/drains/splits are removed, you can head home. It’s a good idea to have help with any heavy luggage and make sure the trip is not too strenuous. Be sure to walk frequently before this travel day to avoid blood clots (in the legs or elsewhere) called deep vein thrombosis.
There is a routine schedule for follow-up appointments that can either be done in-person (for local patients) or virtually (for out-of-town patients). If done virtually, you will use our secure and private internet browser accessible patient portal called Remedly where you can take photos and ask any questions.
Going back to work and social life with major structural changes to the face is incredibly challenging. You will receive comprehensive information about your recovery process and resuming activity during the educational process around surgery. In brief, patients will be asked to wear a compression garment for the first week and maintain a soft diet for the first two weeks. After two or three weeks, patients can begin to drive (once they have stopped taking narcotics). We recommend that patients begin increasing their activity starting at week three so that you’re able to resume everyday tasks and go mostly “back to normal” by six weeks post-op. Most of the swelling goes down by the end of the first month, but may be present to some degree for up to 9-12 months depending on which procedures are performed during surgery. Most incisions in the skin are healed within 2 weeks after surgery, however, scars ultimately take about 12-18 months to take their final form. Incisions/scars on the face typically heal very well and our staff will help you with short and long term scar care recommendations.