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Facial Feminization Surgery Timeline: The Preoperative & Postoperative Processes

This article is an introduction to the timeline or preoperative requirements and postoperative steps for those interested in Facial Feminization Surgery (FFS) or other kinds of Gender Affirming Facial Surgeries (GAFS). We go over tips for the preoperative consultations, obtaining insurance coverage for the procedure, and requirements for patients who live in the San Francisco Bay Area as well as those coming in from out of town. From there, we outline the postoperative steps. For a more in-depth review of the recovery process, click here. For FFS before and after pictures, formerly called “male to female facial surgery results,” click here.

What steps do I need to take to get Facial Feminization Surgery (FFS)/Gender Affirming Facial Surgery (GAFS)?

1. Request and prepare for your first surgical consultation

Schedule a virtual or in person consultation with one of our two expert facial surgeons: Dr. Ellie Zara Ley or Dr. Alexander Facque. The first consultation can be overwhelming, which is why we recommend coming prepared with any questions you’d like to discuss–for example: about medical conditions, aesthetics, recovery, costs and risks. 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! Before your consultation, you may be asked to send us photos of your face. Please follow this guide to taking facial surgery photos.

2. Complete the initial consultation

Your consultation may be in-person or virtual, and will go over a large amount of information to help you better understand the gender affirming facial surgery process. You will learn about the different techniques used in facial gender affirmation and the important risks and benefits specific to each procedure. Dr. Facque or Dr. Ley will work with you to create a unique, individualized surgical plan to best suit your needs.

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. Dr. Facque or Dr. Ley 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.

If your appointment is in person, you will be photographed to help with pre-surgical planning. As a result, we ask that you arrive at your consultations without any makeup on.

Please note that virtual consultations incur no fees. The fee for in-person consultations is $150 and will be applied toward the overall fees of the procedure after the fact. In the case that your insurance covers all or a part of the procedure, the consultation will be charged in accordance with your insurance. For questions about the insurance coverage process, refer to step number five on this list.

3. Complete the CT Scan

Patients will need a preoperative computerized tomography (CT) scan in order to finalize their surgery plan. The CT scan will help your surgeon learn more about your face shape and 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.

4. If needed, secondary consultation

Since the first consultation can be lengthy, many patients request secondary consultations to review questions and information that have come up since the initial appointment. A second consultation can take place over the phone, virtually, or in-person. You can also reach out to our surgeons through our Patient Contact Form if you have questions that can be answered through written communication.

The CT scans will be reviewed during the second consultation if they have been completed. After this optional appointment, 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.

5. If needed, obtain insurance approval

If you are hoping to have insurance pay for your surgery, you’ll need to get approval. In determining patient eligibility, our office uses the informed consent model and therefore doesn’t require letters of support from therapists. However, if you would like your procedure(s) to be covered, the insurance approval process requires provider support letters. For more information about the guidelines for mental health provider letters and other requirements for insurance approval, you can look here.

The GCC has 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. Our team has an incredibly high success rate for securing coverage for our patients with insurance.

Congrats! Your Facial Feminization Surgery (FFS)/Gender Affirming Facial Surgery (GAFS) surgery date has arrived!

6. Schedule surgery

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.

Depending on the operating room you are assigned to, you may need to be tested 5-7 days before their scheduled surgery date for COVID-19. If the patient returns a positive test for COVID-19, the surgery rescheduling will depend on a variety of factors such as vaccination status, symptoms, age and comorbidity status.

Around this time, your surgeon will provide you with a doctor’s note for your employer. The note will contain the amount of time off your employer is required to give you and any restrictions that will need to be accommodated once you are able to return to work. The reason for surgery and the exact nature of the procedures performed will remain confidential.

7. Preoperative visit

About 3 weeks before surgery, you will have a preoperative visit where you can ask any final questions you may have of Dr. Facque or Dr. Ley. . This visit can be either virtual for patients who live outside 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. This is also when you will sign informed consent forms for the procedure. At the conclusion of this visit, you should feel 100% comfortable with all of the details surrounding the surgical process.

8. Photography appointment (out of town patients only)

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 or Dr. Ley one or two days before surgery. Our staff will take your photographs at this visit and will also conduct a detailed physical exam to make sure everyone is on the same page regarding the goals of the procedure and the operative plan.

9. Surgery date!

Our staff will tell you exactly when to arrive at the surgery center. Many of our facial feminization surgery patients stay overnight in the hospital or recovery unit after surgery and are usually discharged the following morning. Whether or not your surgery requires an overnight stay will be determined in your pre-operative appointments based on your unique medical needs and the procedures you will undergo.

What are the immediate, logistical steps to recover from Facial Feminization Surgery (FFS)/Gender Affirming Facial Surgery (GAFS)?

10. First post-op check-in

Dr. Facque or Dr. Ley will check in with their patient the day after their surgery. For patients that spend the night in the hospital, this includes seeing them to change facial dressings such as bandages and gauze. For those that have an outpatient surgery, meaning that they will not spend the night in the hospital, their surgeon check-in will be via phone call or video chat.

11. Early recovery (7-10 days)

During this first week after surgery, you’ll take it easy, keep comfortable, and ideally maintain a low-to-no sodium diet with soft foods to allow any incisions in your mouth to heal properly. Physically, this is the most acute stage of recovery. Your body knows how to heal, so find ways to allow that process to unfold. For example, we recommend that our patients walk frequently during this time to avoid blood clots (in the legs or elsewhere) called deep vein thrombosis.

If you have any questions you can reach out to your surgeon. They will give you a work hour and after hours phone number to get in touch with them if necessary. It is extremely important that you keep your first in-office postoperative appointment visit, which is usually 7-10 days after surgery.

12. First in-office post-op visit

Around 7-10 days after surgery, you will have an appointment to see your surgeon 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. Any other stitches and staples will also be taken out. Additionally, you will receive instructions about the next stage of recovery, including care for simple dressings, if needed.

13. Travel home (for out of town patients)

After that first visit, once your sutures, drains and/or splits are removed, you can head home. It’s a good idea to have help with any heavy luggage, since you cannot lift heavy objects, and make sure the trip is generally not too strenuous.

14. Subsequent follow-up visits

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.

15. Recovery milestones

Going back to work and social life with major structural changes to the face is incredibly challenging. During the pre and post-operative educational processes, you will receive comprehensive information about your recovery process and resuming various activities. 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 or scars on the face typically heal very well and our staff will help you with short and long term scar care recommendations.

For a more detailed guide of the physical recovery milestones, aesthetic recovery milestones or the emotional recovery milestones involved in Gender Affirming Facial Surgery, we invite you to visit the hyperlinked articles.