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FFS Scar Care Healing: The Comprehensive Guide

Facial feminization surgery (FFS) includes a variety of procedures patients can choose from to create a more conventionally feminine appearance and can be an important part of a gender-affirming journey.

Medically reviewed by Jennifer Richman on April 30th, 2025

As with any surgery, FFS can leave scars. The same is true for facial masculinization surgery (FMS) and non-binary facial surgery. Oftentimes, patients want to minimize the appearance of scars on their face, since it’s the most visible part of the body. Understanding the options for scar care can go a long way in helping patients feel comfortable with their surgical results by reducing the texture and discoloration of scar tissue.

In your free facial surgery consultation, you can create a surgical plan that takes into account the risk of scarring. Likewise, following postoperative scar care instructions and pursuing any necessary treatments can help significantly reduce the visibility of facial scarring.   

FFS Scar and Incision Overview

Every facial surgery is unique and tailored to the specific patient’s needs, goals, and possibilities. As a result, not every FFS patient will have to worry about visible scars or internal mouth incisions. This also applies to FMS and non-binary facial surgery, your care team will present you with the best options possible based on your needs.

Options for scar care following FFS include at-home techniques, treatment options from your surgeon’s office and non-surgical providers, and surgical revisions of the scar tissue. Patients may want to explore multiple options depending on the number and visibility of their scars, as well as how well they heal. 

Types of FFS incisions

There are two types of FFS incisions: external and internal. 

External incisions are made on the outside of the face. These can be visible or hidden due to the way they heal or their placement. For example, a scar might be hidden in the hairline or up under the chin, out of sight. Internal incisions are never visible, as these are made inside the mouth.

What FFS procedure types leave visible vs. hidden scars?

Understanding which procedures are more likely to leave visible scars is an important decision-making factor when planning your FFS in a free virtual or in-person consultation. In fact, it could be the determining factor for certain patients, such as those who have a history of keloid scarring. Additionally, patients who are concerned about long-term visible scars, and patients who have darker skin tones and are prone to hypopigmentation (when scars have less melanin than the surrounding skin) may choose procedures that come with invisible scars and/or lower scar risk.

Procedures that create visible external scars include:

• Brow bone reduction (if performed with a hairline incision)
• Brow lift (if performed with a hairline incision)
• Hairline advancement
• Lip lift
• Tracheal shave (if incision is placed below the upper neck crease)

Procedures leaving hidden external scars include:

• Brow bone reduction (if performed with a coronal incision)
• Brow lift (if performed with a coronal incision)
• Rhinoplasty (nose)
• Lift augmentation (fat transfer)
• Tracheal shave (if incision is placed on or above the upper neck crease)
• Skin tightening or lifting techniques (usually hidden behind the ears, in the scalp/under the hair, etc.)

The following procedures leave internal scars (invisible):

• Cheek augmentation (all kinds)
• Jaw contouring
• Jaw augmentation
• Genioplasty (chin)

3 Tips for Healing External FFS Scars

To help heal external FFS scars, consider:

1. Proper scar massage that starts early and remains focused on reducing the scar(s) as much as possible for the long term.
2. Antibiotic ointment to reduce infection risk and speed healing in the first week after surgery, as well as silicone gel massaged into the scars twice a day for the first year, beginning approximately three weeks after surgery.
3. Avoiding sun exposure for the first year as much as possible, through clothing, sunblock, and sunscreen for protection, to reduce the risk of hyperpigmentation.

Healing Internal Mouth Incisions

If your FFS scars include internal mouth incisions, these will be closed with dissolvable sutures. You must follow your surgeon’s oral hygiene instructions while these sutures are healing to reduce the risk of infection, reopening the wound, or other complications. 

You’ll also need to be careful with your diet and avoid chewing hard food such as nuts if you’ve had genioplasty or jawline surgery. You may also need to avoid sharp foods like chips if you have incisions in the upper mouth, such as to insert cheek implants. Follow your oral hygiene and soft diet instructions until your surgeon tells you otherwise.

Treatment Options for Scar Complications

What are Scar Complications?

Common scar complications include hypertrophic (raised, thickened) scars, keloid (scars that grow beyond their original boundaries), hypopigmentation (loss of pigmentation), hyperpigmentation (excessive pigmentation), and pain from fibrosis (excessive tissue repair, leading to increased scar creation).

FFS Scar Care Treatment Options Offered by the GCC

At the Gender Confirmation Center (GCC), we offer Kenalog steroid injections to reduce inflammation that can lead to widened, thickened (hypertrophic) scars. These injections are performed in the office beginning three months post-op, and repeated as needed every four to six weeks. The first three injections are free for GCC patients and $150 per treatment for additional injections.

FFS Scar Care Treatment Options Outside of the GCC

• Microneedling and microchanneling

When patients need treatment options we don’t provide, we refer them out to trusted professionals in the area, such as Jen Lee, a gender-competent tattoo artist in San Francisco who handles microneedling and other options. 

Lee states that, “Early microneedling reactivates the healing process, stimulating the body to produce collagen and elastin, which can significantly improve final scar appearance. Starting at six weeks post-operation with surgeon’s clearance, treatments are performed every 4-6 weeks for a total of 3-6 treatments.”

Microneedling is also performed by Toni Wallin, another trusted provider we refer to who operates out of San Diego, Napa, and Minneapolis, and who has treated GCC patients. 

• Scar tattooing

Scar tattooing is a way to blend scars into the surrounding skin tone. It can also be used to enhance areas of the body that were previously treated, where scars may be present. GCC works with several gender-competent providers who provide scar tattooing services and other gender-affirming care.

• Broadband light therapy

Using broadband light therapy reduces pink/red colored scars due to increased vascularity. We recommend that patients wait until they’re three months post-op for this treatment, which is often performed every four to six weeks. Anywhere from one to three treatments may be needed, depending on the provider and the needs of the patient.

Revision Surgery for Surgical Scars

If a patient opts for revision surgery to excise scars and start over, this may help the body focus on healing only that one area. Additionally, it can improve the outcome through more rigorous care of the scar, reducing scar visibility at maturation.

If a GCC patient requests a revision within 12 months after surgery, we will waive the surgeon’s fee for that procedure. If you used insurance to cover your initial procedure, it will likely cover the revision as well.

Frequently Asked Questions: FFS Scar Care and Incision Recovery

When can I start scar care after surgery?

You can start scar care once your incisions heal. Generally, you’ll have your first post-op appointment six to nine days after surgery, and you may be asked to start a scar care protocol at that time. If you have questions about it, this is the right time to ask your surgeon. Then, after 3 weeks from surgery, patients can begin silicone treatments and scar massage.

Treatments like broadband light therapy, steroid injections, and microneedling or microchanneling should wait until three months post-op. This is a general guideline, and it’s essential to get approval from your surgeon before undergoing these treatments.

How do I massage a scar on my face? 

To massage a scar on your face, you’ll want to use mild pressure and rub in a circular motion. Make sure to rub the skin immediately surrounding your scar at the same time. You can use your finger and thumb to apply pressure and rub in one direction to help drain fluids and break up adhesions. Applying oils or lotions helps keep the scar hydrated, and we recommend silicone scar gel to help the healing process. 

It’s normal for scar massages on the face to feel a little uncomfortable, especially when applying pressure to break up fibrosis/scar tissue. As your nerves heal, you might also feel some tingling. It’s important to push through the discomfort to reduce any buildup of fibrosis, help with discoloration, and flatten scar tissue. However, scar massage should not be painful.

When is it too late to massage scar tissue?

Over time, patients can increase pressure on their scars as the tissue becomes less sensitive to massage. It’s never “too late” to massage scar tissue. Scar massage is most effective when started early and frequently (three times a day, five minutes per scar), but can also be done after scar tissue has matured to help with flatness and overall scar appearance.

Can massaging a scar make it worse?

When performed properly, massaging scars won’t make them worse. The term “worse” is often used by patients when talking about scars that are discolored and large. With proper scar care, you can expect smaller, flatter, and more pliable scars. 

However, there is a significant difference between massaging scars and massaging an open, unhealed incision. Massaging an unhealed incision can open it further and make it more visible. For this reason, we recommend waiting until 3 weeks after surgery. Also, not following best practices, such as massaging without oil, cream, or gel, may worsen a scar. 

Significant pain, dryness, or cracking, or a scar that looks like it’s trying to open, are all indications that you may need to change how you approach your scar care.

What is the best oil or product for massaging scar tissue?

The consensus is to use a combination of sunscreen (we recommend a minimum of SPF 30), scar massaging, scar oils/creams, silicone therapy, and scar compression (including silicone scar sheets) for scar care.

There have been a few clinical studies on how effective different scar care products are, although silicone scar therapy products have consistently yielded positive results across the board . However, it has also been noted that no single treatment option is the definitive option because each wound and patient is different.

Anecdotally, massaging with vitamin E oil, BioOil, and silicone has helped many of our patients reduce the appearance of their scars. Other products we recommend are silicone-based scar strips/tape, and silicone gel + SPF, such as Biocorneum. 

How can I fade my surgery scars?

To fade your surgery scars, our practice recommends:

• Massage: Start this early to encourage pliability, flattening, and reduced fluid buildup, and maintain a frequency of three times per day and five minutes per scar.
• Compression: This will encourage fluid to move away from the area, reduce swelling, and help keep scars flatter as they heal.
• Hydration: Proper hydration is essential to keep scars pliable and help reduce their chance of cracking open.
• Sun protection: Protecting your scars from the UV rays reduces discoloration and can help them blend in more fully as they mature.

Can I remove surgery scars?

Scars are permanent, so removing them isn’t possible. However, depending on the specifics of your health and the location and size of your scars, you may opt for a revision surgery to excise your current scars. 

A revision surgery can create a new scar with less tension on it, and help your body focus on healing only the scar/incision as opposed to the incision in addition to  other wounds from surgery. That may improve the outcome. 

Also consider that starting from scratch helps patients focus more rigorously on scar care the second time around, which can help reduce visibility.