Treating Incisions After Facial Feminization Surgery

Facial feminization surgery (FFS) involves many different procedures that are all designed to target the skin, bones, and soft tissues in the face to reverse or neutralize the impacts of testosterone during puberty. Scarring, as well as swelling and bruising, are all normal and unavoidable parts of recovering from facial feminization procedures.

Where are FFS incisions made?

Each patient’s FFS journey is unique and tailored to their personal surgical goals and experiences with dysphoria or discomfort with different areas in their face. Therefore, the amount, size, and location of FFS scars will depend on each patient’s individual surgery plan. 

Generally speaking, there are four locations where incisions are made during facial feminization surgery, and each one is associated with at least one procedure. Patients might not have all four incisions made depending on their unique surgery plan that they discuss with Dr. Facque

  • Hairline/coronal incision: This incision usually runs either along or is hidden behind the hairline and is made to perform hairline advancement, frontal sinus setback, and brow bone contouring
  • Under the nose: This incision is made under the nose and curves under the nostrils. This incision is made to perform rhinoplasty and lip lifts.  
  • Inside the mouth: This incision is the only one that will not scar because it is inside the mouth rather than external. The incision will run under the gum line under the bottom teeth, extending at or beyond the last tooth on each side of the mouth. This incision is only made to perform mandible/jaw bone and genioplasty/chin contouring
  • Under the chin: This incision is small and placed under the chin in order to perform a tracheal shave

In all cases other than rhinoplasty, incisions are closed with dissolvable sutures, meaning that there won’t be any stitches that will have to be taken out. For patients who have had rhinoplasty, any sutures or splits that are used during surgery will be removed at the first post-op appointment about 7-10 days after surgery.

How should I treat my external scars after FFS?

With proper treatment and after-care, the texture and coloring of scars can be reduced. Generally, scars will continue to get more pigmented and raised for the first 3 months after surgery before they begin to soften and lose their pigmentation. Scars will continue to heal over the course of the first 12-18 months after surgery, and a combination of scar massage, using antibacterial and silicone ointment, and keeping scars out of the sun can all help promote scar healing.

For folks of color with a richer skin complexion, there is risk of hypo-pigmentation, meaning that scars may lighten in color and therefore be more visible. Following these guidelines can help reduce the risk of hypo-pigmentation, and you can chat with Dr. Facque to learn more about scar placement on more melanated skin.

FFS Scar Massage:

Once patients have been instructed to begin scar massage, patients should use the tips of their fingers to apply small, firm, circular movements along their scars. This will help soften the scars and prevent any raised texture along the scar lines. Scar massage can also be done inside the mouth using your tongue to apply pressure along the internal incisions.

Antibiotic Ointment and Silicone Gel:

For the first week after surgery, patients must use antibiotic ointment on their scars twice a day. This will help prevent the scars from getting infected after surgery and help their overall healing process. Once the scars have completely closed and Dr. Facque gives the ok to move onto the next step of scar treatment (usually about 3 weeks after surgery), patients should massage silicone gel into their scars twice a day. Patients should continue to apply silicone scar gel to their scars for the first 12 months after surgery.

Keeping Scars out of the Sun:

For the first year, scars should be protected from the sun. This is because sunlight can “tattoo” or leave permanent pigment along the incision lines, which can lead to hyper-pigmentation. The best way to do this is to avoid the sun as much as possible.

When you do go outside, the best way to protect scars from the sun is with a physical barrier, like a hat or other objects that help block the sun’s rays from hitting the scars. The second best way is by using a sun-block with a metallic ingredient like zinc oxide or titanium dioxide on the scars. This is different from regular sunscreens and will provide more protection. The least effective method, but still a necessary and important part of scar treatment (and skin care), is using regular sunscreen with an SPF of at least 30. Both sun-blocks and sunscreen should be applied at least 15 minutes before sun exposure and should be reapplied every hour while in the sun.

Caring for Internal Mouth Incisions

The best way to heal the incisions inside the mouth is to eat soft foods for at least a week while those incisions heal. Progressing too quickly to solid food may lead to delayed healing of these incisions. We recommend using a water flosser and/or rinsing out your mouth with a gentle mouthwash to keep internal incisions clean before you’re allowed to brush your teeth. Learn more about caring for mouth incisions here.

In Summary:

  • Scarring is a normal part of recovering from any surgical procedure, and this is true of facial feminization surgery.
  • There are three main ways that folks can help heal their scars after facial surgery: scar massage, using antibacterial and silicone scar ointments, and keeping scars out of the sun.
  • Connect with Dr. Facque to learn more about scar placement on richer skin tones and/or about the surgical plan that feels the best for you.