Facial Feminization Surgery in the San Francisco Bay Area

Medically reviewed by Jennifer Richman on December 02, 2024.

Why Choose San Francisco for Facial Feminization Surgery?

San Francisco is one of the most traveled-to cities for gender-affirming surgeries generally, and Facial Feminization Surgery (FFS), in particular. Board-certified professionals in the city have training and experience in gender-affirming facial surgery techniques, along with access to some of the world’s best facilities and cutting-edge medical technology. 

The area provides a welcoming environment to the LGBTQ+ community, coupled with the peace of mind that you will receive some of the best care available. This mix of quality treatment and compassionate support brings many patients to the San Francisco Bay Area for FFS. This guide will cover information about facial surgeons, travel tips, recovery instructions, and how to get FFS in San Francisco.

How to Find Care in the San Francisco Bay Area and Beyond

Finding care in the San Francisco Bay Area is easy with the proper support. The Gender Confirmation Center is here to offer a range of care and treatment options that will fit your needs, but if you would like additional support from trans-competent providers, feel free to visit the WPATH provider directory or the LGBTQ+ healthcare.

What is FFS?

Facial Feminization Surgery (FFS) is a set of gender-affirming procedures for patients to experience greater gender congruence with their facial features. 

Each FFS procedure is different. During a free consultation, in-person or virtually, you and your surgeon will discuss which procedures can best help you meet your goals. 

Transgender women, non-binary folks, and gender non-conforming patients can choose between procedures that alter the upper (hairline, brow bone, and eyebrows), middle (nose and cheeks), and/or lower (lips, chin, jaw, and trachea or Adam’s Apple) thirds of the face.

Facial Feminization Surgery procedures we offer include:

Finding the Right Surgeon in San Francisco

The San Francisco Bay Area is home to excellent surgeons committed to gender-affirming care for all their patients. With multiple surgeons in the area, patients can consult with medical professionals and choose the person they feel most comfortable with. 

Additionally, receiving gender-affirming care in the area is easier than in many other regions of the country due to the overarching focus on inclusivity and acceptance that is part of the local culture.

Why Choose GCC?

The Gender Confirmation Center provides a caring patient-focused approach to gender affirming procedures, which is why GCC provides :

  • Free consultations with guidance from our experts
  • Sought-after surgeons who have board certification and hospital privileges
  • Specialized training, continuing education, and experience
  • Before-and-after photos to understand expected results
  • Patient reviews and testimonials for peace of mind

At the GCC, we prioritize scheduling patients for consultations who are either cash-pay or have all of the required documentation to solicit a pre-approval insurance authorization to cover the procedure. If you need help acquiring documentation for insurance, our insurance concierge team will provide you with free assistance once you have solicited a consultation.

Prior to your consultation, you will need to send us photos of your face from seven different angles, following these specific instructions. You must be honest about your medical history, health, drug and alcohol use, as well as the medications and supplements you are taking. Doing so will help us create a surgical plan that will maximize your safety during and after your operation.

During the consultation, you will get the chance to talk with your surgeon about which procedures would be the best fit for your needs. It can help to come to the consultation with either photos of facial features that resemble the results you would like (such as photos of a family member) or a sense of which facial features are sources of gender dysphoria for you. The consultation is your time to have any questions or concerns about surgery answered.

Surgeon Recommendations for FFS in San Francisco

Two of the most sought-after surgeons in the San Francisco Bay Area are Dr. Alexander Facque (he/him) and Dr. Ellie Zara Ley (she/her). 

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

Dr. Ley is a board-certified surgeon, animal lover, and one of the only trans women of color to provide gender-affirming surgery. Before joining GCC in 2022, she worked as an assistant clinical instructor of plastic surgery at the University of Utah and a private practice dedicated to gender surgery in Arizona. 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 for her skill level and her ability to empathize with them as a fellow trans person. 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.

Who Can Benefit From FFS Surgery?

Patients who are seeking gender-affirming care to feel comfortable in their bodies and with their presentation can benefit from Facial Feminization Surgery. Most FFS surgeries involve staged results over several procedures. After each procedure, you may have bruising and swelling. Additionally, you can expect different recovery levels between each stage, with some taking longer than others.

As with any surgery, there are risks to consider. The most common risks are infection, seromas, bleeding, and adverse reactions to anesthesia. Additional risks include delayed healing, nerve injury, changes in skin sensation, asymmetry, and more.

If you experience any symptoms that worry you during your recovery period or notice excessive bleeding, increased pain, drainage of pus, fever and chills, or increased swelling after the third day, consult your doctor to ensure you receive any needed treatment.

At GCC, we provide gender-affirming care and do not directly offer cosmetic surgeries. Patients can receive FFS as well as other types of gender-affirming surgeries, including facial masculinization surgery, top surgery, breast augmentation, bottom surgery, and body contouring. 

We do not have HRT or BMI requirements for our surgical procedures and operate under the informed consent model. That means we do not require support letters for patients not using insurance for their gender-affirming surgical procedures in most cases.

If you have physical or mental health conditions, it is vital to have them in check before any surgical procedure. A free surgical consult with GCC can help determine whether you are a good candidate for your desired procedure(s) and whether additional medical testing or clearance may be necessary. 

The Surgical Process: What to Expect

  • 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. 

Recovery Timeline and Expectations

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. You must stay in town for at least that long to deal with any urgent complications in the rare case that they do arise.

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 who 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 who 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. Antacids 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. 

Travel Tips and Resources for FFS in San Francisco

As a facial surgery patient, you must stay in town for seven to 10 days after surgery, at which point you will generally be cleared to travel home. In total, you should expect to be in San Francisco for 12 to 15 days.

When looking for flights, consider Oakland International Airport (OAK) and San Francisco International Airport (SFO). Ticket prices vary, and sometimes you can get a better deal at one airport over the other. The Bay Area Rapid Transit (BART) train runs from both airports and can drop you off at designated BART stations.

If you do not have someone to travel with you and provide care and support during the post-op part of your stay, consider Maitri or QueerCare. Other options include T4T Caregiving, Health at Home, or the trans services offered by San Francisco Community Health Center.

Often, staying outside San Francisco is cheaper than finding lodging within the city limits. Patients traveling from out of town can view the BART map to find an option close to a BART station, which will minimize transportation spending. Anywhere within a 45-minute to one-hour journey from our offices is suitable for lodging. 

Options for staying outside San Francisco include, but are not limited to:

  • San Bruno (south of San Francisco, the city nearest to the San Francisco Airport)
  • Millbrae (south of San Francisco)
  • Oakland (in the East Bay)
  • Berkeley, Emeryville, or El Cerrito (in the East Bay)

Costs and Financial Considerations

The cost of facial surgery 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 before surgery. 

After your surgical consultation, your surgeon’s office can provide you with a precise quote for your procedure. Costs vary due to geographic location, surgeon experience, the amount of time you will need to be put under anesthesia, whether or not you will need to spend a night in the hospital after surgery, and other factors.

With the help of our insurance concierge, many of our patients can 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. 

Frequently Asked Questions about FFS in San Francisco

To discover whether gender-affirming surgical care is right for you, speak to your care team or book a free virtual or in-person consultation for more personalized information.

Am I a good candidate for FFS?

Physical and emotional health are both critical when seeking FFS. Your age, health history, surgical goals, and other factors determine your eligibility for surgical procedures. If you have certain health conditions, such as diabetes, a bleeding disorder, heart or lung disease, or a previous stroke, you may need additional medical clearance to proceed.

How can I afford FFS?

There are several ways to afford FFS, and most medical plans in California are required to cover gender-affirming care. However, there can still be additional expenses, and patients traveling from other areas of the country or the world may not have coverage for these procedures. We also accept trusted medical financing options such as CareCredit and have numerous scholarship opportunities to lower the barriers to access.

What is the recovery time for Facial Feminization Surgery (FFS)?

Most people who have FFS can return to their normal activities in six weeks. Contact sports have longer wait times, and if you don’t heal as quickly due to a medical condition or complication, you may need to wait longer for more strenuous activities.

How Is Facial Feminization Surgery (FFS) Performed?

Facial Feminization Surgery is performed under general anesthesia. You may be able to go home from the hospital after a short time in the recovery room (outpatient procedure) or may need to spend the night in the hospital (inpatient procedure). Which option is offered to you will depend on the number of procedures you undergo and your unique health needs.

Why should I get FFS in San Francisco?

The San Francisco Bay Area is popular for its high-quality gender-affirming surgeons and inclusive attitude toward transgender and nonbinary folk. Coming to San Francisco ensures you can consult with multiple surgeons, receive valuable information, and experience your surgery and post-op healing in a supportive, caring environment.

Additional Resources

Have questions? The following educational resources and additional materials can help provide you with more information on gender-affirming care options such as Facial Feminization Surgery, along with the full range of risks and recovery recommendations.