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 with training and experience in gender-affirming facial surgery techniques have access to some of the best facilities and some of the most cutting-edge medical technology in the world. The welcoming environment to the LGBTQ+ community that much of the city provides, and the peace of mind that you will receive some of the best care out there brings many patients to the San Francisco Bay Area for FFS. In this guide, we will go over information about facial surgeons, travel tips, recovery instructions and how to get FFS in San Francisco. 

What is FFS?

Facial Feminization Surgery (FFS) is a set of gender-affirming procedures patients can choose 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 & eyebrows), middle (nose & cheeks) and/or lower (lips, chin, jaw & trachea or Adam’s Apple) thirds of the face.

What to Expect During Your Consultation

Facial surgery consultations at the Gender Confirmation Center (GCC) are free of charge. Since many of our patients come from out of town, we offer virtual appointments with both Dr. Facque (he/him) and Dr. Ley (she/her/they). 

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. It is important that you are 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.

Finding the Right Surgeon in San Francisco

The following factors can help patients choose which surgeon would be best for their FFS in San Francisco:

    • Board certification and hospital privileges are non-negotiable. Undergoing surgery with providers who do not have these qualifications can put patients’ health at serious risk.
  • Specialized training, continuing education and experience working with transgender, non-binary and gender non-conforming patients. Not all facial surgeons have the training, experience and sensitivity to properly serve gender diverse patients. Gender-affirming surgery can differ from other cosmetic and reconstructive procedures.
  • The surgical consultation is a space for you to get to know your surgeon. Your surgeon should be open to your feedback on what you do and do not want. Likewise, the answers they give to your questions can help you determine whether or not they are a good fit for you.
  • Before-and-after photos, patient reviews and testimonials can help you get a sense of the kinds of results a surgeon is able to deliver.

In some cases, patients may want to schedule consultations with multiple surgeons to get a sense of who would be a best fit for them.

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. It is important that you 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 that 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 that 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. Antacid 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. 

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 6 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 communities. In his professional formation, he was valedictorian of his graduating class in medical school, recipient of the Dean’s Scholars Award and finished his training in the Gender Surgery Fellowship under the guidance of Dr. Loren Schecter. He is deeply committed to centering his patients’ needs in the creation of 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. Prior to joining the GCC in 2022, she worked as an assistant clinical instructor of plastic surgery at the University of Utah and worked at 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 not only for her skill level, but also for her ability to empathize with patients as a trans person herself. 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.

Travel Tips and Resource for FFS in San Francisco

San Francisco has one of the most expensive costs of living of any city in the United States. Still, many patients choose to travel to the San Francisco Bay Area for FFS because of the natural-looking, high-quality results and state-of-the-art medical technology that surgeons offer. 

Many of our patients at the GCC travel from out-of-town to undergo gender-affirming surgery in San Francisco. As a result, we have compiled a free travel guide with resources and tips to help you save costs on travel, lodging and more. Likewise, if you’re interested in doing some sight-seeing before your operation, you can find tourist recommendations there as well.

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 prior to 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 more factors.

With the help of our insurance concierge, many of our patients are able to 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.