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What will my face look like after FFS? Post-operative aesthetics and healing

This is an introduction to the aesthetic recovery timeline for Facial Feminization Surgery (FFS) or other kinds of Gender Affirming Facial Surgeries (GAFS). Many of the inquiries we receive about “male to female (MTF) surgery results” or “facial feminization surgery (FFS) before and after” have to do with a patient’s concerns about how their appearance will change over time. Overall, it takes 9-12 months for patients to see their final results, although it often takes longer for skin to tighten and scars to fully mature. This is why we typically wait a year to make any facial surgery revisions. We go over the general appearance healing timeline for bruises, swelling, and scars and what you can do to maximize healing (e.g., tobacco, marijuana and alcohol consumption restrictions). For a more in-depth review of the recovery process, click here. For FFS before and after pictures, click here.

While it may be hard to tell exactly how your face will look after facial surgery, your surgeon will listen to your concerns and needs and do his best to help you visualize what your final outcome might be. The overall post-op appearance for patients who undergo FFS is dependent on their facial shape, skin characteristics, and the techniques and incisions used during your surgery.

Healing From Facial Feminization Surgery

As mentioned in the surgery overview, facial feminization surgery consists of multiple procedures located in four regions of the face: the upper third of the face, middle third, bottom third, and the neck. However, not all patients will ask for or be appropriate candidates for procedures in all of those areas, making the recovery time for FFS individualized for each patient.

The information below will outline the typical recovery for someone who has had procedures done in two of the three facial areas, meaning that recovery will likely take longer for a patient who has more procedures and will be shorter for a patient who has fewer procedures.

Generally speaking, patients will take 3-6 weeks off from work and 1-2 weeks off from normal daily routine tasks. This depends on the nature of the patient’s work, their motivation to get back to work in a certain time frame, as well as their emotional journey during the recovery process. Going back to work and re-engaging in a social life with major structural changes to the face can be incredibly challenging and should not be understated.

The incisions will mostly be closed by the two week post-op mark, although the scars will continue to heal and mature over the following 12-18 months. Similarly, the bruising will mostly be resolved, and post-operative pain will likely be reduced to discomfort that is manageable without narcotics in this time frame.

In this informational video, Dr. Facque (he/him) describes how the healing timeline is different for each facial surgery procedure. Keeping this in mind can help you maintain realistic expectations around how long it will take for you to see the results you are hoping for after surgery:

Maintaining Realistic Expectations After FFS Procedures

It’s important to maintain realistic expectations after having facial feminization surgery. FFS is a powerful and often life-changing procedure for folks who experience dysphoria or discomfort related to the shape of their face, but there are trade-offs. There are three main reasons why it can take so long to see final results after surgery:

1. While the scars will do the bulk of their healing between 12 and 18 months post-op, they will continue to mature for an additional 2-3 years after surgery.
2. Most of the swelling will resolve in the first month, it may take up to 9-12 months for the swelling to completely fade away; this is especially noticeable with mandible/jawbone contouring.
3. Lastly, surgeons and patients rely on the skin to tighten up after surgery to see the effects of the changes underneath. This phenomenon is called skin retraction, and this is one of the main reasons why it takes so long for some patients to see their final results.

Generally speaking, visible results from procedures in the top third of the face (forehead/brow) tend to show up the fastest while the scar in the forehead or scalp takes the longest to heal. In contrast, incisions in the mouth for the procedures of the jaw or chin are healed within a few days but the results of those surgeries take the longest to see. In all, patients normally begin to see their final results from their facial feminization surgery around 9 months to a year post-op, although some patients are able to see changes as early as the first day after surgery. After a few weeks, enough of the swelling and bruising will have resolved for patients to be able to see some of the changes to the bony structures of the face and their soft tissue features.

Because final results are often not visible until 9-12 months after surgery, this is how long we wait until we consider any revision surgeries. Any revisions will require a longer recovery period.

Head to the post-op articles to read more about the recovery milestones and healing after facial feminization surgery.

Achieving Ideal Post Op Results After Facial Feminization Surgery

Just as with chest reconstruction or breast reduction top surgery and breast augmentations, avoiding alcohol and nicotine in any form are required before and after surgery. Specifically, patients are asked to stop nicotine use 6 weeks prior to surgery, as nicotine prevents scars from fully healing. There is less research on the effects of marijuana smoke on surgery recovery, but any amount of smoking within this window does have an impact on general anesthesia and can lead to respiratory complications in the immediate post-op period. For patients who use marijuana medically, edibles or oil may be a way to reduce those risks. Methamphetamine use can also lead to seriously devastating complications when combined with general anesthesia and can cause issues with wound healing.

Additionally, gaining or losing weight can affect post-op results. While all bodies change in size and shape naturally over the course of time, for patients who are actively attempting to lose weight, it is recommended to postpone surgery until their weight has more or less stabilized. This is especially important for interventions in the lower third of the face and the neck. The Gender Confirmation Center does not have BMI restrictions for our patients, but the risk for surgical and anesthetic complications generally increases the higher a patient’s BMI is.

We believe that patients should have full autonomy over their bodies, and that all bodies are unique. If you want to speak with Dr. Ley (she/her/they) or Dr. Facque (he/him) about your unique body, facial shape, and facial feminization surgery goals, contact us or schedule a free consultation today!