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Everything You Need to Know About Facial Feminization Surgery Recovery

This is an ultimate guide to the steps you’ll need to take to successfully recover from FFS organized by the major postoperative recovery milestones. We recommend that our patients finalize their recovery plan a few weeks before surgery, so we encourage you to consult this timeline on what kinds of support you’ll need at different points in the recovery process, such as: when you’ll need 24/7 care, when you’ll be able to return to work, etc.

Since there are many procedure options available under the umbrella of gender affirming facial surgery, the following is an approximation of what one is likely to experience. If you have questions about how the following post-op recovery milestones apply to your specific set of procedures, we highly recommend that you speak with your surgeon. We also have more specific guides on the emotional recovery process, visible incision and scar care, internal mouth incision care, healing bruises and swelling, as well as postoperative complications.

VERY IMPORTANT: If you experience excessive bleeding, pain, drainage of pus, fever and chills, increased swelling after day 3, or any other complication, please reach out to your surgeon at (415) 780-1515. You can reach them day or night by calling the normal office line.

Practical Milestones After Facial Feminization Surgery

Week 1 (first 7 days):

• Leaving the hospital: A family member or friend must drive you home from the hospital. Depending on how many procedures you get done and what types of procedures are performed, you may stay the night in the hospital after your surgery. Regardless, once you leave the hospital, someone should stay overnight with you for the first few nights. If you have any questions, please ask one of our nursing staff members.
• Swelling: You may notice swelling and bruising develop around this time, likely around the eyes, cheeks, and nose. It may feel hard to see, breathe through your nose, or consume more than liquids during this first week. Swelling and bruising may get worse for the first few days before they start to resolve. Swelling peaks on the third day post-op, and begins to reduce after 72 hours. Icing and arnica montana supplements can help mitigate these effects.
• Icing: Cold or ice packs help to reduce swelling, bruising, and pain. During the first three days post-op, we ask that patients apply ice packs for 20 minutes to the face every hour. Icing can still help reduce swelling after the first three days, but it will not be necessary to do so at the same frequency. However, if a patient undergoes a rhinoplasty, they should not apply any pressure to their nose for at least six weeks. This means that during the first 72 hours post-op, it is necessary to have 24-hour care so that overnight ice packs are still being applied.
• Preventing ice burns: Using ice packs should not hurt. The face should not be exposed to ice for more than 20 minutes at a time. Before placing it against the skin, put a cloth between your skin and the ice. We often recommend patients check the temperature on the back of their hand before placing it on the area they were operated on; sometimes you can inadvertently hurt your skin if you don’t check the temperature before placing it on the affected area. Some areas of the face and neck will be numb after surgery, which can also lead to inadvertently hurting your skin. If the ice still feels uncomfortable, you can reduce the frequency of its use.
• Bandages, Compression and Elevation: Depending on the procedures you undergo, you will likely leave the hospital with gauze over your incisions and bandages wrapped around your face. You should keep your dressings as clean and dry as possible. Don’t remove them unless instructed to do so. We recommend keeping your head elevated at all times and keeping snug compression garments or bandages on the face as much as tolerable for the first week after surgery. This will help reduce swelling, although some swelling will still occur and will last to some degree for up to 6-18 months depending on the amount and types of procedures performed.
• Diet: Please maintain a low-to-no-sodium diet to reduce swelling. If there are any incisions in the mouth–from mandible contouring, a genioplasty, or silicone cheek implants–we recommend that you maintain a soft food diet for at least two weeks. Eating hard or sharp foods especially can pre-maturely open the incisions.
• Incision care: During this time, all exposed incisions, namely the hairline “coronal” incision, should be treated with Bacitracin or Neosporin cream twice a day to keep them moist and to prevent infection. To apply the antibiotic ointment, bandages will first have to be taken off, gauze thrown out, cream applied, and new gauze applied over the incision sites before re-wrapping the bandages. To take care of incisions in and around the hairline, please do not brush or wash your hair by pulling away from the scalp or incision line. On the other hand, incisions inside of your mouth should be treated delicately and cleaned only with mouthwash after every meal. For more about internal incision care, such as when patients can start brushing their teeth with a soft or baby toothbrush, see here.
• Sinus precautions: If you had a frontal sinus setback, you will be on sinus precautions for the first three weeks, which includes no nose blowing during this time. If you have to sneeze, we recommend you do so with your mouth open to reduce internal pressure.
• Showering: You may start showering 24-48 hours after surgery as long as you keep the face and neck dry. As a result, we recommend that patients bathe themselves or are bathed by a support person with a sponge. Water splashing on the face is ok, but you should not submerge your face under water or even run your hair or face under the shower until after your first in-person visit with your surgeon.
• Physical activity: It is important to go on daily walks to reduce the risk of blood clots. For the first week, just walk around your house. Take care to avoid stairs, cluttered areas, loose rugs, and any other obstacles that could result in slips, falls, or injuries while you’re taking narcotics or have increased swelling around the eyes.
• Exhaustion: As you might expect, undergoing any surgical procedure that involves general anesthesia is a quite rigorous experience for the body. Therefore, you should expect to feel some amount of physical exhaustion in the first couple weeks after surgery. Small tasks, like walking to the bathroom, taking a sponge bath, or getting the mail might be much more tiring after surgery than you are used to, so we recommend setting up adequate post-op support to help reduce any physical exertion.
• Changes in sensation: It is very common for patients to experience facial tightness, numbness and discomfort post-op, which may make certain facial expressions difficult. One common change in sensation has to do with hairline advancement. Because this procedure manipulates the nerves on the scalp, patients may experience numbness, tingling, phantom pains, or itchiness on the scalp or other areas of the face. Some patients find that using their fingers to put some light pressure on the scalp may alleviate some of the itchy and tingling feelings, but it’s important not to disrupt the healing process by rubbing or scratching your incision areas as they heal.
• Smoking: Smoking reduces capillary flow in your skin. We advise you not to smoke at all or consume other nicotine products during the first 6 weeks after surgery. Marijuana use should be restricted to edibles or tinctures during this time.
• Alcohol: Alcohol dilates the blood vessels and could increase postoperative bleeding. Don’t drink until you have stopped taking prescription pain pills, the combination of pain pills and alcohol can be dangerous. Wait at least one week to drink alcohol after surgery.

Week 2 (days 7-14):

• First Post-Operative Appointment: Around a week after your surgery, you will be scheduled for an in-person follow-up appointment with your surgeon or one of our supporting medical staff to check on your healing and remove any staples and non-dissolvable sutures.
• Bandages, Compression and Elevation: At this point, patients do not need to wear bandages during the day, though it is still recommended that they wear them at night for precaution. It is advisable to continue wearing compression garments as comfortable. Otherwise, patients should continue to maintain their head elevated 24/7 as keeping it level or at the same level as the heart when lying down can increase swelling.
• Incision care: As your incisions heal, you may use Aquaphor or Vaseline to keep them lubricated. It is essential to prevent them from being exposed to the sun. If you have internal mouth incisions, you may start brushing your teeth gently with a soft toothbrush. We still recommend that you rinse your mouth with mouthwash after every meal and eat only soft foods. Regardless, all patients should continue a strict low-sodium diet through the second week of recovery from facial surgery.
• Showering: Once your surgeon has given you the green light, you may begin to wash your hair in the shower if it is safe for water to finally run over the incision site. When washing your hair, do so gently, preferably with baby shampoo, and avoid brushing or otherwise pulling the hair away from the incision site. Shampoo can help remove scabs and otherwise keep the coronal incision clean during this time.
• Physical activity: Plan to continue going on several short walks per day. This will help your body recuperate from anesthesia and help prevent any blood clots from forming. Otherwise, try to avoid any straining or weight lifting.
• Driving: Once you’ve passed the 1 week point, you may be able to drive as long as you are off prescription pain medication and feel safe doing so.

Weeks 3-5 (days 15-35):

• Scar care: Exposed scars should continue to be treated with Vaseline or Aquaphour and kept out of the sunlight. Patients should start massaging their exposed scars, applying pressure to flatten them; feelings of slight discomfort or pressure are normal during a scar massage, though it should never reach the point of pain. Once you’ve passed the 3 week point (day 21), you may begin to treat your scars with silicone. Refer to our scare care instruction guide for more detailed information on helping your scars heal.
• Bandages and Compression: At this point, patients no longer need to use bandages, though the use of compression garments is still encouraged.
• Diet: Patients may slowly come off the no-to-low-sodium diet at this point. Likewise, patients may slowly come off of a soft-food diet if they have internal mouth incisions. Though, if any bone contouring was performed, they still may be sensitive to food that is hard or requires greater force to chew.
• Physical activities: After three weeks, you may resume light physical activity. You may get in a pool and bathe as long as your incisions are closed. Prior, no heavy lifting or bending over should happen within the first 3 weeks of healing. You may go to the bathroom, sit and watch TV, etc., but NO MATTER HOW GOOD YOU FEEL, DO NOT CLEAN THE HOUSE, REARRANGE THE ATTIC, ETC.!  We do not want you to bleed and cause any more swelling and bruising than is unavoidable. It is possible that this could result in an emergency that would require treatment in an emergency room or even the operating room. Importantly, in the long term, bleeding after surgery can lead to complications that may affect your result!
• Sinus precautions: If you had a frontal sinus setback, this is your last week of sinus precautions: avoiding nose blowing and sneezing with your mouth closed.

Week 6 weeks post-op:

• Physical activity: Patients may resume full activity at this point, other than competitive/contact sports or any yoga/stretching with prolonged inversions.
• Returning to Work: While some patients may return to work sooner than this point, we recommend patients begin resume work and other lifestyle activities at this time. Generally speaking, our surgeons will not write a work notice for longer than 6 weeks after surgery.
• Scar care: Keep scars out of the sun, continue to massage them, and continue use of silicone gel.
• Pain and swelling: After this point, your body will continue to heal, swelling will continue to go down, and incisions will continue to fade. By now, about 80% of your swelling will have gone down, though it will take until around month 12 for your swelling to be completely gone–for example, to see the final shape of your jaw if you had a mandible contouring. If anything feels painful, strange, unexpected, or just “off,” please get in touch with our office to talk about what you’re experiencing.
• Changes in sensation: Because all facial feminization procedures involve either contouring bone or manipulating soft tissues, cartilage, or skin, there are some changes in sensation to be expected while recovering from FFS. Often, patients will report feeling a tightness in their face that may take some getting used to. Face tightness is typically described as discomfort associated with moving certain areas of the face and the need to re-learn certain facial movements. This usually resolves around 1-2 months after surgery.

6 months post-op:

• Future operations: Especially if you had a rhinoplasty, we ask that you avoid undergoing any major surgery that involves general anesthesia before this point.

12 months post-op:

• Final results and revisions: Generally speaking, final results are not visible until a year has passed since your Gender Affirming Facial Surgery. That said, scar maturing and skin tightening often take up to 18 months. As a result, we generally do not conduct any revisions before 12 months have passed.

In Summary…

Recovery from facial surgery can be an emotionally difficult process as you wait for the most visible part of your body, your face, to heal. Besides having an active support network, Dr. Facque describes in the video below how good communication with your medical providers can be of enormous help. You should be able to ask medical staff, like a physician’s assistant (PA) or a registered nurse (RN), if you will need medical attention for what you are experiencing in recovery.