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Everything You Need to Know to Prepare for Facial Surgery

This is an overview of all of the preoperative requirements and suggestions for Facial Feminization Surgery (FFS) or other kinds of Gender Affirming Facial Surgeries (GAFS). Being well-prepared for your facial gender confirming surgery can make great improvements in a patient’s recovery process and mental health post-op. To help your experience be as smooth as possible, we provide you with important instructions you can follow for the weeks and days leading up to your procedure. Specifically, we go over: (1) restrictions you will need to comply with before surgery, (2) preoperative healthy habits, (3) getting medical clearance, medications, and medical supplies for your operation and lastly (4) what to do during the final days leading up to your procedure.

1. Pre-Operative Restrictions:

Six Weeks Prior to Surgery

• We ask all our facial feminization surgery patients not to smoke for at least 6 weeks before and after surgery. It is essential that patients not smoke cigarettes or consume any other nicotine products (vaping, gum, patch, etc.) during this time. Additionally, if you are a marijuana user, we also suggest that you switch to edibles or tinctures during this time to avoid smoking.
• Do not have any laser hair removal or electrolysis performed on your face or neck within six weeks of surgery as this will irritate the skin and affect the surgery. You may resume 4 weeks after surgery.
• Patients who are on hormones (estrogen and/or progesterone) must stop their HRT regimen two weeks prior to surgery to decrease risk of blood clots and deep vein thrombosis. Patients will be allowed to resume their HRT regimen after their first post-op appointment or after they have traveled home (if flying). It is ok to continue spironolactone.
• We ask that patients avoid all alcohol consumption for at least one week prior to and after facial surgery. Drinking alcohol while taking prescription pain medication is extremely dangerous and is not permitted.
• Stop taking medications containing aspirin or ibuprofen one week prior to surgery. Review the list of drugs containing aspirin and ibuprofen carefully. Such drugs can cause bleeding problems during and after surgery. Instead, use medications containing acetaminophen (such as Tylenol).
• A week before surgery, please limit your intake of Vitamin E to less than 400 mg per day.
• Review this article for a list of herbal supplements to discontinue a week before surgery as they may increase bleeding and/or interfere with anesthesia.
• Please do not have any dental work done within a week prior to surgery–this includes regular teeth cleaning.
• If you are having surgery on the forehead or brows, do not get your eyebrows shaped prior to surgery as this can affect the post-op result. It is important for patients to come in with their fully grown-out, natural eyebrows so that your surgeon can accurately reshape them.
• Avoid coloring your hair five days before surgery and not until four to six weeks after your surgery, with your doctor’s approval.

2. Preoperative Healthy Habits to Improve your Recovery Process for Facial Feminization Surgery:

Going under general anesthesia is a physically intense experience, so we recommend maintaining a balanced diet and consistent physical activity prior to surgery. Because patients are often sedentary for a short while after surgery, maintaining good physical health will help your body to better recuperate after surgery and may help increase your overall mood during recovery.
Here are a couple ways our patients have been able to maintain a healthy lifestyle before and after surgery:

• Avoid Fad Diets: A ‘fad diet’ is a term that promises quick weight loss (usually through an unbalanced or unhealthy diet). An unbalanced diet means you’re usually cutting out one food group (or multiple), which means you could be losing out on important vitamins. Losing weight quickly may be appealing but can be dangerous for a number of reasons.
• Adopt a Balanced Diet: Focus on eating whole foods, vegetables, and fruit. Avoid sugar, fried food, and processed foods. If you’re currently using government assistance for food, look into your local farmers’ market. A lot of farmers’ markets have a service where you can use your EBT debit card in exchange for coins you can use at the vendors’ booths to buy food.
• Personal Trainer or Workout Friend: Finding a trans friendly or trans identified personal trainer or workout buddy can be a great motivator. If financing is a challenge, ask the personal trainer if they offer a sliding scale. Sometimes attending just one session is enough to gain some confidence in different exercises you can do on your own. Don’t forget, you can work out virtually from the comfort of your home.
• Vitamins: Vitamins help your body heal, which is especially useful when recovering from surgery. We recommend patients start taking 500mg of Vitamin C daily starting at least one week before facial feminization surgery. Vitamin C can irritate bowels, so start slowly. Additionally, you’ll have to limit your Vitamin E intake 7-10 days before your surgery.

3. Medical Clearance and Preparation for Facial Surgery:

• You will usually have your preoperative visit and lab work done about two weeks before surgery. Note that there may be additional costs for laboratory work, particularly if anything a patient’s medical history warrants additional testing. Surgery cannot be performed without the required laboratory results in order to ensure your safety during the operation.
• Please be sure we have a reliable phone number registered with the Gender Confirmation Center to reach you in the time leading up to surgery.
• You will receive your prescriptions about 1 week before surgery. Make sure to have post-operative prescriptions filled. These include pain medications, prescription mouthwash for mouth incisions, and stool softener to aid with the side effects of prescription pain medications.

The following is a list of over the counter medications and other supplies we recommend our patients get prior to surgery. For more information on when it is appropriate to use each of these items during the recovery process, see here:

• Throat lozenges and cough drops 
• Lip balm
• Mild or baby shampoo for use after scalp or facial surgery
• Breath mints or mouth spray
• “Sensitive” labeled mouthwash for rinsing out oral incisions (use prescription mouthwash for first two weeks, then switch to over-the-counter mouthwash)
• Antibiotic ointment (Neosporin or Bacitracin)
• Petroleum jelly (Vaseline or Aquaphor)
• Antacid if you have a sensitive stomach
• Acetaminophen (Tylenol if an over the counter pain medication is needed prior to surgery, any NSAIDs like Ibuprofen/Advil aren’t allowed in the week leading up to and following surgery)
• Saline eye drops to moisturize eyes after surgery, i.e., Natural Tears, ReFresh
• Gentle facial cleanser (Cetaphil) and moisturizer
• Warm socks or booties with traction on the bottom (to help avoid any slips)
• Child’s covered cup or flexible straws with cup or glass
• Ultrasonic humidifier (especially helpful following nasal surgery)
• Night light (to avoid tripping if you need to get up when it is dark)

4. The Final Days Before Surgery:

One to two days prior to surgery we recommend that our patients get the following preparations ready. We recommend that you set out clothing that is loose and buttons or zips up the front. A warm-up or jogging suit is ideal. No pullover tops should be used for three weeks after facial surgery. Additionally, most FFS patients stay overnight in the hospital, so please bring the following items in a bag with you:

• Your cellphone, wallet, other essential items/documents
• All prescription medications, including prescription mouthwash
• If you are not going to have any internal mouth incisions, you may bring a toothbrush and toothpaste
• Small overnight bag to hold the clothing you wear to the surgery facility
• It is recommended you bring the following, in the very rare event that you will stay two or more nights: bathrobe, pajamas, or gown that buttons up the front, and slippers

Please follow the following steps for the night and morning prior to your surgery:

• Do not eat or drink anything after midnight the night before your surgery. Your stomach must be empty to decrease nausea and avoid anesthesia problems. When brushing your teeth, you may use mouthwash. You can take your routine medication with a sip of water.
• DO NOT eat or drink anything prior to surgery. You may take regular prescription medications such as blood pressure, thyroid, etc. with a small sip of water. Be sure you do not take any aspirin-containing products, blood thinners, etc. Bring your prescription medications with you to the hospital or surgery center.
• You may shower and wash your hair, but do not set or spray it. Do not use facial or body moisturizer. Do not shave the morning of surgery. Brush your teeth with minimal water and use mouthwash.
• Wear flat shoes that are easy to slip off.
• You should not wear panty hose or girdles, and should not wear make-up. In addition, please do not wear jewelry, earrings, rings, or hairpins, or false eyelashes. It’s best to leave all of these at home.
• If you wear contact lenses, eyeglasses, or dentures, bring your cases with you. Be sure your name is on the outside. Bring your glasses if you wear contact lenses as contacts might not be comfortable to wear for the first few days after surgery; however, if you are getting a rhinoplasty, you should not wear glasses or have any pressure placed on your nose bridge for the first six weeks after surgery.
• Arrive in the admitting department of the hospital or surgery center two hours before your procedure is scheduled to begin, or when you have been directed. The surgery center staff will greet you and prepare you for surgery.

What about piercings and facial surgery?

If you have piercings on your face, you should let your surgeon know prior to surgery. In the informational video below, Dr. Facque (he/him) explains how piercings play a role into planning surgery and when patients can get facial piercings post-op: