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Facial Feminization Surgery: Should I Get All My Surgeries at Once?

Transgender women and nonbinary people are often faced with the uniquely individual decision of how to align their internal sense of feminine self with more masculine external traits. Most, if not all transgender women undergo hormone replacement therapy (HRT) to help enhance their features with a more feminine look. However, even after a year of HRT, they may still be faced with features that look more masculine than they would wish, causing gender dysphoria.

Having a more feminine face allows the patient to identify with their gender more closely. Following Facial Feminization Surgery (FFS), many transgender women experience improved self-esteem and increased confidence in their appearance. However, there may be many complex procedures involved in FFS, so many are left wondering should I get all my surgeries at once? Or should I have multiple procedures?

At Zinsser Plastic Surgery, Dr. John Zinsser and our expert team are here to help you navigate your FFS journey to help you achieve your aesthetic goals so you can finally feel comfortable in your own skin.

What Is Facial Feminization Surgery?

Facial feminization surgery is a complex collection of procedures that enhances the shape of the face. The goal of FFS is to revise the facial features to look more feminine to allow you to be more comfortable and confident. For many transgender individuals, this is an important and intimate step of accomplishing their transition to align their internal sense of self with their physical characteristics.

Some examples of FFS procedures may include creating a smaller forehead, augmenting the lips and cheekbones, or redefining the jawline and chin. Having multiple procedures simultaneously may seem overwhelming, but it is common to have them performed together.

Depending on the number of procedures included in your FFS, you may have them all at once or they may be separated into two surgeries—one surgery for the top section of the face, and a second surgery to address the bottom of the face. When FFS is completed in one comprehensive surgery, it may last eight to nine hours.

While there are general characteristics that comprise a gender’s overall aesthetic, every patient has unique facial features. The design of your facial feminization surgery will be tailored to your specific needs and anatomical structure.

Many FFS procedures can be performed together, including:

Your FFS Consultation

During your FFS consultation, Dr. Zinsser will work with you to develop a customized treatment plan based on the procedures you wish to include in your FFS. Our goal at Zinsser Plastic Surgery is to help you to feel comfortable and confident in your own skin.

To ensure you are prepared for your facial feminization surgery, Dr. Zinsser will explain the risks and benefits of your FFS in detail. Then, he will assess your physical and mental health, examine your facial features and skin quality, and discuss crucial decision points.

Depending on the extent of your FFS and the procedures included, Dr. Zinsser may recommend completing your full FFS in multiple stages to ensure your health, safety, and optimal results. One reason behind recommending multiple stages may be surgeries that require extensive time under anesthesia or involve significant blood loss.

How Do I Prepare for FFS?

During your consultation, your surgeon will explain your FFS options and their potential results. They will also provide you with a thorough list of activities that will help you to best prepare yourself for FFS. Here are some examples.

  • If you haven’t already been eating a nutritious diet, prior to your surgery is a good time to modify your eating habits. Before surgery, focus on preparing your body for healing by providing it with nutrient rich foods, including fresh vegetables, lean proteins, and low sodium foods.
  • Beginning a healthy exercise program prior to your FFS can help make your recovery process easier.
  • Quit smoking, vaping, or using other nicotine products at least one month prior to your surgery. Smoking and nicotine affect the body’s healing process and can significantly impact your recovery and results. It’s also important to remain smoke-free at least one month after surgery.
  • If you are seeing a mental health provider, continue that practice. A therapist can help you with coping skills during your preparation for FFS.  
  • About two weeks before your procedure, stop taking herbal supplements, especially those that contain garlic, fish oils, ginseng, or zinc. You should also avoid taking medicines that contain aspirin as they can cause additional bleeding.
  • Limit caffeine and alcohol consumption for at least two weeks. Avoid alcohol altogether for at least 48 hours prior to your procedure.

Plan for Recovery

Recovery is one of the most important aspects of any surgical procedure. While you’re preparing your body for a healthy recovery, it’s also a good idea to prepare your environment. Here are some tips for planning a safe and healthy recovery.

  • Fill any prescriptions a week prior to your surgery, including pain medications or antibiotics.
  • Have your support system lined up. Arrange for someone to stay with you for the first few days as you may need help doing simple physical tasks.
  • Rest is crucial following surgery. Create a comfortable, relaxing place to rest with plenty of entertainment.
  • Arrange essential items in advance to ensure you can easily reach items you’ll need.
  • Have plenty of pillows to sleep with your head or upper body elevated per your surgeon’s recommendations.
  • Prepare nutritious meals in advance that may be frozen and easily reheated to ensure you’re not worried about food prep during recovery. If you aren’t handy in the kitchen, consider signing up for a meal delivery service or ask for help with meals.

How Long After Starting HRT Can You Get FFS?

While it is not necessary to be on hormone replacement therapy (HRT) for any length of time prior to getting your facial feminization surgery, it might be a good idea to wait at least a year after starting HRT. A year might sound like a long time, but the timeframe allows the hormones to have a greater effect on your facial features.

After this time, you might find that the hormones have changed your facial appearance, and you might not feel like you need as many procedures as you initially thought.  

What Should I Not Do Before FFS?

While your surgeon should provide you with a list of activities to avoid prior to your procedures, here are some examples.

  • Smoking, vaping, or using any other nicotine products prior to your FFS is prohibited for at least four weeks prior to and following your procedure.
  • Avoid drinking alcohol for at least 48 hours prior to your surgery. Alcohol can thin the blood or interact with anesthesia, leading to serious complications.
  • It’s important that you don’t eat or drink after midnight before FFS. However, make sure to eat a balanced dinner the night before your surgery.
  • Even if you’re having trouble sleeping, don’t take any sleeping pills the night prior to your procedure.
  • Shower and shampoo before your procedure; however, don’t apply deodorant, sprays, lotions, or creams. Avoid swallowing water or toothpaste when brushing your teeth. Wear glasses rather than contacts. Remove all piercings before heading to the surgery center.
  • Avoid restrictive clothing on the day of surgery. Instead, wear comfortable clothes that are easy to remove—a loose button up or zip up shirt works great.

How Do You Know if You Are Ready for FFS?

While the possibility of achieving a more feminine face with FFS is exciting, it’s also normal to feel apprehensive in making this important decision. Some doubt or hesitation is normal, and it creates an opportunity to assess your feelings, ensuring you are fully prepared—mentally, emotionally, and physically—for the next step.

Before having facial feminization surgery, most insurance companies and surgeons require a letter from your mental health provider to determine you meet the criteria for the World Professional Association of Transgender Health standards, which include:

  • Well-documented and persistent gender dysphoria
  • The ability to make fully informed medical decisions and to consent for treatment
  • You have reached the legal age to make health care decisions—age 18 in the US
  • How you manage and control any significant medical or mental health concerns
  • Your current support system
  • How facial feminization surgery may improve your quality of life

The decision to have FFS is yours alone. While advice and support from others, including doctors, mental health professionals, and supportive family and friends, is immeasurably important, only you can make the decision of how to proceed with your FFS. Follow your instincts and go with what feels right, but make sure you allow yourself plenty of time to think so that you can avoid getting pressured into a choice you may be uncomfortable with.

Here are a few other factors to help you consider whether you’re ready for your facial feminization surgery.

Gender Dysphoria

When deciding whether you should have your FFS procedures at once or which surgery you should have first, you may ask yourself how gender dysphoria impacts your quality of life. Consider creating a list of ways your quality of life could be improved by completing your FFS, including better self-image or self-esteem.

Support System

With any surgical procedure, it’s important to develop a strong support system. Prior to your procedure and during your recovery you’ll need assistance from your family and friends, including emotional and practical physical support. Reach out to those who have supported you in the past.

Mental Health Check

A therapist can help you manage many mental health concerns, including helping you talk through the deeply personal decisions you will face in determining whether to have your FFS at once. With many physical, mental, and emotional expectations to manage, a therapist can help you handle stress relating to your FFS and making other informed decisions about your health.

Establish Your Gender Identity

Facial feminization surgery is a collection of major procedures that changes your face permanently, so take adequate time to establish your gender identity before committing to a surgical solution. Exploring your gender identity in a comfortable space can help you make sure you’re making the right decisions for you.

Explore your gender identity for at least a year to determine how you feel before considering surgical intervention. Insurance companies and surgeons may not approve your FFS until you have been living as your gender for at least a full year.

External Factors

When you’re determining whether to have your FFS all at once, you need to consider your complex feelings, but you also may need to take other factors into account. Outside factors that can impact any surgery may include financing, fees, insurance approval, or even scheduling time off work for a healthy recovery.

Why Should I Choose a Board-Certified Plastic Surgeon?

With many options available, finding the right plastic surgeon for your unique situation can be a challenge. There are many factors to consider when choosing your plastic surgeon; they should be professional, sincere, highly experienced, and board-certified.

The first factor to consider when choosing a plastic surgeon is board certification. By selecting a board-certified plastic surgeon, you’re choosing a doctor who upholds unsurpassed standards of education, knowledge, and skills.

Choosing a board-certified plastic surgeon with an impeccable reputation not only ensures your optimal results but also that your health and safety are in good hands and that you’ll receive appropriate care throughout your cosmetic surgery journey.

When choosing your FFS plastic surgeon, another important factor to consider is that you feel confident trusting your surgeon and openly communicating with them.

Choosing Zinsser Plastic Surgery as Your Richmond FFS Specialist

When you’re searching for an FFS specialist, finding one who is highly experienced and wholly compassionate is invaluable. At Zinsser Plastic Surgery, we only have one goal: helping you achieve your goals so that you can feel comfortable in your own skin. Dr. John Zinsser and his expert team have developed an inclusive gender-affirming environment where they aim to help you create the appearance you deserve.Contact Zinsser Plastic Surgery PC at (804) 474-9805 or complete our online form to schedule your FFS consultation today.