Facial Feminization Surgery: What to Expect and Post-Operative Care
Much of the post-operative course is determined by which procedures were done on your face. Not every patient will require “full” facial feminization. The procedures performed will be determined after detailed discussions and analysis, upon which the patient and the surgeon determine a very specific, personalized plan. The post-operative recovery and specific instructions are delineated below for the type of procedure performed:
Scalp Advancement/Brow Lift/Forehead Reduction
These 3 procedures are often performed together. In some cases, a drain is placed. If that’s the case, then the drain will typically be removed on the first post-operative day. You will have a large head dressing that is also removed on the first post-operative day. Your surgeon will gently cleanse the incision line, and you will be instructed on wound care: application of antibiotic ointment to incision 3x/day. The incision can be left exposed, but if there is any leakage (which can be expected for several days), a gauze roll can be lightly applied over your head. The sutures will be removed at 7 – 10 days after your operation, depending on how you’re healing. Expect swelling and bruising in your forehead and around your eyes. The worst of it will be gone by 2 weeks after the operation. Some patients experience numbness in the top of their scalp—this resolves in a few weeks. In a small percentage of cases, this may take up to a year.
For most patients, this procedure is usually the most uncomfortable. Immediately after the operation, you will have tape across the top of your nose, and on top of that, you will have a metal or rigid plastic splint to protect your nose. If any work was done on your septum (such as straightening a crooked septum), then you may have plastic splints (“Doyle splints”) in your nose that are held in place with a suture. All of these dressings and splints must remain dry. The dressings, splint, and sutures will be removed at 1 week after the operation. Drainage, swelling, bruising (especially around the eyes), and stuffy nose are all to be expected after the operation, and can persist for up to a month. You may find yourself having to breathe primarily through your mouth. Apply antibiotic ointment to the incision at the bottom of your nose and around your nostrils 3 times/day. To help relieve some of the stuffiness, use saline nasal spray every few hours. Bleeding is quite rare. This can be stopped with direct pressure and the use of Afrin nasal spray (3 times/day x 3 days). If bleeding doesn’t stop with these simple measures, contact your surgeon. Much of the major swelling and bruising will resolve by 10 days, but expect some swelling to persist up to 9 months. I tell all my patients that you will not see your final results until 1 year after the operation.
Jaw Tapering/Genioplasty (Chin Surgery)
All your incisions will be in your mouth. Since dissolvable sutures are used, there will be nothing to take out. You will most likely have a bulky facial dressing, as well as a compressive tape on your chin that will be removed 1-2 days after your operation. Ice to your face for the first 24 hours will help with swelling. After removal of your dressings, we may then fit you for a compressive garment to be worn for the next 2 weeks. Stick with a soft diet (nothing hard, crunchy, or chewy; a good rule of thumb is to not eat food any tougher than the consistency of scrambled eggs) for 4 weeks. Rinse your mouth gently with warm water (tap water is perfectly fine) after each time you eat. You will be prescribed an antiseptic mouthwash (“Peridex”) to use for 1 week after the operation (“swish and spit” 3 times/day). Gentle brushing of teeth is allowed. Swelling and bruising varies among patients, but expect most of it to be resolved by 2 weeks. You may experience numbness and tingling of your chin, lips, and lower teeth. This resolves in 2-4 weeks in the majority of patients; in a smaller percentage of patients this can persist up to 1 year.
Thyroid Cartilage Reduction (“Tracheal Shave”)
After the operation, you will have a small vertical incision on your neck. The incision will be closed with dissolvable sutures (so nothing to take out) and covered with a piece of tape (“Steristrip”), that you will be allowed to shower over in 2 days. The steristrip will come off on its own in about 7 days. In most patients, pain and swelling is minimal, but can vary from person to person. Temporary voice changes may occur in some patients, but this resolves after the swelling has subsided (usually in 10 – 14 days)
Take it easy, particularly for the first 2 weeks. Facial feminization surgery is major surgery. You should keep your head elevated for at least 2 weeks after the operation (using lots of pillows behind your head, a soft foam wedge, or a recliner). Avoid bending over and doing anything that increases your heart rate or blood pressure. Avoid lifting anything heavier than 20 lbs for 2 weeks. Light walking is okay, starting immediately after your operation. Exercising and other strenuous activities can be resumed at 4 weeks after your operation. You will most likely want to take a week off from work, depending on what you do. The majority of patients feel comfortable returning to work and public view by 10 – 14 days.
It is okay to start taking showers 2 days after your operation. Regular soap and water is fine. Apply antibiotic ointment (avoid using neomycin since this causes allergic reactions in some people) to any incisions 3x/day for 7 days. Avoid any stringent skin care or hair products for 1 month.
Expect to be swollen and bruised after your facial feminzation surgery! The face is richly vascular, so this is entirely normal. The worst of your swelling and bruising will occur at 2 days post-operatively, with the majority of it resolves by about 2 weeks. It does take time to see your final results: At 3 months, expect to see 80% of your results, and at 6-9 months, expect to see your full results.
Minimize sun exposure over the next 9 months after your operation. If you are in the sun, wear a protective hat, and always use sunblock (which should be the case, regardless). All wounds take 9 months to a year to fully mature. If any unsightly scarring does occur, there are various means of addressing it early.
You will be prescribed a strong pain medication (an opioid-type medication containing either oxycodone or hydrocodone), which most patients typically use for 3 – 7 days (pain is variable among patients). Some patients are fine with regular Tylenol after their FFS, but the majority need something stronger. You will also be prescribed a 7-day course of oral antibiotics, and if any oral incisions were used, you will be started on an antiseptic mouth wash. Avoid the use of any NSAIDS (such as ibuprofen, naprosyn, or aspirin) for 2 weeks since they can cause bleeding.
Arnica montana is an herbal medication that can be purchased over the counter and used for two weeks post-operatively to help reduce bruising and swelling. You should start taking this medication the day before surgery.
Medications and all post-op instructions will be reviewed with you in detail prior to sending you home. Every patient’s post-operative regimen will be individualized based on their particular medical history and operative procedures.