Facial Feminization Surgery (FFS) | Legacy Surgical Partners

Welcome to Legacy Surgical Partners – we look forward to caring for you! Our priority is to make your surgery process and everything in between as pleasurable, empowering, and accessible as possible. Patients are expected to follow guidelines established by the WPATH Standards of care Version 8. We follow these standards—not as a gatekeeping hurdle—but as minimal guidelines that are useful guideposts that are protective. Though regret for gender affirming surgery is extremely rare, we are medical professionals who are here at your bequest. Surgery is irreversible, which puts the onus of responsibility on both patient and provider.

We're here to help you make essential decisions and know what to expect in surgery planning and recovery. Our team consists of:

Surgeons
A physician assistant
Medical assistants
Sugical coordinator
Office team
And you

That’s right, you! We value your input, your perspective and all the work you are and will be doing to prepare for and recover from surgery. We look forward to getting to know you better and learning how we can help you.

We want to make your surgery and recovery as smooth as possible. We’ll answer any questions you have and make sure you have the best possible outcome.

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I. Facial Feminization Overview

We know this surgery is extremely important. It takes incredible trust to allow a surgeon to perform this operation. We want you to know that your trust in our team humbles us, and we take it very seriously.

The first step in this complex process is understanding your options and creating a plan that meets your needs. We’ve created this overview to help you make essential decisions and know what to expect.

What is facial feminization surgery?

The goal of facial feminization surgery (FFS) is to treat a variety of aspects of the face to make your face look more feminine while, most importantly, maintaining your unique appearance. Not everyone would want or benefit from every facial feminization technique. Since each person has unique features and goals, there is no "cookie cutter" surgical strategy for FFS.

We like to think of the face in three regions:

Upper Third: the eyebrows, orbits, forehead, and the hairline.
Middle Third: the eyes, cheeks, and the nose.
Lower Third: the lips, jaw, chin, neck, and tracheal cartilage.

II. Before Surgery

Before your first consultation, we encourage you to:

Consider your goals and priorities for surgery. Whether your goals are to reduce misgendering, improve your self-image, a combination of both, etc.
Write down your questions and bring them with you to your visit.
Reflect on the areas of your face that you like. It will be essential for us to maintain those aspects of you. Everyone has feminine and masculine traits to their face. We will ask you to consider which features fit your identity and which you find particularly bothersome.

Your First Consultation

Your first consultation is an opportunity for us to learn about your hopes and goals. You will receive a questionnaire to help us meet your needs and measure the results before your appointment. Your surgeon will review various surgical options and explain the process.

Evaluate your facial anatomy by taking measurements of your face and documenting asymmetries.
Assess your overall health to see which surgeries can meet your goals. You may be asked to lose weight or make lifestyle changes to prepare your body for surgery.
Ask you to have a CT scan completed of your face as this is needed to get a better idea of bone anatomy and helps with surgical planning.

A fair amount of time is spent during the consultation with your surgeon, but you may also meet the other care team members. When team members introduce themselves, they will discuss their role in your care and answer your questions.

Facial Feminization Options

Not all patients will benefit from all types of facial feminization surgery. It helps to think about concerns in areas of the face, as similar surgical approaches can often reach different areas of the face. Facial feminization can range from one to multiple surgeries depending on needs, desires, the number of areas treated, and patient recovery goals.

Upper Third

This area addresses the hairline, the forehead and the orbits (bony structure around the eyes).

Middle Third

This area addresses the eyes, nose, and cheeks.

Lower Third

This area addresses the lips, jaw, chin, neck, and tracheal cartilage.

III. Preparing for Surgery

FFS is very complex and can involve an extensive set of procedures. A large part of its success depends on your preparedness. This means being in the best possible physical and mental health before the surgery.

Above all else, it is crucial to have reasonable expectations about what is possible for your body and what your surgeon can realistically accomplish. We recommend you:

Talk with a mental health professional who has an understanding of gender care to help navigate this complex process and exciting period of your life.‍
Connect with peers who have been through this surgery for support. Please keep in mind that each person’s surgical plan, result and experience is unique. Information shared on some online forums may not be relevant to your surgery. Due to patient privacy laws, we never comment on another patient’s specific issues or experiences. We are happy to clarify anything related to your individual care.

Healing from FFS

Healing from FFS will depend on what surgeries have been performed and will vary from person to person. It is not uncommon for patients to have some anxiety after surgery or a feeling of claustrophobia among those who have undergone extensive facial surgeries. Swelling and bruising can be significant after surgery. Avoid exertion, straining, bending or lifting for two weeks after surgery.

You and your surgeon will discuss activity restrictions and limitations at your post-op visit. You are encouraged to walk short distances for the first few post-operative days and progress as tolerated. Elevate your head by sleeping in a recliner or propped up in bed with several pillows for 3-5 days after surgery to help minimize bruising, swelling, and discomfort. A humidifier/vaporizer will assist in keeping nasal secretions more liquefied, aiding in draining nasal passages. Do not wear glasses for six weeks after surgery. No contact sports for two months after your surgery.

Maximizing Healing

We like to think about surgery like running a marathon. You will be stressing your body and will have to do significant healing. In the months and weeks leading up to surgery, maximizing your health—both mental and physical—will aid in having a swift recovery.

To maximize healing, we recommend:

Getting roughly 0.5 grams of protein per weight in lbs daily to maximize healing (Ex: 150lb x 0.5=75g of protein per day).
Reducing sugar and processed foods.
Remaining active before having surgery. Keeping up with or adding a workout plan will benefit your overall health and aid in a speedy recovery Examples can include adding daily walking, home yoga, or simple home workouts with body weight to your daily routines.

IV. Planning for Recovery

We understand the importance and urgency of this surgery. We also know your success hinges on being well-prepared. Remember, this is a lifelong investment in your health. Optimal preparation can improve your chances of positive physical and mental health outcomes.

V. Surgical Results Gallery

Below are examples of facial feminization surgeries performed by our team. These images are shared with full patient consent and are intended to help you understand what to expect. They include pre-op and post-op views, which may contain nudity and surgical results.