What’s It Like Being Put Under General Anesthesia for FFS?

Publication date: 6/2026

A common question patients ask Dr. Mittermiller before facial feminization surgery is what it’s like being under anesthesia. The idea of being fully unconscious while someone operates on your face can seem like the most uncomfortable part of the whole experience, especially for people who have never had surgery before. Knowing what actually happens, from the moment the medication enters your IV to the moment you open your eyes in recovery, tends to make the day far less intimidating.

This page walks through what general anesthesia for FFS is really like. If you are still in the planning stage, it pairs well with the practical checklist on the “Preparing for Facial Feminization Surgery” page, which covers fasting, transportation, and what to bring on the day of your procedure.

Why FFS Is Performed Under General Anesthesia

Facial feminization surgery usually combines several procedures in one operation. A single surgical plan might include forehead and brow bone reduction, hairline adjustment, rhinoplasty, and contouring of the jaw and chin. This is detailed work on the facial bones and soft tissues, and it can take anywhere from 6 to 10 hours with very extensive cases exceeding this.

General anesthesia keeps you completely unconscious and free of pain for that entire window. For surgery that involves the bones of the forehead, jaw, and chin, lighter options like local anesthesia with sedation are not enough. Dr. Mittermiller uses general anesthesia because it provides total stillness, controls pain at a level bone work demands, and protects your airway during procedures that involve the nose and mouth. It also lets the surgery proceed without interruption, which matters when the goal is a precise, predictable result.

It can help to think of general anesthesia as a controlled, fully reversible state of unconsciousness rather than a deep sleep. You are not aware, you do not form memories, and you do not feel pain. When the medications are stopped at the end of surgery, the state reverses and you wake up.

The Pre-Operative Evaluation: Making Sure You Are Ready

Before anyone schedules your surgery, you go through a medical evaluation to confirm you are healthy enough for both the procedures and the anesthesia. This typically includes a review of your medical history, a list of every medication and supplement you take, and any known allergies or past reactions to anesthesia. Depending on your age and health, you may also need blood work, an EKG, or clearance from your primary care physician.

If you are a transgender woman taking estrogen, your hormone therapy is part of this conversation. Estrogen has a known association with blood clots, and patients often worry about what that means for a long surgery. The reassuring news is that studies of facial feminization patients have found very low rates of venous thromboembolism, with one cohort reporting no clotting complications among patients who continued estrogen through the perioperative period.¹ VTE risk does increase with the duration of surgery, although this varies greatly depending on patient and surgical factors. Dr. Mittermiller reviews your specific situation and hormone regimen with you directly rather than applying a single blanket rule.

It also helps to be open about a few things that change how your anesthesia is planned. Smoking, sleep apnea, acid reflux, and any history of difficult intubation or a bad reaction to anesthesia all matter, and so does heavy alcohol or recreational drug use. None of this is asked to judge you. It is asked so the team can choose the safest medications and airway plan for your body.

You will also receive fasting instructions, and following them matters for your safety. An empty stomach lowers the risk of aspiration while you are unconscious. Your surgical team will give you the exact timing for your case, and the “Preparing for FFS” page explains how this fits into the rest of your day-of-surgery routine.

Meeting Your Anesthesia Team

On the day of surgery, you meet the anesthesiologist or nurse anesthetist who will care for you throughout the operation. This is your chance to ask questions, mention anything that worries you, and review your history one more time. If you have had nausea or a rough recovery from anesthesia in the past, tell them. That information changes how they plan your medications.

An anesthesia provider places an intravenous line, usually in your hand or arm, which is how the anesthesia medications and fluids are delivered. Many patients feel calmer once they understand that a single person is dedicated entirely to monitoring them for the whole surgery.

If anxiety is running high at this point, that is normal, and you can say so. Many patients are given a small dose of a calming medication through the IV before they are even moved into the operating room, which takes the edge off and often blurs the last few minutes before sleep. The operating room itself is bright and cool and has more equipment than people expect, but you are usually only awake in it for a short time.

What Going Under Actually Feels Like

When it is time to begin, the anesthesia provider gives medication through your IV. You may be asked to breathe oxygen through a soft mask, and some providers will ask you to count backward or simply talk with you while the medication takes effect.

Within a minute or two, you start to feel heavy, warm, or pleasantly drowsy. Most patients describe a brief floaty sensation and then nothing. There is no struggle and no awareness of falling asleep. The last thing you remember is being in the operating room talking to your team, and the next thing you know, you are waking up in recovery and it feels as though no time has passed. Whether your surgery took one hour or ten, the experience of being under feels instantaneous.

Once you are unconscious, a breathing tube is usually placed to protect your airway and help you breathe steadily throughout the operation. This happens after you are fully asleep, so you do not feel it and you will not remember it. That breathing tube is also the most common reason for a mild sore throat afterward, which is covered later in this article.

What the Anesthesia Team Monitors During Your FFS

You are never left alone under anesthesia. The anesthesia provider stays with you for the entire procedure and tracks a continuous stream of information about your body. Standard monitoring during general anesthesia includes heart rhythm by EKG, blood pressure, oxygen levels through pulse oximetry, exhaled carbon dioxide through capnography, and body temperature. Some cases also use depth-of-anesthesia monitoring, which helps the provider give exactly the right amount of medication so you stay safely unconscious without going deeper than necessary.

Longer FFS cases add a few extra layers of care. Because you may be on the operating table for several hours, the team pays close attention to how you are positioned to guard against pressure injuries, nerve injuries, and thermal dysregulation. Warming devices help maintain your body temperature, and measures such as compression on the legs help reduce the risk of blood clots during extended surgery. None of this is something you experience consciously, but it is happening the entire time you are asleep.

Waking Up in the Recovery Room

When the surgery is finished, the anesthesia medications are stopped and you begin to wake up. The breathing tube is removed as you regain the ability to breathe on your own, usually before you are alert enough to remember it. You then spend time in a recovery area, sometimes called the PACU, where a nurse monitors you closely as the anesthesia wears off.

Waking up is gradual rather than sudden. Most people feel groggy, a little disoriented, and very sleepy at first. You might drift in and out for a while, and that is completely normal. Some patients are discharged the same day once they are stable, while others stay at least one night under supervision, depending on the extent of their surgery. The early hours and days afterward are described in detail on the “Recovering from Facial Feminization Surgery” page.

Common After-Effects and How They Are Managed

General anesthesia is safe, but it does come with some short-lived after-effects. Knowing about them in advance keeps them from being alarming.

Grogginess and a foggy head are the most universal. You may feel emotional, talkative, or simply slow for several hours. This clears as the medications leave your system.

A sore throat is common and comes from the breathing tube. It is one of the more frequent minor effects of intubation, and one study of patients intubated under general anesthesia found a sore throat in about 62 percent of them.² It is usually mild and resolves within a few days. Throat lozenges and staying hydrated help.

Nausea is the other frequent complaint. Postoperative nausea and vomiting affect a meaningful share of patients after general anesthesia, and it is more likely in women and after longer operations.³ The encouraging part is that it is very manageable. Anti-nausea medication given during and after surgery sharply lowers how often it happens, and your team can tailor this to your history.

Shivering, chills, and a dry mouth can also occur as you wake, and these tend to pass quickly with warm blankets and fluids. If any after-effect feels severe or does not improve, your surgical team wants to hear about it.

How Safe Is General Anesthesia for FFS?

Modern general anesthesia is remarkably safe for healthy patients, and the screening you go through beforehand exists specifically to keep it that way. Serious complications are rare, and the dedicated monitoring throughout your surgery is designed to catch small problems before they become big ones.

One specific fear patients raise is waking up during surgery. This event, called anesthesia awareness with recall, is rare, happening in only about one to two cases per thousand general anesthetics.⁴ Depth-of-anesthesia monitoring further reduces the chance during a procedure like FFS.

Facial feminization surgery itself has a strong safety record. In Dr. Mittermiller’s experience, and across the published literature on FFS outcomes, it is a common and safe procedure for transgender women.⁵ Choosing an experienced surgical team and being honest during your pre-operative evaluation are the two best things you can do to keep your own risk low.

Dr. Mittermiller is a plastic surgeon with specialty training in craniofacial surgery and facial feminization surgery, and he works with experienced anesthesia providers so that the part of the day you will not remember is handled with the same care as the surgery itself. If you have questions about anesthesia, your appearance goals, or whether FFS is right for you, you can learn more about the full procedure on the facial feminization surgery page or reach out through the contact page to schedule a consultation.

Frequently Asked Questions

Will I feel anything during FFS?

No. Under general anesthesia you are completely unconscious and unable to feel pain. You will not be aware of the surgery, and you will not remember anything between the moment the medication takes effect and waking up in recovery.

Could I wake up during my surgery?

Waking up with awareness during surgery is rare, occurring in roughly one to two cases per thousand general anesthetics. Your anesthesia provider continuously adjusts your medication, and depth-of-anesthesia monitoring is often used during FFS to make this even less likely.

How long will I be under general anesthesia for FFS?

It depends on how many procedures are in your plan. Facial feminization surgery can run anywhere from one to ten hours, depending on the number of procedures being performed. However long the operation lasts, the time will feel instantaneous to you because of the way general anesthesia works.

Why do I have a sore throat after waking up from anesthesia?

The sore throat comes from the breathing tube placed in your airway after you are asleep. It protects your breathing during surgery and is removed as you wake. Mild throat soreness is common and usually settles within a few days.

Will I feel nauseous after general anesthesia?

Some patients do. Nausea is one of the more common after-effects of general anesthesia, and women and longer surgeries carry a somewhat higher risk. Anti-nausea medication given during and after your procedure greatly reduces how often it happens, so tell your team if you have had nausea with anesthesia before.

When will the anesthesia fully wear off?

You will feel the strongest grogginess in the first few hours, and most of the mental fog lifts within the first day. Because judgment and coordination can stay impaired for about 24 hours, you should not drive, make important decisions, or be alone immediately after surgery. Arrange for someone to take you home and stay with you.

Citations

1. Price R, Debryn D, Mukerji S, Nozari A, Jeffrey Spiegel, Eugene Kim (2023) No Thromboembolic Complications After Facial Feminization Surgery in Transgender Patients Utilizing Estrogen Therapy: A Retrospective Cohort Study. Transgend Health 8 (4):344–351. doi:10.1089/trgh.2021.0170 https://pubmed.ncbi.nlm.nih.gov/37525836/
2. Bekele Z, Melese Z (2023) Incidence and risk factors for postoperative sore throat after general anesthesia with endotracheal intubation: prospective cohort study. Ann Med Surg (Lond) 85 (6):2356–2361. doi:10.1097/MS9.0000000000000786 https://pmc.ncbi.nlm.nih.gov/articles/PMC10289720/
3. Trimas SJ, Trimas MD (2015) Use of Aprepitant and Factors Associated With Incidence of Postoperative Nausea and Vomiting in Patients Undergoing Facial Plastic Surgery. JAMA Facial Plast Surg 17 (4):251–255. doi:10.1001/jamafacial.2015.0307 https://pmc.ncbi.nlm.nih.gov/articles/PMC10289720/
4. Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB (2004) The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 99 (3):833–839. doi:10.1213/01.ANE.0000130261.90896.6C https://pubmed.ncbi.nlm.nih.gov/15333419/
5. Tirrell AR, Abu El Hawa AA, Bekeny JC, Chang BL, Del Corral G (2022) Facial Feminization Surgery: A Systematic Review of Perioperative Surgical Planning and Outcomes. Plast Reconstr Surg Glob Open 10 (3):e4210. doi:10.1097/GOX.0000000000004210 https://pmc.ncbi.nlm.nih.gov/articles/PMC8929523/