Preparing for Facial Feminization Surgery

Facial feminization surgery (FFS) is a complex set of procedures that often involves a long recovery process. Dr. Mittermiller has put together this page to help patient optimally prepare for surgery. Some of the details will vary based on individual preferences and situations. It is always important to discuss specific details with your surgeon.

Support – Who will help me after surgery?

Facial feminization surgery often results in significant facial swelling. Many patients do not feel comfortable going outside to run errands or prefer to recover in the peace of their own home or hotel. For these patients, it is important to have a person available to help if necessary. This may include running to the grocery store to pick up more food and drinks or taking a trip to the pharmacy to pick up more medications or medical supplies. In some scenarios, it may involve driving patients to the clinic or back to the hospital for evaluation of new medical conditions.

Work – How much time should I take off work?

The amount of time one takes off work after FFS is highly dependent. First and foremost, you should talk with the surgeon to see what they recommend. Usually, people will want at least 1 week off work. This allows the swelling to come down slightly and most people will have stopped taking narcotic pain medications after 1 week. If possible, 2 weeks off work is better. It is usually enough time for people to have had their first postoperative appointment, which is when the staples or sutures are removed and it allows more time for the swelling to improve. It also provides a bigger buffer for people to stop taking narcotic pain medications. The most amount of time somebody would want to take off work is 1 month. However, this is often excessively long for most people.

Patients who are flying from out-of-town for facial feminization surgery should plan for at least 2 weeks off work and potentially even longer. This allows time to settle into their hotel or rental unit prior to surgery and it allows a few days after their first postoperative appointment to prepare for returning home.

Food and drink – What should I eat after FFS?

The types of food and drinks that are allowed after surgery often depend on the specific procedures that were performed. If no incisions were placed inside the mouth and there were no manipulations of the jaw muscles or bones, then a regular diet can often be continued after surgery. In these scenarios, it is simply important to make sure people eat a nutritious diet.

For patients who had incisions placed within the mouth during FFS (facial feminization surgery), the diet can vary slightly. Surgery on the lower jaw often results in tenderness of the muscles that help with chewing. In these scenarios, it can be helpful to have foods that fall within a “soft” diet for after surgery. This includes liquid foods such as soups and smoothies, but can also include foods that are mashed or solid foods that can easily be broken down between the tongue and the roof of the mouth. If there are any questions about specific foods, these should be reviewed with your surgeon.

Foods that can be uncomfortable to eat following surgery include hot or spicy foods. These can aggravate incisions that are inside the mouth.

Drinks that are dense in protein and nutrients can be helpful for patients who have a difficult time holding down food following surgery. It can be helpful to have drinks such as Ensure or Gatorade in these scenarios to stay hydrated and to make sure that enough nutrients are being ingested following surgery.

Supplies – What should I buy before facial feminization surgery?

There are a variety of products that can be helpful prior to surgery. Specific product recommendations can be found on a separate page (here) on this site. Not all the products are necessary for every patient. It is important to review the procedures you will be having and evaluate whether specific products match your needs.

Supplies – What should I bring with me to surgery?

There is frequently not much to bring with you to surgery. This often involves the following items.

Essential Items

Identification and Insurance
Driver’s license or government-issued photo ID
Health insurance cards

Medical Information
A list of all current medications, including dosages, vitamins, and supplements
A list of allergies or sensitivities
Any pre-operative instructions provided by your doctor
Copies of any relevant medical records, if requested

Personal Items
Comfortable, loose-fitting clothing to wear after surgery
Eyeglasses or contact lens case (do not wear contacts during surgery)
Hearing aids, if applicable
Personal hygiene items (toothbrush, toothpaste, etc.) if staying overnight
If staying overnight, consider pajamas or a robe and slippers with non-slip soles. You will likely receive a hospital gown that can be used instead of any of your own clothing.

Recommended Items

Comfort Items
A book, magazine, or other form of entertainment
Headphones (if you are not anticipating wearing a bandage that covers your ears)

Electronics
Cell phone and charger

Other
A small amount of cash
A notepad and pen

Items to Leave at Home

Valuables (Do NOT bring)
Jewelry, watches, and other expensive items
Large amounts of cash

Unnecessary Items (Do NOT bring)
Avoid bringing too many items, as they can be easily misplaced.

Attire – What should I wear to surgery?

When preparing for surgery, comfort and practicality are key. Here’s a breakdown of what to wear, keeping in mind that you’ll likely be changing into a hospital gown during the hospital stay.

Loose-fitting Clothing – Choose clothes that are easy to put on and take off. This is especially important after surgery when you might have limited mobility or discomfort. Avoid tight clothing that is difficult to put on, wear, or remove. 

Easy-to-Remove Items – If you have a choice, go for clothing with zippers or buttons, rather than those that need to be pulled over your head. Elastic waistbands are ideal for pants or shorts.

Footwear – Wear comfortable, slip-on shoes with non-slip soles. This will help prevent falls, especially after anesthesia.  They will be easy to put on and take off when getting in and out of bed in the hospital or facility.

NO Valuables or Piercings – Leave any jewelry, watches, and other valuables at home. They can be easily lost or misplaced. Remove any body piercings. If there is a concern the piercings will close, replace the pierced areas with non-conductive, silicone items.

NO Makeup, Nail Polish, or Artificial Nails – Do not wear any makeup on the day of surgery. The makeup can be difficult to remove and can harbor bacteria that may result in an increased risk of surgical site infections. Makeup around the eyes can get into the eyes if not removed prior to surgery. Certain types of nail polish and artificial nails can interfere with monitoring instruments during surgery.

Always follow any specific instructions provided by your surgeon or the surgical center. They may have additional recommendations based on your individual procedure.

Transportation – How will I get to surgery and back home from surgery?

It is important to know how you will get to and from your surgery. There are many options available to people. Often, the easiest option is to have a friend or family member drop you off and pick you up from surgery. Sometimes, this is not an available option. In these scenarios, sometimes insurance companies will provide transportation to and from a hospital. If somebody is counting on this option, they must talk with their insurance company ahead of time to confirm this is a viable option. The patient should know exactly how to request the transportation when it is needed.

Once the method of transportation has been determined, it is important to know where the pickup and drop-off areas are located at the surgical facility or hospital. If parking is needed, you should figure out in advance where to find parking. Ideally, you should also know where to go within the facility once you arrive. Some people prefer to do a “dry run” by visiting the facility and making sure they know where to park and where to go prior to the day of surgery.

In any case, people should allow plenty of leeway on the day of surgery to arrive on time. Especially in Los Angeles, traffic can by highly variable, so plan accordingly!

Printed Instructions – What information have I received from my facial feminization surgeon?

All surgeons should be providing their patients with information about surgery. This information can include the details seen below.

General Information

Surgery Date, Time, and Location – Confirmation of the date, time, and address of the surgical facility.
Surgeon Contact Information – This is helpful if there are any last-minute questions or concerns.
Facility Contact Information: The facility can sometimes provide additional information about the facility such as parking locations or limitations.

Pre-Operative Instructions

Fasting Guidelines – This contains specific instructions about when to stop eating and drinking before surgery. This is vital to prevent complications during anesthesia.
Medication Instructions – This should contain information on which medications to continue or stop taking before surgery, including prescriptions, over-the-counter drugs, vitamins, and supplements.  
Hygiene Instructions – This will have guidelines around showering or bathing before surgery, including whether to use any specific soaps or cleansers.
Clothing and Personal Items – The surgeon may have specific recommendations on what to wear and what to bring to the surgical facility.
Transportation and Accommodations – This should have instructions on arranging transportation to and from the facility, and information about any necessary accommodations for overnight stays.  
Pre-Operative Testing – There may be information on any additional required pre-operative tests, such as blood work, EKGs, or imaging studies.  

3. Surgical Procedure Details:

• Detailed Description of the Procedure: An explanation of the surgical procedure, including what will be done and why.  
• Risks and Benefits: A thorough discussion of the potential risks, complications, and benefits of the surgery.
• Alternatives to Surgery: Information on alternative treatment options, if any.
• Anesthesia Information: Details about the type of anesthesia that will be used.
• Expected Recovery Time: A realistic timeline for recovery, including when you can expect to return to normal activities.

4. Post-Operative Instructions:

• Pain Management: Information on pain medications and other pain management techniques.  
• Wound Care: Instructions on how to care for your surgical wound, including dressing changes and signs of infection.  
• Activity Restrictions: Guidelines on activity limitations and when you can resume normal activities.  
• Follow-Up Appointments: Scheduling information for post-operative follow-up appointments.
• Emergency Contact Information: Instructions on who to contact in case of complications or emergencies.
• Dietary Instructions: Any specific dietary restrictions or recommendations.

5. Financial Information:

• Insurance Coverage: Information on insurance coverage and any out-of-pocket expenses.
• Payment Information: Details on payment procedures and deadlines.

6. Consent Forms:

• Informed Consent: Forms that you will need to sign, indicating that you understand the risks and benefits of the surgery and agree to proceed.

7. Contact Information and Questions:

• A list of phone numbers and email addresses to contact the surgeon’s office with any questions.
• A section where you can write down questions to ask your surgeon.

Key Considerations:

• Read Carefully: Take the time to carefully read and understand all the information in the packet.
• Ask Questions: Don’t hesitate to ask your surgeon or their staff any questions you may have.
• Keep Records: Keep a copy of the packet for your records.

It is extremely helpful for patients to read the instructions from their surgeons both BEFORE surgery and AFTER surgery. Reading the instructions before facial feminization surgery allows patients a chance to mentally prepare for surgery, to confirm they have all the appropriate supplies, and to prepare their living situation for the post-surgical state. Reading the instructions after FFS is helpful because many of the instructions will make more sense. Patients often have new questions after surgery and these questions are often answered in the surgical packet. The surgical packets frequently have many instructions and so it is difficult to remember them all for a future situation.