General FFS FAQ's
On this page I have tried to answer some of the many questions that FFS patients ask about their surgery:
Will I still look like me after FFS?
The central character of someone’s face is actually very difficult to change and FFS will generally only make you look like a more feminine version of yourself so you should still be completely recognisable as you to yourself and to everyone else after FFS. Of course, the more you have done, the more the face changes and it is possible to take facial surgery to a level at which it may become harder to see yourself in the result. This is more likely to happen when someone has cosmetic procedures repeated too many times or has extreme changes. I believe that the whole purpose of FFS should be to reveal the female version of your own face.
Is FFS dangerous?
All surgery carries a degree of risk but FFS is not unusually dangerous. Many of the procedures involved are standard facial procedures like rhinoplasty and cheek implants. Some of the other procedures are more unusual but are no more risky. To minimise danger, be in the best health you can before surgery – the most important thing is to stop smoking well before surgery (I would advise several months); try to be within your recommended body mass index (BMI); be reasonably fit and eat a healthy diet. You can check your BMI here.
Is FFS painful?
Surprising as it may seem, most patients suffer relatively little pain with FFS. Breast implants and SRS are generally much more uncomfortable. Once again this is very variable from person to person – some may have pain, others may have none at all. If there is some pain it is usually short-lived and fairly easy to control with standard painkillers.
How long will I need to take off work?
It depends on what you have done and how quickly you happen to recover. For small procedures like lip filling or a brow lift you could return to work in a few days but for more invasive work like forehead, jaw and chin surgery, you may need at least 2-3 weeks off work or longer if your job is physically demanding.
How long will it take me to fully recover?
It depends on what procedures you have done and how quickly you heal (everyone’s different). It also depends on what you mean by “fully recover” – after extensive FFS, the face can still be changing in subtle ways a good year or more after the surgery. The worst of the swelling can last at least 6 weeks, bruising may only last 3 or 4 weeks, nerve damage may take a couple of years to fully recover but it is all very variable from person to person.
Can any face be feminised?
Pretty much any face (even the face of a non-transsexual woman) can technically be feminised to some extent (though this would not normally be necessary of course). For example, Jennifer Aniston has quite a masculine chin and technically it could be made more feminine, however it is clear that she doesn’t need it done because overall her face comes across as both female and beautiful. It is important to understand that although any face can be feminised, it is not possible to make every face look completely female. This is because there are some masculinities that cannot be altered with surgery. For example, women tend to have larger eyes in proportion to their skull than men and no surgery can give you bigger eyeballs (it is possible to emphasise the size of your eyes with make-up and through procedures like brow lifts, blepharoplasties and forehead recontouring).
I have seen a masculine feature on a beautiful woman - does that mean I can get away with the same masculine feature myself?
Normal female faces do often have some masculinities - Jennifer Aniston, as I’ve just mentioned, has a masculine chin. However, it is a mistake to assume that if someone like Jennifer Aniston can still look female despite a masculine chin, then maybe you can get away with it too. You have to look at the big picture – everything else about Jennifer Aniston from her voice to her skin to her height, to her body shape to her mannerisms, is extremely feminine and one masculine feature in the context of so much femininity simply doesn’t matter - in fact it tends to add a little character. Most transsexuals will have many other unfixable physical masculinities to contend with and in that context a masculine chin or forehead could be a problem. Basically it very much depends on the individual – it is important not to feel like you must surgically feminise every single operable feature but it is important to also know if a feature is going to cause you passability problems. Often the decision is borderline and one of the purposes of Virtual FFS is to help you spot which changes are probably important and which are probably not.
Should I wait until I’ve been on hormones a while before I have FFS or Virtual FFS?
That would be ideal but it is not always possible or practical. The bones of the face are not affected by hormones but the soft tissues are - they make the cheeks fuller, the jaw narrower and the skin softer. I can usually simulate these effects to some degree (see question above) but there is always some guesswork involved. If you wait until hormones have done their work then the virtuals will be more accurate and you will have a clearer idea of what needs to be done. If you go ahead before taking hormones then there is some risk that you might end up having more done than you really need. I try to predict which procedures might be optional once hormones have done their work but there is always some guesswork involved. See my page on hormonal effects for more on this. It is also important to consider the psychological effect of hormones – when we are starting out we often hate even the tiniest masculinities but once hormones have softened you and if you are also passing well, you may start to feel that your face is not such a huge obstacle and might therefore decide you don’t need quite so much surgery.
How feminine is feminine enough?
I have written a whole page on this issue for my thesis. Here's a link.
Who is the best FFS surgeon?
There is no “best” FFS surgeon and people choose their surgeon for different reasons. There are several factors involved like whether the surgeon offers the actual procedures you are looking for; whether you personally like the look of the surgeon’s work; whether your budget limits your choice of surgeon or whether you are able to travel abroad. There are not many surgeons who specialise in FFS but I believe it is generally best to search out a surgeon who does and it is best to be prepared to travel, even halfway across the world for the right surgeon for you.
Why do different surgeons recommend different procedures for the same face?
FFS is as much art as science and different surgeons will sometimes have different ideas about the best way to feminise any particular face. Some surgeons are more aggressive and might for example recommend extensive chin surgery to make a small improvement while others will feel that the complications associated with chin surgery are not worth risking for such a small change. Some surgeons also feel that forehead reconstruction is too invasive for FFS and will not do it. Another thing to consider is that although most surgeons are ethical people, there are some surgeons out there who will recommend the procedures they can do rather than the procedures you actually need. I recommend you get opinions from several surgeons (and me!) before you make any decisions as this may help show up any unlikely suggestions.
Can I go to a normal plastic or cosmetic surgeon for FFS?
It depends on what you are having done but generally no because they don’t offer the type of bone surgery many of us need for FFS and they don’t have the specialised understanding of male/female facial differences. You would expect them to have a good understanding of facial gender but I have seen inappropriate advice given by cosmetic surgeons to people needing FFS on several occasions. I don’t mean to show any disrespect to cosmetic surgeons in general – on the whole they are highly skilled people but in my experience, many don’t have the deeper understanding of facial feminisation that most of us need. I therefore recommend you go to an FFS specialist.
Will I have visible scars?
Some FFS procedures do leave visible scars. For example: scalp advances can leave a visible scar at the hairline and a lip lift can leave a visible scar just under the nose. In many cases these scars are not very noticeable. There is no sure way to avoid scarring. Many people assume that if the surgeon is good then they will not scar but this is not actually true - a good surgeon will do everything possible to minimise scarring but some people scar more easily than others and it is possible to be left with a strong scar even if the surgeon’s work was perfect. Dark-skinned people such as those of African descent are at greater risk of scarring than light-skinned people.
Will I look “plastic” after FFS?
That is a difficult one to answer because people have different ideas about what looks plastic. For example I feel that Joan Rivers (an extreme example!) looks very artificial but some people feel she looks great. One rule of thumb is that the more you have done, the more it is likely to show but the most likely cause of a face or feature looking plastic is that a procedure has been overdone. For example, you do sometimes see eyebrows lifted too far in FFS leaving the patient with a surprised expression and another problem area is overdone noses that have been made too small and/or too scooped.
Will my surgeon charge me for revisions?
Different surgeons have different rules so discuss this with them during your consultation and don't wait until you need a revision to find out. Some surgeons do charge, others don’t charge for their work but do charge for the anaesthetist and hospital facilities and some will revise completely fee of charge.
How do I know what sort of forehead procedure I need?
The type of forehead procedure you need depends on 2 things: firstly on the kind of result you want and secondly on the underlying structure of your particular forehead. It is not possible to tell from the outside what the underlying structure of your forehead is like - for that you will need to see inside the forehead with an MRI scan, CT scan or x-ray. Please see the page on foreheads for more detailed information on this.
Which is better - a scalp advance or hair transplants?
That depends on your particular needs. A scalp advance is more invasive than hair transplants because it involves a deeper incision and cuts through nerves that supply sensation to the scalp. It also leaves a scar along the hairline. If you are having bony work on the forehead or a forehead lift, you may need the same long incision that a scalp advance would use anyway. This means that the scalp advance is not really going to be any more invasive than the procedures you are already having. However, if you are having forehead work done endoscopically or only need to fill the corners of your hairline rather than bring the whole hairline forwards, then you can avoid the deeper incision, nerve damage and scar by having transplants. Transplants do involve an long incision too but it does not go as deep, does not sever nerves that supply the scalp and it is round the back of the head where the scar is well hidden under the hair. See the page on hair and hairline for more on this.
Will I need a face lift after FFS?
Jaw and chin surgery cause a lot of swelling and this swelling can stretch the soft tissues of the lower face. This is made worse by the reduction in the amount of bone. If you are relatively young, the skin is very elastic and will easily contract again when the swelling goes down to fit the new smaller bone structure snugly. But if you are older (typically over about 40 but very variable) the skin may no longer be elastic enough to fully tighten back and in that case you may need a face lift to take up the remaining slack. The face lift is usually done a few months after the jaw and chin surgery. See the jaw and chin pages for more on this.
Will I pass without make-up after FFS?
This depends on many factors including the degree to which your particular face can be feminised, your stature, your voice, your clothing, hair and your mannerisms. Passability is a complex issue but it is safe to assume that after FFS you are likely to pass much more easily than before FFS and that may mean that you will not need to worry so much about make-up.
Will I still be able to pass as male after FFS if I want to or need to?
It depends on your result and your overall femininity but in most cases yes. If you pass for female easily then passing for male might require some effort. For example: you might have to try things like keeping your hair very short, wearing very masculine clothes, walking and moving in a manly way and using a deep voice etc.
Can I do FFS in separate stages?
Generally yes but there are some exceptions: Face lifts are usually done after Jaw and chin surgery, not before. The other area where exceptions may occur is with forehead and nose surgery (see next question).
Can I have my forehead and nose done separately?
Nose and forehead surgery often need to be considered together. This is because the nose and forehead need to flow nicely into each other. It generally depends on the area where your nose meets the forehead (the nasion). Basically, if you can set back your brow bossing to the ideal position without it actually sitting behind the bridge of the nose and causing a step between the two, you will probably be able to have your forehead done without needing a rhinoplasty. Likewise you will probably be able to have a rhinoplasty without forehead work as long as the changes to the bridge of your nose are not going to cause a step between your nose and forehead.
Do I need a psychiatrist’s referral letter for FFS?
Generally no. I have heard of one surgeon in the UK asking for one and the younger you are the more likely they are to ask but in most cases you will not need one.
Are there age restrictions for FFS?
Different surgeons will have different rules but generally you can expect surgeons to require you to be 18 or over before they will perform FFS on you. There are sometimes upper age limits too – some surgeons may set a maximum age like 65 or 70 but this will probably be flexible depending on your general health – the healthier you are, the more likely the surgeon will be happy to operate.
Are there weight restrictions for FFS.
Many surgeons will not operate on patients who are beyond a certain weight for their height. Obese people have a much higher risk of complications so it is worth trying your best to get within your recommended body-mass index (BMI) before surgery. You can check you BMI here.
Should I stop smoking before FFS?
Definitely. Many surgeons will not even consider you for surgery if you are a smoker. Smoking can cause serious complications, for example, it restricts blood vessels and that can lead to tissue death and necrosis. If you are planning FFS please stop smoking several months before-hand and don’t lie to the surgeon if you are still smoking.
How can I find a local FFS surgeon?
There are very few surgeons specialising in FFS in the world so it would just be a matter of luck if you happen to live either near one or even in the same country as one. I advise people to be prepared to travel for their FFS as the best surgeon for their needs could be on the other side of the world.
Is it safe to have FFS in Thailand?
Yes, as long as you go to a reputable surgeon but that rule applies to any country in the world including the USA and European countries. The top FFS surgeons in Thailand are as highly skilled as any in Europe or the Americas and work from hospitals with excellent facilities.
What happens if I have FFS abroad but have a complication after returning home?
Serious complications like infections will generally take place in the first few days after FFS. Most FFS surgeons will require you to stay in the country for up to a month after surgery and after that complications that need immediate attention are rare. You may have to travel back at a later date though to fix a non-urgent complication like asymmetry.
If I travel abroad for FFS, can I get back home with my old passport picture?
Many people worry about this but I have never heard of there being a problem. If questioned, explain to the customs officers that you have had some facial surgery. You are likely to still be extensively bruised and swollen at this point and that should prove you are telling the truth. You can also get a note from your surgeon confirming that any change in appearance is due to extensive facial surgery. The note does not have to mention “feminisation” or “transsexualism”.
Can I get FFS on the NHS?
At the moment, as far as I know, there are no FFS procedures available on the British NHS. Sometimes, if you are having surgery for a medical problem like rhinoplasty to correct breathing difficulties, the surgeon will make some aesthetic changes at the same time if you ask them to.
Can I get my teeth feminised?
Theoretically yes but not everyone agrees on what the actual differences are between male and female teeth. I think that female teeth tend to have more rounded edges and often, the 2 upper frontal incisors are slightly longer than the incisors next to them. It is very variable from person to person though. I personally don't think you need to worry about tooth gender much. Females also tend to have narrower upper and lower jaws than males but this cannot be changed.
Will FFS affect my singing voice?
I am a singer myself and I did not notice any changes to my singing voice caused by nose or forehead surgery. However, tracheal shaves can cause voice problems – if the voice box is weakened, it might be difficult to get as high as before as there is not enough structural strength in the larynx to support the vocal cord tension needed for high notes. Other voice problems are also sometimes reported after tracheal shaves like the voice becoming hoarse.
Will lip surgery affect my ability to play brass instruments?
I have been asked this more than once. I suspect it varies from case to case but it is best to assume that a lip lift or lip filling are likely to affect your embouchure. If you make your living as a brass player, you need to consider this very carefully.