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FAQ: Facial Gender Surgery

What is Facial Gender Surgery?

Facial gender surgery (FGS) is a combination of procedures that allow a patient to have a more gender affirming appearing face.

What type of surgeries are included in FGS?

We offer both surgical and non-surgical treatments.  The types of FGS procedures we offer include, but are not limited to:

  • Botox/fillers
  • Forehead contouring
  • Malar/cheek contouring options
  • Rhinoplasty, Septoplasty
  • Jaw contouring
  • Chin contouring
  • Lip augmentation
  • Tracheal Shave 
Facial Feminization SurgeryAn example of facial feminization surgical procedures.
 

How do I choose what surgery is best for me?

Surgical planning depends on your surgical goals. Only you can choose what areas of your face you would like to have surgically corrected. You do not need to pick one surgery; most often, to achieve your goals, several procedures and interventions can be considered.  You and your surgeon can discuss your goals and priorities when developing the surgical plan together.

Can everything be done in one surgery?

The preferred approach for patient safety and insurance constraints is a staged approach.  This allows us to prioritize goals, and adapt plans to healing and recovery.  This is the safest approach so you are not under anesthesia for an unsafe amount of time.

How long is the surgery?

Surgical length depends on the type of procedure you are having. The more complex the procedure, the longer it takes.

Do I need preoperative imaging?

Yes. Every FGS case requires a 3D CT scan of the face so we can evaluate the bones and create 3D models for surgical planning.  There will be a soft tissue scan done before surgery, and post-operative imaging as well.

These 3D CT scans must be done at either the Johns Hopkins Outpatient Center or Johns Hopkins Green Spring location.

Will I have to stay in the hospital?

Most surgeries include a 23-hour observation admission to make sure everything is healing well after surgery.

When will I need to follow up?

Follow-up varies depending on the procedure(s).  Most initial post-op appointments occur within 5 days from surgery and are scheduled before you leave the hospital.

Will I be in a lot of pain after surgery?

You may experience some discomfort for a few days after surgery, but generally 4-5 days after surgery your pain will begin to decrease and you should be able to return to some normal activities, with restrictions.

Can I shower after surgery?

For the first few days after surgery, you will need to avoid showering and should sponge bathe the rest of your body. After your initial post-operative appointment, you will be able to shower. It is important to use non-scented soap when bathing and never spraying the surgical site directly with water. 

What post-operative care is required after a tracheal shave?

You will have an incision on your neck that is closed with non-dissolvable stitches. These stitches will be removed approximately 10-days after surgery. The incision and stitches should be covered with a piece of gauze and clear tape, such as tegaderm. Do not remove this dressing until seen in your first clinic appointment.

Can I shave my neck after a tracheal shave?

You should avoid shaving the surgical site for at least 4-weeks to allow the skin and incision to heal. It is especially important not to shave over any stitches, as a razor can pull out the stitches too early and the wound will open.

What post-operative care is required after jaw contouring?

This surgery requires making an incision inside the mouth, which will be closed with dissolvable stitches. You will have to clean the inside of your mouth with a special mouthwash prescribed to you for a few weeks after surgery.

You will also have to wear a special compressive dressing around your jaw for a few weeks after surgery. This dressing will be provided for you during your surgery.

Can I talk after jaw contouring?

Yes. You should talk after jaw contouring, but it is recommended to not overdo it.  Talking is encouraged, but only as tolerated. 

Is there a special diet after jaw contouring?

After surgery, you should eat soft food for 3-4 days, as your mouth will be sore and it may be difficult to eat solid foods. If you feel like you are not eating enough, you can supplement your food intake with nutritional shakes, such as Ensure. Once you feel up to it, you can begin to introduce more solid foods. You should avoid hot drinks, such as tea or coffee, for 1-2 weeks as the incision heals.

What happens if I cough/sneeze after jaw contouring?

Do not panic. It is normal to cough or sneeze after jaw contouring and this will not affect the surgical site.

What post-operative care is required after forehead reconstruction?

This procedure requires an incision that goes across your head from ear to ear. At the end of the procedure, the incision will be stapled closed. These staples will be removed approximately 2 weeks after surgery.

Do I have surgical drains after forehead reconstruction?

If you are having forehead reconstruction you will have a drain that remains in place during your hospital stay. This drain will be removed prior to your discharge.

Can I get a brow lift at the same time as forehead reconstruction?

Yes. At the time of forehead reconstruction, we are able to do a small brow lift to move the eyebrows to a more desirable location.

What post-operative care is required after rhinoplasty?

After a rhinoplasty, you will go home with an internal nasal splint, and external nasal splint, and a few stitches on the bottom of your nose. All of these dressings will remain in place for about 1 week after surgery.

Will I be swollen and have black eyes after rhinoplasty?

It is normal to have a lot of bruising and swelling under the eyes after your rhinoplasty. After 4-6weeks, both the swelling and bruising will be less noticeable.   

What happens if I sneeze after rhinoplasty?

If you need to sneeze after rhinoplasty, it is important to sneeze with your mouth open. If you happen to sneeze with your mouth closed, do not panic. Make sure the nasal splints have remained in place and did not become loose.

What is fat grafting?

Fat grafting involves taking fat from one location in your body, typically the stomach, and placing it in the face to fill out areas that may be sunken in or depressed.

Is fat grafting the same as liposuction?

While fat grafting follows the same process as liposuction, we only take enough fat to fill in the areas needed on your face – this is typically not enough to notice a large difference in your body.

Where can I get Botox/fillers injected?

There are a variety of areas we can use Botox to achieve favorable results.  These sights include the jaw muscles, around the eyes, lip fillers, among others.  Please keep in mind that insurance companies typically do not cover these services, and they range in price from $1500 - $3500, depending on location; but these injections can be done in clinic very easily.  The amount of time they last varies with each patient and the product we are using, but typically 6-12 months, or even longer.

Download the facial gender surgery FAQs as a PDF.

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