Recovery in Marbella


Recovery in Marbella

The FFS postop period is one of the main sources of concern of facial feminization patients.  Here you will find information on the topic of your care and well-being during the entire facial feminization process.  No answer here? Just ask!

The main objective of psychological care for patients is to offer comprehensive health care, not only physical, but also for mental health. This care allows patients to feel understood and supported in the process of their surgical transition and everything that implies, offered individually and with your companion if desired.

The group sessions are small meetings moderated by our psychologist that are held weekly with patients operated the previous week in which different aspects related to adapting to changes after surgery, transition or life goals are discussed. It is an open group –a place where patients and their companions are comfortable, listened to and free to express what they feel or think. It is also a good opportunity to establish friendships with other patients in the same situation. It is not a therapeutic group it is only a “once in a lifetime” meeting that many patients benefit from.

Hilotherapy is a thermal-enabled therapy that promotes the healing of damaged tissue. It is used for surgical procedures, injuries and chronic diseases that can produce swelling, hemorrhages, edema and inflammation. Hilotherapy not only promotes healing in the FFS postop process but also reduces pain intensity, thus lessening the need for analgesics.

Medical basis

Hilotherapy is the product of the knowledge gained about the healing processes of injured and/or traumatized tissue. In these processes the key points are:

  1. The role of oxygen supply and the supply of nutrients
    After injuries or surgeries, the oxygen and nutrient supply to the affected tissue is considerably disturbed because of the formation of edemas and hemorrhages. The metabolic speed increases as the tissue becomes overwarm from inflammation of the affected area. The need for oxygen is therefore considerably higher as well. Consequently, the damaged area is no longer supplied with the amount of oxygen needed for maintenance and regeneration. Due to this lack of oxygen (ischemia), further cells die off and liquid-binding proteins become free, producing additional edemas and a vicious cycle that leads to hypoxic damage. The medical requirement is to lower the oxygen need of the affected tissue.
  2. The role of vascular functions
    In craniofacial surgery, vascular dilatation works positively on the postoperative healing process. This vascular dilatation is achieved by warming the affected areas. But nonselective warming leads to an increase in the body’s core temperature and an associated rise in the temperature of the soft tissue surrounding the surgical area. The consequences are various side effects for patients, including an increased risk of infection. The medical requirement is to apply only the exact, low-threshold heat directly to the affected area, with very precise temperature control.


Application and the therapeutic response

The immediate application of a controlled cooling therapy (Hilotherm Clinic device, Hilotherm GmbH, Ludwigsburg, Germany) helps resolve edemas quickly and produces a subjective feeling of well-being in the patient. The thermal effect is applied by means of water, which circulates through a mask-type device. The water temperature is set by the medical team to the exact value needed and is then maintained for as long as necessary.

Several studies have shown that the use of the Hilotherm cooling device significantly reduces FFS postop swelling, pain and the length of hospital stays when compared with conventional cooling systems. Satisfaction with the cooling method was significantly higher in the Hilotherm group than with patients receiving conventional cooling.

The applied temperature is set at +16°C in our case for 48 h, which does not impede lymphatic drainage. Thus, in this situation, hilotherapy clearly reduces the oxygen requirement in the area around the affected face part, reducing the metabolism speed, so that the amount of oxygen that reaches the injury is sufficient for regeneration.

The concept is to encourage a more comfortable FFS postop recovery while providing a little extra attention to patients, who will, in turn, benefit from pleasant sensations that neutralize the negative effects of the surgery, manual lymphatic drainage (MLD) is administered beginning shortly after the operation. The prompt application (1-5 days after surgery) of MLD by specialists considerably decreases any edema and speeds the recovery and adjustment of the soft tissues.

Physiotherapy in the FFS postop period has two main goals:

  • First, to improve the physical and psychological welfare of patients using different techniques to reduce any negative consequences resulting from the surgery and resolve any concerns patients may have about their evolution.
  • Second, to ensure speed recovery, enabling the patient to return to their personal or professional activities as soon as possible. To meet these objectives, we adapt the physiotherapy to each patient and type of surgery to achieve optimal results in the evolution of tissues.
What is manual lymphatic drainage?

Manual lymphatic drainage (MLD) is a massage technique that works on the skin’s surface, following the anatomic lymphatic pathways of the body, accelerating and even redirecting superficial lymphatic circulation and accelerating the absorption of edemas. A manual lymph drainage session begins in the neck to clear out the main lymphatic pathways, facilitating drainage from the face. Unlike other types of massage, it produces neither redness nor pain and does not have a stimulant effect. To successfully administer this technique, knowledge of the anatomical distribution of the lymphatic and superficial ganglions and their interconnections is necessary. MLD descends to facilitate the flow of the lymph from the affected areas to unaffected ones. It is possible to perform MLD in the case of late or latent edema three days after surgery if contraindications do not exist. MLD must be applied by a specifically trained physical therapist. The procedure takes approximately 40 min and is usually performed at least twice a week for 2 to 4 weeks. It has been demonstrated that the greatest reduction of the edema is obtained during the first week of treatment; during the second week the results become stable.

Why is MLD recommended?

Manual lymphatic drainage is very important in the postoperative treatment and care of facial feminization surgery. A manual technique that improves lymphatic circulation, its use helps, above all, to eliminate post-surgical edemas. MLD improves tissue scarring, decreases postoperative discomfort and accelerates recovery. Manual lymphatic drainage is a proven technique that we employ with all of the aesthetic and facial feminization surgeries that we perform, including:

  • Forehead reconstruction, rhinoplasty, jaw recontouring and mentoplasty
    These are the operations that most benefit from correct post-surgical manual lymphatic drainage treatment, since edemas often appear around the eyes, nose, and jaw.
  • Lifts, blepharoplasty
    Manual lymphatic drainage helps eliminate edemas more quickly, accelerates tissue recovery and decreases postoperative pain and discomfort after a lift or blepharoplasty. It must be administered carefully, especially in the areas near the incisions.
  • Scar treatment
    When treating scars, manual lymphatic drainage is the first measure employed to facilitate scarring. By reducing the edema, it fosters the supply of nutrients and the elimination of metabolic waste, both of which are necessary for good scarring.

What are the objectives of MLD after surgery?
  • To accelerate the reabsorption of edemas and hematomas
  • To eliminate the residues of the medicine, anesthesia and saline solution used in the operation
  • To foster the regeneration of any lymphatic vessels and capillaries after submental liposuction
  • To decrease discomfort and ensure postoperative well-being
  • To decrease the length of the postoperative period
  • To accelerate tissue recovery
  • To prevent the scar from reddening and forming cysts, which could produce a permanent retraction in the skin
  • To accelerate the reabsorption of fibrous areas by stimulating the macrophages
  • To improve the condition of the skin
  • To accelerate the recovery of the skin’s sensitivity
  • To facilitate skin retraction

MLD makes it possible to control postoperative recovery and help the patient feel better. Moreover, the patient is aware of the very close, positive support of the health staff, which contributes to a faster recovery, eliminating the negative perception of this stage.

The World Health Organization (WHO) has approved the use of acupuncture as an adjuvant therapy alongside conventional pharmacological therapy in the treatment of post-surgical pain. The therapy is particularly indicated in the postoperative situation: reducing inflammation, pain, as well as moderating stress and increasing relaxation for improved quality of sleep when it is needed most.

Facialteam provides acupuncture for FFS patients in order to accelerate the natural physiological processes of tissue regeneration and homeostasis. A powerfully relaxing anti-stress effect which helps to paliate surgery-related anxiety.

The therapy is twofold:

    1. The regulating signal from the nerve fibers that conduct the pain signal transmitted by acupuncture has physiological effects that decrease pain during the postoperative period.
    2. It has also been shown that acupuncture increases the level of endorphins, natural substances with an analgesic and comforting effect, in the blood. The skin fibers of the autonomic nervous system are stimulated, producing vascular and lymphatic regulation, which helps reabsorb edemas and inflammation. The higher cerebral centers are also activated, reducing post-surgical stress, increasing psychological and physical relaxation and providing a repairing sleep.


What the therapy is like

This therapy is done with the patient lying down in comfortable clothing that leaves the neck, shoulders, forearms, hands, calves and feet exposed. The patient removes all rings, bracelets and earrings. Two morning sessions are done on two consecutive days or one session in the morning and one in the afternoon, as needed. The sessions last around 30 minutes.

Throughout the therapy, the patient must stay as relaxed as possible with their eyes closed. If the patient can sleep, that’s even better. Once the therapy is over, the patient should stay relaxed and lying down for a while, then sit up briefly before standing up, maintaining the state of relaxation.


Acupuncture is a technique from traditional Chinese medicine that involves the insertion of very fine-gauge needles into specific points on the body, known as acupuncture points. The punctures are practically painless and the therapy provides the relaxing, comforting sensation that is necessary in the first few days after surgery.

The new “Balance Method” system developed by Dr. Richard Tan is based in treating only the distal points in the areas between the elbow and the hand or between the knee and the foot, which is where the energy meridians connected with the neck, face and head begin and end. This way, we treat the facial area without the need to insert needles in recently operated or sensitive areas.

We will use specialized needles of the highest quality, stainless steel and sterile, of a very fine caliber (0.22 mm), with a silicone coating for minimally noticeable insertion.