Frequently Asked Questions

FFS Surgery

Smoking

As smoking counteracts the wound healing process, we strongly recommend not smoking for 3 weeks before and 3 weeks after the surgery.

Health

Please notify us of any health conditions you may have and any medications you take, which will be kept confidential. HRT does not need to be suspended before surgery since we will administer an antithrombotic agent to counteract the clotting effects of the hormones.

Swelling and bruising

During the FFS post-op period, patients will generally encounter two phases as the healing evolves:

  1. Inflammatory Phase:

    Usually lasting 3-4 months, this part of the FFS postop may be divided into two sub-stages:

    1. Early inflammatory Stage: During the first 3-4 weeks after surgery, when the noticeable bruising and swelling persists.  Pain and discomfort during this period may occur. Numbness is typically at it´s maximum level. During this period, wearing compression bandages to reduce the swelling may be recommended after chin or jaw surgery.
    2. Late inflammatory Stage: During the 2-4 months after surgery. At a much lesser degree, minor symptoms are common such as residual swelling, fibrous tissue presence, irregularities, asymmetry etc. which may vary from day to day or even from morning to night. Continuous pain is not expected, but some discomfort may still be present, especially stiffness in the area. Numbness diminishes gradually, slowly regaining sensation even up to a year or more.
  2. Re-adaptation Phase: 

    Re-adaptation of the tissues initiates when the majority of the edema (swelling) has diminished to about 80%. It takes 12 to 15 months approximately to fully repair. Primarily, the soft tissues will need to readapt to the new bone surface. The remaining residual swelling will continue to subside gradually over the year, when the final results are more definitive (except with a rhinoplasty, which may take 18-24 months).

    One of the most important aspects of the FFS postop process involves the appropriate aftercare management of the patient, both immediately after the operation as well as on the long-term. Proper recovery has a strong influence on whether the patient returns to her usual routine swiftly. The immediate postoperative period is the most intensely influential one, both physically and emotionally. It requires a strict protocol to ensure that the patient receives constant care and is made to feel that she can count on the close support of the professionals involved in her treatment. While the situation may vary according to the patient, the face usually experiences significant inflammation after surgical manipulation, which is most obvious in the eyelid, nose, jaw, and chin areas.

During the FFS post-op period, patients will generally encounter two phases as the healing evolves:

  • In advance as well as postop FFS, use of arnica-based topical balm
  • Rest!
  • Medical prescription for anti-inflammatory and analgesic medicine
  • Compression bandage and the application of cold to the operated area (hilotherapy)
  • Manual lymphatic drainage
  • Acupuncture: traditional, auriculotherapy, electroacupuncture and laser acupuncture

The prior use of arnica balm combined with the immediate application of hilotherapy and the early administration of manual lymphatic drainage and acupuncture considerably decrease any edema and speed the recovery and adjustment of the soft tissues. Finally, we recommend using compression therapy (elasticated facial garment provided) for 2-3 weeks after jaw and chin recontouring surgery to assist in tissue repositioning.

Emotions

During the first days following surgery you are swollen, bruised, and sore, both physically and mentally. We are here to give you all the support and care you need. Additionally, a professional psychological support service is available. We also recommend preoperative treatment to assist with the transition.

Lumps and scabs

Tightness, hardness and lumpiness around the face, jaw, and neck is common and will subside over time. After 24 hours, manual lymphatic drainage is administered to aid tissue recovery. Do not pick or remove any scabs or crusting.

Pain

The pain is surprisingly moderate with facial feminization. Most patients will experience discomfort more than pain, which is usually easily controlled with normal painkillers. However, if you continue to experience pain, you should contact us. Pain medication is generally not needed after one week.

Numbness

A total or partial lack of feeling near the treated area is normal and will gradually improve with time, usually between 3-6 months. In some cases, this may take up to one year.

Bleeding

You may experience light bleeding in or around the incision areas, which is not a problem. However, if you find any large and/or hard collections of blood or experience excessive bleeding, please alert our office as soon as possible.

Medications

We will provide you with a postoperative medication packet with antibiotics and painkillers, modified according to each patient’s needs. Other complementary medicines or ointments will be recommended as needed. We suggest you consult your physician before resuming any discontinued medications.

Cleaning external incisions

If you have sterile strips covering the wound or a bandage, do not touch them and keep them dry. To clean your face, use a gentle soap. With clean hands, simply apply it to your face, avoiding the incisions. Rinse your face as normal with cool water and carefully dab it dry with a clean cloth. Allow it to air dry completely or use a hairdryer on a cool setting. Any remaining moisture in the wounds should be removed by dabbing them with gauze and a small amount of 60% alcohol. When thoroughly dry, you may opt to use an antibacterial ointment to keep the incisions clean and soft, which helps them heal quickly. Never pull the skin and be gentle! Keeping the incision areas as clean as possible will also help us remove your sutures more easily. If necessary, we will see you for wound care in the clinic.

Personal hygiene

You may shower 24 hours after your surgery. Baths are acceptable, if they are short and not too hot, but avoid soaking any of the treated areas in water. Your incisions can get wet but should not be soaked for long periods. We recommend using Betadine shampoo. Do not bend over to wash your hair; instead, tilt your head back in the shower. When washing your hair, always gently massage towards your incisions, never away. Do not be alarmed if the wound bleeds a little while washing your hair. Be gentle with your face and scalp, especially when toweling dry and do not apply pressure to the scalp. Only use a hair dryer on the low, cool setting for the first 8 weeks after the surgery. If you are candidate for a Simultaneous Hair Transplant (SHT), please follow the specific postoperative instructions.

Movement and food

At the hospital, once the catheter is removed (if it is used), you may try to get up gently and eventually take short slow walks in the hallway, unless your doctor says otherwise. During the first week after surgery, you should rest as much as possible. However, it is good to take short, low-impact daily walks once you feel better. You also should avoid bending over at the waist for the first six weeks after surgery to minimize the amount of blood flowing to the area. Instead, bend at the knees and/or turn your entire body if necessary. Keep your head elevated at all times. Avoid excessive chewing by consuming soft foods like fruit shakes, yogurt, soup, eggs, pasta, rice, or pudding following surgery. With forehead reconstructions, you should not blow your nose for 2 weeks and sneezing should be done with your mouth open.

Eating

It is not advisable to eat solid food during the 8 hours before surgery. The last meal before fasting should be light to ensure an empty stomach. It is best to limit your intake to soft foods at room temperature or cooler. Do not drink liquids during the 8 hours prior to surgery. Soft drinks, tea, coffee, and sodas, which may delay clotting or wound healing, should also be avoided the day before.

Sleeping

When sleeping, use two pillows to prop up your head and support your neck, trying to keep your head slightly higher than your heart. Do not sleep on your side for one week and if necessary, place pillows on the sides of your face to keep yourself from turning your face while sleeping.

Work and play

We highly recommend total rest and relaxation for two full weeks following surgery. If you give your body ample time to recover and relax physically, emotionally and mentally, you’ll heal faster in the long run. A positive mentality has also been proven to aid healing, so practice your new smile!

Physical activity that raises your blood pressure or produces sweating should be resumed carefully and slowly after 6 weeks. Travelling is permitted after one week, but ask for help with any heavy luggage. After two weeks, you may resume high-demand driving, sedentary work, and light exercise like slow walking. Intense exercise (running, Pilates) may be resumed 6 weeks after your surgery, depending on your recovery. Yoga, especially upside-down poses, should be avoided for 8-10 weeks. Ask us if you plan to do any high-impact or heavy contact activity soon.

Beauty

Do not use hot hair rollers or get your hair cut, permed or colored for six weeks. You can apply light makeup gently after 1 week. Avoid heavy ear jewelry. Strong anti-ageing skin treatments should be avoided for 3 months. Avoid electrolysis/laser 3 weeks prior to surgery. Hair removal can be restarted 6 weeks after surgery.

Sun

Avoid sun exposure to the surgical area for six weeks and use sunscreen, even on cloudy days, on the incisions for at least one year. This will improve the quality of the scar and help it fade over time. Sun exposure causes skin damage, which leads to early signs of aging.

Support

Our patient coordinators will take care of you from the first contact to long after your surgery. They’ll help you with logistical details such as accommodation and organizing appointments as well as airport transfers. They’ll also give you a mobile phone so you can reach them at the touch of a button, 24 hours a day.  In addition, our staff psychologist is available when required for personal sessions, in addition to the group support sessions provided.

Should I bring someone to my surgery?

Yes, it is preferable to come with a close relative or friend during your stay in Marbella.

How long will I be in the hospital?

Most patients must spend one to two nights in the hospital after their surgery. After this, a nurse will visit you periodically at your chosen hotel to assist with wound care, hair washing etc.

How do I reach the doctor after hours if there is an emergency?

Most patients must spend one to two nights in the hospital after their surgery. After this, a nurse will visit you periodically at your chosen hotel to assist with wound care, hair washing etc.

How soon after facial feminization surgery can I travel?

There are usually a number of follow-up appointments after your surgery you need to complete before leaving town. We usually recommend not travelling for at least 8-10 days after your FFS.

What happens if I need to see the doctor when I get back to my country?

First, contact us during our office hours or after office hours through HC Marbella International Hospital. We collaborate with several doctors in different countries who can help you. If we do not know a doctor in your area, we advise you to consult your personal physician. After your visit, we will discuss the problem with your physician and recommend the appropriate treatment. In extremely rare cases, you would have to come to Marbella.