Facial Harmonization Surgery
I’m undergoing Facial Feminization Surgery (FFS), which is also sometimes called Facial Harmonization Surgery (FHS). Here’s my experience so far, and a bunch of info I learned that I had trouble finding when I was researching it.
All information here applies specifically to me, my exact situation, and advice given by my doctors. I don’t know that it will apply in anyone else’s circumstances.
This article is a sequel for my Gender Confirmation Surgery article from last year. I’ll try not to repeat myself too much, so check that one out if you have unanswered questions after reading this one.
What I’m Doing
For more details, including reference videos about facial harmonization surgery (FHS or FFS), see the What is Facial Feminization Surgery? section of my previous post.
💸 = Not fully covered by my insurance
My doctors and support staff have told me these “cosmetic” designations are not doctor-informed choices. My surgeon recommended all the procedures I selected. He’s not a salesman trying to upsell me; he’s a specialist in gender-affirming head and neck surgery. He just advised that these choices are the best way to get to where I want to be within one safe-as-possible procedure.
At least getting them done at the same time as my covered procedures greatly reduces costs for OR time, anesthesia, recovery costs, time off work, supplies, etc.
Hairline Advancement
This procedure pulls the hairline above the forehead down and smooths out its variance. It can’t work miracles, but it can cover a little under a centimeter.
Frontal Cranioplasty with Orbital Rim Contouring
This is possibly the most invasive part of the surgery, and also the part I’m most excited about. My prominent brow has always made me dysphoric. It also drops a shadow and creates the sunken eyes look I’ve also always been self conscious about.
Brow Lift
The brow lift will supplement the cranioplasty and hairline advancement to ensure my eyebrows still land in a good place after. My surgeon is aware I don’t want to look surprised or angry all the time.
Rhinoplasty & Hump Reduction
I loved my grandpa, but I’d prefer my grandma’s nose. I also have a deviated septum this will correct.
Cheek Fat Augmentation –💸$2,195
This is one of the most important parts of the procedure for me. I’m aiming for a more “heart-shaped” lower face, as opposed to how flat my cheeks are currently. HRT has helped a little bit, but I need a boost to supplement it.
Upper Lip Lift
This pulls the upper lift closer to the nose by removing a small flap of skin beneath the nostrils.
Lip Augmentation –💸$2,195
Adding some volume to my lips. I’m going to be cautious and conservative about how much we enhance here, because I notice a lot of people go overboard.
Mandibuloplasty (Chin Contouring)
Reduces the protrusion and height of the chin.
Neck Submentoplasty (Mini Neck Lift) — 💸$5,080
To compensate for the reduced surface area of my chin contouring, I’m tightening up the loose skin on my neck. It’ll also help with some after effects from my major weight loss years ago.
Total Cost of Non-Covered Procedures 💸
$10,782.50 😬
(I’ll also have copays for the covered procedures. I’ll try to remember to share that total once those are confirmed)
If you have the ability to help me recover from this surgery in any way, I could definitely use it. See my Call for Support section at the end of this article. (Including non-monetary options) 💖
What I’m Not Doing
All of these would’ve been covered by my insurance. They were offered but not strongly recommended for my case.
Jaw Reduction
This part of the procedure is especially arduous, and I don’t mind the width of my jaw, so I’m opting out of this part.
Tracheal Shave
I don’t have a prominent Adam’s apple, and I’m wary of messing with anything near my throat if I don’t need to.
Vocal Cord Surgery
I know friends who’ve done it and the results are mixed. I won’t post photos of this surgery as they’re… gross.
I have faith in my vocal training to get where I want to be eventually. I’ve been trying to get close to Mary Elizabeth McGlynn’s gorgeous voice.
When I’m Doing It
August 3rd, 2026
For anyone considering medical transition
Know you’ll have to fight constantly to have your needs heard and to overcome all the obstacles everyone puts in your way. I encourage using the spite you build waiting on hold constantly as fuel.
And if you’re transfemme: As many cis women in my life have put it, “Welcome to navigating the medical system as a woman.” Enjoy the bittersweet gender euphoria that comes from not being listened to by doctors.
FFS Timeline
| When | What |
|---|---|
| 11/7/2023 ✅ | Began HRT |
| 1/11/2025 ✅ | Requested a Referral for Gender Affirming Surgery |
| 2/21 ✅ | Got Referral for Gender Affirming Surgery Consideration |
| 3/11 ✅ | Met w/ Gender Affirming Care Counselor Referred for Nurse Consultation |
| 4/29 ✅ | Nurse Consultation Referred for (pending) Surgeon Consultation |
| 5/23 ✅ | Attended Informational Webinar Mandatory before getting Surgeon Consultation Appointment |
| 5/27 ✅ | Got a Surgeon Consultation Appointment |
| 8/18/2025 ✅ | Surgeon Consultation Approved to move forward with chosen procedures. Waitlisted for an appointment (est. 9 months for surgery date — mid-May) |
| 5/20/2026 ✅ | Confirm Surgery Date |
| 6/22 | Halt Laser and Electrolysis Hair Removal 6 weeks before surgery |
| 6/30 | Physician Assistant Consultation #1 Confirm procedures, ask questions |
| TBD | CT Scan Map my face. Appointment should be set at first Physician Assistant Meeting |
| 7/16 | Physician Assistant Consultation #2 Confirm final details, prep |
| 7/25 (Day -9) | Last Happy Hour Before Surgery One last little party before surgery. (let me know if you want an invite) |
| 7/27 (Day -7) | Start Quitting Stuff 1 week before surgery No drinking, edibles, pain relievers, ketamine therapy |
| 8/2 (Day -1) | Last Meal Before Surgery Timing TBD. (let me know if you want an invite) |
| 8/3 (Day 0) | Surgery Day Hospital overnight |
| 8/4 (Day 1) | Discharged Home Drive home and begin pain management regimen |
| 8/4-5 (Day 1-2) | No Showers |
| 8/3-9 (Day 0-6) | Soft Food Diet for up to 1 week after surgery |
| 8/5-6 (Day 2-3) | Pain & Swelling Peak Likely 2-3 days after surgery Prepare pain management and emotional support for this window |
| 8/7 (Day 4) | Post-Op #1: Doctor Call Generally 3 days after surgery |
| 8/11 (Day 8) | Post-Op #2: In-Person Check-up “Most patients feel significantly better” one week after surgery |
| 8/17 (Day 14) | Sleep Normally, Return to Work No longer need head elevated |
| 8/24-31 (Day 21-28) | Resume Hair Care Haircut, Keratin — 3-4 weeks after surgery |
| 9/18 (Day 45) | Post-Op #3: In-person Check-up, Resume Normal Activities Some numbness and swelling may continue for months after |
| 9/18 (Day 45) | Resume Laser/Electrolysis/Waxing/Hair Color 6 weeks after surgery. This is when I’ll finally feel presentable again! |
| TBD (Day 90) | Post-Op #4: Check-up 3 months after surgery |
| TBD (Day 180) | Post-Op #5: Check-up 6 months after surgery |
| TBD (Day 270) | Post-Op #6: Check-up, Resume Sunbathing 9 months after surgery |
| TBD (Day 365) | Post-Op #7: Check-up 1 year after surgery |
Fears
When I’m anxious or scared, I find it helpful to say the fears aloud. To expose them to sunlight and scrutiny, and hopefully hear how easy they are to ameliorate.
Before Surgery
Torschlusspanik
a German term literally translating to “gate-closing panic”. It describes the deep anxiety and urgency felt when you realize time is running out to reach specific life goals, find a partner, or seize opportunities before the “window” closes.
- My access to gender affirming care is revoked before I can get it done.
- I get sick or injured right before my surgery date.
- Loved ones roll their eyes at me asking for support again.
- Sleeping overnight in a hospital will be emotionally difficult.
During Recovery
- My pain won’t be managed properly.
- Emotional difficulty waiting for my face to heal.
- My caregivers are overloaded, stressed, resentful.
- I need to use more sick time than I have.
After Recovery
- Medical malpractice, complications, I’m botched.
- Weening off pain meds will be hard, as chronic pain returns again.
- I don’t recognize myself in the mirror.
- The bill arrives, and it’s higher than expected.
- Recovery time jeopardizes my city council run.
- The numbness and possible touch-starvedness affects my morale.
And as I often remind myself…
Fears are inversions of
gratitude and hope.
Hopes
And some mantras or facts to remember to help me get there.
Before Surgery
- Gender affirming care is protected, perhaps even strengthened.
- The days before surgery go smoothly, and I don’t even miss my pain relief or anti-depressants.
- Loved ones happily show up for me like they’ve done before.
- I’m barely conscious during my hospital stay and it goes by fast.
During Recovery
- Zero issues with pain management, few gaps or flare ups.
- My only emotion during recovery is impatient excitement.
- My caregivers have lots of help and don’t need to disrupt their lives much to care for me.
- I return to work without using up too much sick time.
After Recovery
- Surgery went off without a hitch, and I recover quickly and with minimal scarring.
- Weening off pain meds is easier than last time.
- I love who I see in the mirror.
- Reminder: Swelling and bruising won’t be fully gone until up to a year after surgery.
- The bill is lower than expected.
- My city council run never misses a beat.
- I can feel touch and other senses soon after swelling goes down.
These outcomes feel more likely than my fears, but we’ll see. 🤞
My Questions
A list of questions I asked along the way and the answers, once I get them. (❓ = I’m not sure about this yet)
I have a deviated septum. Can I include fixing that in my facial harmonization procedure?
Yes.
I have a low impact sitting remote job. How long do you estimate I should take time off work?
1-2 weeks.
How long should my caregiver(s) expect to take off work?
At least 1 week.
Can my wife stay with me overnight at the hospital? Is there a bed or cot available for that?
Your wife can stay overnight. There is usually a sofa or reclining chair in the room.
Physician Assistant
How long before surgery do I need to quit [blank]? How long after can I resume?
| Activity / Substance | Stop | Resume |
|---|---|---|
| Alcohol | 1 week before | After prescription pain meds |
| Brushing Teeth | Day of | Day after surgery. “Brush your teeth gently (especially lower teeth) after eating.” |
| Coffee | Day-of | Next day |
| Electrolysis | 6 weeks before | 6 weeks |
| Food (regular diet) | ❓ | 1 week |
| Hair Color | 2 weeks before | 4-6 weeks |
| Haircut & Hair Color | 1 day before | 3-4 weeks |
| HRT | 😢 2 weeks before | 2-3 days after (as long as you’re up and moving around) |
| Ketamine Therapy | 1 week before | After prescription pain meds |
| Kissing | 😢 Day of | 💖2 weeks (light) |
| Laser Hair Removal | 6 weeks before | 6 weeks |
| Marijuana (edibles) | 1 week before | Next day |
| Pain Relievers (OTC) | 1 week before | After prescription pain meds |
| Skin Care Routine | 1 day before | 7-10 Days for non-incision areas 3-4 weeks for incision areas |
| Strenuous Physical Activity | 1 day before | 4 weeks |
| Sun Exposure | 1 day before | 6-8 months after |
For your skin and hair care,
you can continue your usual gentle facial and scalp routine, including shampoo, conditioner, and basic moisturizer, up until the night before surgery. Please avoid harsh scrubs, retinoids, acids, home peels, or new products on the face starting about 7 days before surgery to reduce the risk of irritation. The morning of surgery, you can wash your face and hair with your usual gentle products, but do not apply makeup, sunscreen, styling products, or facial creams afterward.
There is no issue getting sun exposure prior to surgery. I would try to prevent sunburns though. Also try to keep the incisions out of the sun for about 6-8 months post op to ensure it will scar well.
After surgery, I generally recommend waiting about 3 to 4 weeks before a haircut and at least 4 to 6 weeks before hair coloring near any incision areas, depending on how you are healing. Color can be irritating to healing skin and hairdressers often need to manipulate the scalp and hairline.
Physician Assistant
For gentle skincare, the timing is different for each area we operate on. In general, you can usually resume very mild, fragrance-free cleanser and moisturizer on the non-incision areas of your face within about 7 to 10 days, once the swelling is improving and there is no drainage. Over the actual incisions (hairline, around the ears if applicable, and under the chin), you should avoid regular skincare products until the skin is fully closed, the sutures are out, and the surface looks smooth rather than scabbed or raw. For most patients, this is around 3 to 4 weeks, which matches what you are thinking, but I will give you specific clearance at your post-operative visit based on how you are healing. Avoid exfoliants, retinoids, vitamin C serums, scrubs, and any strong actives for at least 6 weeks, and then reintroduce them very gradually.
Surgeon
For post-surgery diet restrictions,
You will be on a soft food diet, not just liquids. Soft foods: scrambled eggs, mashed potatoes, cottage cheese etc.
Physician Assistant
Will my post-op pain medications be liquid?
You should be able to take pills (oxycodone, Tylenol, ibuprofen) after your surgery. It is rare for patient’s to have issues taking pills after surgery.
Physician Assistant
Will Kaiser provide ice/gel packs?
Cooling gel packs after surgery are very helpful for comfort and to reduce swelling in the first 48 to 72 hours. Kaiser will give you a few to go home with but you should have some at home as well.
I recommend that you obtain a few soft, flexible, reusable packs ahead of time. Any over-the-counter gel pack that can be cooled (not rock-hard when cold), wrapped in a thin cloth, and shaped gently to the face is fine; you do not need a special brand.
Plan to use them intermittently, about 15 to 20 minutes on and 20 minutes off while awake during the first few days, always with a cloth barrier to protect your skin.
Physician Assistant
Normally after submentoplasty surgeons prescribe facial compression. Is that possible when we’re also doing hairline advancement?
Yes, for the submentoplasty portion it is standard to use a compressive dressing or wrap under the chin and along the lower face to help reduce swelling and support the soft tissues as they heal. You will leave the operating room with the initial dressing on, and before discharge we will show you exactly how it should sit, how long to keep it on continuously, and then how many hours per day to use it after that.
Surgeon
Additional Links
- Recovery After Facial Feminization Surgery (Kaiser Permanente)
Another Request For Help
Just like last time, I’ll need similar support. I’ve created a MealTrain Page to track who’s helping out and how and I’ll send emails and texts around when we get closer to the surgery date.
Monetary Support
The MealTrain page will also include options for monetary support. My GoFundMe page is also still open. Anyone interested can also use the Monetary Gifts section of my Wish List or just ask me.
The donations I received for my top surgery in November really helped my family get through the time I couldn’t work or take care of my own needs. I’m still in debt, but it’s much less compounded by interest than it would’ve been without y’all.
Thank you. 💖
Quick Reference for FFS Support
Re-posted from my previous article about Gender Confirmation Surgery and edited to be specific for Facial Harmonization Surgery.
One-Time Tasks
- ✅ Driver to surgery (day 0)
- ✅ Visit/stay during hospital overnight (day 0)
- ✅ Driver home from surgery, help from car to bed (day 1)
- Driver to first post-op appointment (day 7)
- Driver to second post-op appointment (day 28)
In-Home Assistance
For the in-home care stuff, it’d also be wonderful to relieve my primary caregivers for a few hours here and there so they can live their own lives a bit too.
| Task | Timeline | Notes |
|---|---|---|
| ✅Help Getting In/Out of Bed | days 1-3 | Walking to/from the bathroom mostly. |
| Meal Prep | days 1-3 | Mostly heating/plating prepped meals. |
| ✅Medication Reminders | days 1-3 | Nudge me to take meds if I’m out of it. |
| Dog Walking | days 1-5 | 2 walks daily around ~9am, ~5pm. |
| ✅Let Visitors In/Out | days 1-5 | |
| Wound Care | days 1-14 | Help applying ointment or replacing bandages. May only be needed for the first few days. |
| Mail/Packages Pickup | days 1-14 | May not be needed. |
| Laundry, Groceries | days 3-5 | May not be needed. |
Emotional Support
Being stuck in bed and unable to work or go out sucks. Company can distract me and make the time go by more pleasantly.
| Activity | Timeline | Notes |
|---|---|---|
| Remote | days 2+ | Phone, Video Calls, Discord, etc. Depends on how well I can talk (energy, pain, etc.). |
| Very Low-key | days 2+ | In bed, watching movies/shows together. FFS: I may not be ready to talk much, my vision may be obstructed. |
| Low-key | days 5+ | Out of bed, talking normally. We can game and do some light walking, but I may need you to hold Rogue’s leash for me. |
| Chill | days 8+ | Basically a normal chill hangout. |
| Active | days 28+ | Resume physical activities like hiking, swimming, etc. |
I theorize these acts are the ones I’ll need the most. Boredom and isolation really suck for anyone, but I feel extra sensitive to them.
Recovery Meals
It’d be lovely if you’d like to visit and enjoy meals together or drop something off to help!
After I’m released from the hospital, I’ll have special dietary needs for a while.
| Diet | Timeline | Notes |
|---|---|---|
| Soft Foods | days 1-6 | Soft pasta, tender meats, heartier soups (tomato, cream of mushroom), meatballs, soft-cooked veggies, cheeses (mozzarella string cheese, cottage cheese), soft flaky fish, cold cuts |
| Normal | days 7+ | My second week after FFS I’ll want to exercise my jaw muscles more, so I’ll be ready for chewier foods around then. |
Finally, as always…
Thank you. 💖
I’ll keep saying it in person too. I love you all.