Facial Feminization overview
Facial feminization is a process that involves various plastic surgery and reconstructive procedures that will give a male to female trans patient a more feminine look.
"It's not just her technical expertise as an amazing plastic surgeon, it's her deep understanding of the human condition that makes Dr. Sigler stand apart from her peers. In my transition, I have had surgeries in other places where I felt like I was on the production line—pretty much just a piece of meat. Dr. Sigler was very different. She really spent the time to hear my story and understand what who I am and where I was going. She is one of the most compassionate people I have ever met, and certainly a gifted and skilled surgeon."
—Chastity, 46, New Jersey
What are the various procedures involved?
Depending upon your current physical characterics and outcome desires, the following is a list of procedures that may be needed to accomplish your facial feminization goals.
Eyelid surgery | blepharoplasty
Rhinoplasty | nose job
Malar | cheek implants
Liplift and/or lip injections with fillers or fat transfer
Craniofacial procedures such as forehead remodeling which involves treating the frontal sinuses and supraorbital rims
Jawline shaving plus advancement genioplasty, giving some refinement to the jaw and bringing the chin forward to provide a more slender appearance
What facial feminization can and cannot do
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Am I a good candidate?
You are an ideal candidate if:
• You are in good health
• You do not smoke
• Your pre-op lab work is normal
• You have had counseling or therapy prior to surgery
• You have friends or family available for your post-operative care
• You are willing to follow post-operative instructions
• You are able to take 7-14 days off work to rest at home and heal
Pricing and payment
Facial feminization is a combination of multiple procedures. For a general idea you may want to review the
price list here. Dr. Sigler will go over your particular circumstamces and desired outcome to prepare a price quote for you.
A deposit of $1000. via U.S. bank transfer or PayPal is required three weeks in advance of your surgery to confirm the date and time of your procedure. Balance is due prior to surgery.
Prepping for your surgery
During the consultation, your medical history will be taken in order for Dr. Sigler to evaluate your general health. A careful examination will also be conducted. Together with Dr. Sigler, you will discuss the procedure and communicate your desires, your concerns and the results you hope to achieve. You may bring photographs to show Dr. Sigler examples of what you are looking for. Dr. Sigler will go over details of the procedure itself and the possible risks and complications as it pertains to any medical or structural issues she sees in your case. She will go over the type of anesthesia to be used. Once you have all your questions answered, you will both agree on a surgery plan and a proposed date. Photos are taken before and after the surgery in order to determine the amount of improvement.
It is critical to know your expectations, your health status and your medical history in order to choose which surgical procedures will render the best results. Ideally you will have had some counseling or a psychological evaluation which states you are ready for this physical transformation. While many of these procedures can be reversed, facial feminization surgery is still a big decision. Alternatively, results can be further enhanced with surgical revisions or adding more procedures at a later date
Setting Your Surgery Date
A deposit is required to confirm the date and time of the procedure. See pricing and payment above for details.
If You Smoke
If you smoke, this habit should be stopped at least two months prior to surgery. This includes vaping and marijuana smoking.
Two Weeks Prior to Surgery
Review and download this list of medications and supplements to avoid.Stop taking any medication on this list two to three weeks before the surgery. Avoid any intake of aspirin, ibuprofen, Naproxen (excedrin, Motrin, Aleve, Advil), vitamins that include vitamin E, and energy drinks as well. Arrange for family or friends to be available for assistance when you return home to recuperate. Clear your schedule. Make a list and organize your environment to be safe and condusive to bedrest. Stock your kitchen and plan ahead for a period of time spent watching TV, reading or simply relaxing.
Pre-op labwork should be done two weeks before the surgery with your own doctor, and then sent to Dr. Sigler. If you prefer Dr. Sigler to do the labwork, you will need to make arrangements prior to your surgery date.
Required labwork includes:
CBC (Complete Blood Count), CMP (Chemical Metabolic Panel), PT (Prothrombin Time) and INR, PTT (Partial Thromboplastin Time) and any other labwork specific to your particular medical condition(s), such as a Thyroid Hormonal Panel.If you are over 50, it will be necessary to have a cardiovascular assessment including an EKG and possibly a chest x-ray. Dr. Sigler will advise.
Specific studies are required if the bone structure of the face is to be operated on such as the forehead bone remodeling or the jaw and chin, Those specific studies are X rays and CT scans. That way the surgeon will be able to assess the thickness of the bone covering the frontal sinus, the volume of such sinus, dental structures in case of the mandible.
Approval for Surgery
If you are currently undergoing treatment for a medical condition or disease, a letter from your treating specialist must be sent to Dr. Sigler at least two weeks prior to the surgery stating you are cleared to go ahead with the procedure, and include any pre-op and post-op recomendations in order to avoid possible complications during or after the surgical procedure.
Night before Surgery
Eat a lighter dinner and do not eat or drink past midnight.
Day of Surgery
Do not eat or drink anything except a little water. Allow sufficient time to get to the surgery center. Using Dr. Sigler’s car service is usually the most efficient way to ensure a timely arrival. Intake is typically scheduled two hours prior to the actual surgery. You will meet with Dr. Sigler for your pre-op consultation, pre-op photos and markings on body or face, and for a final discussion about your procedure. Paperwork is completed and final prepping by your surgical team is carefully performed.
Post surgery care
Your post surgery care specifics will depend upon which surgeries you have had.
Generally you can expect the following post surgery care of a facelift, but there may be further instructions given to you at the time of your consultation. This is just a guide:
5-7 days stitches out pending Dr. Sigler's evaluation — this also may be done in several visits depending on surgery and patient
5-7 days regular activities (keep head elevated to avoid excessive blood flow)
2-3 weeks regular exercise
You can expect redness and swelling around the incision areas. Bruising may occur, depending upon the type of surgery you had. It is important to keep the stitches covered in antibiotic ointment.Keep the head elevated and use ice or cold compresses every few hours for the first three days and three nights. week to reduce swelling and bruising. Continue to use for the rest of the first week if swelling and brusing are still present.
Use extra pillows to prop yourself up at a 45 degree angle in bed or on the couch. Rest and sleep on your back for the first week. Avoid physical efforts such as bending over or lifting anything heavier than 1 pound for the first two weeks in order to keep strain and blood flow away from the neck and face.
Post-surgery pain is minimal to moderate and the jaw may typically feel tight; accompanying soreness may be treated with analgesics.
Avoid heat or sunlight to the face in orde to reduce swelling. Avoiding sunlight to bruises on face will avoid permanent dark discoloration to the skin.
When a necklift is performed, the patient must avoid turning the head sideways since bleeding in this area may occur up to two weeks after the surgery. Therefore, driving is prohibited for two weeks following a facelift/necklift.
A compression garment to the neck is sometimes recommended (depending the case) during two weeks to be worn day and night and then, only at night during other two weeks.
Dr. Sigler will determine when the sutures are to be removed and this may be done in stages in order to minimize scarring. Scars from the incisions fade significantly with time and are, for the most part, inconspicuous because they are located within natural creases. Swelling and discoloration disappear in a week or two. Swelling can be reduced by keeping the head in a slightly elevated position when reclining. A thightness or numbness of the treated area may be present for weeks or months, depending upon the patient's healing and lifestyle.