How you prepare

Feminizing surgeries are typically deferred until adulthood.

Before facial feminization surgery, you'll meet with your surgeon. Consult a surgeon who is board certified and experienced in the procedures you desire.

Every person has a unique facial structure. Your surgeon will ask you about your own ideas about your face and recommend procedures that will most effectively contribute to the feminization of your face. Your surgeon will also describe your potential results.

To plan your surgery, you might need a CT scan. This will allow your surgeon to obtain detailed anatomical information. Your face will also be photographed before and at several intervals after your surgery.

The surgeon will refer you for an appointment to discuss your anesthesia. Follow your doctor's specific instructions on preparing for your procedures, including guidelines on eating and drinking, adjusting current medications, and quitting smoking. Your doctor will also give you instructions to follow after your surgery to improve your results.

In addition, before you can have certain feminizing surgeries, you'll be required to meet specific criteria. To start, your doctor will evaluate your health to rule out or address any medical conditions that might affect or contraindicate treatment. The evaluation might include:

• A review of your personal and family medical history
• A physical exam, including an assessment of your internal reproductive organs
• Lab tests measuring your lipids, blood sugar, blood count, liver enzymes and electrolytes
• A review of your immunizations
• Age- and sex-appropriate screenings
• Identification and management of tobacco use, drug abuse, alcohol abuse, HIV and other sexually transmitted infections
• Discussion about contraception and future fertility

Although giving your informed consent after a discussion about the risks and benefits of the procedure is an acceptable standard of care, most surgeons and insurance companies will require a mental health evaluation by a provider with expertise in transgender health. The evaluation might assess:

• Your gender identity and dysphoria
• The impact of your gender identity at work, school, home and social environments, including issues related to discrimination, relationship abuse and minority stress
• Mood or other mental health concerns
• Sexual health concerns
• Risk-taking behaviors, including substance use and use of nonmedical-grade silicone injections or unapproved hormone therapy or supplements
• Protective factors such as social support from family, friends and peers
• Your goals, risks and expectations of treatment and your future care plans

Consent

Since facial feminization surgery might cause irreversible physical changes, you must give informed consent after thoroughly discussing:

• Risks
• Benefits
• Cost
• Alternatives
• Social and legal implications
• Potential complications
• Procedure irreversibility

Health insurance might not cover surgical procedures considered cosmetic for the general population, even though these procedures might be essential to alleviating your gender dysphoria.

You might also consider talking to others who've had facial feminization surgery before taking this step. They can help you shape your expectations of what can be achieved and what personal and social problems you might experience during treatment.