Does Facial Feminization Surgery Leave Scars? What to Expect
Will facial feminization surgery leave visible scars?
The short answer is sometimes.
In this guide, I’m showing you exactly what kind of scars to expect, where they show up, and how we keep them as invisible as possible. I’m also sharing the advanced treatments that can take your healing even further.
If you’re considering facial feminization surgery, you can book a consultation with CMF Surgeons to discuss your surgical plan.
For more guidance on FFS, watch our Facial Feminization Surgery YouTube playlist.
What Types of FFS Scars Are There?
There are three types of FFS scars: visible, hidden, and invisible.
Hidden Scars
The most common scars that we’ll use are what we call hidden scars.
Anytime we’re working against the hairline, we’re right against where your hairline is. We have a technique called beveling, where we can allow hair to grow back through the scar.
That helps us hide the scar within the hairline.
Invisible Incisions
In my line of work, invisible incisions are through the mouth.
That’s how we get to the cheek. That’s how we get to the jawline and sometimes even underneath the jawline.
All of that can be done through invisible incisions inside the mouth.
Visible Incisions
Very rarely do we use a truly visible incision.
Occasionally, with a tracheal shave or something where we’re dealing with more of the neck, a direct incision over the voice box itself may be necessary.
For most of my tracheal shaves, I use what’s called a submental incision, far up underneath the chin.
That essentially becomes a very well-hidden scar.
Where Can FFS Scars Be Located?
The most common incision for facial feminization surgery is going to be up in the hairline.
Hairline and Forehead
The hairline incision or forehead incision is how we get to the brow and the upper part of the forehead.
If we’re moving the hairline, that incision is right against the junction of the hairline and the skin. That also gives us access to everything underneath.
We place it right in the immature hair follicles to help us hide the scar.
Under the Nose
If we’re doing a rhinoplasty, I typically perform what’s called an open rhinoplasty.
That means we make a very small incision across the skin right underneath the nose.
Inside the Mouth
Most things involving the cheeks can be done from inside the mouth.
That includes cheek augmentation, whether we’re using fat or an implant, along with jawline contouring, genioplasty, buccal fat removal, and lip repositioning.
These are all done through incisions inside of the mouth.
Under the Chin and Neck
The other incision is what we call a submental incision, which is how I typically get to the tracheal shave.
If we’re doing a neck lift, tightening the neck muscles, or removing some neck soft tissue to improve support, those can also be done from an incision underneath the chin itself.
How Long Do FFS Incisions Take to Heal?
FFS incisions can take different amounts of time to heal depending on their location.
For most patients, a hairline incision is essentially fully healed on the outside by the three-week mark.
By fully healed, I mean the incision is sealed from the outside environment. You can bathe and go underneath water. That’s what we consider a fully healed wound at that point.
For incisions underneath the nose or underneath the chin, including a submental incision, those are generally fully healed by around the two-week mark.
Internal or intraoral incisions are usually essentially fully healed after about one week.
After that initial healing, the scar process takes hold underneath the surface.
It’s not something that we just leave alone. We’ll help you manipulate the scar and create a more favorable scar as it continues to mature.
But the outside portions of those wounds generally follow that three-week, two-week, and one-week timeline, depending on where the incision is located.
What Factors Affect the Appearance of FFS Scars?
There are a lot of patient factors that can affect an FFS scar.
That includes your age, sun damage, sun exposure, history of acne, and the overall nature and characteristics of your skin.
How well do you take care of your skin?
Have you done skin care for years, or have you never really applied sunscreen?
Another factor is where we actually need to place the scar.
Your individual anatomy can have a very big impact on how visible a scar may be.
Other factors include your general health and medications you may take.
These are all things that, as part of the consultation and workup process, we’ll identify and help you manage to get the most optimal scar outcome.
How Do You Care for Your Scars After FFS?
One of the things that we pride ourselves on is a very heavy focus on postoperative care, and a big part of that is how we manage scars.
We’ll always take you through a detailed review of where your scar is and exactly what you should be doing with it.
Hairline and Forehead Scars
For hairline and forehead scars, we generally leave them alone for about three weeks, other than applying Vaseline or antibiotic ointment.
Starting somewhere around the four- to six-week mark, I’ll have you begin massaging the scar.
That helps make it a little softer.
It can also help your forehead and the area of your hairline move more naturally against the structures underneath.
Upper Eyelid and Nasal Scars
For upper eyelid scars and nasal scars, we don’t really have to do much.
They’re very well hidden, they’re very small, and they’re in skin that is generally very favorable.
Occasionally, I’ll have somebody massage a nasal scar, but that’s pretty few and far between.
Intraoral Scars
For internal or intraoral scars, I’ll generally have patients start massaging them at around the one-week mark.
That’s for two purposes.
One is to help push out some of the fluid.
The other is to prevent some of the fibrosis, or the scar tissue sticking down to the structures underneath.
Chin and the Labiomental Fold
One area that’s especially important is the chin because we do a lot of chin reshaping.
When you reshape the chin, you’re going to affect what’s called the labiomental fold, which is the fold right underneath your lower lip.
We start massaging that at around the two-week mark.
The goal is to prevent it from feeling tight and to prevent the scar tissue from distorting the lip when you’re moving it, eating, or speaking.
That’s a very important part of the process.
Submental and Neck Scars
With any submental or neck scars, we’ll usually have you start massaging at around the two- to three-week mark.
That helps flatten the scar and make it feel smoother.
It also helps the underlying and adjacent tissue feel much more natural by putting some active massage on it.
Longer-Term Scar Care
Generally, somewhere between six weeks and three months, we’ll have you start doing more formal scar and skin care.
That can include silicone strips.
Silicone strips can help soften a scar, decrease pigmentation, make it feel smoother and more linear, and decrease some of the overall fibrosis within the scar.
Other options are scar creams, vitamin lotions, vitamin E capsules, Mederma, or other commercially available scar-care products.
I’ll recommend a lot of these because it’s not necessarily the material that’s most important.
It’s the habit of doing it.
If you commit to caring for the scar, that usually means applying something or massaging it one, two, or three times a day.
That’s how we work toward the best long-term scar.
There are also scars where we may use steroid injections, Botox injections, or even surgical scar excision if we need to further optimize the scar.
For all scar care, one of the most important things is sunscreen or keeping the area covered while the wound is healing.
It’s also very important that we help you understand how to clean and care for the wound during that immature phase, usually during the first one to four weeks.
A lot of that is simply not picking at it, knowing how much you can manipulate it, and having us help you manipulate the scar appropriately.
The goal is to keep it clean, keep it healthy, and allow it to maximize its healing potential.