Deciding to undergo gender confirmation surgery can be incredibly affirming and overwhelming, all at once. Beyond the fact that expenses can be significant if your procedures are not covered by insurance, there’s simply a lot to learn. The technical aspects can be very elaborate—and in many cases, the recovery can be too. While swelling and bruising are often commonplace side effects of plastic surgery, certain gender confirmation surgeries have post-op protocols that are more intricate than just keeping incisions dry or keeping your head elevated as you sleep.
No matter which procedures you book, remember that one of the most invaluable tools for recovery is mental health support. “There are complex emotions that bring [patients] to this decision,” says Dr. Heather Richardson, a board-certified surgeon in Beverly Hills, California. “Like getting married or getting your dream job, you may have this vision of what your life is going to be like once you’ve crossed that line—and sometimes it’s not exactly what you pictured. Maybe it’s better, maybe it’s different.” Don’t be afraid to lean on your loved ones for support or seek out trans support groups. And allow yourself to be excited too: all the doctors we spoke to agree that the majority of patients are thrilled with their outcomes.
Here, top surgeons known for their expertise in treating trans patients break down exactly what to expect of the recovery after the most popular gender confirmation procedures.
Facial feminization surgery recovery
Many procedures fall under the broad umbrella of facial feminization surgery (FFS). According to Dr. Harrison Lee, a board-certified facial plastic surgeon in Beverly Hills, California, who is recognized for his work performing Caitlyn Jenner’s FFS, nearly all of these procedures require about two weeks of recovery, with the largest concern being swelling and bruising.
As long as your provider hasn’t put in any drains, showering is a go within a day or two, and light cardio—aka walking around—within the first week of your procedure is recommended, to support healing, but you’ll need to avoid strenuous exercise for at least a month. “The lymphatic drainage system is damaged after any kind of surgery,” explains Dr. Lee. “The blood supply gets [to the surgical area], but leaving it is an issue—therefore, swelling can persist for weeks if you do any intense cardio right away.”
Sleeping elevated and on your back for the first few days after your procedure is also crucial. “Some patients interpret that as sitting straight up, and they can’t even sleep,” says Dr. Lee. “We emphasize 30 degrees elevated—two to three pillows—and that we want you to sleep. Sleep is critical to the recovery process.”
Hairline advancement
Hairline advancement, which lowers and rounds out the hairline to create a more feminine look, is typically combined with a brow lift and/or a forehead reduction, otherwise known as brow bone contouring, to smooth out brow ridges that can masculinize a face. Though every patient is different, most patients spend a week indoors recovering, with puffiness and discoloration resolving throughout the second week.
As long as you avoid your sutures, wearing sunscreen is OK immediately, as is donning a loose-fitting hat, to protect your face from the sun; Dr. Lee notes that many scar creams are formulated with SPF 30. To make sure you don’t irritate your incision, you cannot color your hair for at least four weeks. “You may experience generalized hair loss because of the shock of the surgery,” says Dr. Lee, who notes that it will take at least eight weeks to see regrowth. “We generally try to preserve the hair follicles in the front, when we advance the hairline, so that the hair grows through and camouflages the scar.”
Rhinoplasty
While liquid nose jobs have increased in popularity lately, plastic surgery remains the gold standard for transfeminine patients. Dr. Lee feminizes a nose by lifting the tip up, increasing the nasolabial angle to about 100 degrees, then softening the bridge of the nose. You can expect to look like the stereotypical representation of a nose job patient, with a facial cast and two black eyes. The cast will come off after a week, when you can cover that bruising with makeup, but most patients opt for two weeks of social downtime. It will take considerably more time to see the true outcome of your rhinoplasty, however. “It takes anywhere from six months to a year for the swelling to resolve and to see the final result of the nasal tip.” says Dr. Lee.
Cheek, chin, and jawline contouring
Cheek implants are placed above the bone through tiny incisions inside the mouth (right above your upper canine teeth). Once you’ve had your implants inserted, proceed with caution for about two weeks post-procedure. “Anything can shift the implant,” warns Dr. Lee, even minor trauma to the face. “We usually tape around it and leave that tape on for about 10 days.” In Dr. Lee’s hands, his patients’ facial swelling tends to resolve after two weeks, but it may take a few months to see the final outcome.
Because men often have strong jaw angles and broader chins, contouring these areas can be incredibly transformative. Chin and jaw contouring can also result in serious disfigurement if performed by unqualified providers. Dr. Lee, who holds a DMD in addition to an MD and is experienced in oral and maxillofacial surgery, notes that he’s seen patients whose prior providers have removed the entire masseter muscle during their jaw surgery or aggressively shaved the chin to the point that the soft tissue there falls, creating a “witch’s chin.”
Instead, Dr. Lee uses a saw to cut down the jaw, then performs a genioplasty, to reconstruct the chin. Recovery time is about two weeks. While you won’t have to restrict how wide you can open your mouth or anything post-procedure, you’ll need to adhere to a liquid diet for about 10 days. “With a genioplasty, we’re putting in plates and screws,” he says. “You don’t want any food particles getting in there and potentially infecting the plate and bone.” He recommends clear liquids for the first few days, then advancing to milkshakes, soups, and then soft foods, like mashed potatoes and scrambled eggs.
There is a potential complication that can occur during surgery that typically resolves itself: numbness of the lip and chin. “The mental nerves can get a little bit bruised during the surgery, but eventually—in about six months, very rarely up to a year—the sensation fully returns.”
Lip enhancement
At Dr. Lee’s practice, lip enhancement typically comes courtesy of a combination of filler and a bullhorn lip lift. “I’ve used implants before, but the problem with implants is that you can feel them, and they feel hard,” says Dr. Lee. Recovery takes about 10 days, and makeup can be worn after the outer sutures are removed (usually at the five-day mark). But take it easy with your lips; in rare instances, Dr. Lee has seen the lip lift incision come apart. ”We don’t want overactive lip activity, under any circumstances,” he warns.
Voice feminization surgery recovery
Your vocal cords work by vibrating when whispering, speaking, or singing. Adjusting their length, size, or tightness will change the way they vibrate, adjusting the pitch of your voice. Though one might assume that recovery from this procedure would be quite challenging, Dr. Toby Mayer, a board-certified plastic surgeon in Beverly Hills, California, who has been using his proprietary voice feminization surgery technique for more than 40 years, shares that you can speak directly after the procedure, if you desire. “There is no required vocal rest,” he says. “Some patients choose to rest their voice the first day because it’s more comfortable.” You may also want to consider eating softer foods for your first few meals after surgery, to reduce any discomfort.
Dr. Mayer’s method involves a tiny incision in the natural fold of the neck, through which he’ll often perform a tracheal shave too (more on this shortly). As is the case with most surgical aftercare, he recommends avoiding strenuous activity post-procedure, especially anything involving your neck, as not to cause any issues with your incision. The suture will be removed after two weeks. “The main concern after voice surgery is hyperextension of the neck, so I ask the patient to avoid that for four to eight weeks,” he says. Otherwise, recovery is simple, largely painless, and successful. “There is a 90% success rate with this procedure,” he says, “If it works, it works. Your voice will not drop years later.”
Adam’s apple reduction, or tracheal shave, recovery
During a tracheal shave, a provider must spread the muscles over the cartilage of the trachea in order to remove some of it, smoothing the contour of the neck for a more feminine look. Dr. Lee does so by going through a small incision under the chin. In some cases, he looks inside the throat and places a needle above the vocal cords, to ensure they remain untouched during the procedure.
Though the vocal cords aren’t addressed during a tracheal shave, swelling from the procedure can cause hoarseness or discomfort when speaking. Vocal rest for two weeks is recommended, but “some patients don’t do very well with that—they persist in speaking,” says Dr. Lee. During recovery, eat softer foods and avoid drinking alcohol until your throat no longer hurts when you swallow. Pro tip: Even though it seems gentler than speaking normally, don’t whisper when your voice hurts. Studies show that in most people, whispering strains the voice more than speaking.
Top surgery recovery for transfeminine patients
When it comes to transgender women booking surgeries for fuller breasts, the procedure and recovery are like those of most breast augmentations, with a few differences. “A lot of [transfeminine] patients have usually been on hormones for a number of years, so they usually have some degree of breast tissue,” says Dr. Lisa Cassileth, board-certified plastic surgeon in Beverly Hills, California. “It’s not like a male chest—it’s actually like a small female chest.”
Though this additional tissue can help create a more natural-looking result, Dr. Cassileth often incorporates fat grafting into her augmentations, for an especially feminine appearance. “I take the fat from areas where you want to add curve,” she says. This includes the waist, the lower leg, and the upper arm.” Regarding the implant placement itself, Dr. Cassileth usually inserts it under the fascia but in front of the muscle, adding extra support with GalaFLEX surgical mesh to create an internal bra. Subfascial placement helps prevent “pec flex” deformities that can occur from submuscular implant placement, particularly in physical patients. “When you do your bicep curls, you can see your implants go up and down,” explains Dr. Cassileth.
Immediately after surgery, all the traditional rules apply—sleep elevated and on your back with your knees flexed and feet flat for the first few weeks post-procedure, ideally, to minimize swelling and prevent any unnecessary pressure on the implant. But for Dr. Cassileth, the foremost concern is the incision. “You don’t want people to get an infection, which could somehow infect the implant or get into the surgical space,” she says. In addition to keeping the area clean as it heals, patients should avoid immersion in pools, hot tubs, or the ocean for a month. For that month, patients should also skip any high-impact activity, though light fitness activities at the gym can be resumed after a week. (If the implant is submuscular, heavy lifting and push-ups should be avoided for a month.)
The beauty of getting an internal bra is that it eliminates the need for a traditional, external bra, but otherwise, Dr. Cassileth lets her patients wear wire-free bras at the month mark, restricting the use of any garments with underwires until after the incisions have fully healed. “Incisions are very prone to irritation and chafing for a few months, so it’s good to baby them,” she says. “If you want to wear [an underwire bra] for a two-hour event, fine, but not for any long events, especially if you’re drinking and you won’t notice that something hurts.”
Top surgery recovery for transmasculine patients
Top surgery isn’t a breast reduction, per se—it’s closer to a gynecomastia surgery. And though this aspect of surgery often goes overlooked, it’s especially important to consider how the procedure is performed, if the patient has a family history of breast cancer. Dr. Richardson often works in tandem with Dr. Cassileth to make sure that their transmasculine top surgeries are both oncologically sound as well aesthetically pleasing to the patient. If all the breast tissue is removed, the surgeon will have to take great care to leave as much fatty tissue as possible in order to not take away too much volume in the chest, which could affect the cosmetic appearance.
Interestingly enough, not all plastic surgeons performing top surgery talk with their patients about their desired final look. “In many cases, there is no discussion on the chest appearance they’re interested in having,” says Dr. Richardson. “Do you want something that leans toward the feminine, hypermasculine, or gender neutral?” These conversations are critical to a satisfactory surgical outcome, especially for such a momentous gender confirmation procedure. “I’m now on my fourth [transfeminine] reconstruction where the patient had remorse,” says Dr. Cassileth. “Some patients with big breasts who have a more masculine identity don’t want to have big breasts but aren’t ready to have a male chest either.” Adds Dr. Richardson, “there’s a whole litany of choices, and you only get one shot at this.”
Almost always, top patients will have drains placed and binders wrapped around the surgical area. “We’re creating large, raw surfaces on the inside,” says Dr. Richardson. “Adding drains can help speed up the process where tissue sticks to itself, sealing down and healing, eliminating the fluid that’s weeping out and making it so there’s no space for the fluid to collect and create a seroma.”
Patients can expect that the surgical area will feel tender for the first few days; drains are often removed after a week to 10 days, when you can start to shower and do light cardio. It’s at this point that you’ll begin to feel changes. “I always warn patients that the healing process is going to evolve over the next two to six months,” says Dr. Richardson. The tissue will tighten up, maybe feeling hard or lumpy, and appear swollen. Simultaneously, the scars will get pink and thick, then feel hard and tight. Gradually, the nerves that were damaged during surgery start to “wake up,” which will create tingling sensations, then the tissue will begin to soften. “I tell patients not to decide what they think about it for a good solid year—give it a year of healing,” she says.
But it’s usually far sooner than one year that the patient will be ready to reveal their new look. “Usually, within the first two to six weeks, people are comfortable with showing their result,” Dr. Richardson says. “This is one of the first times where a trans person gets to be in control of what they look like—they’re so excited.”
Bottom surgery recovery for transfeminine patients
A full-depth trans vaginoplasty is the combination of multiple procedures: a provider is removing the testes, creating a clitoris, and taking apart and degloving the penis, all in one session. “It’s a big surgery—you need about a month off work,” says Dr. Praful Ramineni, a board-certified plastic surgeon in Washington, D.C. Patients are usually held in the hospital for about a week, to ensure their pain is well-controlled and that they’re up and moving, generally within the same day. “If somebody lies around all day, they’re much more likely to develop a blood clot,” he warns. After one month, patients can resume strenuous cardio.
What’s unique about trans vaginoplasty recovery is that the post-procedure protocol requires you to put stress on the surgical site almost immediately. Before you’re released from the hospital, your provider will remove the surgical packaging from the neovagina. They’ll then bring in a pelvic therapist. “Some patients may have a little bit of incontinence with coughing, sneezing, or laughing because they haven’t worked with some of their pelvic floor muscles,” says Dr. Ramineni.
In addition to helping you with Kegel exercises and strengthening your pelvic floor, this therapist will provide you with a set of dilators and teach you how to use them. “Dilating holds the area open so that the space doesn’t latch down,” Dr. Ramineni explains. “Patients who dilate will maintain that depth and width in intercourse.” He has his patients dilate three times a day for 30 minutes a session, gradually increasing the dilator in size, depending on their comfort level. He suggests having heavy pads on hand as you recover, as oozing and bleeding are very common.
That brings us to intercourse. Though all surgeons’ recommendations will be different, Dr. Ramineni allows his patients to start having intercourse two months after surgery, but solo sex can start sooner, at about one month. “Because it’s different hardware, the techniques will change,” he explains. “The patient sometimes has to work with the new clitoris for a while to master the techniques so they can have pleasurable intercourse—not just intercourse itself.”
Just don’t be nervous if you find your new vagina to be unattractive after surgery. Simply because of gravity, trans vaginoplasty can result in significant and lasting swelling. “It won’t really look that great for several weeks to a couple of months,” says Dr. Ramineni. “Some patients have aesthetic changes up to about nine months.” There is not much to be done to speed up that process—waiting it out is key.
Bottom surgery recovery for transmasculine patients
While some transmasculine patients choose to leave their vaginas intact, others have hysterectomies and vaginectomies, to safely close the vaginal canal. Others undergo phalloplasty, a complex procedure during which a urologist and plastic surgeon work together to create a neophallus from the tissues, nerves, arteries, and veins of the forearm, thigh, or back over the course of three separate procedures. However, for patients seeking the aesthetics of a penis without the complexity of skin grafts or multiple procedures, metoidioplasty is a popular choice.
Metoidioplasty, also referred to as a “meta,” is usually performed after a year of hormone therapy, which enlarges the clitoris. During the simplified form of this masculinizing genital surgery, a provider cuts the ligaments securing the clitoris to the pubic bone. Releasing these ligaments lengthens the clitoris, creating a neophallus that may be further augmented with genital tissue. Though it can’t be used for penetrative sex, the neophallus can be stimulated to erection. All providers are different, but many perform metoidioplasty as an outpatient procedure; consider taking two weeks off so you can heal comfortably.
The recovery from this procedure is fairly simple. As long as the incisions are kept clean and dry and they heal well, the patient concern is largely pain management. However, the more frequent iteration of this surgery makes healing more complex: “A lot of patients get urethral lengthening, where we use some of the labia minora to create a new tube and lengthen the urethra,” explains Dr. Ramineni. “So instead of just coming out between their legs, urine will go up towards the head of the neophallus.”
Most patients, regardless of the type of metoidioplasty they’ve undergone, are fully recovered by the six-week mark (after a month, you can resume more intense cardio and heavy lifting). If you’ve opted to lengthen your urethra, though, it’s key to use caution around the area for the first few weeks. The tip of the neophallus, in particular, may be slow to heal; you’ll be wearing a catheter for a few weeks, to maintain good hygiene. Though this can help prevent leakage (fistula) or narrowing (stricture) of the new tube, the catheter can tug on the tip of the neophallus, causing irritation. Go slow and be gentle with yourself, especially while your catheter is installed.
Once the catheter comes out, a patient will be able to urinate standing up with no assistance, though swelling can cause spraying and splashing that may make it challenging to hit the toilet at first. Practice makes perfect! Says Dr. Ramineni, “As time goes on and swelling resolves, the stream gets stronger and more pronounced.”
