When I can get FFS (Facial Feminization Surgery)?

The most widely accepted guidelines for surgical timing those issued by the World Professional Association for Transgender Health (WPATH).  For procedures like GCS and mastectomy there are clearly defined guidelines that are meant to assure the patient has considered how transition will affect all aspects of their health and lives.  FFS does not have as clearly defined guidelines for a couple reasons.  First, it doesn't affect fertility or function. Second, FFS is broad term and the actual procedures required to feminize two different faces may be completely different.  In my practice I have different requirements for different FFS procedures.  I would like to know that every patient has thought through how transition will affect their social lives, their family lives, and their work lives.  For any procedure I would like them to have started hormones, have a plan to start them, or have a reason they haven't started them.  For some procedures, like cheek augmentation, I would like patients to have been hormones for at least 6 months and ideally a year.  For other procedures, like rhinoplasty, I don't have any hormone duration requirement.  I hope that helps a little.  I recommend you sit down with an experienced FFS surgeon to discuss what you would like to change and make a plan.  Good luck!-Dr. Rolfes

I do not require you to be on hormones for any particular period of time in order to schedule facial feminization. Hormones can improve overall skin quality, but it will not create significant changes enough to change a surgical plan. 
Any letters you have are helpful if you want to go through insurance, but not every surgeon requires them - particularly for FFS. 
Most surgeons who specialize in FFS do video consults since there are so few in the country. That would be helpful in determining what the best procedures would be for you. 
Best of luck to you,
Sarah Saxon, MD

If you are going to have the surgery by yourself, not for an insurance, then you can discuss with your doctor your goals an establish a plan working for you, your expectations, your time availability and your budget,