Cis Facial Feminization

No two faces are the same, and in fact yours and mine are two amongst 4 billion on the planet. So it stands to reason that a surgery fashioned for you or for me should be equally unique. As a concept, Dr. Rad’s FaceOpsTM is not “à la carte” style surgery where “cookie cutter” procedures are done without special nuance, but rather bespoke customization. Amongst the infinite variations in anatomy and aesthetic possibilities, Dr. Rad relies on his artistic eye and deep experience to customize surgery for each patient. Drawing on his depth of knowledge of facial anatomy and the most modern surgical techniques to modify it, from porous polyethylene structural bone implants to correct deficient midfacial and jaw bone structure, to deep plane face and neck lift with deep sculpting to take decades off your face, to fat grafting to restore natural youthful volume and to rejuvenate your skin, to endoscopic brow and eyelid lifts and shaping. Dr. Rad studies your anatomy and tailors your perfect result along with you all with your specific goals in mind. Aesthetics are fundamentally about powerful emotions and nuanced harmony, concepts that transcend time back in history to greats such as Michaelangelo, Monet. Computer simulations can never capture the aesthetic nuance and stunning synergy for which Dr. Rad’s results are known.

First, a consultation through which Dr. Rad understands your aesthetic vision, areas of focus and, combined with his expert analyses of your bone structure and soft tissue, he formulates a highly specific, customized surgical plan designed solely for you. This often requires a combination of procedures, each one intended to correct subtle signs of imbalance. But keep in mind that the art lies in the hands performing the procedures, not the procedures themselves. Knowing how much change, to what magnitude, direction and type (ie, fat or muscle or fascia or biocompatible prosthetic) is the 6th sense that gifted surgeons possess. Just as a beautiful piano concerto, on a page, stands in its own beauty. But it’s the pianist who brings it to life, some so much better than others, and the most gifted pianists have the ability to move their listeners in a deeply emotional way.

Likewise, surgeons have different skill levels and aesthetic nuance, and bring to life the best results to varying degrees of ability. The level of artistry required to achieve natural, beautiful and long lasting results requires tremendous nuance. As Dr. Rad frequently says, “millimeter changes throughout the face can synergize beautifully into stunning yet natural results.” Put simply the devil is in the details. These details are reflected in surgeons’ before/after photographs which is why you must evaluate these with an aesthetic eye. But you need not understand every technical nuance — it’s an overall feeling, your “gut instinct” that hits you in a split second that tells you what you need to know. You have only one face and so, in addition to how the surgeon focuses on safety, listen to your instincts when you evaluate surgeons’ results. Dr. Rad has built his reputation on delivering striking yet natural results that resonate deeply with his patients.

Dr. Rad takes the following surgical approach:
1. Dr. Rad’s cis facial feminization surgery must be done with a combination of sedation, local (injected) anesthetics, and light general anesthesia with an airway tube for safety and comfort. Think of the various depths of anesthesia as like different depths of the ocean – from surface to the bottom could be miles deep. Open-heart surgery is like the “bottom of the ocean” depth of anesthesia whereas it requires only “under the surface of the water”. This makes facial surgeries very safe from an anesthesia standpoint and the length of time for surgery, oftentimes from 5-8 hours depending on the complexity of surgery, is less of a material concern.

2. The combination of procedures that you planned out during your consultation with Dr. Rad will determine the surgical approach that Dr. Rad will carry out.

Recovery is a process of tissue healing and feeling back to normal that requires time. The length of time depends on which facial areas are treated, the complexity of surgery, and individual healing factors. The key principle of surgery that Dr. Rad always adheres to is minimizing surgery to achieve best results, thus minimizing healing and recovery time. Since each case is different, Dr. Rad will guide you through the recovery process with comprehensive information based on your unique situation.

Recovery is not painful after cis facial feminization and mild/moderate tightness is normal. Swelling peaks in 2-3 days then rapidly decreases. Patients can resume most normal activities almost immediately, including walking, child care and basic pet care, except heavy lifting. Most patients taper off stronger pain medicine in a few days as pain is not a significant part of recovery. You will see Dr. Rad within a day or two, then again one week after surgery.

Moderate bruising and swelling will distort your facial features for the first week after cis facial feminization. However, during the first through second weeks swelling and bruising rapidly resolve and visible signs of surgery dissipate over 2 weeks. Looking “normal” to others is a process that takes a few weeks, and some will require more time, others less. It depends on your innate tissue healing physiology. Returning to work in 1-3 weeks is common, depending on the degree of comfort you have with others potentially seeing any evidence of surgery. Return to exercise is between 3-8 weeks, depending on your baseline level of intensity.

Care post-surgery is important for both your recovery and results whether at your home or at a hotel. For your safety, as you’ll be somewhat sleepy, you will need a responsible adult to stay with you for at least the first night. If you’re interested in having an experienced private duty nurse, we can help facilitate this care.

Once home or in a hotel, you will mostly rest, although you should be able to perform “activities of daily living,” meaning being up and about and doing basic self care. Since your head will be wrapped, you’ll defer showering until your first post-op appointment with Dr. Rad 1-2 days after surgery.

During the daytime you should walk 10-15 minutes each hour and should not be on bed rest. Pain is relatively mild and most patients need a mild pain medicine to help them sleep. Tissues react with swelling and bruising that distorts facial appearance and causes facial muscles not to work normally, but this is normal and temporary. Cold compresses and head elevation helps with comfort and swelling.

Since nausea is not uncommon after anesthesia, no matter how light the anesthesia given, nausea prevention is essential and straightforward by taking an anti-nausea medicine such as Zofran (Ondansetron). Nausea side effects typically wear off in 24-48 hours. Other side effects of anesthesia include feeling a bit groggy or “out of it”, but this is relatively mild and wears off quickly. Dr. Rad recommends not planning important work-related activities or phone calls as you will not feel your sharpest.

Drinking liquids is most important to maintain hydration. Dr. Rad recommends Gatorade, or Drip Drop and Liquid IV electrolyte replacement powders mixed in water. If neck lift has been done then patients often feel some neck tightness that is normal, common and temporary. You will see Dr. Rad within the first few days to check on your early healing.

To enhance your results and “protect your investment”, Dr. Rad recommends consulting with Dr. Sherber for laser resurfacing, injectable neuromodulators such as Botox or Daxxify, a results-oriented skincare and sun protection regimen, and non-invasive skin tightening with Thermage FLX. Just like regular tune-ups or oil changes to keep your car running well for many miles, you can maximize the “mileage” you gain from your cis facial feminization surgery through these maintenance treatments under Dr. Sherber’s care.

To see Before & After results, visit our gallery page.