Potential complications and risks of facial surgery

Most serious

You could die. Some of the complications below are potentially fatal.
Blood loss
Rarely, patients have hemorrhaging after surgery. There is an additional small risk that donor blood could carry an infectious disease like hepatitis or HIV. Steps to avoid this: stop all drugs that affect clotting at the time recommended by your surgeon.
Blood clots
These can lead to heart attack, stroke. Steps to avoid this: stop all drugs and hormones at the time recommended by the surgeon.Stop smoking.
This can result from the surgical procedure or from improper postoperative care. This could affect your recovery time, your surgical outcome, and in extreme cases could possibly kill you. Steps to avoid this: be very diligent about hygiene postoperatively.
Fluid in the lungs is sometimes contracted after surgery. Steps to avoid this: Stop smoking. Get in shape. Use an incentive respirator after surgery or do breathing exercises. Walk or at least sit up as much as possible after surgery.
Death of tissue. This can be caused by infection, tissue rejection, or loss of blood supply to tissue. Steps to avoid this: Stop smoking. Get in shape.
Caused by stroke from a blood clot, or a severed nerve. Extremely rare. Some women hove noted mild to moderate effects on muscles around the mouth, usually on one side or the other. This is sometimes connected to changes in speech patterns (see below).
Allergic reaction
Severe allergic reactions can cause your air passage to close or send you into shock. Reactions can be from anesthesia, certain drugs such as penicillin. Non-fatal reactions include rashes and hives. Steps to avoid this: Inform the doctor of all allergies and report every drug (prescription and non-prescription) you have taken in the month prior to surgery.
Visual changes
Some women have reported visual problems due to tightened tissue and swelling. Those who have had double vision or distortion in one or both eyes usually see it resolve in a few days to a month, as swelling subsides. In severe cases, you may require a temporary eye patch or even surgical correction. Blindness could also occur, but is extremely rare.

Speech changes

Some women have reported slurring or lisping following facial surgery, especially chin work, ranging from very slight to noticeable. It seems to affect control of the lower lip in some cases. Personally, I find certain consonant combinations containing "s" a little harder to say, and my s's in general are a little softer (not noticeable to others). I have a bit of a hard time saying "jewelry" now. Another friend has a hard time saying "syllable," Others have not reported this problem. In my case, this minor side effect is inconsequential in comparison to the overall benefit, but you need to consider these risks.

Less serious

Weakness and fatigue
Invasive surgery takes it out of you. As your body recovers, your energy is directed toward healing. You may find mental and especially physical activity more difficult for many months after surgery. Sometimes, there's also a psychological component to this fatigue, as most patients have post-surgical depression of varying degrees. Steps to avoid this: Get in shape prior to surgery. Stop smoking. Do not overexert yourself after surgery. Take it easy and eat right.
You may have numbness in some or all parts of your face, which can make it difficult to notice saliva or food on your face, and make you less sensitive to potentially damaging hot or cold things.
You may have permanent pain in some areas from a severed nerve, etc.
You may find some areas too sensitive to be touched. In some cases this is permanent.
You may have mild bleeding as your incisions heal. This is especially common with noses and work done inside the mouth. It's important to keep these areas as clean as possible. You may want to use old sheets and wear old clothes as you heal from nose work.
Sore throat
Some people get a very sore throat from the breathing tube put in during general anesthesia. This can last a few days to many weeks and can be severe enough to make it difficult to eat and drink. Extra hot and extra cold foods might be especially hard to swallow. Steps to avoid this: ask the anesthesiologist to use the smallest tube possible. Plan on eating soft foods at or around room temperature. Yogurt and applesauce, and lukewarm soups and juices can be good.
Sometimes tiny nerves which have been cut or disturbed during surgery will feel like they send out tiny electric shocks as they regenerate and heal. This can be surprising and occasionally painful. They can last for as long as a few months.
Swelling and bruising
These are to be expected after surgery, and very greatly by individual. Some people look fine immediately after, where others look as if they'd had a severe beating. Usually it looks worse than it feels, but it can cause people to stare if you have to leave to house or travel before it subsides.
Post-surgical nausea from anesthesia is quite common. It can range from loss of appetite to severe vomiting. Surgery often leaves patients constipated. Steps to avoid this: you might want to consider natural or over-the counter laxatives as soon as you begin recovery.
Skin problems
Some people get rashes and bed sores from not moving around much after surgery. It's also possible to have an allergic reaction to drugs, foods, leg pumps etc. following surgery. These usually resolve themselves quickly.


Those of you seeking shots of my FFS results can paste this address into your browser: http://www.tsroadmap.com/physical/face/ffspix.html

Surgery will result in a scar. Depending on your skin type, the surgeon's skill, and your postoperative maintenance, this may range from unnoticeable to quite prominent. Steps to avoid scarring: Show your surgeon any incisions or scars so he or she can get a sense of your tendencies. Follow surgeon's postoperative instructions diligently. Ask if your surgeon recommends vitamin E oil, silicone sheets, oral vitamin B1, cortisone creams or other topical preparations. Keep any stitches and staples dry and clean.
Certain procedures may require a tissue graft of skin, cartilage, bone, hair, or other tissues. In this case, you may have a scar at the donor site as well as the graft site. Steps to avoid graft scarring: same as above.
These are raised dark scars that occur in certain skin types. They are more common in Black skin. Steps to avoid keloids: Tell your surgeon if you or a family member has had keloids previously. There are certain drugs and vitamins which can lower your risk of keloids. Ask your surgeon if you think you may be at risk.
Some patients have unsatisfactory cosmetic results. Common problems include too much or too little change. Sometimes changes make the face look disproportionate afterwards, since it throws off the balance of your features. This can make it look like you had work done.
Sometimes, the work can leave brows looking too high, skin too tight. It can make lips look too high or too low. It can make nose or mouth look off-center. Everyone's face is asymmetrical, and sometimes improper work can make this more noticeable.


Almost everyone suffers a bout of post-surgical depression of some degree or another. In extreme cases, it can be debilitating. Some people pin too much hope on surgery as a solution for problems surgery won't solve. Surgery may help you pass better, but it won't make you pass flawlessly. It might make you look better, but it won't make you gorgeous or make you look like you're sixteen or something. Most people have a bit of depression after a major goal-- think of new mothers and post-partum depression. There's a lot of excitement leading up to a big event, followed by a return to business as usual. After you climb a mountain, you have to come back down. Steps to avoid this: Having realistic expectations of the recovery and outcome. Having visitors after surgery-- don't isolate yourself. Planning to see your therapist during recovery.
It's very common to be anxious and worried as you heal. Immediately after surgery, you often look horrible and might worry that you'll never look normal again. As the bruising and swelling subsides, you will usually see this anxiety subside. Steps to avoid this: thorough research of the procedure and the surgeon you choose. Talking with others who have had the surgery. Having realistic expectations of the recovery and outcome.
Some people get depressed afterwards because they feel they made a poor choice of surgeons or decide they should not have done the procedure at all. This is especially true in cases where there are complications or poor cosmetic results. Steps to avoid this: thorough research of the procedure and the surgeon you choose. Talking with others who have had the surgery. Having realistic expectations of the recovery and outcome.

Note from an FFS patient on disappointing outcomes and additional surgeries

Many of us have complications following surgery, ranging from poor outcome to rejection of hardware used. In some cases, we have to have additional work done, some of which is out of our own pockets. The letter below explains one woman's experience, but it is more common than many of us realize. I myself had a minor complication on my chin work and on one of my breast implants, both of which I had to get corrected.

While it's good to hope for the best, you need to be aware that there is a chance you will need additional work. I don't know what the percentage is, but I know many women who have had to get back on the table for one reason or another.

I am a post-op post-op woman (that is to say, I have had sex reassignment surgery, or as it is called in my geographical region, gender confirmation surgery; plus facial feminization surgery). The following comments apply to the now-famous San Francisco FFS experience which so many girls have undergone. Names, both my own and others involved, have been omitted to ensure that no personal critiques occur.
Great work is done in San Francisco. The surgical team are the best that this field has to offer. But unlike some websites would have you believe, they do not work miracles. Magic wands exist only in fables. There is only science and anatomy, and these limit what may be achieved.

It is popular to have reconstruction of all facial features in one marathon surgery: forehead, nose, upper lip, chin, and jaw. Some lucky women go home looking like movie stars after this work. Their pictures are legend on the web. What is hardly ever discussed, however, is how many girls are repeat visitors to the hospital. For many like me, that prohibitively expensive day in the operating theater is just a good beginning. Work at the hairline is often done in stages, meaning that visitors to the guesthouse are like folks collecting frequent flyer miles. The very nature of the surgery often causes other surgeries to be necessary. The basic effect of FFS is to diminish the size of the skull (and change the geometry of the bones). For many, this leaves a great deal of skin hanging outside the now-smaller bones. This baggy skin acts as a shroud, masking the good work inside. Thus another surgery to remove skin becomes necessary. Then if you do the facelift, the newly stretched skin causes a wrinkly effect around the eyes, looking like premature aging. So another procedure at eye level becomes necessary. And so on.

My message is that too many of us are cleaning out our life savings on that initial surgery, under the assumption that we will need nothing further. Then the patient arrives home flat broke with only marginal improvement, and no funds to complete the job. Doing everything over several treks west would have cost me the price of a small house hereabouts. I implore the reader to plan for eventualities. Then if you get lucky and you look perfect after day one, you can literally smile all the way to the bank. Thank you for listening, and good luck to you all.