Facial Feminization Surgery FAQ
Welcome to our FAQ page dedicated to Facial Feminization Surgery (FFS). As Catalyst, we understand that undergoing FFS is a deeply personal and transformative journey. We’re here to guide you every step of the way. On this page, you can find answers to common questions about our procedures, what to expect before, during, and after surgery, and how we support you throughout this process.
We also provide specific information on navigating the healthcare system in Ontario, including details about coverage options, referral processes, and local resources. Our goal is to ensure you have all the information you need to make informed decisions with confidence.
How do I get a referral sent to you for FFS?
Since OHIP doesn’t cover FFS, a referral from your primary care practitioner is not required. That being said, a referral is preferred to keep your PCP in the loop.
Keep in mind that your consultation fee is covered by OHIP with a referral. Please ask your referring practitioner to email us at info@catalystsurgical.ca
Once I have my consultation, how long do I want for a surgery date?
Wait times from consultation to surgery vary dramatically, depending on your schedule. Part of your consultation with Catalyst Surgical involves discussing this timing. For example, if you’re a college senior, it isn’t a great idea to book your surgery in that academic year. If you’re looking to book the first available date, that can be anywhere from weeks to a couple of months away.
Some times of the year are more in demand than others. April and May are highly requested for surgery as the academic year ends for post-secondary institutions. Our surgery date wait times can be longer during those times.
We want you to have surgery as soon as possible. We also want you to schedule surgery around your life, not your life around the surgery.
Surgery is already a stressful experience. We don’t want you to experience additional stress, especially when the stressors can be predictable or scheduled. We will work with you to find the best date for you.
Additionally, health issues can delay your surgery date. We might need to follow up on abnormal bloodwork or verify with a specialist that we can safely perform your surgery at the Catalyst facilities rather than a hospital. Potential health issues need to be treated or managed so there’s as little risk as possible to your result and safety.
Do you do type III forehead contouring?
We use the ForeContour technique from Facialteam. It is classified as a type III forehead reconstruction.
Do I have to be on hormones to get FFS?
If you are using or going to use hormone therapy, the general recommendation is to wait 6-12 months before undergoing FFS. This is because of the skin-softening effects of estrogen which can affect how your skin drapes after the bone changes of FFS. We aim to minimize the number of subsequent procedures you might need after FFS.
If you are not on hormone therapy and have no intention of starting, there is no requirement to be on hormones for FFS.
What can I do to get ready for surgery?
If you smoke or use nicotine products, you should consider quitting. This is something to consider right after your provider has submitted your application to OHIP. Talk with your providers about how to quit and what options might be helpful for you.
You should consider starting to plan your post-surgical plan:
- Who will help take care of you after (someone should stay with you for the first 24-72 hours)?
- Where will you stay (if you can’t stay at home)?
- Who will take you to and from appointments, especially on the day of surgery and the first couple of weeks after?
Please make sure your health card is not expired.
If you have an employer or teachers/professors, consider talking with them now about time off (between 2 weeks and a month, depending on what you do). Figure out what paperwork you’re going to need.
Consider using a mask and/or limiting your social contacts closer to your surgery date. Your surgery will be rescheduled if you have symptoms of any illness on the day of surgery.
Do you have a BMI limit?
Since the Catalyst facility is not a full hospital, we have limits to who can have surgery safely here. This doesn’t mean you can’t have surgery. We just need to come up with a plan on how to make sure you’re safe if something were to go wrong during surgery.
Even though BMI is not necessarily a great measure of health, some aspects of having a higher body mass make surgery more risky.
If your BMI is higher than 35, we will need to perform additional evaluations and possible testing to make sure it is safe for you to have surgery at our facility.
If your BMI is 40 or higher, it is unlikely that we will be able to do your surgery at Catalyst Surgical.
In the case of your surgery being too risky at the Catalyst facility, we will figure out how to move your referral to a surgeon who can perform the surgery in a hospital.
This doesn’t mean you can’t have FFS, or have to lose weight to have FFS. We’re not interested in forcing you to lose weight. While you might not be able to have surgery in the Catalyst facility, we will do our best to find alternatives. Unfortunately most of these alternatives will not be in Canada.
Do you have before and after photos?
There are several reasons why we use before and after photos differently than other clinics:
Public photos are almost always only our best work.
It can create a false sense of expectation as to what your results will look like. Most people asking for before and after photos are looking for security and reassurance. Can your surgeon do the thing you want them to do?
Surgery is not a one-size-fits-all outcome. Although we have a set process for how you move through the surgical experience, results are not uniform.
We trained with some of the best FFS surgeons as well as the best gender-affirming surgeons in the world.
Your gender journey is not for us to use for promotion.
We do not want our clients to feel any pressure to share anything they don’t want to. While we do require photo consent for your medical records, consent for our marketing materials is up to you.
If you want to help others on the same journey, we encourage you to post your photos on your platforms. To make it easier for people to find results from us, you can use the hashtag #catalystsurgical and tag us @catalystsurgical. Keep in mind that we don’t have power over who uses the hashtag and what they post.
You don’t always see how features of the body affect the look of the after photo.
We do our very best to deliver you the best result for your face, but we don’t get to control every aspect of the final result. Skin quality, individual physiology that affects wound healing, lifestyle habits, and pre-existing anatomic features are all factors that greatly influence your final result that are not within surgical control.
An after photo that looks “bad” to you might be a very good result, given those surgically uncontrolled factors. How your foundational anatomy affects your result is something that takes years of training and experience to see. Most of our clients do not have that experience, even if you see a before photo of facial features that looks very similar to yours.
Just because you don’t like an after photo doesn’t mean the person in the photo doesn’t love it
Generally, people who post their photos or who allow the use of their photos love their results enough to share them. Seeing examples of things you don’t like can give you an idea of your personal aesthetic preferences, or how your gender dysphoria uniquely speaks to you.
Communicating your likes, dislikes and goals is much more important in the surgical process than what you see in other people’s results. We talk about what’s possible, predictable, and controllable for your unique anatomy.
We want you to always have ownership of your photos
For us to post your photo on our marketing platforms, we need permission to do it. When you give us permission to use a photo, we also gain partial ownership.
We will not use photos in your medical record for any other purpose.
If you decide to share your photos, you retain ownership over them. You are in control of whether it continues to stay published or not.
We understand that certain clients feel highly uncomfortable with proceeding without seeing previous work. Sometimes we are not a good surgeon/client match for many reasons, and this may be one of them.
I take Sertraline (or another SSRI) and am worried about Serotonin syndrome with some medications.
While there are case reports of serotonin syndrome interacting with both tramadol and ondansetron (both medications that we use before, during and after surgery in varying combinations), these reports are generally for high doses of tramadol and ondansetron and with repeated use.
We do not prescribe the doses of tramadol associated with serotonin syndrome and only give you a limited supply. Some people don’t need the tramadol at all after surgery.
We only give you one dose of ondansetron before surgery and sometimes a dose after. We do not send you home with a prescription for it.
How long do I need before I can go back to work/school?
This depends greatly on what activities are involved in your daily life. Some people who do mostly desk work from home are ready to do some desk work in 1-2 weeks. People with heavy manual labour jobs should not expect to return to full workloads until 2 months after surgery.
Surgery is a stressful experience and energy management is an important part of recovery. You might not have much pain after surgery, particularly 2 weeks after, but you might not have the energy or attention to perform at your pre-surgical level. Most people take 2-4 weeks from work to allow themselves to recover.
Our suggestion is to usually arrange for more time off work than the bare minimum. If you feel great before that time, you can always re-negotiate with your employer.
Surgery timing is something we discuss as part of your consultation so that you can decide when surgery is best for you, knowing that you’ve wanted surgery for a very very long time, and that “yesterday” is the time you would prefer.
When can I have sex again after surgery?
The main limiting factor to having sex after surgery is pain. If it doesn’t hurt your surgical site during sexual activity, you’re probably fine to do it.
For those who have had rhinoplasty (nose surgery), you will want to avoid bumping or pushing your nose for the first 4-6 weeks.
For those who have had jaw or chin surgery, with incisions inside the mouth, you will want to avoid actions that involve wide mouth opening or things that go back and forth in your mouth for about 3 weeks.
Most forms of masturbation are usually feasible after the first week. Partnered sex can be quite varied and if you participate in any kinks or fetishes, you might need specific discussions to avoid affecting your surgical result.