How long to wait for FFS after starting HRT?

[SnoBrittany]

I am wondering how long I need to let HRT take its course with changes to my face from Estradiol before going under the knife to get the changes I need.   My concern is making changes to a moving target might not be a good idea.   I know the advice for Top surgery is at least a few years into HRT to let the majority of breast development happen before getting implants.    The same question occurs to me for facial surgery.

I would be especially grateful to hear anecdotes from those of you who have had successful FFS as to how long you waited after beginning HRT to have your facial procedures done.   I am starting my 6th month of HRT now.

[Megan.]

I'm only on my 4th month of HRT,  and don't know if I'll ever have the money for FFS but my personal approach will be to give the HRT two years. You may find at that time that you either don't need it or need less doing,  saving money,  time, discomfort and reducing risk. -  just my view.

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[rmaddy]

2 years.

[AnonyMs]

I'm not sure why you'd need to be on HRT at all if the FFS is bone work.

[JennyBear]

To the OP:

    While the minimum required by most surgeons is at least a year, I agree with giving it 2 years. Even if your face changes rapidly, as mine is, you still need to give your body time to more or less complete the process.

    Think of it this way. A surgeon is like a marble sculptor. If he works on a soft medium like clay, all of his work may be for nothing, or might become grotesque with the wrong changes to the clay. Wait until the clay hardens into stone, and the sculptor (surgeon) can perform more accurate work that you will be satisfied with for the rest of your life. No one wants to have to go through the same surgery twice.

Regarding Bone:

    While not to a large extent, there are minor changes to facial bone structure during HRT for both M2F's and F2M's. Add to this, that a surgeon cant completely see your bone structure itself before surgery, or the way that changes to the fat, skin, and muscle will "hang" on the bones. It's an estimate. Knowing that the flesh is changing, why rush a surgery that changes the way it "hangs" on the bones when that basic process is not yet complete.

Both:

    Many find that the changes from HRT itself eliminate the need for FFS, or at least for parts of it. I myself am rethinking having my jawline done. Still plan on brow reduction though. Give it time and maybe save yourself some money, if not additional unnecessary suffering.

[AlexisRene]

HRT does not change bone structure aside from those who begin very young & avoid puberty. If HRT did change bone structure, we would have people torching their livers via tripling their meds to avoid painful & expensive FFS procedures.

HRT may thicken the layer of soft tissue(forgive, forget the technical term) beneath the skin & soften the overall appearance. However, there are no guarantees that will happen & did not happen for me.

So while there is nothing wrong with waiting to see what may happen over 12-24-36 months. Also do not see anything wrong with going ahead with FFS day one so long as ones Docs all agree. Emphasis on the latter part of that. 

[JennyBear]

    Actually it does change it, though not to a large degree. Loss of bone mass throughout the body is a side effect of testosterone reduction, aka HRT for M2Fs, and a propensity for bone mass gain is a side effect of increased testosterone levels, aka HRT for F2Ms. If you don't believe it, look at the study conducted by the Olympic committee that finally allowed post op M2F's to compete as women.

     Check your facts before you hypothesize that someone else is wrong please. More importantly, look up all the side effects of any medication you take.

[AnonyMs]

My understanding is that MTF HRT leads to bone density loss, but not a change of shape. I'd imagine testosterone leads to both density increase and a change in shape, as I believe male bone development continues well past puberty.

Leigh Dorei has some video's on FFS with Facial Team, and I don't think she's on HRT at all.

https://www.youtube.com/user/LeighbyTM/videos

[AlexisRene]

    Actually it does change it, though not to a large degree. Loss of bone mass throughout the body is a side effect of testosterone reduction, aka HRT for M2Fs, and a propensity for bone mass gain is a side effect of increased testosterone levels, aka HRT for F2Ms. If you don't believe it, look at the study conducted by the Olympic committee that finally allowed post op M2F's to compete as women.

     Check your facts before you hypothesize that someone else is wrong please. More importantly, look up all the side effects of any medication you take.

Thank you! I have & admittedly continue to learn daily. It is why we should participate in such forums. To learn. Is it not? Although had assumed we were discussing facial bone structure within the aspect of how long to wait for FFS procedures after beginning HRT?  If that is still the case, will stick with my original response. HRT will not change bone structure. HRT alone will not add to zygomatic prominence, reduce brow bossing, open the orbital rims around the eyes, reduce jaw/chin mass structure etc. Heck, it cannot even be counted on for a good nose job. OK, the last one was for humor.

You can wait 12/24/36 months & those bones will remain the same. The layer of soft tissue may thicken over them to soften ones appearance. But again, that is soft tissue.

Long term, details of bone shape(bone remodeling/resorption/replacement see first link) do change over the course of a lifetime regardless of ones own natural progression(aging) or the introduction of HRT. Yes T &/or E do play a role in the skeletal structure over a lifetime. But are we really discussing a time span of 20-30-40 years with relation to FFS?

None of the above means anyone should or should not have FFS. Some are quite happy without ever having it. Have a friend who did not even need to address thyroid cartilage, much less FFS & she did not begin HRT until her 30's. You can see from my photo on the left that thyroid cartilage is an obvious visible marker(aside from others) for me. So we are all a bit unique. However, in all levels of honesty. HRT alone will not change bone structure one has to work with as outlined.

First link as mentioned above.
https://courses.lumenlearning.com/boundless-ap/chapter/bone-development/

More info as has been discussed here in years past.
https://www.susans.org/forums/index.php?topic=88481.0

Further, while this research by Dr. Maddie Deutsch, Director of Clinical Services at the UCSF Center of Excellence for Transgender Health states to wait the standard 2 years, he is stating the same with regard to bone structure. 

"Your eyes and face will begin to develop a more female appearance as the fat under the skin increases and shifts. Because it can take two or more years for these changes to fully develop, you should wait at least that long before considering any drastic facial feminization procedures. What won't change is your bone structure, including your hips, arms, hands, legs and feet."

Full paper at link.
https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy

[SnoBrittany]

Thank you everyone.  My takeaway is that waiting a couple of years will likely reduce the risk that an FFS procedure would end up requiring revision or otherwise further modified by HRT afterwards.

[JennyBear]

Although had assumed we were discussing facial bone structure within the aspect of how long to wait for FFS procedures after beginning HRT?  If that is still the case, will stick with my original response. HRT will not change bone structure. HRT alone will not add to zygomatic prominence, reduce brow bossing, open the orbital rims around the eyes, reduce jaw/chin mass structure etc. Heck, it cannot even be counted on for a good nose job. OK, the last one was for humor.
You can wait 12/24/36 months & those bones will remain the same. The layer of soft tissue may thicken over them to soften ones appearance. But again, that is soft tissue.
Long term, details of bone shape(bone remodeling/resorption/replacement see first link) do change over the course of a lifetime regardless of ones own natural progression(aging) or the introduction of HRT. Yes T &/or E do play a role in the skeletal structure over a lifetime. But are we really discussing a time span of 20-30-40 years with relation to FFS?

    I agree with that in about 90% of situations. However there is one facet of facial bone structure that does change with Testosterone reduction/increase. That is bone density. True, it really won't affect facial tissues. However, in the case of M2F's, the loss of density causes certain bones to be slightly more fragile, in particular the side of the jawbone and the occipital lobe. Won't affect most, but if you still participate in competitive sports, in particular martial arts (especially boxing,) it is cause for concern. Those bones are more easily broken. If you don't do contact sports and are lucky enough to avoid any accidents impacting the face, then it will never affect you. Slightly off topic, but still important to know.

HUGS!

[ClaireBear]

Bone density is a measure of the quantity minerals per unit of volume of bone. 

A reduction in bone density is not a change in shape.  All it means is that there is less minerals distributed across the pre-existing shape.  An increase in bone density is not a change in shape (or growth).  It is an increased concentration of minerals per cubic millimetre of bone.

When our bone density reaches critically low levels (osteoporosis), our skeleton does not shrink.  It becomes lighter, more fragile, and has less minerals spread across the same shape.

[Deborah]

If you wait two years or so you may find that you don't need FFS at all.


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[JennyBear]

Bone density is a measure of the quantity minerals per unit of volume of bone. 

A reduction in bone density is not a change in shape.  All it means is that there is less minerals distributed across the pre-existing shape.  An increase in bone density is not a change in shape (or growth).  It is an increased concentration of minerals per cubic millimetre of bone.

When our bone density reaches critically low levels (osteoporosis), our skeleton does not shrink.  It becomes lighter, more fragile, and has less minerals spread across the same shape.

    No argument there, 100%$ correct on those definitions. I had already clarified/corrected the statement about facial structure. With regards to osteoporosis: while it's true that no, our skeletons don't actually shrink, it's usually a colloquial/metaphorical description in the loss of height due age, or supposed to be anyways.

HUGS!

[Rachel]

I was on HRT 3 years prior to FFS.

It took time to visit surgeons, decide on procedures and schedule the work and sell things to finance the work. I decided to have FFS January 2016 and had the work done Sept. 2016.

If you need bone work then HRT will not change that. Depending on age and amount of bone work then a neck, med face, blethoplasty and forehead lowering may be needed to stretch the skin. If you do bone work and skin tightening at the same time you may not get the best skin tightening result.

Doing FFS in stages is an option. I did it all at one time and I will be doing a revision for fine tuning.

[Charlie Nicki]

Interesting topic. So the consensus seems to be at least 2 years.

[JennyBear]

Interesting topic. So the consensus seems to be at least 2 years.

    Other than your basic rhinoplasty, since HRT wont affect the shape of the nose, yeah.

HUGS!