Facial feminisation surgery

Practical information FFS surgery

Patient coordination

Our patient coordinator, Lilia Koss, assists with finding accommodations, airlines and organizes your taxis and appointments. She will also help make your post-operative time in Marbella as comfortable as possible.

• Flying to Malaga
  Our patient coordinators will suggest airlines from your country to Spain. From Agave Clinic to Malaga international airport is only a 25 minutes taxi drive. More than 60 airlines fly to Malaga. We’ll pick you up from the airport and bring you back for free. About 40% of the population of Marbella is of non-Spanish origin so you’ll find English-speaking people everywhere.
  
  
• Hotels in Marbella
  We will help you find your preferred accommodations nearby and assist with reservations. Room service, internet and other amenities are available upon request. Prices vary according to the season.
  
  
• Aftercare in Marbella
  Our personal care and attention continues long after your procedure. During the first week post-op, you will have frequent appointments in Agave Clinic. Once you return home, we hope to arrange for 3-month, 6-month and 1-year evaluations with the surgeons. In Marbella and at home, you will always be only a call or email away from direct contact with our team.
  
  
• Consultations and check-ups abroad
  Once a month we offer consultations and check-ups in the UK, Barcelona and in the Netherlands (Blaricum and Papendrecht). You can make an appointment by contacting Agave Clinic in Marbella. If you’re interested in dental implants and have a panoramic x-ray it would be very useful to bring it with you.

Personalised counseling

Agave Clinic would recommend to consult our psychotherapist that could see you the day before and 2 - 3 days after the surgery. We recommend this service for patients over 35 years of age, in order to recognize and interpret your reactions to the experiences and problems which are being addressed by FFS, cosmetic or jaw surgery. Through Jungian psychology, a method based on the relationship between the concious and unconcious mind, our clinical psychologist may facilitate your personal development process.

Counselling Costs

Counselling Costs: 65€ for a 1-hour session
An initial session is recommended before surgery, with a follow-up session a few days after surgery.
65€ per hour for additional sessions.

More information

Please visit www.psychotherapy-vanboxtel.com or email marlies@psychotherapy-vanboxtel.com for more information.
Ms. van Boxtel is a clinical psychologist, with post-graduate training in the U.S. and Switzerland. Her affiliations include the International Association of Analytic Psychology (IAAP), American Counseling Association (ACA) and is a board member of the dutch association, Nederlands Associatie voor Analytische Psychologie (NAAP). She is fluent professionaly in German, Dutch and English.

Typical Schedule of a FFS patient

• Day 1:  Arrival—The taxi driver will wait for you in the airport, holding a sign with your name.  The trip to Marbella takes about 30 minutes. 

  Depending on your flight, you may come directly to Agave Clinic for the pre-operative consultation.  You will have a meeting with the surgeon to confirm the treatment plan, sign consent forms, and receive an informational packet.  Lilia will take you to the hospital for preoperative tests, where the anesthesiologist will also meet with you.

  You should plan to do a bit of shopping for essentials before the surgery. This way you may get the rest you will need post-op.

  You refrain from food or drink for 8 hours before the scheduled operation.  Nervousness may impede a good night´s sleep, but try to rest.
  
  

• Day 2:  Surgery—Plan to arrive 1-2 hours before your scheduled procedure, recently bathed and without any makeup or skin creams. Lilia will assist you in admissions and to settle in.  You may leave valuables in a small safe in your room, where you will be provided with a surgical pajama and basic toiletries. After changing and having the IV placed, you will be taken to the OR to meet again with the anesthesiologist before surgery.
  Normally, only a one-night stay is required in the hospital.  With extensive procedures or if unaccompanied, patients may stay for two nights.
  
  
• Day 3:  Return to Hotel—After a morning session with the cooling mask, Lilia and the surgeon will stop by to discharge you from the hospital.  Before returning to the hotel, you will come to Agave for any bandage changes or wound treatment. If you are alone, a nursing assistant may be required to accompany you to the hotel for the first couple of hours.
  
  
• Day 4 - 8:  Revisions—You have our aftercare team available everyday if necessary. You will have scheduled appointments with the surgeon or nurse to change wound dressings, evaluate your healing and for cooling mask sessions if necessary. 
  
  
• Day 9:  Final Revision and Departure—You will have an exit interview with the surgeon and the Patient coordinator.  Any remaining stitches or staples will be removed and post-operative videos, photos and x-rays taken.
  We will provide you with an authorization to fly and instructions for returning to work or sports.
  

Transportation

Our patient coordinators will suggest airlines from your country to Spain.  We will also arrange a round-trip airport shuttle, included in your treatment plan. However, local taxi transportation is the responsibility of the patient. Plan to travel light (no more than 20kg / 44lbs) so as not to over exert yourself on your return trip.

Hotels in Marbella

Choose a hotel within walking distance of the old centre and the seafront, where most of the restaurants are. Agave Clinic is a 15 minute stroll from the city center.  A hotel in the historic city center with room service, internet connection and a fridge/coffeemaker in the room are convenient, but not always available.  Agave Clinic´s patient coordinators will help you with reservations (certain establishments offer us discounts).  Prices can range between 40 – 200 Euros per day. The day you check in, request extra pillows, which will be handy for after surgery.

Duration of stay—Prepare to be in Marbella from four to twelve days, depending on the extensiveness of the procedure: one day before, and two to ten days after the day of surgery.

Going out in Marbella—At the end of your stay, when you are more likely to want to get out a bit, and we have a list of possible activities we can help arrange.  Choose a hotel within walking distance of the old centre and the seafront, where most of the restaurants are.  A leisurely walk for fresh air and sun or a bit of shopping will be easier from the city center.  Agave Clinic is a 15 minute stroll from the old city center.  We will provide you with a local map.

Clothes and other stuff to take along

• Cloths—Marbella is very hot and humid in the summer and temperate year-round.  In the autumn, winter and spring you may need a jacket in the evenings.  Although it rarely rains, it is possible between October and April.  You will need a hat to protect your face from the sun’s rays. 
  To avoid pulling clothes over your head postoperatively, bring some button-down or zip-fronted shirts.
  
  
• Avoid Boredom—Bring personal entertainment items such as a laptop, music, books, journals, crosswords, etc.  The first few days after surgery you will probably spend most of the time resting in your room.
  
  
• Adaptor—If you want to use any electrical equipment you will need an appropriate adapter.
  
  
• Food—In the case of jaw or intraoral procedures, you may find it difficult to chew normal foods or open your mouth wide enough for normal-sized utensils. Straws and a baby fork and spoon may be useful. Even a large syringe or flexible baby bottle works for consuming pureed foods. Plan to be on a bland pureed diet for a few days after surgery. We recommend hyper-caloric shakes and mix for purchase in pharmacies, which contain all the nutrition you need until you are able to eat normally.
  It may be helpful to have a stroll around the neighbourhood before surgery to locate the nearest pharmacy and supermarket.  It is a good idea to purchase beforehand any toiletries, food, drink, moist towelettes, or antiseptics to care for your incision points while at the hotel.  The first 48 hours post-op you may not feel up to shopping for necessities. We will provide you with a list of useful items to bring or to purchase before surgery.
  Once you are ready to go out, local restaurant food is varied and affordable.
  

The Hospital

You will have 24-hour care during your two nights stay in the hospital, which is next door to Agave Clinic.  English-speaking attendants are also available.  If desired, additional nights in the hospital are possible although not recommended by doctors.  There is an additional fee of 250 Euros per night.

Other practical preparation tips

• Medical history—Once you have chosen us to be your surgeons we must be given your written medical history as soon as possible so we have sufficient time to take the necessary measures.
  
  

• Anticoagulant medication—Any anticoagulant medication you are taking must be stopped in good time. Please contact the physician that gave you the prescription, ask what measures should be taken, and report this to us.
  
  
• Hormones—On the day of surgery you’ll receive some antithrombotic medication. Therefore it’s not necessary to stop taking hormones.
  
  
• Smoking—We strongly advise you to stop smoking three weeks before surgery, as smoking counteracts wound healing.
  
  
• Travelling companion—It is highly advised to come with a friend, partner or family member to help you with basic daily tasks such as dressing, bathing, or cooking and to keep you company.
  
  
• Eating and drinking before surgery—On the day of the surgery you should refrain from eating and drinking after midnight, unless otherwise instructed.
  
  

Postoperative information after FFS

• Swelling and bruising—
  
  

  During the first postoperative hours a mask with a constant temperature of 15 degrees Celsius will cool the skin of your face and keep bruising and swelling to a minimum. This will add to your comfort and aid in a more rapid recovery. Nevertheless you should be prepared to be rather bruised and swollen for about one week. This will subside, depending on the individual, over the course of several weeks or months.

  
  
  
• Medications—Postoperative pain normally is surprisingly mild. The day before surgery we will provide you with some painkillers for the first few days.
  
  
• Nurse—You will be discharged from hospital 1 - 2 days after surgery by your surgeon. If necessary, we may require an assistant to accompany you to the hotel, who will help you get settled back in. Patients who travel alone may be required an extended hospital stay or nursing care in the hotel (additional fees involved).
  
  
• Aftercare—Provided by an experienced support team, which is permanently at the patient’s disposal. During office hours, contact with our specialists may be made by phoning our direct line. After hours, this contact is available through the 24-hour emergency services of the USP Hospital of Marbella. 
  During the frequent check-ups, a nurse will change bandages, clean wound areas and remove any stitches. You will also see your principal surgeon at these visits, to evaluate healing.  Upon request, you may have also have additional sessions with the cooling mask, which may alleviate the discomfort of swelling. 
• Going out in Marbella—At the end of your stay, when you are more likely to want to get out a bit, and we have a list of possible low-impact activities we can help arrange.   A leisurely walk for fresh air will help you recuperate, as long as you are careful with the powerful Mediterranean sun. 
  
  
• Leaving—Before you leave Marbella you will be seen at Agave Clinic. If necessary sutures and stapples will be removed 5 to 7 days after your surgery.
  
  
• Work—About two to three weeks after surgery you can start working again. The swelling will disappear completely in about one year.
  
  
• Check-up—We need to see you again after three months for a check up and after one year to evaluate the final result. These check ups can take place in London or Marbella.

Payment, guarantee and conditions

Payment

After you have received our written proposal by e-mail you will need to make the decision if, and when, you would like to have your surgery performed. To book your surgery a non-refundable deposit of €1000 will be required, the remainder will become due two weeks before surgery.

Guarantee

If you are dissatisfied with the result of your surgery, and we think we could improve matters by performing a second one, we would be willing to do so without fee. However, the costs of using the operating room, and (if applicable) admission and materials will be for your account and will need to be paid 14 days in advance of the treatment.

Of course, in case of surgeon error or clearly unsatisfactory results, you don’t have to pay anything.

General Conditions

Here you can find the general conditions of Agave clinic.