FAQ

FAQ

Practical

Proposal

More than 6 months ago I received a proposal from you which has now expired. Do you want me to send new pictures?

As we try to improve our techniques all the time we would like to make a new proposal. Ideally this is done during a consultation in person. If this is not possible, please send your pictures as explained in http://2pass.eu/practical/proposal/, preferably without make-up.

Do I need a Paypal account to be able to pay with Paypal?

You don’t need a Paypal account to be able to pay with Paypal. Just click on the bottom link on the right in the Paypal window (see screenshot below).

You don’t need a Paypal account to be able to pay with Paypal, just a credit card

Will it be possible to make a professional proposal based on pictures of the face only?

We prefer a face to face consultation if reasonably possible. Being able to touch the face is better for analysing a face. In most cases though good pictures as described in http://2pass.eu/practical/proposal/ will give the doctor enough information to make a professional proposal. If necessary the proposal can be slightly adjusted the day before surgery during the preoperative consultation.

Consultation

Do I need a Paypal account to be able to pay with Paypal?

You don’t need a Paypal account to be able to pay with Paypal only a credit card. Follow the steps below if you don’t have a Paypal account.  paypal_checkout_-_review_your_paymentpaypal_checkout_-_log_in

Can I wear make-up during the consultation?

It is no problem to come with a light make-up to the consultation. Try not to make it to heavy so Dr Bart van de Ven can make a good assessment of your natural facial features.

Booking your operation

Can I pay for my surgery at arrival using credit card or check?

No you can’t. We only accept bank transfer or cash payment (bank notes).

Can I pay my deposit with Paypal or credit card?

We don’t accept payments for operations by Paypal. The only way to pay the operation is by bank transfer.

How long is the waiting time to book an operation?

The average waiting time for an operation at the moment is two months. For big surgeries it can be a bit more, for small surgeries often less. You can check availability through our online operation planner.

Can I pay the money back on a monthly base?

We don’t provide credit to patients. The full amount has to be paid before the operation. In banks you will find professionals that can judge if it is wise for you to take a credit. We understand you wish to have your surgery as soon as possible, but don’t underestimate the stress a too high financial obligation can cause.

Why can I not book more than 6 months in advance?

The maximum in advance that can be booked is 6 months. We do this because we noticed a lot of things can happen in 6 months that disrupt planning (in the life of the patient but also in the life of the doctor).

Dates automatically open up 6 months in advance. So if you want to book a particular date, best is to schedule in your calendar to do this 6 months before this date. As the date is blocked for everybody, you don’t have the risk somebody else takes the date (you do have the risk Dr Bart van de Ven is on holiday).

What if you are ill at the moment of the scheduled surgery?

If a letter of a medical doctor saying the patient really was not able to be operated because of physical illness, the surgery will be rescheduled without cost.

Can I be put on a waiting list to be contacted just in case someone cancels her surgery?

Yes, we can put you on a waiting list if you want. You will be contacted if someone cancels. In our practise this rarely happens by the way.

Preparing for the surgery

Is it mandatory to book the place to stay in Antwerp after discharge?

If you live not too far from Antwerp it is not a problem you return home the day after surgery and come for a postoperative consultation with Dr van de Ven 8 days after surgery.

Are the postoperative controls obliged?

No they are not obliged. Just let us know which control you can not attend.

Is the preoperative consultation obliged?

Yes it absolutely is. Without this, Dr Bart van de Ven cannot operate.

Can my partner sleep in the hospital with me?

We have two double rooms in the clinic. Please let us know if you want your partner to sleep in the hospital as well and we will arrange this for you if the room is available. An extra 100 euro is charged for this (if no further stay in the Guesthouse is reserved).

What if I take any coagulant like Aspirin or Sintrommitis? Do I have to stop taking them?

Please contact the doctor that prescribed this medication to you and ask him if you can just stop it for a while. Ideally we would like you to stop Aspirin from 10 days before the surgery till 3 days after the surgery.
If you take Sintrommitis it should be stopped a few days before surgery, but often you will need some other anticoagulant that is more controllable to replace it. Your doctor will give you the correct instructions.

Do I need to remove nail treatment prior to surgery?

The reason this is sometimes requested is for the anesthesiologist’s monitoring of the pulse oximeter, which measures the level of oxygen in the blood. This can also be monitored and measured by attaching the sensor to the toe or earlobe, so our anaesthesiologist does not request to remove gel nails.

I’m a bit overweight. What is the maximum BMI for elective surgery?

In principle the maximum BMI is 30. If your BMI is higher but you are in good health, your case is considered on an individual basis by our anaesthesiologist.

Why you don’t ask for the blood group?

Dr Bart van de Ven needed to do a blood transfusion in his patient so far twice in his life. So the incidence is very low. If it is necessary the blood lab will ALWAYS do a cross test with the blood of the patient before giving the blood so why test it before? In the case of acute need for blood the blood group O-negative is given. This occasion did not ever occur in our practice (but Dr van de Ven’s blood group is O neg which means he would be able to give his own blood…:).

When should I stop my electrolysis / laser hair removal sessions before FFS?

There is no problem for us if you have a hair removal session two days before your surgery.

When should I stop my HRT treatment before FFS?

You can continue your HRT treatment before, during and after your FFS. You will receive an anti-thrombotic injection the day before surgery to prevent blood clothing. We prefer you to continue taking your hormones because FFS is emotionally already perturbing enough without messing with your hormone balance.

When do you need to have the results of the bloodtests? What if the results are abnormal?

If the results of your tests are all within normal range you can bring them to your pre-operative consultation so we can add them to your file. It is not absolutely necessary you scan them and send them by email. In case some of the results are clearly abnormal you should ask your GP or a specialist if it has any consequences for the planned surgery. Per definition 5% of test results is out of normal range. That means that very often it is without consequence.

What happens if I need to see a doctor when I return to my home country?

We would advise you to see your GP or the doctor that is on call. We would then discuss the problem with this doctor once you’ve been seen, and recommend the appropriate treatment. In extremely rare cases it might be necessary for you to come to Antwerp.

When will I be able to get up and walk around after the surgery?

In the hospital, once the catheter has been disconnected, you should gently work up to getting out of the bed and walking around a bit, unless your doctor advises differently. Listen to your body carefully and get plenty of rest, but don’t stay in bed all day. After a few days you’ll like to go outside, which you should do.

Will I be able to eat?

If you haven’t had any treatment involving your teeth a sliding genioplasty or orthognathic surgery, you’ll be able to eat normally quite soon. Due to the effects of general anesthesia, you should only feel nausea for the first few hours. You may prefer to eat softer or pureed foods initially if you have intra-oral sutures. Patients should prepare accordingly in advance and purchase juices, yoghurt and soups to have during for the first few days after surgery.
After a sliding genioplasty you should be very careful not to put too much force on the lower jaw e.g. by eating raw meat (steak) or biting an apple. The jaw is really weak in the chin area and it will take about 6 weeks until it has regained it’s original strength.

What kind of pain can I expect?

Pain is surprisingly mild, considering the extensiveness of the surgery performed. Many patients don’t speak of pain at all but more of discomfort. With normal pain suppressants and anti-inflammatories, any pain and swelling can be well managed.

When should I expect to return to work?

Normally our patients return to work after 2 to 6 weeks, according to the extent of surgery.

What about smoking?

As smoking counteracts wound healing we strongly advise against smoking during the 3 weeks before surgery until 3 weeks after surgery. Smoking dramatically increases the risk for skin necrosis and should be avoided at all times.

How long should I stay in Belgium after surgery?

When it is an extensive surgery you can fly home 8 days after surgery. For a typical schedule have a look at the following webpage: http://2pass.eu/practical/operation/typical-stay-in-belgium/

FAQ about the procedures before operation

General

How would the clinic deal with an emergency if serious complications were to arise during the procedure?

If a patient needs hospitalisation we would transfer her to the Middelheim hospital which is 8 minutes or 3,5km from our clinic.

We have had this situation 2 times in more than 700 surgeries. In case this would be because of a mistake from our side we have an insurance that covers the cost. More likely is that it happens without anyone having made a mistake. In that case most health insurances cover these costs.  If you don’t have a health insurance it’s your (financial) risk.

When can I judge the final result?

After three weeks you would look presentable but it takes at least 4 months to get a good impression of the final result. Sometimes after chin and jaw work it can take up to a year for the swelling to completely disappear. Scars take about a year to fully mature.

What type of care is needed after the treatment? Will I require check-ups in my own country?

All care in Antwerp is provided. In general no extra care is needed in your home country. Check-up with Dr Bart is after 4 months and can be in any city where Dr Bart van de Ven provides consultations.

What happens if there are complications after the procedure and is this covered?

We will correct the complication if surgically possible, without charging any surgical fees. Hospital, material and traveling costs are for the expense of the patient.

How long is the waiting time to book an operation?

The average waiting time for an operation at the moment is two months. For big surgeries it can be a bit more, for small surgeries often less. You can check availability through our online operation planner.

Is FFS painful?

There is no complete answer to this. It depends entirely on the pain threshold of the patient, and the operation procedures performed.Most procedures will involve the need for some incisions, and closure with sutures. Inevitably these will lead to some level of discomfort for some period post-operation. Mostly patients describe it as ‘uncomfortable’ rather then ‘pain’.

Can I loose feeling permanently in some areas following FFS surgery?

Some temporary numbness in any of the areas where bone work is done is an absolute certainty. That could include the scalp, forehead, chin, jaw or even cheek areas depending on where the surgery has been done. This is simply because the flesh is detached from the bony area. Several thousand minor nerves are severed, and it will obviously take some while for those areas to heal. Up to 18 months is not unusual, but less than that is more common.

I’m a bit overweight. What is the maximum BMI for elective surgery?

In principle the maximum BMI is 30. If your BMI is higher but you are in good health, your case is considered on an individual basis by our anaesthesiologist.

Will I have numbness?

The treatment areas will feel numb in the beginning. It will take 3-6 months to recover feeling, and you may not regain the same level of feeling as before.

Should I wait with FFS until I have taken hormones long enough?

The hormones will have their effect on the soft tissues of your face: the fat will redistribute and the muscles will atrophy a bit. Also the facial hair will diminish and hair to the scalp will become denser and thicker. All this will make your face look softer and more feminine.
Dr van de Ven will try to make your face as feminine as possible and there is no negative effect to your face becoming even more feminine after your FFS due to the hormones. Those last changes will be very subtle. Therefore Dr van de Ven does not see a reason to postpone FFS if you have only started taking hormones recently.

Forehead recontouring and hairline lowering

For the forehead recontouring, is there any shaving required?

No, shaving is never required for the incision.

Is it safe for titanium screws staying inside my body for long term?

Yes it is. Two of the greatest benefits of titanium are its high strength-to-weight ratio and its corrosion resistance. Couple this with its non-toxic state and its ability to fight all corrosion from bodily fluids and it’s no wonder titanium has become the metal of choice within the field of medicine. Titanium is also incredibly durable and long-lasting. In principal they are not removed anymore and stay in the body. Only in case of an infection on the plates (rare) they will have to be removed.

Another benefit to titanium for use in medicine is its non-ferromagnetic property, which allows patients with titanium implants to be safely examined with MRIs and NMRIs.

How long does it take for the final result to be visible and the blue stains to disappear completely?

After the forehead recontouring procedure patients heal relatively quickly. However, healing is different for every patient. Mostly for this procedure a final result can already be visible after one to two weeks. But if the blue stains are severe (10% of patients, and there is no way to predict to whom this will happen), it can take up to 4 weeks for the blue stains to completely disappear.

Does bone grow back once it has been cut or shaved down?

In our experience no bone has ever grown back.

Is there a risk for sinus problems after forehead recontouring type 3?

Until now we have never had a patient complaining about sinus problems after this procedure.

 

Is the skull less strong after this procedure?

Weakening of the skull is not applicable; the skull is very strong and remains  strong.

What are the chances that I will experience hair loss after the operation?

Many patients experience temporary hair loss. On average the hair grows back in about 6 months.

Is it possible to have hair replacement done at the same time as the procedure to give a female hairline?

If you have just a hairline lowering it basically is possible to do hair transplantation at the same time. But practically this is not possible as Dr van de Ven doesn’t do hair transplantation himself. This is done by the hair transplantation clinic, which uses a different operating theatre.

Will I experience loss of nerve sensitivity in the scalp area?

For sure there will be temporary numbness of the scalp which recovers to a variable degree. I can be that the sensation of the scalp will never be as before, but nobody really makes a big deal of this.

What will the hairline scar be like?

The hairline scar will be irregularly curved for a natural effect. In the beginning it will be red and quite visible, but after about 6 weeks it will become less conspicuous and the hair will start to grow through the fine scar. Maturation of the scar will take approximately one year.

Will the scar be visible? That defends on the density of the hair just behind the hairline. If the hair is dense the scar will be hardly visible once the hair roots that have been pushed under the scar have grown through the scar. In case the hair is thin it could be the scar becomes visible when you pull the hair backwards.

Hairline lowering with expander

Is it common to have complications during the expansion?

Complications during expansion have become very rare since we place the expander on the back of the head. Leakage of the expander or a serious infection have never occurred.

How much time should there be between placement of the expander and the actual hairline lowering?

Depending on the amount of hairline lowering necessary you will need 6 – 8 week for the expansion

How often should I inflate the expander?

Twice a day you will have to inflate 10ml of water (saline). We will supply you with all the necessary things after the expander has been placed.

Is the expansion very painful or disfiguring?

Thanks to a new technique developed by Dr van de Ven the expander can be placed on the back of your head. With the new technique patients don’t complain of pain during the expansion anymore and it has become much easier to hide the expander.

Browlift

Rhinoplasty

Could breathing be more difficult after a reduction rhinoplasty?

In a normal nose the respiratory route is critical at just one point which is the internal valve. By the use of spreader flaps or spreader grafts Dr van de Ven will make sure that there the nose doesn’t become smaller.

How often is revision surgery necessary after a rhinoplasty?

Rhinoplasty is considered to be an operation with high risks, primarily because of the limited predictability of the aesthetic result. Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases. What are the reasons? A perfect result immediately after surgery may be totally different one year later. Limited predictability is mainly due to the dynamics of the healing process. Many different types of tissues are involved: bone, cartilage, mucosa, skin, fat, fascia, muscles, nerves, vessels, perichondrium and periosteum. The individual reactions of these tissues are not always under the control of the surgeon. This is especially true for cartilage, the main supporting structure of the nose.

The risks for rhinoplasty-complications can be reduced with increasing experience. A prerequisite is continuing education and an earnest distinction between complication and mistake. Dr Bart van de Ven has build up a decent experience with noses during his carrier. To help the healing process he developed a device called ‘nose moulder’ that drastically decreases some of the aesthetic complications after rhinoplasty. Because of the real pressure possible with this splint less fluid collection between skin and underlying tissue is the result. Fluid can be replaced by the body by scar tissue, compromising the aesthetic result. The real pressure also gives a real fixation of the bone cuts. This results in significant straighter noses.
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Cheek augmentation with medpor implants

Are all the cheek augmentation contours the same or can the doctor decide on the shape and size?

The doctor can decide on the size and shape of the implant. In 80% of cases the same implant is used, but if indicated other sizes and shapes are used.

Jaw angle and chin recontouring

Will the skin adapt to the new shape of the jaw?

The volume of the jaw and chin will be reduced and the swelling after this type of surgery can be massive. In a young patient with good elastic skin, the skin recuperates from all that stretching.  If you are older, the skin will possibly not completely readapt to the new jaw shape resulting in a previously not existing sagging skin. That is why a lot of older FFS patients (late 30’s and older) may need a facelift. A facelift is best not performed at the same time as a jaw and chin recontouring because the result is suboptimal. We recommend at least 4 months between the two operations. The facelift helps enormously to show off the newly formed jaw and chin, resulting in a very female shape of the face.

Can a facelift be performed at the same time as a jaw angle reduction?

The swelling after a jaw angle reduction can be massive. That is why a facelift is best not performed at the same time as a jaw recontouring. The results will be suboptimal. We recommend at least 4 months between the two operations. The facelift helps enormously to show off the newly formed jaw and chin, resulting in a very female shape of the face.

With a chin height reduction is there significant sagging of the skin around the chin?

Of course there will be relatively more skin around the chin after a bony reduction of the chin. A hanging chin can however be avoided by meticulous suturing of the muscles of the chin and by wearing of the facemask that Dr van de Ven will provide you with after the surgery for 3 weeks. The facemask gives a strong upward support to the chin. If in spite of these measures the skin is still sagging around the jaw and chin (this happens mostly in elderly patients with less elastic skin) one of the 3 types of facelift that Dr van de Ven performs can bring the solution.

Is it possible for the lower lip to move upwards after a chin height reduction? Does the smile change?

Yes, if you reduce the height of the chin and you suture the muscle well, the lower lip moves upwards.

Is it safe for titanium screws staying inside my body for long term?

Yes it is. Two of the greatest benefits of titanium are its high strength-to-weight ratio and its corrosion resistance. Couple this with its non-toxic state and its ability to fight all corrosion from bodily fluids and it’s no wonder titanium has become the metal of choice within the field of medicine. Titanium is also incredibly durable and long-lasting. In principal they are not removed anymore and stay in the body. Only in case of an infection on the plates (rare) they will have to be removed.

Another benefit to titanium for use in medicine is its non-ferromagnetic property, which allows patients with titanium implants to be safely examined with MRIs and NMRIs.

Can a chinplasty or jaw recountouring be performed when you have dental implants in that region?

Dental implants normally have a maximum length of 14mm. Natural teeth are longer. That’s why dental implants never create problems during a chinplasty or jaw recontouring.

Can dental implants still be inserted after a recontouring of jaw and chin?

The removal of bone will be done at the lower border of the jaw, far away from the teeth. So dental implants can be inserted after just as before.

Does bone grow back once it has been cut or shaved down?

In our experience no bone has ever grown back.

Liplift

How visible is the scar?

Initially the scar will be visible as a red line just under the nose, partly hidden inside the nostrils. Because of a technique developed by Dr van de Ven there will be hardly any downward pull caused by the orbicularis muscle (sfincter muscle around the mouth). Therefore the scar will remain thin and after about 12 months it will be difficult to detect.

Lipofilling

How long does the fat stay?

In general 70% of the fat stays forever. Therefore a little overcorrection is done during the operation.  Repetition is needed for about 50% of our patients. There are many factors that determine how long fat grafting lasts. Some fat is always reabsorbed by the body, the amount can vary considerably from body to body. The fat that stays after 6 months, stays forever. After 6 months, if necessary, another fat graft may be performed until the desired effect has been obtained.

Adams appel reduction

Typically how long is it after surgery to get your voice back to “normal”?

The voice cords need about 2-3 weeks to make normal use of the voice possible. We cannot exactly, if you use your voice extensively for professional reasons, when this is 100% back as before. We have no feedback on this matter.

How will the scar be after an adams apple reduction?

All incisions leave a small white line in the end.

As this line is placed in an discrete spot (angle between neck and chin), it will be as good as invisible from most angles.

After two weeks nobody should notice from a distance. After 1 year the scar will be completely healed (white).

How the swelling and the bruise of the tracheal shave looks after 2 weeks?

In general you will hardly notice anything. But occasionaly (1 every 50 patients) there is some postoperative bleeding, which needs about a 6- 8 weeks to completely dissolve.

Will reducing the adam’s apple have any negative effects on my voice?

That is why we plan a CT scan to know exactly where are the vocal cords and how much cartilage can be removed. Until know we didn’t have one patient who had this complication.
It is possible though that oedema (swelling) of the vocal cords caused by irritation by the tube that was introduced by the anaesthesiologist or the surgery itself makes the voice weak and/or coarse for a period of about 2 weeks .

Facelift

How long does it take to completely recover from a facelift?

You should count on not being as socially active as normal for about two to three weeks. The swelling starts to subside on the third day, and is usually hardly visible after a week to ten days. You can go out (for shopping, etc.) from the first day after the operation.

Can a facelift be performed at the same time as a jaw angle reduction?

The swelling after a jaw angle reduction can be massive. That is why a facelift is best not performed at the same time as a jaw recontouring. The results will be suboptimal. We recommend at least 4 months between the two operations. The facelift helps enormously to show off the newly formed jaw and chin, resulting in a very female shape of the face.

What about smoking?

As smoking counteracts wound healing we strongly advise against smoking during the 3 weeks before surgery until 3 weeks after surgery. Smoking dramatically increases the risk for skin necrosis and should be avoided at all times.

Croton oil skin peeling

I have been treated for skin cancer on my face for the past three weeks with efudex topical creme 5%. I would like to know approximately how long would I have to wait before getting a croton oil peel.

The skin needs to be completely healed and I would wait a minimum of 8 weeks. By the way, a croton oil peel may be as curative and protective as Efudex.

Can a chemical peeling of the whole face also be done without general anesthesia?

We offer a complete chemical peeling in local anesthesia with deep sedation. The anesthesiologist is present, the patient is asleep but breathes spontaneously.

A peeling just around the eyes or just around the mouth can be done without any anesthesia. There will be an absolutely bearable burning sensation that lasts for about 10 seconds. After that the treatment is completely painless.

What products or procedures should I avoid before a chemical peel?

One week before the peel avoid waxing, electrolysis, deploritory creams, and laser hair removal. In general you should avoid anything that can irritate the skin, including the medical preparation ointments we prescribed to you (stopping 5 days before is enough).

Until how long before the peel can I have a laser hair removal?

You can have a laser hair removal session until one week before the peeling. One week is enough time for the skin to recover from this irritation.

Can the croton oil be used under the eye area for crows feet and the under eye wrinkles?

An excellent location for segmental peeling is the eyelids. Lower eyelid skin in particular responds very well to a croton oil peeling. When peeled appropriately, the thin eyelid skin contained within the borders of the orbital rim is very forgiving, and healing is well tolerated and easily camouflaged with makeup or glasses. Another advantage of the lower eyelid peel is that it can easily be done with the patient under local anesthesia and in a gradual fashion. If a patient requests a quicker recovery, a lighter peel can be done and repeated in the future with additive effect. The lower eyelid can ultimately be peeled to the patient’s satisfaction.

This is one of the best applications of the croton oil peel and is a good starting point for those who are reluctant to begin with a full face peel.

FAQ about the recovery process after the operation

General

What happens with the sutures? How long until they dissolve?

How long does it take for the skin sutures to dissolve?

White skin sutures are dissolvable, blue or black ones have to be removed after about 6 – 8 days. The white skin sutures dissolve in 1 or 2 weeks. If they would still be in the skin after 2 weeks they will easily break when you pull with your fingers.

How long does it take for the sutures in the mouth to dissolve?

That normally takes 5 – 7 weeks. If they would still be in your mouth after 7 weeks you can easily remove them just by pulling as they will immediately break.

In general, how long after FFS can I sport again?

If osteotomies (rhinoplasty, sliding genioplasty, forehead recontouring type 3) have been performed your should wait around 6 weeks before you do sports where someone could accidentally hit you in the face. Other than that it is up to you to FEEL when your body is ready for sports again.
As rule of thumb we would say that it takes 3 – 8 weeks before you can start sporting after FFS. This depends on the extend of the surgery, your age and your physical condition before the surgery.

How long after the operation should I wait to apply make-up and other creams?

You can start to use make-up and perform your daily cleaning rituals almost immediately on all areas without wounds. For the incision areas you should wait about two weeks.

What happens if I need to see a doctor when I return to my home country?

We would advise you to see your GP or the doctor that is on call. We would then discuss the problem with this doctor once you’ve been seen, and recommend the appropriate treatment. In extremely rare cases it might be necessary for you to come to Antwerp.

How do I clean the extra-oral incision areas? What should I do and for how long?

If there are steri-strips covering the wound or you have a bandage you should not touch it and keep it dry. If there are no strips or bandages, extra-oral incision area’s should be cleaned carefully on a daily basis by bathing the area as advised and patting it dry carefully. After about 2 weeks the wounds will be healed enough to begin applying a special ointment to improve the scars. For this we recommend Dermatix gel, which you can buy at any pharmacy. Use this ointment with gentle massage for about 3 months until the scar has matured.

Where will the swelling be?

Immediately after surgery the swelling will be mostly in areas of loose connective tissue (cheeks, lips, around eyes). During the first few days, the swelling will move downwards towards the lower jaw and neck due to gravity. Swelling and bruising differ strongly from one person to another and can be anywhere. Preferential places are around the eyes and in the lips, but can also involve the lower jaw and neck. Bruising may not appear immediately and will gradually fade over the course of several weeks.

How long will I have swelling?

About 80% of swelling will have disappeared after 2 to 3 weeks. For a final result you’ll have to wait up to 1 year.

Can I stay in the sun?

The young scar is very sensitive to the sun´s rays as it contains very few melanocytes. Therefore during the first 6 months after surgery we recommend protecting the scar with a sunblock or to stay out of the sun. During the first week after surgery it’s better to keep out of the sun completely as the risk for infection might be higher if your face and body get too warm.

How long after the operation I should wait until starting facial hair removal procedures again?

After bone surgery the area that was worked on is can be very sensitive to pressure. If this is the case we advice 3-6 weeks to heal from surgery. Some patients on the contrary experience temporary numbness after the surgery and reported us that with electrolysis that was handy, as it didn’t hurt that much.The reason some say to stay away from electrolysis or laser post FFS is to avoid infection. With electrolysis and laser bacteria can get in the bloodstream. And from there to the fresh wounds in your face. But, as the wounds are already exposed to all kind of bacterias in the mouth and on the skin, this argument is not valid in the case of facial feminisation surgery.

Of course the scar itself shouldn’t be lasered or electrolysed. Scars need to heal before they are hit by the laser. This takes until 6 months after the op. You can just get the laser technician to avoid the area.

Forehead recontouring and hairline lowering

When can I start using Minoxidil on my hair after forehead reduction or hairline lowering?

You can start Minoxidil after proper healing of the incision wounds, three to four weeks after surgery.

After a hairline lowering and browlift I now have bumps along my hairline which are irritating, do these settle down?

Those bumps are the Endotines that have been placed just inside the hair to prevent the hairline from pulling back. They will resorb in about a year, sometimes even a bit more.

How long does it take for the endotines to disappear?

According to the manufacturer it takes about 3-6 months for the endotines to absorb. According to our experience it takes about 6-18 months before the endotines dissolve completely.

When can I wash my hair?

Almost immediately. Don’t be alarmed if the wound bleeds a little bit while washing your hair. For wound healing it’s very good to remove all excessive blood cloths and crusts, even better when you use shampoo. Just remember to blow-dry thoroughly and dab with a drying antiseptic, like alchohol, afterwards to eliminate any remaining moisture.

I feel air under my forehead skin after the operation, is this normal?

After a forehead recontouring there is often a connection between the frontal sinus and the space under the forehead skin. If you blow your nose, air can be pushed into that space. If you push the skin with your fingers you can hear a typical crackling sound. This is absolutely harmless.

This air escape will disappear in time when the skin is reattached to the bone. To help this process you will be provided with a forehead mask, which you should wear for two weeks. This mask will push the skin against the bone. Also care should be taken not to blow your nose too hard. After two weeks you can take the mask off and carefully try to blow your nose. If still air escapes to the space under the skin, the forehead mask must be used longer.

Will type 1 forehead recontouring give me the best possible results?

In about 1 out of 3 patients that need forehead recontouring Dr van de Ven will use only shaving (type 1). In all other patients he does the type 3 forehead recontouring meaning the anterior wall of the frontal sinus needs to be set back. If Dr van de Ven proposes a type 1 forehead recontouring he does this because he really thinks he can have the best possible result with it and can save the patient some costs (type one is cheaper because it’s less work). If during the surgery he will come to the conclusion it would be better for the patient to perform a type 3 recontouring he will without charging extra costs.

I’m having double vision in the first week after forehead recontouring, is this normal?

It is possible the first two weeks because of the swelling around the eyes double vision occurs (5 procent of patients). This is annoying and evening frightening but ALWAYS resolves. We never had a patient with permanent double vision.

How long does it take for the final result to be visible and the blue stains to disappear completely?

After the forehead recontouring procedure patients heal relatively quickly. However, healing is different for every patient. Mostly for this procedure a final result can already be visible after one to two weeks. But if the blue stains are severe (10% of patients, and there is no way to predict to whom this will happen), it can take up to 4 weeks for the blue stains to completely disappear.

Hairline lowering with expander

Jaw and chin recontouring

Will I be able to eat?

If you haven’t had any treatment involving your teeth a sliding genioplasty or orthognathic surgery, you’ll be able to eat normally quite soon. Due to the effects of general anesthesia, you should only feel nausea for the first few hours. You may prefer to eat softer or pureed foods initially if you have intra-oral sutures. Patients should prepare accordingly in advance and purchase juices, yoghurt and soups to have during for the first few days after surgery.
After a sliding genioplasty you should be very careful not to put too much force on the lower jaw e.g. by eating raw meat (steak) or biting an apple. The jaw is really weak in the chin area and it will take about 6 weeks until it has regained it’s original strength.

What happens with the stitches in my mouth?

They dissolve in 5 – 7 weeks. They don’t have to be removed. If they would still be in your mouth after 7 weeks you can easily remove them just by pulling as they will immediately break.

How can I expect the feeling in my chin and lower lip to be after a chinplasty?

After a chinplasty the feeling in the lower lip and chin is always disturbed. If the mental nerve (that comes out of the jawbone just behind the chin and then runs into the lower lip and skin of the chin) has not been ruptured during the surgery, for sure sensitivity will come back. It is not possible however to predict when and to which extent. Mostly the recovery will take between several weeks and several months but it can take up to even 2 years. It is normal that sensitivity of lower lip and chin doesn’t recover completely.

If the mental nerve has been ruptured (in the hands of Dr Bart van de Ven around 1%) it can be sutured. Of course the prognosis will then be worse. Damage to the mental nerve will however not be visible to the outside world as it is a 100% sensory nerve. It doesn’t contain motor branches so function of any muscle is not involved.

Rhinoplasty

How long should I wear the nose moulder?

You should try to wear the nose moulder as much as possible during the first 3 weeks after surgery. Please make sure the nose moulder is placed in the middle. If it hurts you should make the elastic band wider and/or leave the nose moulder completely off for a while.
After the first 3 weeks we advise to wear the nose moulder every night until the check-up 4 months after the surgery.

How long should I wait to see the final result of a rhinoplasty?

After a rhinoplasty you have to be really patient. During the first 3 months it can be very swollen. Especially if you have a thick type of skin it can take more than a year for all the swelling to disappear. The nose can continue to change until 1 – 2 years after surgery.

Would it help my nose swelling if I put some tape across it?

The tape helps partly to avoid the swelling from forming. Once the swelling is there, the tape will not let is disappear. Only waiting….Also the nose moulder is not useful for the swelling, this is only to keep the nosebones in place.

Croton oil peel

A few weeks ago I had a croton oil peel. Now I have some dark spots in my face. What should I do?

These darks spots are signs of postinflammatory hyperpigmentation (PIH). This This is a frequent and transient (so temporary) complication of croton oil peeling. Permanent problems have not been seen. Best is to continue the daily application of tretinoïn- and hydroquinone-ointment that you have received from us before the peeling for 3 to 6 weeks. It will help to remove the hyperpigmentation. Also it is very important for you to stay out of the sun until 6 months after the peeling and use the sunblocker that we gave you.

After a chemical peel how long should I wait for laser hair removal?

You should wait two weeks to have your laser hair removal treatment done provided all signs of inflammation have resolved and there are no signs of increased pigmentation.

How long do I have to wait before I can shave again?

You should wait until the skin has completely healed, which takes about 10-14 days.

Other procedures

We are now two weeks after the operation with an incision under the lower eyelids and the lower eyelids are a little bit pulled down. What should I do?

Frequently when performing the transcutaneous blepharoplasty the orbicularis muscle is denervated and lid tone is diminished.  As the tone of the muscle returns the lid position should as well.  To prevent ectropion (lid margin evertion) two weeks after surgery you should start regular upward massage of the lid several times daily for 3 to 5 minutes (at least 3 times a day). This will improve lid tone and the lid position. Lower blepharoplasty takes one year to fully mature into post operative results.

We are now two weeks after the operation with an incision under the lower eyelids and the lower eyelids are a little bit pulled down. What should I do?

Frequently when performing the transcutaneous blepharoplasty the orbicularis muscle is denervated and lid tone is diminished.  As the tone of the muscle returns the lid position should as well.  To prevent ectropion (lid margin evertion) two weeks after surgery you should start regular upward massage of the lid several times daily for 3 to 5 minutes (at least 3 times a day). This will improve lid tone and the lid position. Lower blepharoplasty takes one year to fully mature into post operative results.

What happens with the stitches in my mouth?

They dissolve in 5 – 7 weeks. They don’t have to be removed. If they would still be in your mouth after 7 weeks you can easily remove them just by pulling as they will immediately break.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.