Sunday, December 30, 2012

Facial Surgery - Notes from the other side

As I mentioned a little over two weeks ago, I went in for facial femiinization surgery (FFS) on December 13. I promised a post from the other side, and here it is. 

Disclaimer - boring surgery stuff ahead

This post is for anyone who is interested in what FFS was actually like. As is my usual practice, I won't name names (not even of my surgeon) but if you want more specific information I'll be happy to talk about things like that privately. On the other hand, if you're not interested in what it takes to have your face redone, feel free to bail out at any time.

What is "the works"?

The first question is what exactly did I have done? While I didn't have the world's most masculine face, I did end up getting pretty much everything done, "the works" as you might put it. And I realize that for those who haven't been there "everything" isn't a good answer. NOTE: this is NOT an attempt to use technical terms. If you want the technical terms for all of these procedures consult with a more complete FFS reference or surgeon.

Let's just start at the top of my head: 

  • hairline advancement - that means my scalp was partly detached, pulled/stretched forward, and stuck back down, advancing my hairline by about one inch. 
  • forehead lift - my forehead was pulled up, tightening it and pulling out the wrinkles. This was really more for rejuvenation than feminization
  • brow reduction - the ridges over my  eyebrows were ground down to remove the prominence that males have there
  • eyebrow lift - my eyebrows were slightly lifted
  • under eye skin peel - the skin right under my eyes was about 70% removed by a chemical peel, to make it grow back smoother. Again a rejuvenation thing.
  • cheek implants - soft plastic implants were put in each cheek to make them project forward, as opposed to the more hollowed male look that I had
  • nose work - my nose was reduced slightly, the "bump" was taken out, and my deviated septum was repaired. I can already breath better than I ever have in my life
  • fat grafts - fat removed from around my navel was centrifuged and re-injected at my temples, and around my upper lip, for more youthful and feminine fullness.
  • jaw muscle reduction - the muscles at my jaws which tend to give a squarer, more masculine appearance, were cut down
  • jaw angle and projection reduction - basically my jaw was ground down to both project less and be less square
  • tracheal shave - my "adam's apple" bump was reduced
  • neck lift - my neck skin was pulled and tightened to get rid of the "turkey neck" effect that is both aging and a bit masculinizing.

So that's "everthing" pretty much. It means that almost every part of my face was disrupted in one way or another. A fair amount of this work was done from the inside, so the number of incisions you might see is not as great as you might think - I have an incision at my hairline, pretty much all the way around each ear, under my nose and under my chin.

So how does all of this come about?

The process starts with consultation with the surgeon and their suggestion of what shoud/might be done and how much it might cost. Not surprisingly, the surgeon will have his opinion and you'll have yours on both points. Coming together on what willl be done or not done and why is the biggest issue you have work out - feel free to get other opinions, ask questions, and even argue with the surgeon. I did a fair amount of soul searching in deciding whether I wanted to do everything or not. And some of it is more for youthful appearance than anything else - I was okay with that (as I've mentioned). I even paid for someone knowledgable to use photoshop to simulate what each procedure might do for me.

Once that's worked out, and you have reserved a date (I decided to save up my time off from work and do it during the slow time at the end of the year), there is a ton of administrivia to take care of - paying (let's just say my credit cards ended up with a truly amazing amount of reward points), getting medical clearance, laying in needed supplies (including a few gross of q-tips and gallons of hydrogen peroxide), signing what seems like a hundred pages of releases, arranging post-op care, etc. 

Day of Surgery

There were a few pre-surgery restrictions, like stopping vitamins, supplements and hormones, but nothing much else except for the final two - a head to foot shower with antibactierial soap (yep, good old yellow Dial) and NOTHING to eat or drink starting at midnight before surgery. And nothing means NOTHING, not even a sip of water.

I actually managed to get a little of sleep before we got up to get to the surgeon's at 6 am. People tend to assume, since this was surgery, that it would be in a hospital, but a lot of surgeons have their own facilities for surgery. Hospitals are expensive and full of sick people and bacteria, so they're not always the first choice for elective surgery. 

From that point things moved pretty quickly - I changed out of my jammies (yes, I wore jammies to surgery) and into a gown and associated paraphenalia. An IV drip was inserted, a few final pictures were taken after the surgeon used a marker to decorate my face, I got on the table, and... I woke up about 12 hours later in a tiny recovery area. (Clearly there must have been something in that IV.) And some stupid heartrate monitor was driving me mad with it's continual beeping... (I did not fully appreciate at the time what it would have meant if it hadn't been continually beeping!)

After a couple of hours I was "recovered" enough to be dressed, wheeled to the door, and to be helped into the caregiver's car for the drive home.

Here's where accounts diverge. What I recall is walking slowly but steadily and being coherent enough to give the caregiver turn by turn directions from the interstate (she did have written directions as well, but it was dark) to our house. What my wife remembers is that when we arrived, she looked out the door to see a heavily bandaged figure who couldn't figure out how to open a car door, mumbled unintelligibly, and who on standing immediately drooled on her own shoes. I'm sticking with my version, thank  you very much.

How long does it take to heal?

For the first three days, I was propped up in bed and fed pudding and vicodin, punctuated by occasionally getting up to walk a lap around the apartment. Then I got the main dressings removed and took a wonderful, but exhausting, shower. Painkillers continued to be my friends for most of the first 10 days, but things steadily progressed, and by two weeks after the surgery I was starting to feel more normal. Sure, I still got exhausted easily, but I was starting to sleep normally and had said good-bye to the nasty paranoid dreams vicodin gives me. 

So right now, that's about where I am. I have to massage the swollen areas and scars for an hour a day, and wear a supporting head "garment" for 18 hours a day, but I'm starting to feel better. Taking a shower no longer exhausts me. Sensation is returning to some areas, like my forehead, but others, like the top of my head and under my chin remain pretty numb. I'm told that things are going well, and I expect to be working in a few days and mostly of back to normal in a few more weeks. 

The swelling will take months to fully go away and it will also take that long to get sensation back everywhere, so full recovery will be an ongoing project in 2013, but one that I think will be worth it.

Are there pictures?

In case you're wondering, yes, I have been taking pictures. And no, I'm not sharing them now. I'll hold them until I can put together a more triumphal procession than I can now. Even my tolerance for being a work in progress has limits!

Are you happy? 

So am I happy? It's still a bit early for wild celebration. It's also surprisingly hard (and demoralizing) to see yourself so bruised and swollen. The fat grafts have left my upper lip way too thick, the swelling has given a bit of a snub nose, and so on. But all of those things are improving, as the surgeon promised. So things are getting better every day as I continue to heal.

For a while there I was looking in the mirror, searching in vain for some sign of someone I recognized. That has all been more than a bit scary... but today I looked in the mirror more closely and caught a glimpse of someone... it was the first time I'd seen her, but there could be no mistake...

It was me. 

Tuesday, December 11, 2012

Facial Surgery

A lot has happened over the past 10 months. I started seeing a therapist, started hormones, came out to friends and family, transitioned at work, and mostly traversed the legal hurdles of changing my name. I braved air travel and the TSA, hotels, car rentals, even Las Vegas, with my new identity and escaped unscathed. Some of those milestones were scary, some of them caused me to lie awake in bed worrying about how I would get through them, but in the end, none of them was as hard as I'd feared. Particularly transitioning at work, which absorbed hours of stewing and fretting, was so much more positive than I'd ever dreamed it might be.

So now I'm charging full speed towards a different milestone - facial feminization surgery. In just under 36 hours I'll be in surgery to have almost every aspect of my face remodeled. I'm excited, scared, doubtful, certain, eager and hesitant.

FFS, as it's called, is a controversial subject. Not having it says that you're confident and comforatble in the image you project amd that you don't care about society's judgments on feminine appearance. Or perhaps it says that you are naturally feminine in appearance or that you don't have or care to spend the astromomical  sums a thorough face remodeling requires.

On the other hand, having FFS may say that you are vain, that you are a slave to conventional views of feminity, or that you have delusions that changing your face will fix your life. Or it may say that you want to blend in, be invisible, or  just  have the luxury of not being read the first 30 seconds someone sees you.

I like to think in my case it means that after all of this time I will be able to look in the mirror and see someone who matches my internal view of myself just a bit more. It should make me appear younger, and I happen to like that. It seems to me that it will go a tiny way towards giving me back a few of those many years of seeing someone else in the mirror.

I'm aware that this will come at a fairly high price. It's costly, it's time consuming and a burden on those around me. It's major surgery - almost every part of my face and the underlying tissues, from the hairline to the base of the neck will be sliced, diced, ground down, built up, or otherwise disrupted. It will be painful and the recovery will be measured in weeks and months. I'm aware of all of this and in some ways I dread it. 

When it's done, I have no illusions that I'll be, in the words of my surgeon, "stunning". Nor will all my problems go away, nor will a lifetime on the wrong side of the gender tracks be erased. But if I can look in the mirror and sometimes see a bit more the person I've always been inside, if it makes me feel a bit more confident and a bit more relaxed out in the world, above all if I look a bit more like ME, then I think it will be worth it. 

So the bottom line is that I'm determined to go forward. From Thursday on I'll be out of touch for a little while... wish me luck - I'll see you on the other side.