I first heard about FFS (facial feminization surgery) when I was 17 or so, not long after I had discovered what the word 'transgender' meant. The first information about FFS I found was probably Lynn Conway's (
http://ai.eecs.umich.edu/~mirror/FFS/LynnsFFS.html). She obviously looks great, but to be fair, she looked very feminine before and had been very successful in a completely passable life as a woman.
I had never really at this point in my life hated what I saw in the mirror. It was a stable sight every day. It wasn't perfect I guess but I was content with it.
In the ten years that followed though, I had become obsessed with my face. This was for many reasons:
1. I had gone through male puberty and being a transsexual, hated what it had done to me. So when I would recoil at the sight of pictures of me or images of me in a webcam, it should have been no surprise. I didn't look at all what I looked like in my mind. I still don't. I coped with it before through a mental self-defense mechanism - by pretending I looked the way I did in my mind wherever I went.
2. I've always hated pictures of myself that were taken... particularly one feature that always seemed to make face so long and unattractive: my long chin. It gave me a terribly unproportional face. I had always seen a wider face in the mirror. Then I discovered that you look different in real life than you do in the mirror. That made me think then that the person in the pictures was what I actually looked like, and that terrified me... so I started to spend more time looking up FFS.
3. I have never had a relationship. I'm in my late 20s now... and I've watched everyone else go on dates, talk about their sex lives, get married, move in together. Most 12 year olds these days have more dating experience than I do. Most 15 year olds have more sexual experience than I do - I have none. It's because of this reality that I have become obsessed with the way I look. Clearly if I've never attracted ANYONE in the 26 years I've existed on this Earth, then there must be something hideously wrong with my face. So, this is what I've come to believe, with a maddening intensity that increases year after year.
These are 3 main reasons why I started to think I needed plastic surgery. Obviously once I had realized I could not pass as a woman, then I became desperate.
The first FFS surgeon, and plastic surgeon, I ever visited was Dr. Sherman Leis. He seemed like a good choice because he was relatively close to me. (For those that are familiar with Pennsylvania, I'm in Allentown and he's outside of Philadelphia, in a very affluent town.)
I had met Dr. Leis at my first transgender conference (Keystone, 2010) and he seemed like a nice guy. A mentor of mine had really liked him, and I decided I was going to go down and seriously talk about having surgery.
His recommendations for me were subtle and conservative: bring the forehead down a little, do some minor tweaking on the nose (the bridge in particular), do bonework above the eyes where the brow ridge was, obviously the adams apple.
Of course what I wanted most to hear was what he would do to my chin, the feature I hated more than anything else, the feature that was driving 90% of the desire to have plastic surgery - and his response was that my chin needed to be augmented and that he could shorten it a little, but he suggested that he would not aggressively shorten it.
To me, that was not enough to go ahead with it, but I did go back to him. Before I had left the last time he had taken pictures of me, pictures of what I looked like. That day I had dressed up - technically it would be considered a form of conservative drag - but I had dressed up as a woman, and as I usually was at the time, I was quite happy with how I looked. This is usually called 'euphoria' - before it sinks in that makeup and a wig really doesn't make you look like a woman - but I didn't know that then...
Well the second I saw the pictures, my heart sank. I left there intending to drive off the highway, off a cliff to a quick and easy death... all I did was drive out and up north, out of my way, and drive back down... but the image I saw would forever stay in my mind. It was horrifying. Worse than any horror movie I could ever see. It is the singular, most horrifying thing I've ever seen in my entire life.
Obviously that put a big cloud over Dr. Leis, so I ruled him out.
This left what I call the Big Three... the FFS surgeons with the most name recognition in the United States:
Dr. Jeffrey Spiegel of Boston, MA, Dr. Mark Zukowski of Chicago, IL, and Dr. Doug Ousterhout of San Francisco, CA.
I found out they were all going to a conference in Boston, which was far from Pennsylvania, but not undoable... so I decided I would pay the $500 for the weekend and go. I was determined to find the surgeon that would save my life...
I had wanted aggressiveness - since Dr. Leis' conservative suggestions combined with the picture he took of me, which he said was "a fine picture," scared me into wanting and pushing for a more aggressive surgeon.
I've met with all three of them but they were very brief consultations.
Dr. Z and Dr. O both had their consultations in their own rooms, while Dr. S's was at a table in the middle of the bar/restaurant.
I only saw Dr. Z and Dr. S' presentations and both were good. Dr. Z's was very defensive, he used the word "poo-poo" a lot regarding how others view his endoscopic techniques ('They poo-poo it, but...'). Dr. S' was much more scholastic. I unfortunately did not see Dr. O's.
I took into account age. Dr. O was rumored to retire and he's around 80, while the others are younger.
I also took into account their relationship to the field of FFS. Dr. S is a teaching surgeon. He believes he takes FFS much more seriously than Dr. Z does.
I felt wonderful after Dr. Z saw me (for just a few minutes). I remember feeling like I could literally dance through the halls of the hotel. He didn't tell me that much except that I would be a "very beautfiul woman." He was the only one of the three to notice my eyes ('You have beautiful Italian eyes'). Not that that is so important, but it does matter, considering that is the only feature of mine I think is attractive.
Dr. Z said I had the potential to be "lethal." That excited me and scared me at the same time, but more so it made me question his sincerity, as I felt that was completely overdoing it. I figured this is the line he gives to everyone so that they'll sign up with him.
I think this is a good time for Rule 1:
Rule 1: FFS is a business and an industry, for everyone involved in it. They all have assistants that act as cheerleaders and team players. The assistants are there not just to assist, but to influence your decision. They act as representatives of the surgeon, who is often times a very busy man. The assistants are usually over-the-top in pleasantries, which may make them seem too nice. Take it all with a grain of salt. The FFS surgeons, and any plastic surgeon for that matter, ALL try to sell themselves to you. If they acted insecure and had no confidence, would anyone take them seriously? No. So they're going to be very confident about what they can do, and yes, they want your money. This is their livelihood. It's an honest living, but just watch out for the salesman in them. They ALL have a salesman in them, it's not just 'Dr. Z'. .
Continuing on, Dr. S said I would be "very attractive," that I would not just merely pass but be "ogled."
Dr. O really didn't say how pretty I'd be. I don't know exactly how to describe his consultation but I know it didn't go well enough for me to feel the way I did coming out of Dr. Z's. Now, had Dr. O said to me, 'You'll be beautiful,' maybe I would have felt differently... He did say one thing that lingered in my mind:
I am the only surgeon that can give you the chin you want - a chin that's in perfect female range. This being my major concern, it stuck in my mind.
Rule 2: See the evidence that's walking around you. Going to conferences gives you a chance to look at the finished products. It's not just pictures, these are real people now. Take a good hard look at the actual patients, post-op. Take everything that's uttered about them by other people - all of the gossip that's done behind people's backs - and throw it out the window. What do YOU really think? Whose patients look better to you? Which patients don't look adequate enough, and who did they go to?The only thing that anybody ever said about Dr. Z's patients were that they all looked the same. To me, that didn't qualify as enough of a reason. I listened to how Dr. S and his assistant criticized Dr. Z's patients, but ironically nobody from Dr. Z's team ever criticized Dr. S' patients or their work.
In my opinion, from looking at a few of them, I didn't see it. I didn't see how they all looked that much alike. Does Dr. Z have an aesthetic? Yes. Does he try and give all of his patients this same aesthetic? Perhaps... but I was swayed heavily by a Dr. S crowd against going to Chicago.
I didn't think that most of the patients I saw from Dr. S passed and I felt they looked very masculine even after their surgeries. Now that's not to say there were others of his that passed. There was one in particular, a younger patient, not that much younger than me, who was quite beautiful. I guessed because of her very sexualized appearance that she was one of Dr. Z's patients, but a patient that had gone to Dr. S told me that she had gone to Boston. This was very influential in my final decision because I had not seen any of Dr. S' younger patients, and I gave him the benefit of the doubt at that last moment, that just because there were patients of his I wasn't that impressed with, here was one that was extremely impressive.
Rule 3: Don't rush into it. Take the time. Don't rule out doctors because they are far away. Make sure that you talk to them as much as possible. Don't let other people sway you. Make an independent judgment and try and clear out what other people tell you to do. This is YOUR face, no one else's. Rule 4: Write down EXACTLY what you want. Make sure YOU KNOW exactly what you want because if you don't, then the surgeon sure as hell ain't going to know. If you don't know, then he'll just make a decision in the OR of what to do and you might not like what he does, so make sure you're specific. Get answers BEFORE you go into the OR. Demand them, even. This is a form of plastic surgery. Talk about aesthetics, talk about symmetry, talk about facial proportion. It's your face, make sure you know what's happening to it. If you want a wider face, then say that. If you kinda like your jaw as a guy and the squareness it gives your guy face, then for God's sake don't have a jaw tapering done. If there's much you like about the way you look in the mirror BEFORE you have the operation, even if you look masculine, be very conservative in your approach...Rule 5: Just because it might take longer and be more of a headache (travel plans, money spent on airfare, hotel reservations in cities you know nothing about), Go with an incremental approach if you're considering it. If you're unsure, go with incremental. It's a safe way to not do too much too fast. If you don't intend to go full-time or aren't ready to really go part-time, and need TIME, then for God's sakes don't have a full FFS done. Have a procedure done. Try it out. See if it makes a difference. Weigh all of your options. Grow out your hair, get a spray tan, style your hair as a guy and take a look at it. This might sound ridiculous but it could very well change how you feel about yourself. Little things can do wonders for your self-confidence. There's a lot of stuff that's done to people that's not really needed. Just take your time with it. Don't rush it through just because you have a masculine face. We've gone through male puberty. Of course we have a masculine face. Don't throw all your eggs into one basket and think that FFS will necessarily give you a feminine face (despite the name) If there's one feature in particular you don't like, find the surgeon that would do the best job on that individual feature and learn more about what he does. Ask to see before and afters of that feature - if you're not satisfied, then that's not a good sign, but if you are, then proceed further - don't sign up on the spot, think about it, call the office again... Don't feel like this is something you have to rush through, especially if you're 26. You have a long time to think about it... Nothing's happening overnight anyway. So why act as if you've got to have it all done in one day?
LEARN from my experience. It's been a rollercoaster. I'm not satisfied with the outcome. I've tried to talk myself into being okay with it, but it's not a stable result, and the main objective has not succeeded. I do not pass as a woman - at all.
I went to Dr. S in Boston. Now if you happen to have an upcoming surgery with him, this is exactly what I want you to do. I wish I had someone tell me this the night before my pre-op meeting with him. LISTEN:
1. There's a pre-op meeting in which he will sit you down in a room, which to me felt more like an interrogation room because it was very small and you're lying down in this dentist's chair as he talks to you from one angle. During this pre-op, he'll go over with you what you're going to have done the next day. Don't nod and yes the man. TALK. This is your last chance to talk. You won't have another, believe me.
2. Take a look at what you're doing. If its full FFS that you've signed up for, well analyze it. Do you really think you absolutely need the forehead work done? You will have scars and the forehead will be very sensitive, and there will be stitches stuck in there if you have thick black hair. If you like your nose as is when you look at yourself in the mirror, question the rhinoplasty. If you like your jaw (this is very important), DO NOT, i repeat DO NOT have the jaw tapering done. Tell him: Do not touch my jaw. Even if its a package deal with the mandable, don't touch the jaw. If its the chin you don't like, tell him you can try your best to make the chin smaller, but don't touch the jaw. However, if you definitely want a thinner, more tapered jaw, then make up your own mind... Just be careful. I would strongly recommend the incremental approach. Be careful about anything that might change your face shape... such as a mandible contouring.
Just be careful is all I'm saying. Dr. Spiegel's work is rather conservative. DO NOT, even if he tells you, expect to pass. DO NOT go by what happens in the first week. You will look much as you did before.
Rule 6 (and this applies to every surgeon in the world): Even if there's a feature you can't stand (for me, it was my chin), DO NOT think that just because you're having work done on it that you're going to be happier than you were before. There always is a strong possibility that you might actually wind up preferring the way it was before, however flawed that one was, because whenever you have surgery done, YOU LOSE CONTROL. You will either be ecstaticly happy, moderately satisfied or content, or very or extremely unsatisfied with the result, and it could be any one of those three. Don't be obsessed with individual features - such as chins - don't have massive 5-6-7 operations on your entire face if there's much of the face you don't really think needs to be done at once.
As for me, I'm going to wait it out. It's been a few days longer than 3 weeks - but I can already see that the wide, square jaw I had before, something I liked, even though it was technically considered a masculine feature, is gone - and that I am very unhappy with the mandible contouring.
Dr. S told me when I asked him, in a moment of desperation and panic, that nothing is irreversable. I have no idea what this really means but I think that he was telling me the truth.
The way I feel coming out of this operation is that What I liked about my pre-op face is gone, and What I didn't like about my pre-op face is still there.
In hindsight, I consider the forehead procedure to have been a terrible decision but to be fair it hasn't completely healed. I'm not that happy with the rhinoplasty... I'm actually quite surprised at how inadequate the over-the-eye stuff is. I still look very masculine over my eyes. The cheek implants are barely noticeable. The mandible change is the hardest to accept. I wanted a wider face. I said I wanted a rounder one, but what I meant was wider. Words matter. The jaw is something I should have never touched. When I thought the estrogen was beginning to chip away at it before, I freaked out. Clearly I like the idea of a square, wide jaw... even on women, and for me, it's something that I now am looking at in my next operation.
The chin, the very reason I went to have the operation in the first place, is still nearly as long as it was before. The doctor did not tell me that he could not meet my request until the very moment I was about to go into the OR. Had he told me in the consultation there was nothing he could do for it, it would have most certainly changed my mind about the whole thing. This is why I say don't become obsessed with individual features, even the most masculine ones.
I'm trying to tell myself that things will get better, that there's still a chance for me, because I'm very, very scared... but fear never provides one with clarity or leads them to make good decisions. I know that. I've learned that.
All I know is that I will never pass as a woman, or get back what I have lost, or be really content, until I let this all completely heal and then think of how to make it better.
I hope you all read this and listen to what I have to say and take it seriously. I have a history of making bad choices. I've made mistakes. This is not an anti-Dr. Spiegel post, it's an "anti-going about it the way I did" post.
Just remember any operation is a VERY VERY SERIOUS undertaking. You may regret it afterwards. Just know that, take your time, listen to your heart, and if you can't hear what it's saying, then you're not ready... Know that you're losing control whenever somebody operates on you. Even if you think they know what you want, even if everything seems to have been covered... go into it expecting the very worst, not the very best.
Recovery from any surgery, especially rhinoplasties, and 3x more so Full FFS, is very painful.
DO NOT LISTEN to people when they tell you it is not. I was told that I'd be in "discomfort." There's a hell out of a lot of a difference between "discomfort" and downright agony.
You will NOT be able to sleep. You will NOT be able to eat, or talk, or smile. They are shutting down your body. It takes weeks for things to come back.
So just know this. Take it very, very seriously. Don't rush into it. Don't think that Facial Feminization Surgery will make you look perfect or beautiful or even more feminine. You might be of the opinion afterwards that it makes you look less attractive, more masculine, less passable. It could very well happen. There are no guarantees. Surgeons can make mistakes. They are human.
I'm not against FFS. I'm just against acting stupid and reckless about it. If you happen to be someone that has money, that doesn't work for a living, that has a trust fund, or anything like that, be extra careful. You could easily just be throwing your money away because it has no value to you.... $40,000 that would take people years to save up was just handed to me, and look what I did with it. I was able to get that money within little more than a week's time, and I arrogantly thought I was superior to other transsexuals because I had money, therefore I would pass, and be more beautiful than they were.
I guess I got what I deserved in the end because I acted reckless and foolish.
Don't make my mistakes. Chances are you're probably a hell of a lot smarter than I am anyway so maybe all of this means nothing.
Just go into this with a clear head... be careful. This is your life we're talking about here... this is your dream we're talking about.
Rule 7, and the most important: Love yourself. If you don't love yourself before this operation, you sure as hell are not going to afterwards. Loving yourself has nothing to do with what you look like. It's a lot deeper than that, my friends. I still don't love myself. I think I'll spend the rest of my life trying. Surgery will not make you love yourself anymore than you did before. There is no surgery for this.
