Author Topic: FFS with Dr. Roop Gill, Kaiser NorCal  (Read 1544 times)

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Offline Michelle_P

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FFS with Dr. Roop Gill, Kaiser NorCal
« on: December 23, 2017, 12:42:26 pm »
As a result of a grievance I had filed with Kaiser, I received a referral for an evaluation by Dr. Roop Gill with the Kaiser Sacramento office.

The appointment took a little over an hour.  Dr. Gill updated her notes on my history and discussed my goals (gender dysphoria relief and safety) in wanting FFS.  She took a complete set of photos, and then we sat at her computer terminal and went over the images.  We discussed details of changes, difficulty, recovery and risks, all sorts of things. This was a more thorough evaluation than I had previously had.

We looked at my CT scans, both slices and volume renderings, and decided on the bone & cartilage work needed:
Brow reduction by opening and reconstructing the frontal sinus (Osterhouts type 3 procedure).
Orbit reduction by burring
Slight nose reduction, with a ‘break’ before the tip, a more feminine trait.  No change in the bone structure setting the width, but removal of some soft tissue near the tip. No rotation needed.
Lip lift via an incision below the nose.
Shaving of bone to narrow the chin, soften the angle at the mandibular joint
Tracheal shave

Soft tissue work:
Eyebrow raise as part of bone work.
Suggested facelift, fat padding at deficit under the eyes, neck tissue, blepharoplast to open eyes further

Since we don’t want to remove tracheal cartilage close to the vocal folds attachment point, a needle is inserted and position checked with a camera in the throat to verify the safe margin for tissue removal.  The cartilage is shaved, or burred if calcified.

The forehead work will be done with a hairline incision.   She suggested I bring by favorite hairpiece in so they could properly mark the incision on the surgery date!  The frontal sinus bone will be removed and reset inward.  My sinus bulge is unusually low so this may impact how much reduction can be done.

A blepharopasty would currently be covered for the right eye. (Pretty droopy; eyelashes touch the drooping tissue). This may change with the forehead work and brow lift.

The mandibular reduction involves burring at the joints and chin.

Dr. Gill would be performing the surgery with the department head observing.  The procedures would be scheduled for mid-April or later, as soon as the OR schedule opens up for surgery planning.

Dr. Gill is new to Kaiser, but has been doing maxillofacial surgery for some time, including pediatric patients, who have relatively little bone to work with.  She seems to have a good aesthetic sense as well as the right skills.  As this surgery would be a full year sooner than what I had previously been waitlisted for, and I do like this doctors suggestions, sense, and skill set, I’m inclined to go with her for my FFS work.   This may also be the only way I can get FFS done with insurance coverage. (See my link to the grievance post at the top of this post.)

I’ll follow up with additional FFS activity with Dr. Gill in this thread.
« Last Edit: December 23, 2017, 01:45:59 pm by Michelle_P »
Earth my body, water my blood, air my breath and fire my spirit.

Electrolysis - Hours in The Chair: 220.75 (8.5 were preparing for GCS, five clearings)
On estradiol patch; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018

Offline Anne Blake

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #1 on: December 23, 2017, 01:22:30 pm »
Michelle,

Dr. Gill's evaluation certainly does seem well thought out and detailed. I was also impressed that she asked for your goals and sought your inputs rather than just telling you what she thought you needed. Good luck with the procedures.

Tia Anne

Offline Rachel

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #2 on: December 23, 2017, 01:32:43 pm »
Good luck Michelle, I am so happy for you. :)
HRT  5-28-2013
FT   11-13-2015
FFS   9-16-2016 -Spiegel
GCS 11-15-2016 - McGinn
Hair Grafts 3-20-2017 - Cooley
Voice therapy start 3-2017 - Reene Blaker
Labiaplasty 5-15-2017 - McGinn
BA 7-12-2017 - McGinn
Hair grafts 9-25-2017 Dr.Cooley
Sataloff Cricothyroid subluxation and trachea shave12-11-2017
Dr. McGinn labiaplasty, hood repair, scar removal, graph repair and bottom of  vagina finished. 4-4-2018
Dr. Sataloff Glottoplasty 5-14-2018

Offline Allison S

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #3 on: December 23, 2017, 01:34:05 pm »
Yes best of luck Michelle! Your posts are motivating me to reach out to my insurance for the same.. crossing my fingers it's the only way I can afford it

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Offline keojampamd

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #4 on: December 24, 2017, 02:16:32 am »
I would recommend if you can also see Dr Andrew Kleinberger in Norcal Kaiser Permanente.  He spent a year long fellowship with Dr. Spiegel doing probably over 100 FFS cases.  Training in FFS is uncommon and highly specialized.  You do not get significant FFS experience during Craniofacial fellowship training.  I spend a good portion of my practice now fixing botched attempts of FFS, particular the Type 3 forehead of new surgeons attempting to perform FFS.  I would clearly ask any prospective surgeon exactly how many FFS surgeries they have performed on transgender fpatients.  You typically do not want to be their first.  The learning curve for FFS is particularly steep and very few places where you can receive adequate training.  Dr. Dechamps-braly a craniofacial surgeon in San Francisco spent years under Dr Ousterhout learning FFS before performing FFS on his own.

Offline Michelle_P

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #5 on: December 24, 2017, 10:58:33 am »
I would recommend if you can also see Dr Andrew Kleinberger in Norcal Kaiser Permanente.  He spent a year long fellowship with Dr. Spiegel doing probably over 100 FFS cases.  Training in FFS is uncommon and highly specialized.  You do not get significant FFS experience during Craniofacial fellowship training.  I spend a good portion of my practice now fixing botched attempts of FFS, particular the Type 3 forehead of new surgeons attempting to perform FFS.  I would clearly ask any prospective surgeon exactly how many FFS surgeries they have performed on transgender fpatients.  You typically do not want to be their first.  The learning curve for FFS is particularly steep and very few places where you can receive adequate training.  Dr. Dechamps-braly a craniofacial surgeon in San Francisco spent years under Dr Ousterhout learning FFS before performing FFS on his own.

I have been evaluated by Dr Kleinberger, in May of 2017, and am currently on a waitlist to eventually be scheduled for surgery. Best estimate is sometime in the first half of 2019.  My California ACA coverage ends in November 2018, when i am forced onto Medicare, possibly Kaiser Senior Advantage.

Kaiser Senior Advantage may not cover FFS. Kaiser Member Services cannot give me a straight answer, which does not bode well. I do have grievances on file to try and get an answer as well as to protest the lack of care.  I have been assaulted twice in the past year directly attributable to my being read as a transgender woman, and my current appearance is distracting to students in the tech training classes I teach.

I need FFS sooner, rather than in a year and a half more, if at all.  How badly could they screw up?  I’m perfectly willing to look like a deformed old woman. It beats reading as a man in a dress, with all the risks that entails. 

See a doctor in private practice and pay the Charge Master rates?  Maybe if I win the lottery.  Overseas to Facial Team or possibly Thailand is barely affordable.
Earth my body, water my blood, air my breath and fire my spirit.

Electrolysis - Hours in The Chair: 220.75 (8.5 were preparing for GCS, five clearings)
On estradiol patch; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018

Offline keojampamd

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #6 on: December 24, 2017, 12:43:43 pm »
Complications that I have seen include

Large hole in the frontal sinus wall causing air to leak into the forehead.  The forehead would move in and out with breathing and forehead puffed out when blowing nose or sneezing.  I performed cranial bone grafts to close the hole and reconstruct the anterior sinus wall.

Large external scars when they were not needed such as external incision along with jaw angle to reduce the jaw.  Large visible incisions over the tracheal cartilage.  They should be placed high above and hidden underneath the chin.  The incision does not need to be any larger than 1cm.    Permanent hoarseness from over resection of the tracheal cartilage during Trach Shave. 


Nerve damage with transection of to the supraorbital nerve and mental nerves causing permanent numbness of the forehead and lower face.

I heard of one case of injury to the superior sagittal sinus causing intracranial hemorrhage.   

The most common complications however are incomplete surgery with unsatisfactory results.  The 1st surgery is the best chance to get the best results and experience matters.  You just don't want to be the 1st couple of cases for a surgeon during the steep learning curve.   I believe the book Facial Feminization Surgery: A Guide for the Transgendered Woman
by Douglas K. Ousterhout MD is essential reading for anyone undergoing FFS.

Offline Michelle_P

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #7 on: December 24, 2017, 03:46:29 pm »
Dr. Keojampa, thanks for the input and discussion of risks.  I do appreciate that, but unfortunately I am not in a position where I can seek out the best possible surgeon.

Surgery is scary.  Surgery has risks.  There are additional risks from surgeons with insufficient experience carrying out procedures for the first time.  I understand this, and have discussed some of these matters with the surgeon.

Surgery from a highly experienced surgeon won’t be covered by insurance, or will require me to go another year and a half as is, and may still not be covered, as I mentioned above. Medicare coverage for transgender-related treatment is at the administrative whim of the Federal Department of Health and Human Services.  Without insurance, surgery is expensive, likely $33,000 to $35,000 (USD) from the good doctor, or $55,000 from Dr. Dechamps-Braly.  We’re talking a year or two of living expenses for this surgery.

Not having surgery also has risks.  Assaults against transgender women are on the rise.  Acceptance in public is being pushed back strongly by current political and ideological trends.  My ability to conduct classes is in jeopardy.  Heck, my ability to walk to the grocery store is at risk. (One assault occurred in broad daylight a block from the store as I was returning home.)

I realize this could just wind up as ‘suicide by doctor’.  I could wind up with my face in ruins, disfigured and in pain or numbed and paralyzed.  This would have effectively no impact on my life, as I am already easily clocked, and treated as a walking freak show once someone in a group reads me.  (Exactly this happened at Dr. Gill’s waiting room.  Nothing like seeing someone stare, then whisper to the person next to them, who stared...)

So, worst case, I’m a different sort of freak.

Best case, it works OK, the male ‘tells’ are reduced or eliminated, and I get to live my life a bit more safely. I can teach classes and have the students pay attention to the materials, not what I look like.

I can take what the insurance will cover and take my chances, or I can go without, with it’s own risks.

Heck of a choice.  Sucks to not be wealthy in a society that insists on for-profit medical care while denying us the right to exist if we are spotted, doesn’t it?
Earth my body, water my blood, air my breath and fire my spirit.

Electrolysis - Hours in The Chair: 220.75 (8.5 were preparing for GCS, five clearings)
On estradiol patch; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018

rmaddy

Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #8 on: December 24, 2017, 05:18:24 pm »
Not getting FFS covered is the norm.  If you can get it covered within Kaiser, tally it a win. 

The only caution I would give is that recovery, at least in our age group, is grueling.

Offline CarlyMcx

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #9 on: December 24, 2017, 09:15:00 pm »
Those of us who are with Kaiser in Southern California are hoping and praying for the day when FFS is covered down here.

Given the family obligations that I have, my chances of raising the money for the minimum I would need (rhinoplasty, brow shave) are not good.  In addition to that Kaiser would likely cover blepharoplasty, some lower jaw work, bucal liposuction, and tightening of the skin under my chin, which are far beyond my means at this point.

Please keep us apprised of your experiences with Kaiser.

Offline Rachel

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #10 on: December 24, 2017, 09:47:16 pm »
Hi Michelle,

I understand how you feel. You are not a freak. I had ffs with Dr. Spiegel 9/2016 and have been on hrt for 4.5 years. I had done everything Dr Spiegel recommended. I sold a lot of “things” to pay for the surgery. People still look like at me and some whisper. It use to bother me but I have grown the ability to not care. Safety is always a concern. More so in warmer months when guys are on corners when I walk by.

I am sorry you have to deal with this. I probably would have been my worse enemy if I did not have ffs. I  look andro so everything I wear and makeup helps heaps. Even with ffs I sometimes get sir, not very often but it happens.

If I were to do it again. Would do ffs in stages, perhaps 2 or 3. This is for healing and finances. I did not think I would make it so I  did what I thought was best the first time. Air fair can be cheap to Thailand or India  $530 round trip from NY with 2 checked bags and one carryon. I play around with the number of days and days of the year week. I looked at China air. I will not go to uae or turkey.

I hope to file my level 2 ffs appeal Tuesday. I most likely will not get any money but I win just by fileing. I will go to the insurance board. I am trans and  will fight. I may not win but I will not lose.
HRT  5-28-2013
FT   11-13-2015
FFS   9-16-2016 -Spiegel
GCS 11-15-2016 - McGinn
Hair Grafts 3-20-2017 - Cooley
Voice therapy start 3-2017 - Reene Blaker
Labiaplasty 5-15-2017 - McGinn
BA 7-12-2017 - McGinn
Hair grafts 9-25-2017 Dr.Cooley
Sataloff Cricothyroid subluxation and trachea shave12-11-2017
Dr. McGinn labiaplasty, hood repair, scar removal, graph repair and bottom of  vagina finished. 4-4-2018
Dr. Sataloff Glottoplasty 5-14-2018

Offline Another Nikki

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #11 on: January 02, 2018, 05:31:12 am »
Good luck Michelle!  As another Kaiser Norcal member, I would be very interested in reading updates- thread bookmarked.
“What you know, you can’t explain, but you feel it. You’ve felt it your entire life—that there is something wrong. You don’t know what it is, but it’s there like a splinter in your mind, driving you mad. It is this feeling that has brought you to me.”

Offline Michelle_P

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #12 on: January 02, 2018, 08:05:43 am »
Good luck Michelle!  As another Kaiser Norcal member, I would be very interested in reading updates- thread bookmarked.
Will do! 

I’m waiting for scheduling now. Should be late April or early May.


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Earth my body, water my blood, air my breath and fire my spirit.

Electrolysis - Hours in The Chair: 220.75 (8.5 were preparing for GCS, five clearings)
On estradiol patch; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018

Offline Allison S

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #13 on: January 02, 2018, 12:55:44 pm »
Hi Michelle,

I understand how you feel. You are not a freak. I had ffs with Dr. Spiegel 9/2016 and have been on hrt for 4.5 years. I had done everything Dr Spiegel recommended. I sold a lot of “things” to pay for the surgery. People still look like at me and some whisper. It use to bother me but I have grown the ability to not care. Safety is always a concern. More so in warmer months when guys are on corners when I walk by.

I am sorry you have to deal with this. I probably would have been my worse enemy if I did not have ffs. I  look andro so everything I wear and makeup helps heaps. Even with ffs I sometimes get sir, not very often but it happens.

If I were to do it again. Would do ffs in stages, perhaps 2 or 3. This is for healing and finances. I did not think I would make it so I  did what I thought was best the first time. Air fair can be cheap to Thailand or India  $530 round trip from NY with 2 checked bags and one carryon. I play around with the number of days and days of the year week. I looked at China air. I will not go to uae or turkey.

I hope to file my level 2 ffs appeal Tuesday. I most likely will not get any money but I win just by fileing. I will go to the insurance board. I am trans and  will fight. I may not win but I will not lose.
Dr. Spiegel won't give any revisions? I think that would be such a disappointment for ms if I did ffs and wasn't passable. Good luck on your appeal!

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Offline Drexy/Drex

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #14 on: January 03, 2018, 03:04:28 pm »
Good luck Michelle  and i fully understand  about  the not waiting  i feel the same way but i look forward to seeing the result i think it will be outstanding didnt think about the wig consideration  though
your dr,s analysis  would give me confidence
I found the part about the procedure for
Recovery sounds scary .....and what the  Dr said  yikes
 Still as you said theres  more to be gained then  lost its almost an imperative
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Offline JennyJupiter

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #15 on: January 24, 2018, 03:43:03 pm »
I'm basically in this same pipeline right now and was wondering if you ever got scheduled or had any updates. I have my consult with Dr. Gill Tuesday after initially getting told "maybe 2 years" (with Kleinberger/Shih) and filing a grievance.

I've been trying to plan a bunch of things around when surgery might happen and it's been getting frustrating. So any information you might have on when you get scheduled is appreciated!

Offline Michelle_P

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #16 on: January 27, 2018, 12:28:40 am »
I'm basically in this same pipeline right now and was wondering if you ever got scheduled or had any updates. I have my consult with Dr. Gill Tuesday after initially getting told "maybe 2 years" (with Kleinberger/Shih) and filing a grievance.

I've been trying to plan a bunch of things around when surgery might happen and it's been getting frustrating. So any information you might have on when you get scheduled is appreciated!

Dr. Gill seems to be getting all the grievance cases! I expect to hear something on scheduling in February, and I will post here.
Earth my body, water my blood, air my breath and fire my spirit.

Electrolysis - Hours in The Chair: 220.75 (8.5 were preparing for GCS, five clearings)
On estradiol patch; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018

Offline Michelle_P

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #17 on: February 03, 2018, 03:51:04 pm »
The Kaiser Sacramento surgery scheduler for Dr Roop called yesterday. The book for April is now open, and they wanted to verify that I was still available starting the latter part of April for surgery.  I don’t have a date yet, but was happy to hear from them at all.

At some point soon, this month or next, I hope to have a surgery date and pre-op appointment. I do have a couple more questions to ask Dr Roop based on Dr Keojampa’s feedback, but so far everything else checks out OK.



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Earth my body, water my blood, air my breath and fire my spirit.

Electrolysis - Hours in The Chair: 220.75 (8.5 were preparing for GCS, five clearings)
On estradiol patch; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018

Offline Another Nikki

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #18 on: February 04, 2018, 11:11:22 pm »
Getting exciting, fingers crossed!!!
“What you know, you can’t explain, but you feel it. You’ve felt it your entire life—that there is something wrong. You don’t know what it is, but it’s there like a splinter in your mind, driving you mad. It is this feeling that has brought you to me.”

Offline Michelle_P

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Re: FFS with Dr. Roop Gill, Kaiser NorCal
« Reply #19 on: March 12, 2018, 02:23:16 pm »
This is getting interesting. I have not yet heard back from Dr Gill’s scheduler.

However, my first choice, Dr Klineberger, apparently has a opening August 28 of this year. The scheduler called and offered it to me.

Oh, decisions, decisions.  Should I accept this?










Oh, who am I kidding?  Of course I grabbed this one.

So, I am now scheduled for FFS on August 28, 2018 with Dr. Klineberger.


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Earth my body, water my blood, air my breath and fire my spirit.

Electrolysis - Hours in The Chair: 220.75 (8.5 were preparing for GCS, five clearings)
On estradiol patch; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018

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