Is it too early for FFS?

[Danielle P]

When I originally planned my transition I decided I should start RLE before having FFS because I thought (still think) it's better to not have to rely FFS in that way. I would be on HRT for 4-6 months and the start RLE and have FFS perhaps 2-3 months later. Now that I am coming up to 5 months on HRT I'm starting to get really scared about starting RLE  and I'm thinking of having FFS first. I always imagined this might happened so it's not necessarily a big deal to me.

What I'm wondering now is: is 5 months to early to start booking in for FFS? My doctor recommended waiting a year because that's approximately how long it takes for the majority of facial changes to complete (on HRT). Second, what do you think about have FFS before RLE? Has anyone else done this, thought about it, recommend or recommend against?

I just want to add that I actually have no idea how long it will take to go through the process of booking consultations, deciding on surgeon and then booking the surgery. I'm guessing it will be around 2 or 3 months, so by then it'll be 7-8 months HRT.

Thank yooouuu 

[AnonyMs]

The surgeons likely to have a wait list. Facial Team is 7 month I think.

[Danielle P]

I'm looking at going to London Bridge Plastic Surgery or somewhere else in London. Sorry forgot to mention that.

[MissGendered]

I can't speak to what you should, or should not do, but I will say that my face is still changing, even 5 years after starting HRT. Being XX intersex, I figured my face would change fast and be done in about a year, but the fact was that some of the biggest changes came after my vaginal surgery two years ago, though year two to three on HRT was also a time of very big changes.

For me, had I had FFS earlier, I would likely regret it now.

Missy

[AnonyMs]

You can get FFS for free on the NHS?

[Danielle P]

I can't speak to what you should, or should not do, but I will say that my face is still changing, even 5 years after starting HRT. Being XX intersex, I figured my face would change fast and be done in about a year, but the fact was that some of the biggest changes came after my vaginal surgery two years ago, though year two to three on HRT was also a time of very big changes.

For me, had I had FFS earlier, I would likely regret it now.

Missy

Can I ask why you think you would regret it? Because you are happy with the results of HRT?

[Dena]

Being off HRT for 10 years caused me to lose a huge amount of facial fat. Look at my avatar and envision me with cheek bones and sunken cheeks. I have been back on HRT for about a year at a half transition dosage and the changes that have taken place in that period of time are amazing. FFS is something I considered but I suspect a couple of more years on HRT will feminize my face sufficiently that FFS will no longer be needed. Will I be knock them dead attractive? No. Will I appear feminine? I think so and that's enough.

[Danielle P]

You can get FFS for free on the NHS?

I don't think so.

[Maybebaby56]

When I originally planned my transition I decided I should start RLE before having FFS because I thought (still think) it's better to not have to rely FFS in that way. I would be on HRT for 4-6 months and the start RLE and have FFS perhaps 2-3 months later. Now that I am coming up to 5 months on HRT I'm starting to get really scared about starting RLE  and I'm thinking of having FFS first. I always imagined this might happened so it's not necessarily a big deal to me.

What I'm wondering now is: is 5 months to early to start booking in for FFS? My doctor recommended waiting a year because that's approximately how long it takes for the majority of facial changes to complete (on HRT). Second, what do you think about have FFS before RLE? Has anyone else done this, thought about it, recommend or recommend against?

I just want to add that I actually have no idea how long it will take to go through the process of booking consultations, deciding on surgeon and then booking the surgery. I'm guessing it will be around 2 or 3 months, so by then it'll be 7-8 months HRT.

Thank yooouuu 

Hi Danielle,

The rule of thumb is to wait at least a year after starting HRT to have FFS, because there are some soft tissue changes that will take place, and that can affect how a surgeon plans facial corrections.  However, I personally know trans girls who did not wait that long, and they turned out fine.  It really is an individual thing. I waited about a year after starting HRT to have FFS, and there were noticeable changes in skin softness, and subcutanenous fat, so I am comfortable with the timeline I chose.

The RLE question is very, very subjective. There are two issues here. One is how feminine you look now, without any medical intervention.  The other is whether you even care if you pass.  Again, I can only tell you about my experience.  I was scared to death of RLE, and swore I would not even attempt it without FFS and a substantial time on hormones. For me, passing was an absolute requirement.  Well, I ended up starting to present as female in public part-time several months before my FFS, even though I was only semi-passable, in my opinion. I went to stores, restaurants, and shopping malls, and I never once saw anybody staring at me, or make a rude comment.  I made sure I was with someone supportive, and that where I was going was reasonably safe.  It really boils down to how comfortable you are with yourself.  If you have to "rely" on FFS, fine.  Do that. If not, then you're ahead of the game if you have decided to pursue SRS.  There is no "right way" to transition.  Every one has a unique journey.

With kindness,

Terri

[MissGendered]

Can I ask why you think you would regret it? Because you are happy with the results of HRT?

You certainly may ask whatever you wish, hun, no worries...

Overall, I am happy with what HRT did for my soft tissues, and fat re-distribution, and that wasn't the case early on, so I would likely have over-done things like a lip lift and cheek implants and maybe even had my face lifted too much.

The overgrowth of bones in my face are the real problem, and now that one can clearly see where the T and growth hormones masculinized my bones, it will be much easier to restore my face to the way it should have been all along.

My feeling is that a surgeon would have created a barbie face for me out what he first saw in year one, and that face would now look distorted...

Hope this helps...

Missy

[Mirya]

I am one of those people who had FFS early.  In fact, I had a feminizing rhinoplasty even before I started HRT.  I was also already presenting as female part-time before my rhinoplasty.

About a month after my rhinoplasty, I started HRT.  And then about 4 months after starting HRT, I went full-time.  And then about 3 months after that, I did the rest of my FFS (which included brow bossing reduction, brow lift, trachea shave, and blepharoplasty).  Note that I didn't do anything to my chin or jaw.  For one thing, my jaw wasn't that pronounced to begin with.  And secondly, I figured that with more time on HRT, the masseter muscle reduction would soften my jaw as well.  I left open the possibility of going back for additional FFS to my chin or jaw if I later felt I needed it.  So far, I don't think I do.

So it's really up to you how and when you want to do FFS.  I do agree that it's generally better to wait a year or more after starting HRT.  But as you can see in my case, I did things differently and in stages.  The downside to doing FFS in multiple stages is that it ends up costing a lot more.  And you have to take more time off work to recover from each surgery.  But it worked out ok for me, and I'm glad I did it this way.  I probably wouldn't recommend it for most people though. 

[staciM]

Mirya, did having feminizing  rhinoplasty first cause any complications with your brow profile, or did they have to go back in to re-contour the top of nose when they did the brow?  I've always heard it was better having those two particular surgeries together.

[AnonyMs]

You can get FFS for free on the NHS?

I don't think so.

If you're going to pay it might be an idea to look elsewhere. I don't think the UK has much of a reputation for FFS.

[Mirya]

Mirya, did having feminizing  rhinoplasty first cause any complications with your brow profile, or did they have to go back in to re-contour the top of nose when they did the brow?  I've always heard it was better having those two particular surgeries together.

Yes, I too always hear that it's generally better to do both the nose and brow at the same time.  But for me, doing them separately turned out ok too.  Actually, better than ok - I'm extremely happy with how things turned out.

There were no complications with my brow profile.  And the surgeon didn't have to re-do my nose.  In fact, right after the FFS, I remember the surgeon saying that the surgery went "perfectly".  I did go to the same surgeon (Zukowski) for both surgeries though.  So that probably helped keep things consistent with the brow and nose.

I also did not do a full Type III forehead reconstruction.  It was just a Type I, which is all I needed.  I wonder if it's more important to do both the nose and brow at the same time for those getting a Type III.

If you want another example of a trans woman who successfully did her FFS in multiple stages, take a look at archlord.  She did hers in 3 separate surgeries (as posted in her forum signature), and it looks like things went well for her too.  She's certainly one of the most beautiful women on this forum!

[Sophia Sage]

HRT is not going to change the underlying bony structures of the face.  Whatever changes HRT will confer -- skin, fat, etc -- will look just that much better with a feminine structure underneath. 

I had facial surgery 10 months after starting HRT, and it did wonders for my dysphoria and, of course, was hugely important in eliciting the female gendering I so desperately needed.

I'm personally of the opinion that it's better to get facial surgery (if that's in the cards to begin with) before going full time -- before coming out at work in particular.  The whole point of the RLE ritual is to determine if getting your desired gendering is what you really really want before having irreversible sex-change surgeries.  Well, you're not going to get a "real" experience of that gendering if you're constantly getting clocked.  Plus, having a good presentation really greases the wheels when it comes to coming out at work, or moving on to another job if that's how everything shakes out. 

[anjaq]

I'm personally of the opinion that it's better to get facial surgery (if that's in the cards to begin with) before going full time -- before coming out at work in particular.  The whole point of the RLE ritual is to determine if getting your desired gendering is what you really really want before having irreversible sex-change surgeries.  Well, you're not going to get a "real" experience of that gendering if you're constantly getting clocked.  Plus, having a good presentation really greases the wheels when it comes to coming out at work, or moving on to another job if that's how everything shakes out.

Well - I would consider a FFS an irreversible "sex change" surgery. If it is done properly, it would be not really that easy to go back to square 1 after that. So if one is really unsure about transitioning. I am not sure FFS is a great way to start with getting sure. HRT is a good way or do RLT without it if you are even less sure. But surgical changes of any kind should be done at the point when one is quite convinced that this is really the way to go, I believe.

[Sophia Sage]

Well - I would consider a FFS an irreversible "sex change" surgery. If it is done properly, it would be not really that easy to go back to square 1 after that. So if one is really unsure about transitioning. I am not sure FFS is a great way to start with getting sure. HRT is a good way or do RLT without it if you are even less sure. But surgical changes of any kind should be done at the point when one is quite convinced that this is really the way to go, I believe.

I agree that HRT and part-time RLE is absolutely wise before considering facial surgery.  Depending on one's workplace, though, facial surgery (along with proper voice work and facial hair removal) may be the way to go to ensure a smoother transition at the place where one's living is made -- after all, these surgeries are very expensive and getting insurance to cover it all can be quite dicey, especially in the States. 

But I quibble with facial surgery being "irreversible" -- anything that's shaved down can be built back up, more or less (though once you've done your nose you should pretty much leave it alone), through bone cement and/or implants. 

More importantly, there are all kinds of steps that could be taken to regain male gendering.  Facial hair can regrow given the right impetus of testosterone, though a full beard is probably impractical.  Voice can be dropped back down into the male range.  Breast growth can be removed.  Bottom surgery (and top surgery for FTMs) is what can't be practically reversed. 

[jentay1367]

If you base this on what Mirya did, I would think early is fine. If you walked by her on the street, the only thought you might have is how pretty she is. Hopefully, I'll be going in one year after starting HRT. That is early by the recommended timeline suggestions, but based on maybebabies and Mirya's results, I'm confident it will all be okay.

[Nina_Ottawa]

What I'm about to ask may not sit well...
Do you think you need FFS? I'm not saying you do or don't, that's entirely up to you.
IMO, beauty comes from within. Confidence in oneself is when you can look in the mirror and accept who you are. We are always, always our own worst critic. We see flaws others don't see.
My early months of RLE was tough, because I was paranoid people were scoping me out. I could never take a compliment. My therapist gave me great advice: always walk with your head up. If someone smiles at you, smile back. If someone stares at you, smile back. And if someone compliments you, don't negate the comment, say thank you and be quiet.

I had the money for FFS and vocal cord surgery, but the more RLE I had, the less and less paranoid I became. I'm glad I never spent the money - other than oodles on electroylsis and what I call minor surgery - trachea shave.

Confidence requires time. I don't know if FFS fixes that immediately. I don't know.

I wish you well which ever way you decide.

[jentay1367]

Unfortunately, you can have all the confidence in the world, if your face screams male, you're going to have a tough go of it. Think Renee Richards. No amount of make-up and dressing femininely will make you blend in. If you don't care of course, that's an entirely different circumstance. To many of us, the hope is to be able to walk out of our houses in minimal make-up and go about our business being recognized female. Some, like Nina get awesome results from HRT. They have a bone structure  that responds well. Others? Not so much. FFS is one of the many wonders available to us as Trans Women that wasn't there previously. I'd never dissuade anyone that felt they needed it from doing it. To those that don't care and have no problem with being clocked periodically, more power to you. I prefer to take advantage of every possibility that is available to me to walk through my life minimizing my chances of being judged or experiencing awkward situations.