Usual order of operations?

[Bari Jo]

Hi ladies, and gents, I think I might have had the order of what I've scheduled in my transition wrong.  I'm doing hrt first, electrolysis same time, within the six month mark I've scheduled hairline restoration.  Finally ending it off with FFS if needed.

However, after much thought and reading of others posts and suggestions.  I think it should be hrt, with electrolosis first.  Then at the year mark on hrt make a consult for FFS.  This is to see what hrt benefits are doing.  If FFS is wanted, do it, wait for it to heal six months.  Then do hairline restoration which can also cover the scars from FFS.  If FFS is not wanted, then no need to wait, go ahead with hairline restoration at that year mark.

Is my thought process correct?  I do want to somewhere place presenting as female in those steps too.  I think it would be after hairline restoration, but if I can do it before I will.  As you can guess, I'm a planner.  Plus I'm impatient, very much so.

What day you wise ladies and gents?  Am I missing anything?  I still feel awfully green here.

Bari Jo

[Jailyn]

Bari Jo sounds right to what I have read on other sites. Most people start with Electrolysis/laser hair because you can do that without doctor's written permission or hoops to go through. As I understand it most wait to do the FFS and breast augmentation. Like you stated it is to see what the hormones will do to your body. As you know it is redistributing the fat and growing you out. If you get either of these procedures too soon, we could see you on an episode of "Botched" jk lol! I have heard about a year and a half to the two year mark for either procedure. Usually what I have read they will do a hairline revision with the ffs procedure. After the healing you may opt for GCS at some point after all that. I have had none of these personally or had a Dr. tell me when I can get these, so just all based off of what I have been reading and studying to educate myself. Good luck, hope all goes well!!!

[kat69]

There is no usual or typical when transitioning.  You go by how you feel about yourself, and of course, following medical advice.  For example, I've known multiple transwomen who have started hormones long before living full time, so as to gain some of the physical and mental changes...all this to assist in passibility.  I know one in particular that was on HRT for two years before starting her RLE, and her last step before starting was BA and FFS.  She wanted to look like a woman to live like a woman.  For many, GCS is the last step.

Just consider what doctors recommend as the only external advice which has any weight.  I've been told by my doctor that BA should wait until after my breasts stop growing...and that takes some time.  Otherwise, I could get BA and then have my breasts naturally keep changing and mess up the BA work.

[Julia1996]

I know it's hard to wait but you might want to wait until you've been on hrt 2 years. Most of the big changes in my face and body happened during year 2 on hrt. You might not even need hrt. From all the pictures I've seen I don't think you will. If you have scars from the hair restoration you can always wear bangs.You also need to watch your weight. I was 98lbs when I started and I wasn't noticing much happening from hrt. My Dr told me I needed to give the hrt fat to work with or it wouldn't have enough fat to redistribute. I went up to 108 and started developing breasts. A couple of months ago after getting opinions from the people here I went to 117lbs. I noticed my hips and butt filled out more.

I think the biggest passability issues for transwomen are facial hair and voice. You can work on those while waiting for hrt take better effect.

[Denise]

When I called about electrolysis pre everything they suggested hormones first to possibly lesson the beard some. 

He originally said that most of his t-female clients had be on HRT for a few months.  I'm not sure what to make of that.

I started laser (must less expensive but only dark hairs) at the same time as hormones.

About the other stuff.  FFS can take a long time to recover completely.  There was a post here about 18 months ago where it took almost 2 years for everything to be healed.  (Minor swelling apparently).

I'm no doctor but I'm thinking FFS before hair, but being in E for a year isn't a bad idea.  In that year the hair will be that much further along.

There is no right order.  A month ago I started a post about what order did people do stuff.  There people who did stuff in exactly the opposite order.  For example, full-time before starting HRT.

Good luck and as others said, whatever makes you happy.

Sent from my LG-H910 using Tapatalk

[jill610]

It seems the order is all about what you want and feel is important. I am on HRT and started laser on face and chest at the same time, planning to add in electrolysis at the 6 month mark. I am planning on ffs in like April time frame though have already seen some really stunning changes in the shape of my face from hrt and gaining 12lb. My boob growth seems to have stalled so if that doesn't pick up then BA will be more of a priority then it is now.

I'm having a hard time locating a voice therapist which is really my biggest outstanding area of dysphoria at the moment.

Good luck with whatever you decide, just base it on your own intuition and not others.

[Colleen_definitely]

I think the biggest passability issues for transwomen are facial hair and voice. You can work on those while waiting for hrt take better effect.

I agree completely.  But I'll add that I have found voice to be the more important one when interacting with people.  Take last night when I checked into my hotel after work.  I was dressed in boy mode but all my IDs say Colleen, same with my credit card that I made the reservation with.  I looked like crap, no makeup, it was a long day, my upper lip and chin are pretty dark due to being freshly lasered and inflamed, my hair was pulled back in a low ponytail, and she wasn't really sure what to make of me as I walked up.  I hit her with girl voice when she asked me for my reservation name, and after that she perked up in that whole "oh you're a girl like me!" kind of way. 

She's not the first to do that.  Guys are generally clueless, women really pick up on things, kids have supernatural abilities that transcend normal human perception.


So after all that rambling, I suggest therapy, voice training, and hair removal ASAP.  Then HRT when you're ready, and finally surgeries of whatever variety you wish.  I was initially certain that I would need FFS but now I'm not so sure.  Sure it looks nice in my VFFS pictures, but at this point I don't think it will be worth the pain or scars.

[Bari Jo]

Quick note of thanks.  I'll read thru and reply as soon as I can.  I've been on set since 3 am, duty calls.

Bari Jo

[echo7]

There are two important points to remember when scheduling surgeries:

1.) Hair transplants should always be done after FFS.  If you do those in the wrong order, the transplanted hairs can and will fall out due to incisions that will be made for FFS.

2.) Voice Feminization Surgery needs to be last.  The intubation tube used for general anesthesia can damage the work that was done by a VFS surgeon, so you want to minimize the number of surgeries after VFS.

[Roll]

What about if hair transplants are only for crown, not hairline? Should that still wait for FFS?

(Also, was anyone else thinking PEMDAS?)

[Julia1996]

What about if hair transplants are only for crown, not hairline? Should that still wait for FFS?

(Also, was anyone else thinking PEMDAS?)

One of my clients had transplants. You totally can't see any scars or irregularities.

[echo7]

What about if hair transplants are only for crown, not hairline? Should that still wait for FFS?

Yes, it's still a good idea to wait.  For forehead work, some FFS surgeons make the incision along the hairline, while others make a coronal incision (at or near the crown). You will have created your own limitations in your FFS options because you did your hair transplants earlier.

[Bari Jo]

Wow, this thread has been most helpful.  I've decided to push off my hairline restoration at least a year and assess  FFS.  Colleen I'm right now in the camp that I need it.  Julia is too kind thinking I won't, but I might feel differently in a year.  I hope I do!

My major disphoria is from beard, hairline and voice in that order.  I can work on two of those:)  Another Susan's girl added smile so, so I'm adding that.  I must say, once the shame cycle stopped it is easier to smile.

Bari Jo

[Dani]

Bari Jo,

If you do not need any brow shaving then do the hair transplants when you wish. But, if you are even slightly thinking of any procedure with a scar on the hairline, it is best to do hair transplants later to better hide the scar.

I am going to get a few hairs transplanted, but first I need to heal completely from the FFS. The incision on the front of my hairline and along the top of my head took about 8 months to fully heal.

[JoanneW]

Interesting topic. Very interesting points about voice and facial hair, especially the intubation for FFS (and other surgeries) messing with voice surgery work.

I was going to get voice surgery sooner rather than later and wait for FFS until HRT had a much longer effect, but I can see that this might not be the best path. There again, the best path also has to match with my other needs in transition. What does this all mean? No idea.

Some have said that HRT can help more after FFS, which makes me think FFS (the other meaning of that three letter acronym) why does everything have to be so difficult)

[Miss Clara]

What about if hair transplants are only for crown, not hairline? Should that still wait for FFS?

(Also, was anyone else thinking PEMDAS?)

It is certainly okay to have a hair transplant before FFS.  What you have to be careful of is to avoid placing the grafts in the area where the coronal incision will be made.  I did exactly that and had success. 

With extensive MPB, assuming you have sufficient donor available, can often require two or three operations with long periods in between to reestablish the elasticity of the scalp.  It can be the longest running aspect of your transition, and it is to your advantage to begin the process as early as possible.

[Bari Jo]

It is certainly okay to have a hair transplant before FFS.  What you have to be careful of is to avoid placing the grafts in the area where the coronal incision will be made.  I did exactly that and had success.  .

This is what im worried about.  The parts i want restored is my receding hairline on the forehead.  Isnt that exactly the area where the coronal incision would be?

Bari Jo

[Miss Clara]

This is what im worried about.  The parts i want restored is my receding hairline on the forehead.  Isnt that exactly the area where the coronal incision would be?

Bari Jo

If the grafts are to restore a receding hairline, I would have the FFS done first.  You want to have the coronal incision made in front of your hairline if possible so as not to lose any existing scalp hair.  If the coronal incision passes through hair covered scalp, it advisable to have those incised hair follicles transplanted in areas that hair is desired, especially if you have limited donor hair to create a feminine hairline.  In my opinion a person should avoid incisions on the visible areas of the face, if possible, in case the incision doesn't heal well.  Forehead reconstruction is one FFS procedure where the rather long incision can be hidden in the scalp hair.  You should assume that a hairline incision will always be visible on close inspection.

[Bari Jo]

You should assume that a hairline incision will always be visible on close inspection.

This comment makes me want to forego the brow shave and just do other ffs.  I might as well get the hairline restoration first then.

Bari Jo

[Miss Clara]

This comment makes me want to forego the brow shave and just do other ffs.  I might as well get the hairline restoration first then.

Bari Jo

Not necessarily, Bari Jo.  If you need forehead reconstruction/contouring, and plan to have it done eventually, you will eventually have to deal with the resulting scar.  The only question is where the incision (and scar) is located.  If you can hide in under your scalp hair, either the hair you have now or the hair you will have grafted to create a nice hairline, I think you will be happy with the result.  Some girls are fortunate to have a nearly invisible hairline scar, but there's no guarantee of that.  So much depends on your individual healing ability as well as the skill of the surgeon to close the incision with minimal tension on the stitches.  I can't say for sure which order of procedure would be best for you because I don't know how much hairline recession you've suffered.  I would advise you to discuss it in consultation with your FFS surgeon.