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I plan to have the following surgery SRS, FFS and BA and I have the flexibility to have the surgery in any order and over any time period. I have a visa that allows me to stay as long as I want in Thailand and I have planned on 6 months.
So I have been trying to sort out what surgeries I should have and in what order. I am over 50 years old and I am most concerned with the anesthesia. I have only had one surgery before – a facelift – and I had bad nausea and worse had a bad mental reaction which caused me to have great anxiety. I recovered after about a week or so and according to my doctor it's referred to as the "doom and gloom" and happens often after surgery. I am advised that it is better to have a few surgeries and stay under GA for a shorter time than to have one surgery over a longer time
The FFS takes 5 hours +, the SRS takes 2 hours + and the BA 90 minutes +.  I can have an FFS and SRS in the same operation which would then be over 7 hours. So I am deciding on doing SRS then a month later FFS and have not quite figured out about the BA. OR I can have a FFS first then an SRS a month later.  The BA can fit into either surgery.
If any of you have experience in this I would really appreciate any advice.

I can't offer any direct help, but I'm getting older and I've been under general anesthetic a few times.

Sometimes I can remember everything about being knocked out and waking, and other times absolutely nothing. Last time I lost the entire day. I also had a bad reaction to morphine a while ago, so I get other painkillers these days. Fentanyl and pethidine. I think some of these drugs affect my memory and others don't.

Anesthesiologists seem to be pretty flexible on what they give you, and you might be better off discussing it with them rather than the surgeon.

First I had FFS (7hr) and three months later GRS (6hr) when I was fully recovered from the first surgery. I am 45 year's old and need some time for recovery.
I had my BA together with the second GRS where some minor corrections were made (my doc always make these corrections.)

I would plan to have some time in between to recover. It is hard to have a surgery when you still recover. And I would not make the BA together with the GRS. I badly needed my arms and my pain level was already very high.

Maybe I should do it in three surgeries keeping the GA time low. I agree with Lara that the BA with the SRS is not going to work, and a BA with FFS would requirte 7 hours plus under GA.

AnonyMs. I will make an appointment to speak with the Anestologist in July when I confirm the dates and procedures.

BUT should I do the FFS or SRS first?

You can talk to your doctor that you plan to do both SRS and FFS, and tell them your anesthesia issue, may be they can give you a good advise. But so far I know it doesn't matter which one you do first.

In my opinion, after SRS you body will develop more feminine look including your face, and it could take two year of developments after srs. And most girl I see they lose weight after srs too. And you staying in Thailand for 6 months so, I think better get srs first and you have more recover time for srs, where FFS might require shorter period of recovering time. Good Luck.

I think I have read somewhere that having SRS and FFS at the same time is not the best idea ever cause the combined surgery and movement restrictions could make recovery a nightmare. I suspect that BA+SRS could be the same, although I have heard of people doing them at the same time. If I was going that route, it would be SRS as a separate surgery, then BS + FFS at the same time or separately.

I am going to see PAI again and discuss this in detail. I am leaning towards SRS first, thanks Naeree, for your recommendation. and definitly not SRS and BA, thanks Emily.

The FFS is the longest under GA and add the BA its just too long. Maybe three surgeries, doing the BA seperatly. I will need to decide before the 18th July.

Please do so :). And maybe ask them about their opinion as to Your age, body capabilities and recovery needed - each surgery is still a major shock to Your body and the less shock You will be taking, the better (probably?).

On the soft factors, you could have a look here:
https://www.susans.org/forums/index.php/topic,190515.msg1697107.html#msg1697107

Not smoking helps... a healthy diet helps... and some regular exercise a few minutes a day beforehand helps...


hugs

Got it. I have printed it out and placed in my file. I am very healthy, don't drink, smoke, exercise daily, and slim. I'm all ready to go.....thank you.

Thank you Emily, and OMG you look so feminine now. Its always so nice to see how we change...and I remember you when we first started this journey.

To some extent your own priorities will determine the right answer, but I would suggest being cautious about the need for BA.

I know of several people who have regretted doing that too early. You'll go on developing post SRS - and some of us went on getting bigger for a full 10 years. I ended up as a F cup and without any BA - so watch out, you will probably get some development post SRS.

Personally I've never had FFS because I didnt really need it, but if that is a worry to you then obviously its worth considering. My own priority was always SRS and in the end that was all I had done, because I found all the other bits either sorted themselves out, or just didnt bother me enough.

Two more things to consider might be alignment of hrt after srs...
possibly adding bioidentical progesterone, for some possible antiandrogenic effects, evening out some effects of estro, and helping with breast ducts...
and possibly adding a very low dose of testo, to help with overall drive and orgasm ability...
https://www.susans.org/forums/index.php/topic,190296.msg1695059.html#msg1695059

and knowing that after operations there might be a phase of post op depression...
alone knowing helps... and maybe having a counselor or someone to talk to if necessary...


hugs

FFS takes as long as needed to complete with procedures.. how long is a matter of how much unexpectedly more complicated things need to be done. What can be 5 hour surgery can also be 10 hour surgery. I have never heard of 2 hour SRS... more like 4-6 hours, depending on the technique of surgeon.

I strongly advise against having the two at the same time. First week after FFS alone is a hell. Although a few surgeons would do the two surgeries at the same thailand trip, they would only do them 3-4 week apart, with FFS done first..
A least 3 months time inbetween would be a LOT better idea. 6 months would be smart.
BA can be done with local plastic surgeons anytime later.. I don't see a reason why put a body through even more shock, than SRS of FFS would do alone.

Quote from: warlockmaker on June 15, 2015, 04:55:16 AM
Thank you Emily, and OMG you look so feminine now. Its always so nice to see how we change...and I remember you when we first started this journey.

Oh, thanks, You are way too nice :). I am OK with my face and butt, but the rest is way to much muscular (unfeminine) to show that body to the outside world, so no bikini for this season (in 2016, maybe).

My GRS with Brassard actually did come in under 2 hours, though I realize that's irrelevant since you'll be in Thailand. However, if you have a bad reaction to GA, it might be worth asking whether there are alternatives; I also never had GA at all, only an epidural block and twilight sedation. Anesthesiologists these days are used to working with patients with special needs, and that might help you make a decision more easily.

I think I'd do FFS first, then SRS. Mainly because recovery from SRS can be difficult and takes a lot of time and you don't want to be doing that while recovering from FFS. Dilating for example when you've just done FFS, I can't imagine that being pleasant. As far as I know there's no such issue if you do FFS first. Leave a decent gap and do the BA some time after that since its relatively easy.

Hi,

Firstly good luck with all the surgeries  :)

My SRS took 8 hours and I've spoken to a few girls who've recently had SRS and they've all been 5+ hour operations. You could do BA with SRS or FFS. What only you will know is how much material the surgeon will have to work with during your SRS and what technique your chosen surgeon uses. You will also know what FFS procedures you are planning to have. I have been given times between 5 and 10 hours for the FFS I am working on having again depending on what work I have done and the technique.

One thing to factor into this is dilation, If your FFS involves eye work your vision won't be good for a couple of days so seeing for dilation may not be easy, It may also turn out that you are not really able to or feel like dilating for a number of days. There will also be the exercises involved post BA which I can only comment on from seeing a friend doing them post her SRS and BA.

If it were me I'd do FFS and leave it about 5-6 weeks then do your SRS and BA together. You can then spend a few months in Thailand recovering and having a nice vacation. If you really don't want to do BA with SRS do it last as it's the shortest length surgery and if you wait a couple of months post SRS then you'll be fine for standing for exercises and free to dilate to your own schedule.

Hope it all goes well

Hugs

Sorcha  ;D

I am planning GRS in Thailand in Jan.  This thread has bee very helpful to me.  I was considering brow bossing at the same time as GRS. I'm now convinced by reading the comments that I should focus on the GRS and fully recover from that before taxing my body too much. I have never experienced any probs. with GA.   Had a cervical fusion in 2004, laminectomy in 2010 and lumbar fusion in 2011 (in which I was under GA for 10 hrs.) "However,  I will turn 68 in Dec. don't want to push my luck.  Thanks!
Hugz!

Thanks Sorcha. I'm lucky that I'm not limited by any time constraints. I know facial surgery, as I did have a rejuvinating lift some 8 years ago. I will have a forehead/brow ridge bone contouring, rhinoplasty and alarplasty, plus a general rejuvinating facelift. I am not sure about the lip lifting surgery and it can be done under a local.

What I am suprised about is the great variance in time required for SRS surgery. I know DR Chett who does it all himself in his clinic and he said 6 hours, then Suporn at 4-5 hours, and PAI Dr Sutin at 2-3 hours. I was totally examined by each surgeon and there is more than adequate skin tho Sutin suggested that some cosmetic changes be done some time later on a local anesthetic.

So if the FFS does not hinder the diliation, then I feel that there is no difference which one I do first. I may just opt for the SRS simply because it is been my life dream to have this done.

I will see PAI again on July 15th and have asked to have a chat with the anesthesiologist and I will see what they suggest. Thank you all so very much.

Quote from: warlockmaker on June 15, 2015, 10:25:53 PM
What I am suprised about is the great variance in time required for SRS surgery. I know DR Chett who does it all himself in his clinic and he said 6 hours, then Suporn at 4-5 hours, and PAI Dr Sutin at 2-3 hours. I was totally examined by each surgeon and there is more than adequate skin tho Sutin suggested that some cosmetic changes be done some time later on a local anesthetic.

I think the time difference would be caused by the different techniques. Suporn's one is really complex, and Dr Chett is apparently doing the same, whereas I think everyone does penile inversion. It's interesting that Dr Chett said longer than Suporn. I wonder if its more than just a difference in guessing?

I don't know about the others, but Suporn does really fine stitches. That's got to take a while.

Quote from: warlockmaker on June 15, 2015, 10:25:53 PM
So if the FFS does not hinder the diliation, then I feel that there is no difference which one I do first. I may just opt for the SRS simply because it is been my life dream to have this done.

If you do the FFS first you can have both of them done more quickly, and since FFS is so visible it might be nicer to have more time for recovery before you return home. Since you have to book them reasonably far ahead, it's probably not practical to change the dates if you find you need more time for recovery than you'd planned. From that point of view do the lower risk one first, which is FFS. I can see you have your heart set on SRS though, which I can totally understand.

I had FFS first because I could live full-time since than and passing is perfect (doing voice training since a while). Recovery for the 7hr surgery was easy and I had almost no pain.

Three months later I had GRS which was quite painful and recovery took months. My doc is using a rather similar technique than Suporn.

He is always doing some corrections if wanted. Because I wanted the porn look some corrrections were made together with the BA.

I am now 1,5yr under HRT and live happily full-time since one year.

You have all been so helpful. I wanted the SRS first but after reading all your comments I have changed my mind and will do the FFS first and wait around 6 weeks before the SRS. Thank you all sooo.... much

You seems to be getting some really good advice and shared experience already and making sense for yourself about what your priorities are for surgery.  I was a Nurse Anesthetist (CRNA) for 33 years and agree with Jenna Marie that you may wish to inquire about options and certainly deserve to have a thorough pre op discussion with your anesthesia providers.

The more they know about your previous experience and personal health history, the better.  There are numbers of anxiolytics, sedatives and antiemetic medications for tailoring an individual plan for you.  There are distinct advantages to  having one anesthetic with multiple surgeries.  I suggest one is that there is only one induction and emergence with the attendant airway maneuvers such as intubation.  The take off and landing concept.  And, on the other hand, there is the longer time span during which a person absorbs lipophilic gases, narcotics and more that can take a long time to really eliminate and get back to feeling less cloudy.

While there are reasonable risks your attitude is critical IMO.  We can be terrorized and in trauma and anesthesia will still work safely, it has too.  We leaned a lot from battlefield and emergency work.  Ideally, tho, you will be able to picture  yourself calm and surrounded by a caring and experienced team, falling asleep and awakening as tho only minutes have passed.  Focus on the post op period when you will likely emerge thirsty, hungry and feeling completely successful.  You did it!  I imagine you can be an assertive patient and let people know what's working and what help you need along the way.  People will say good luck and it is also said that luck favors a prepared mind.  Prepare by envisioning yourself safely on the other side, ready to recover and head home.

I look forward to hearing more about your adventures. 

Hi Tessa. OMG just when I was set on a way and I get someone who has direct professional experience with a medical view, its so kind of you to share this. I just want to be really clear as the technical terminology is unclear for a lay person like me.

Induction means going under GA. So you recommend doing both at once , have I understood correctly? I just spoke with Jessie, the assistant at PAI, and he confirmed that the SRS will not take more than 2.5 hours and he did suggest both surgeries.

I also will meet with the anethestist and go over my history and will raise the points you brought up. I am ever so positive in my attitude - after all I've waited my whole life for this.

Thank you sooo... much Tessa. I will let you know what the final booking are after my appointment on July 10th.

Happy to help!   Yes, strictly from an anesthesia perspective it makes sense, especially given that optimistic time estimate, to combine your surgeries.  Other girls did raise valid ideas about your choices and the special self care needed after SRS.  I have no experience with that.  "Going under" is the induction of general anesthesia, typically a 3 second experience if remembered at all.  Some people even experience a retrograde amnesia.  The combination of pre-op sedatives and GA can allow some people to forget events that happened even before they go down the hall to the surgical suite.  Surgery is nothing you want to remember anyway and they can probably provide pictures and more if you like. 

It is very encouraging to hear that you are feeling so positive.  Keep it up!