Hi Blush,
I posted this response to Brenda at this link:
https://www.susans.org/forums/index.php/topic,180708.msg1603704.html#msg1603704 I am re-posting it here because much of it addresses your question.
I was born January of 1964. I started my public transition, going full-time, January 1, 2013. My beard had been fully removed, using laser, by 2008. HRT had begun November of 2012. My first stage of FFS surgery, forehead contouring and tracheal shave, took place on June 19, 2013. I had my first Rhinoplasty September of 2013. I had revision rhinoplasty August 19, 2014. I had chin and Jaw surgery and lip-lift October 29, 2014.
The only thing that kept me going for the six months from the beginning of January 2013 to end of June 2013, that stretch of interacting with the general public without any facial corrective surgery, was the knowledge that eventually I would have FFSurgery.
During my first six months in public nobody thought I was a woman or treated me as a woman. I was treated as if I was a man dressing as a woman. Negative reactions ranged from fear, to disdain, to disgust, to pity. Positive reactions were entertained politeness or occasionally, I would be congratulated for my bravery. None of those reactions was affirming. But those six months did reinforce my resolve to pursue FFS. I do acknowledge that negative reactions are a spiral. When people frowned at me I often frowned back. When I would get a lot of frowns I would start to expect frowns... which, I am sure would lead to more frown... it is tough. I would try to break the cycle. I would try to "be in the moment." It simply was not enough.
During my FFS research I decided that I was going to have my facial surgery in steps. This is because it was my observation that I was not able to find any single surgeon that (I thought) could handle my three critical areas with equal skill. Also, I held out hope that (just maybe) I would not need all of the surgery that I initially dreaded I would need. Finally, I was scared, the idea of being on the operating table for 8 to 12 hours frightened me.
Now that I've completed my lower face surgery I basically have one surgery left (which is to correct my hairline.) At this point I think I can provide anecdotal comments on having my FFS into the three phases:
1. Forehead and trachea
2. Rhinoplasty
3. Chin/jaw and lip lift.
The positives:
Each surgery, separately, was easier to handle. However, no surgery was easy. My forehead surgery was incredibly difficult and I sometimes wonder if I would have lived had I also had rhinoplasty and jaw surgery at the same time. In retrospect, I think the doctors would have had to stop my first surgery prematurely if it would have been scheduled to last longer. This was due to my allergic reaction to my intravenous antibiotic on the operating table. I literally was vomiting while I was unconscious on the operating table.
My first 24 hours post forehead surgery felt like I was on the edge of death. I know that seems melodramatic. Nevertheless, that is how I felt. It took my body about 24 hours to get the antibiotic out of my system. Once that resolved, the rest of my forehead contouring recovery went very well. Less than 72 hours after my forehead surgery I actually went clubbing for a few hours. I begin to enjoy my time in Buenos Aires very much. I remember it fondly.
The forehead result was better than I had imagined. In 48 hours I went from never passing to being able to pass all the time while walking down the street. And I was passing maybe half the time in face to face interactions. I still was not passing all of the time. However, even when I was clocked, people were still nicer to me post forehead surgery. I have found that even if people figured out I lived much my life as a male, the more feminine I looked the more accepting people behaved.
My rhinoplasty surgery was the easiest surgery compared to the forehead surgery and the lower face surgery.
As I have written recently the jaw/chin/lip surgery has been very challenging for me psychologically. The over month long recovery from swelling had left me in a very deep funk. Lower face surgery was one step backward to take two steps forward.
The biggest positive of my multi-step process is that I think the aesthetic outcome has been maximized. (I'm not writing that I think my result is spectacular. What I am contending is that given my start with extremely masculine features, I think my result is better than what could have been expected in one single surgery.)
When I began my research, I felt that Doctor Ousterhout and Doctor DiMaggio were doing the best foreheads. I chose Doctor DiMaggio because I thought that his procedure built and improved upon Doctor Ousterhout's technique.
I chose a separate (non FFS specific) surgeon for my rhinoplasty because I didn't think any of the FFS surgeons did an adequate job addressing a nose as large, humped and droopy as mine. I had never seen a good example.
I selected Facial Team for my chin, jaw and lip lift because I liked their CT scan approach to my very bony and asymmetrical chin. Also, the limited amount of information I could locate regarding long term sensation change (for all surgeons) in the lower lip was favorable to Facial Team. Finally, that they had three full surgeons, not residents, in the operation room at the same time was remarkable.
People ask why I did not choose Facial Team for my forehead. The reason is that when I was deep in my forehead selection process, there simply were not enough Facial Team forehead examples for me to be confident on predictable outcome. From 2010 to 2012 there were many, many example of Dr. DiMaggio's work coming online and every example was excellent. I also considered most of the U.S. based surgeons but I could not find (except for Dr. O) the consistently predictable or volume of examples attributed to Dr. DiMaggio. This also goes for Dr. Suporn (not enough examples.) I choose to not use Dr. O because when I visited him, in person, and compared him to my interactions with Dr. DiMaggio I preferred the demeanor of Dr. DiMaggio. I liked Dr. DiMaggio's technique and personality better than Dr. O. Dr. O was so against splitting my nose surgery from my forehead surgery that I was not confident that he would do it separately. Every time I brought it up he said no. But I did not get to the point of putting him on the spot. Maybe if I would have forcefully insisted he would have relented.
This was my ranking of forehead surgeons two years ago:
1. DiMaggio
2. Facial Team
3. Ousterhout
4. Suporn
5. Bart
6. Spiegel
If I were redoing that ranking today, it would be different of course. I am going to pass on re-ranking that list today. But I will write, that I think the top two spots are still occupied by Facial Team and Dr. DiMaggio. If hair transplants are going to be part of the process I think it's important to note that Facial Team can offer that during the forehead surgery. As far as I'm aware, that is new.
If a favorite surgeon of others is not on that list it is because I thought they did poor work or there simply was not enough examples of their work, available to me, to be able to reliably project an outcome.
I believe another benefit of breaking up my surgeries into stages was that each surgeon was able to start with a healed image from each previous procedure. I know some argue that one surgeon being able to modify all the parts during one long surgery creates better synergy and balance. I don't agree. I found that being able to plan the next phase while considering the healed phase is better.
Reducing the amount of procedures in each surgery allowed both me and my surgeons to focus on less variables during pre-surgery planning. I believe this increased our ability to communicate with each other, reduced misunderstanding and allowed for a maximum cooperative, predictable, outcome.
The interval between surgeries also allowed me the luxury of time to consider my next step with a healed and progressively more feminine face. This should not be underestimated. I was able to get evolving feedback from some very close friends and doctors such as my dentist and dermatologist about the next best step. This time and evolution also made engaging in virtual Photoshop sessions easier and more predictable as I could model (with actual resolved outcomes) and focus on altering only the parts remaining to be altered.
The negatives:
Cost: breaking the surgery into components probably tripled (maybe more) my costs. This is a huge negative, but an effect for which I had planned. I realize cost makes the idea of breaking up the surgeries unmanageable in many cases.
Time: I have spent a lot more time: swollen, bruised, debilitated and traveling. I am tired of it. It would've been nice to have one surgery (if it had only been one surgery) and just be done with it. It would be nice to be able to get onto the next phase of my life. If people ask me what I've been doing with my life recently: the answer I tell them is working on my stand-up comedy. But, in reality the biggest part of my life is been working on transition, my divorce, (which my wife blames on me having surgery) and healing.
Another huge negative is that having multiple independent surgeries (and being open about it) leads many friends, family and acquaintances to conclude that I am nuts. I had been very open about my surgery and my plans for surgery. I now regret this. People think I've had a lot of surgery. And, of course, the perception is that it's all based on vanity. If I hear one more warning about not turning into Michael Jackson I think I will throw up. I have also received one too many emails about how I just need to find Jesus or, its spiritual alternative... spend more time meditating. Sorry, does that last sentence literally offend everybody?
My perception, of course, is that my surgeries are corrective surgery. But it's hard for me to convey this to a non-transgender audience. If I would have had one FFS surgery, the works, it would be perceived by others as "one" surgery and it would be over. I wouldn't be judged as harshly. It's frustrating when people treated me with disdain because I didn't look like their vision of a woman and later also treated me with derision because I am taking steps to bring my appearance more in line with a stereotype.
It also did not help that I was over 50 years old. In addition to slowing recovery. This led people to conclude that was going through a mid-life crisis. What they do not realize is this crisis began in January 1964 when the doctor mis-categorized me. Those five or 10 seconds of visual inspection, set me on a path, threw me into a canyon, from which it has literally taken half a lifetime to climb free. I was consciously aware I was in a bad predicament when I very young. If there is a crisis, it began much earlier than mid-life. It is only now, in mid-life, that I have the resources of time and money to correct this error. My lifetime of work, to earn the money, to plan the path and follow the plan, has taken me decades.
What I've learned:
I would have worked harder to have each procedure with less time between each. In an ideal world I would not have had other commitments. But, that simply was not my case.
I should have revealed that I was transgender about five years, maybe ten years, earlier. Even if I would not have been living as women full time.
I should not have waited for my wife to "come around" and give me permission to have FFS. For twenty years she was on the edge of saying "yes" she even booked our trip to see Dr. O back in 2006. But when she saw what magic he could do' (there were many, many more photographs in his office than online) she left the appointment in tears. That set me back another 5 years as I tried to work through a compromise with her. This is also where the idea of having FFS in stages germinated.
Additionally, if I were starting over, I would have been much less open (to non-transgender acquaintances) about the surgeries. I would have been much more secretive. (Only about surgery, not about being transgender.)
I need to write that I would still be very open to members of this forum. I will continue to be an open book on this forum. This resource, has been precious.
Finally, if I was only able to afford one procedure the decision is easy, it would have been the forehead.
Thank you so very much to all who have contributed to helped to make this forum.
Kind regards,
Danielle
