My name is Charlotte, I'm 36 years old, and I work in Washington DC. Physically, I'm 5.9, white, with jet black hair at armpit length. This is my first post, even if I read pages and pages, mostly at night when I can't sleep. I'm not happy with my body, and it keeps me awake. I'm the kind to think hard and slow before acting - too hard and too slow maybe.

These last few years, while I was making my mind about what kind of body I wanted, I got most of my facial hair removed. I still have to pluck a few spare hairs with pliers, about 20 mins every 2 weeks, but it's ok as I don't have to shave anymore. I was something I have wanted to do forever. It made me really happy.

Last year I finally made my mind and started HRT in october 2014. Now at 6 months I'm already blessed with nice A cups. I like my tits and my new me more than I could ever have imagined, so much that it made me seriously consider my future.

I know I'd make an ugly girl. As an androgynous guy, I turn heads, but there is still a big difference between an androgynous guy and a girl. I'm thinking about FFS. No, not just thinking, I'm obsessed with the idea of FFS. If I want to move further towards the body I want, I know it will be the only way, especially if the boobs keep growing nicely.

But I'm frightened. I know pain and surgery - due to a bad accident in my twenties, I have had more sugeries on my limbs than I can count on both hands. I'm ok now, and being cut open is not frightening. I'm afraid of side effects and bad surprises.

I've read here: "I have no idea how people cope with more aggressive FFS where people who knew them are no longer able to recognise them." Is that what I am afraid of? No, I don't care if I can't be recognised. I don't care if I can't recognize myself in a mirror. Hell, I hope I won't, because the person I see in a mirror is not myself.

I'd like to ask to others members how satisfied they've been. How they are perceived by others, but I'm not so afraid of that. I know no result is guaranteed.

What I really fear is the small mishaps - lack of sensation in part of my face, scars painful to the touch, scars that are hard to hide, this kind of stuff. I know that too well. I have such things at different spots on body, and I have learnt to tolerate it the best I can, to hide it well, but it is still traumatizing. I'm not sure I'm ready to repeat the experience, especially when we are talking about the face. Cosmetic surgery may not be like fixing shattered bones, but I'm really afraid of having the same stuff happen on my face.

If you already had FFS, can you please tell me what you don't like? The small details, the annoyances. Not what fixes itself in the year after surgery, but what remains. What you see when you look at yourself in a mirror.

I want to get the nose, chin and jaw done, and if I can pay for it, a cheek fat graft. For the hairline and brows, I'm afraid it will make visible scars. Maybe not visible to others, but visible to me. I love to tie my hairs in a ponytail. I couldn't look at myself in a mirror if I had a scar at the hairline. I may be unhappy with my body, but I don't want to make it worse.

Yet, the forties are looming. I feel that every year spend in a body I don't like is a year lost. I want to be happy but I don't believe therapist and surgeons. Their talk is cheap and their pictures carefully selected. Maybe I have a trust problem, but based on my experience they don't really care. Why would they? After all, it's just their job, while it's my life. I know I should't trust strangers on the internet, yet the only opinions I trust are those from person who've walked the same path.

So I hope other members can tell me about their annoyances with FFS. I also hope I'm not asking too much. I don't like to talk about my dissatisfactions with my scars to those who can't understand me. If you can, please tell me about the annoyances, what you don't like. It would help me.

Incision scar for upper face work is not a problem. Most FFS surgeons are able to coronal incision, hidden behind your hairline, or combination of hairline incision and coronal incision... You can also have hair transplant over the incision scar, and to lower your hairline. You can use one of those expensive post-op gels for treating the scars, like Dermatix, or something similar, Which will make scar almost invisable after some time. I was also concerned about the hairline scar, but now it doesn't bother me at all, (I have hairline-coronal incision combination) and it will be practically invisable in half year or something. I'm happy I choosed to have hairline incision, and little hairline lowering for facial thirds balance, instead of full coronal incision.
Upper face is where the feminization happens... forehead reconstruction, orbital rims remodeling, changed eye expression, bridge between forehead&nose, etc... this is where FFS surgeon can help you. Remodeling of chin, jaw, rhinoplasty, cheek filling or cheek augmentation, this are primarily aesthetic procedures. Could be definitely helpful also in terms of feminization, but it is not the difference to what makes a face appear masculine or feminine. Upper face is the essential part for most.

Thanks, that's very reassuring. The idea of a scar on my forehead was just too much for me to imagine. You look fabulous on the profile picture!! It's encouraging to know a combination of hairline incision and coronal incisions gives such great results.

You say the scar became practically invisible. Can you see the scar? Are there some hairdos you have to avoid? Is it painful to the touch or when you brush your hair?

Did you do anything to the lower face? (If I'm asking too many questions and you already posted all that, just tell me where. I tried to click on profiles but apparently I can't yet)

I've got a big long nose, and the jaw angles are noticeable, so I'm not sure I can ignore the lower face. But if the upper face work is so important, I'm wondering it if can be done in a 2 times process: upper face first, then lower face depending on the remaining money and results -- maybe with a different surgeon for each, unless they frown upon that mix and matching.

Thanks:) I believe you need to reach 15 posts, and then you can search profiles, freely post, send PM, etc...

I had combination incision, which is basic zig-zag hairline incision in the front, and in the corners it goes beyond the hairline, in a shape S and is finished an inch above the ears. That way it was also possible to close the M shape in the corners a little. I happy with that. I think having a coronal incision and hairtransplant would also work nicely, but I didn't have the additional thousands for hair transplant. In the end doing the math, with little hairline lowering I saved a couple thousand dollars (hairline gets positioned a little backwards with coronal incision), and I only need to save up for filling up the corners a little and possibly for hiding a scar (probably won't need that).
I can still see the scar, (I had surgery little more than 3 months ago), but like I said, surprisingly, it doesn't bother me. It doesn't look scary or anything like that. It's fading away, the gel is working. I could use make-up to cover it, but I just don't care, and noone seems to notice. I don't have any problems related to scars.. Temporal loss of sensation that happens behind the hairline, on the top of the head (because disconnected nerves) is something you get used to. It is strange in the beginning, but I seem to notice it only when I'm brushing my hair, and while I'm finding the right position to sleep. How long before sensation fully returns varies from one to another. Sensation in the forehead returned in couple weeks in my case... Some report of couple months, or more. Some report loss of sensation in lower face, around chin, lower lip.. well, I didn't experience any sensation loss there. But I also didn't have agressive work in lower face. Just a little shaving to emphasize V-shape, and a small chin implant for improved projection.

You need to understand that what is important for someone, might not be for someone else. Every face is different, and people have different reasons for FFS, and different expectations for different results. It is a lot about what are your goals going in FFS, being smart about expectations and choosing a surgeon who will be able to realize them, resulting with you being happy and satisfied with your new appearance. This is the one surgery, for trans women, where being overobsessive in learning about every detail and aspect actually makes sense. Some people go into it like blindfolded, foolishly trusting the surgeon who recommends the least work, because he shurely doesn't try to sell them too many procedures just to make more money, and gives them the most reasonable quote. That works great in some cases shure, but also result in MANY not completely satisfied patients, who didn't get what they expected. Well, you need to really know what to expect, to have a predictable result and get what you expected. The more reseach, the better...


I know of a lady, she's also here on forum, who had her FFS in three stages (upper face+rhinoplasty+lower face) (link to her very informative post  https://www.susans.org/forums/index.php/topic,180708.msg1603704.html#msg1603704). And many choose to have FFS in two stages... more necessary for those who also need soft tissue work like facelift after bone work in first surgery. So it is smart to divide it in two surgeries, and give one year to heal between both, to have the best result, and predictable result in the end. But also some people just prefer to do a little first, see how it goes, and then have more if needed, or not.
To split it, doesn't make the most sense financially, because of double travel costs, double stay and everything, paying twice for hospital fees, anesthesiologist, etc... but it makes sense to have something done sooner, and have benefit of that, instead of waiting additional year or two or more before saving enough money for all-in-one surgery. I had all done once, mostly because I really really hate flying, and to go through recovery just once.   

Hi Charlotte

I did quite an extensive post on Susan's when I did my FFS, so have a read:  https://www.susans.org/forums/index.php/topic,169753.0.html

Some six months prior to FFS I had my nose fixed, with bone and cartillage removal.  It was inconvenient, but not really painful.  Now,  some 9 months after FFS I am extremely content with the result.  The step change from androgynous girl to unambiguous girl was a huge boost, but at the same time it also removed something interesting and not unattractive from my face.

FFS is a complex mix of the surgeon's technical capability and the ability to render something aesthetically pleasing out of a structure that is not infinitely malleable.  It is major surgery and it obviously can have consequences.  The numb chin and bottom lip returned to an appropriate normality quickly enough. From the genioplasty I have a slightly odd pressure in my bottom teeth between the incisors.  Apparently it should go away, but there are days when I notice it.  If you ever had braces as a kid, it's the feeling you had the day they were tightened.

The FFS was really not painful, and almost all the scars are either internal, or are very fine and not noticeable.  Put it this way:  the physio I had to endure after I broke my wrist was 10 times more painful than FFS.

Regards
Julia

mmmm,  3 months ago, really? Can't believe that!! You are already so fabulous on the picture!! I thought swelling took like 4 months to fully go away. I hope I can be as pretty. As soon as I have 15 posts I will totally bother you by PM to ask for details, pictures etc Also the research you did must still be very fresh! If you do not mind sharing I would be very interested. I want to learn. I'm obsessive by nature. I will explore everything I can. I did that for the surgeries after my accident, except for the very first one. I learned the hard way that surgeons shouldn't be trusted.

My objective is feeling happy when I look in a mirror, working as a woman without being labelled, and generally being as pretty as my money can buy (I'm saving) without suffering from things I could not live with (ex: definitive loss of sensation on a significant part of my face, scars I would hate etc).

How to get there? HRT will help, but it won't fix everything. It can't. I want to give it a year to evaluate the result before deciding what to do, but FFS is very likely.

What do to?  I don't know enough yet. Orbital rims, brow shaving and a forehead reconstruction are definitely on the #1 position of my list now. Do you think asking virtualffs.co.uk for an evaluation is a good idea? (I also have a CT scan from a few years ago on a CDROM)

I'm asking because your posts helped me see the failure in my original idea.  I read the links you posted and another message you posted on https://www.susans.org/forums/index.php/topic,184518.msg1640140.html#msg1640140 and even if I do not know as much as you do, I agree. The upper part seem the most important. I was afraid of scars, but apparently there is no reason to be afraid. The thing I'm really afraid of is definitive loss of sensation. I have that on a part of my leg that was cut open about 5 times and it's not pleasant. It won't ever come back, I waited several years.

On face I'm lucky I only got 3 scars : 2 that are very small (half a inch) on my forehead and hardly visible, and a larger one (nearly 2 inches) under the chin. That one is from a bad day when I couldn't bear my reflection in the mirror and overdosed on various things. I'll spare you the story. Won't happen ever again, no way. Charlotte wants to live now.

But that got me thinking maybe that scar could be used for the sliding genioplasty, tracheal shave and mandibula angle. That would mean nearly no risk of loss of sensation in the lower face.. Apparently Dr Z does that. Since I already have the scar, why not use it?

By the way, can I ask you which surgeon you chose? DiMaggio and the Facialteam seem the best for what I want, but the facialteam may be much more expansive. Depending on my luck I think I will be able to save from 10 to 30k. It will have to be within that budget 

Julia, thanks a lot for sharing your detailed post and the detail about the teeth. I know the feeling :-) If you don't mind sharing your pictures mentioned in the thread, I would be interested.

That picture was made at 2 months after surgery... Some people have noticeable swelling for months. I had less swelling at 10 days than most people have at one month. I listened to my surgeon and his assistant surgeons and I was doing A LOT of massage and I used A LOT of ice. All swelling comes down from all face and stays above your jawline, and it stays there for weeks and weeks or months if you don't massage that area and get rid of it. It's really bad because of possible inflamation, infection, and such... looking terrible is the least problematic of things. It's not pleasant massage, it hurts really really bad, as you need to push and work it as hard as you can tolerate the pain.. I was literally crying while doing it for the first couple days, despite being on strong painkillers and numbing the area with ice before and after massage. I did half hour massage like 6-7 times per day in the first 2 weeks after surgery. Icepacks before&after, and in the mean time, together like 15+ times per day for 10-15 min. Well, it worked amazing... It's just work most girls aren't prepared to do because of pain, and they are stuck with swelling for few months.. Another thing is I didn't have the most aggressive work, as I didn't have any really masculine features.. more like only androgynous features.

Reach 15 posts and bother me as much as you wish. I'm here on forum to share information on FFS, and facial surgery in general, and help with advice as much as I'm able to.
And yes, surgeons often can't and should not be trusted.. This is why it is so important, in my opinion, to approach FFS extremely analytically and be very smart about it, because you need to choose a surgeon you CAN trust. It's not a leg or something like that, this is about remodeling facial features, and how you will look for the rest of your life.
For example, I could only have a trachea shave, and I would probably live happily ever after, without doing anything else (maybe a rhinoplasty). But I had an idea, and it was all about want, not about need. And it was so much worth every single $$$ and all the pain and tears. 

HRT will help, the smoothness of the face and roundening of lower face are important changes to ones apperance. But sadly it does basically nothing for upper face and nothing for bone structures... And for those who want feminine facial features (thats based on underlying bone structure) only surgery can help. I always suggest to wait a while, see what the hormones do to lower face and cheeks fullness, and lips, etc... But in the end, it's good to have FFS as soon as the time is right, and have the benefits of the result sooner instead of later.

Alexandra from virtualffs has a lot of knowledge and very realistic look to it, so even if you don't feel you need photoshop visualisation of after pictures, she always gives a good advice. She often responds to question on yahoo FFS group.

To what I know, I can't say I know of one definite case where sensation loss after FFS was permanent. That doesn't mean there isn't someone with really bad luck, but as far as I know everything returns to normal sooner or later. Nerve damage can happen even to the most careful surgeon, the most problematic is with aggressive jaw&chin work, with height reduction of chin. And it could take a while to return completely.

2 inches scar under chin might be usable, but an incisions inside a mouth aren't really problematic, and it allows a surgeon to easily reach all the place. Only healing is problematic, as you need to wash teeth after every single meal, and use a mouthwash after... for a month, better for two.. you get really sick and tired of washing teeth (and stitches hurt), but infection would be probably much worse.
I trusted dr. DiMaggio with my surgery.

We are so much alike!! I do what has to be done, even if it's painful. And I try to be realistic and smart about what I want.

I don't want to take useless risks, but I also have my objectives and I know I will need more than a tracheal shave to achieve them.

I will spend every cent I could save for the FFS. It is *that* important.

Hi Im only six weeks post op FFS with Dr Spiegel in Boston but I did an in person consult with Dr Z and a skype consultation with Dr Mayer.... I felt they were a waste of time for me due to their brow technique that consists mainly of burring down the bone as much as they can and using filler.... Dr S did a full sinus reconstruction and Im not disappointed there... I did really like Dr Z though but he just wasn't right for what I wanted done....

First of all as Im sure you know there is a ton of good info and before after threads here.... It was very helpful for me to read a lot here on what to expect and the different experience and results from different surgeons...  I was very reluctant to post pics here but I feel like I owed my sisters an honest account of my experience....

I had a forehead reconstruction, brow lift and scalp advance, nose job, lip lift and upper lip augmentation and a full face and neck lift... as part of the face neck lift he also pulled my ears in closer to my head and made my lower ear lobes a little smaller and more feminine looking

I have a scar that goes from the bottom of my earlobes all the way up and across my forehead...

Unfortunately for me Im older, 46 now but I started my transition about a year and a half ago.... I have bad MPB and Im planning on trying hair transplants to try to recreate a feminine hairline at least and use a high quality bonded topper if I need to.... So the scar is pretty visible no matter where he would have put it for now anyway... So I can see your concern about the incision and scar and it being hidden, but I can really help there... He did resect or remove about 3/4" of my old long gone "hairline".... Im still not sure if that will help with the hair transplants yet because that stretched out my scalp and just seemed to reduce my hair density, not sure that was worth it in my case, time will tell I guess.... I plan to start hair transplants in about 5 months... At 6 weeks into recovery I still have a lot of numbness on my scalp behind the scar and a bit on my forehead and orbital rims where they were shaved but in the last two weeks things have been getting a lot better fast... 

The nose job was very subtle because I asked for a very conservative job there.... I love the result but I was happy with my old nose for the most part... Spiegel is pretty conservative there I gathered and that was one of the reasons I went with him...

The lip lift and augmentation have been a bit of a disappointment so far... The scar under my nose and on the sides of my nostrils is very well concealed and not very noticeable and healing nicely... But I feel like he was a bit too aggressive there and I envisioned a bit less of a lift.... Also I feel like he should have done less augmentation on my upper lip and he did none to my lower lip and he should have... Now Im thinking I will have to have my lower lip done to balance things with a local plastic surgeon.... BUT I can live with it for now...

My jaw and chin is where he really was aggressive in taking out the squareness of my chin and I like his work to taper my jaw so far but its still too early to tell what the final result will be... I kind of regret not having masseter muscle reduction, but Im only a year on HRT so Im hoping that will help in time.... I hated my square chin and I really am happy thats gone... I think he should have reduced the length a little more and taken out more of the forward projection but I can live with it just fine now... He didn't do a genioplastly though just a lot of grinding bone... I didn't want the sliding genioplasty and Im happy with the result so far... I have incisions in my mouth all along my lower gums but no external scars... This has by far been the worst part to recover from... The swelling and pain is finally starting to go way down.... It was VERY numb on my chin and jaw but that's getting a lot better fast as the swelling goes down...

Finally I love the results of the face and neck lift, that has made me look a lot younger... He did lipo under my chin and really tightened things up nice on my neck and face... There is a good argument against doing any lifting until the bone work is completely healed.... I do think there is a lot more potential for a better result doing it in two stages... I just decided to get it done all at once though because I really needed it and couldn't take it anymore... Im not disappointed yet but I may need the facelift done again in 5-10 years when Im older or maybe not who knows... 
The scars in front of my ears are invisible, I literally cant even see them now... There are also scars behind my ears well hidden by my hair that I have no idea what they look like...

My ears were totally numb and even behind them where the scars from the neck lift are and it was and still can be hard to sleep but that's getting a lot better fast as well...

Dr Spiegel is not cheap but Im not sure that makes him that much better than Facial Team or DiMaggio or any of the others that are outside the USA.... Im just lucky to have the $$$ to pay cash and I didnt want to go halfway around the globe for surgery but I can see how that could be worthwhile and save a not insignificant amount of $$$... I just wanted to get it all done at once and be done with it but I do want a couple minor additions now...

So that's all I have so far 6 weeks out, you can check out my experience in my long thread here and I plan to keep updating it for the time being as things heal...

I see no problem at all with doing the upper and lower face in separate surgery's even with different FFS docs as $$$ allows... Also you can do a face/neck lift and anything else that's not reconstructive with any good local surgeon who works on cis women....   

So I have no real regrets and while the recovery was brutal and I was less than impressed with the aftercare at Boston medical center everything moves the way it should and my result is very subtle and natural looking Im told.... Dr S is known for a conservative subtle result and thats what I wanted... I didn't want to "look like I had FFS" and that was why I went with him...

You can get a lot more details on my experience in my thread here and Id be happy to try to answer any questions the best I can if you have any...

Thanks Eva!

You said you don't want to look like you had FFS. Are there giveways, like the position of certain scars etc?

I've read cheek implants tend to be a bit overdone. I wonder if that's why you meant.

Let me state that I have numb spots on my face due to a separate neurological condition when I was much younger. I don't even notice them. How often do we touch our face? My numb spots are larger than a quarter each and on the left chin, left cheek and left forehead. The only way I notice is if I touch them. Also there are different kinds of numbness. Two of my spots are numb to hot or cold but not to touch. I can feel a feather but not a hot spoon or ice cube as hot or cold on those.

Those spots have honestly been of no concern to me my entire adult life. I'm not really worried about any other numb spots except maybe right around the eyes (unlikely), the nose (not too worried), or the lips. And since I'm not doing anything likely to invoke nerve damage in the lips, that's the least of my concerns and I am having extensive FFS in 9 days.

Quote from: charlotte15 on April 13, 2015, 08:37:37 AM
Thanks Eva!

You said you don't want to look like you had FFS. Are there giveways, like the position of certain scars etc?

I've read cheek implants tend to be a bit overdone. I wonder if that's why you meant.

Well I guess I mean an overdone look, no not so much the scars giving it away except maybe the one on the neck from a trachea shave but I cant see anyway around that if its needed.... Im still on the fence on whether I should have that done... It wasn't a problem at all before the neck lift and lipo under my chin... I can see it now but people I trust say it isn't something they noticed until I mentioned it... Ive read that if its done poorly the skin on the neck can move with the larynx, and the scar can be too low on the neck... And if not done carefully or too aggressively it can even ruin the voice making it deeper by weakening the thyroid cartilage.... 

Maybe too small of a nose for the face, eyebrows too high with an unnatural expression and possibly even unnatural animation or even no animation , overdone lips (my problem now    ) overdone facelift, too tight ect.... Just a "plastic look" I guess...

Basically I wanted to not look like I had work done but have the masculine brow and chin/jaw rounded and tapered and shortened, bridge of my nose narrowed and nostrils made just a little smaller lip... Upper lip lift and a very slight natural augmentation ect. while also rejuvenating with the face and neck lift getting rid of the damn double chin and saggy neck ect...

Like I said Im overall very happy with Dr Spiegels subtle conservative approach but I really wish I would have been more clear about my expectations for the lip lift and augmentation.... I would have preferred less of a lift and I regret having the upper lip augmented and I feel he should have been more concerned with keeping the lower lip in the right proportion to the upper lip.... If the lips are overdone and not kept in natural proportions it can look weird... I feel he should have done the bottom lip as well as the top with very little augmentation and done less of a lift... Id rather have thin lips that have then look too big, the lift has the effect of making more upper lip visible all on its own and he should have known it was a mistake to augment it as well while doing nothing to the lower lip... Now Im going to have to hope I can find a doc to do my lower lip without screwing that up making it too big....

I donno about implants, my cheek bones and chin projection are very pronounced... I guess I could see problems with that if poorly done... But since I didn't need or want that I never looked into it.... Everyone has different needs and its best to find before/after results that match your facial structure....

Thanks for the explanation. The lips, I don't know but I would totally do them in a 2nd time. It's so easy to fix.

The cheeks, I had read that, but then I saw it done properly and the final result just looks like an angel.

The plastic look, yes, that I would want to avoid.