Hi Everyone,

I rarely start a new topic, but I wanted to share my experience with FFS and recovery, as mine has been much different from many others that have been chronicled on this site. I had FFS on September 15th with Dr. Zukowski. The treatment  plan was very aggressive. I had Type I forehead contouring, brow lift, scalp advance, lower eyelid blepharoplasty, rhinoplasty, septoplasty, upper lip lift, chin contouring, lower face and neck lift, trachea shave, buccal fat removal, and fat transfers to the temples, cheeks, upper lip, and nasolabial folds. It was a nine-hour surgery. After a three-hour recovery at the clinic, I was driven back to my hotel by a nurse.

This is what I looked like hours after my FFS, back at my hotel room:



I was in a lot of pain.  I was taking two hydrocodone tablets every four hours, and begging the nurse for more. I could not even see for the first two days. My throat was raw from intubation and mouth-breathing.  I couldn't really close my mouth without a lot of effort, and my saliva dried up.  Swallowing was very painful.

The nurse I had for aftercare helped me shower on day three, and I got a lot of the bandages off.  The swelling in my upper lip had started to go down, and I could almost close my mouth.  I still could not drink through a straw.

This was four days post-op:



I still had a drain in my neck and behind my ears. That came out on day five. The white thing around my head is a compression garment. It help minimize swelling under the jaw.

This was eight days post-op:



I had to trudge through Chicago O'Hare airport looking like this, minus the compression garment. Amazingly, no one paid much attention.

15 days post-op. A lot of the bruising has gone down.



Finally, 25 days post-op:



So much for "restaurant ready".  The swelling in my nose and neck seems to be getting worse, despite the ibuprofen and daily massages. You can't see them, but I have big bruises under my jaw.

I have been slowly getting better, but it has been a long, hard road. I took two-and-a-half weeks off from work, and went back part-time the third week. I barely was able to do that.  My stamina was close to zero. Finally, I was able to go back to work full time the fourth week, but I am nowhere close to 100%.  On the plus side, I lost 17 pounds in two weeks.

I still have no feeling in my forehead, front of my scalp, under my jaw, or the tips of my ears.  The parts that aren't numb are tender.  I have to sleep with the compression garment on, which took some getting used to. I also had to get used to sleeping on my back. I am a side-sleeper, but that was very uncomfortable because of the pain in my ears. For the first three weeks after surgery I was taking hydrocodone and valium every night just to get to sleep. The pain from the lower face/neck lift has been the worst. I now take 1200 mg of ibuprofen a day for swelling and pain.  I am still bothered by the sutures in my mouth, and I can't open my jaw more than a couple of fingers wide. I'm still spitting sutures from around my ears, under my nose, and at my hairline.

I only point this stuff out because everyone else seems to have had these wonderful, nearly painless experiences, but that's not always how it goes.   Just a warning to those of you dreaming about FFS. I wanted this laundry list of stuff done to my face so I could look and feel beautiful, and I never thought for one minute what recovery would be like. Everyone is different, but for me it has been very, very tough.  I am not telling anyone not to get FFS, I just want people to know what it can be like.

I got very discouraged and depressed about my recovery, and I want to thank some of the people on this site who have reached out and given me encouragement and strength.  I hope this post has been at least somewhat informative, if not helpful to others.

~Terri

My goodness that was a heroic amount of work to have done at the same time and then recover from.
I had FFS the first week of January 2016. I had brow contouring and lift, rhinoplasty to adjust to a small degree the width and slope of the nose, and the laryngeal or tracheal shave.
I thought three things at once was a lot but apparently the three I had done is a very common choice.
Recovery was really good with virtually no real pain just some discomfort.
I had my partner and daughter caring for me at home so I was well cared for.
A cool mist humidifier is a good thing to use through the entire recovery.
It took about four weeks to look reasonably ok but not great and another four until the bruising and swelling was gone.
It is true that we don't really think about the recovery and the pain.
I hope you are through the worst of it and that you will eventually be happy and feel it was all worth it.

I had FFS with Spiegel on Sept 30. I wasn't too worried about the recovery, just that I might regret something. But when I woke up I felt like I made the right choice.

The first night was hard because of the sore throat, but once I could swallow easily, recovery was not painful. I stopped taking pain meds after 7 days.

I have heard that Zukowski recoveries take longer than Spiegel recoveries and that seems consistent with my experience.

Wow thanks for sharing. Sounds like a tough road for sure. Hoping mine isn't so bad but I am only getting forehead and nose done. We'll see how it goes.

Terri, thank you for sharing your FFS experience here.  I'm sorry you've had such a difficult recovery though. 

Quote from: cej on October 15, 2016, 06:15:52 PM
I had FFS with Spiegel on Sept 30. I wasn't too worried about the recovery, just that I might regret something. But when I woke up I felt like I made the right choice.

The first night was hard because of the sore throat, but once I could swallow easily, recovery was not painful. I stopped taking pain meds after 7 days.

I have heard that Zukowski recoveries take longer than Spiegel recoveries and that seems consistent with my experience.

Well for me, I didn't have a sore throat at all.  And absolutely no difficulty swallowing either, even though I had a trachea shave done by Dr Zukowski as part of my FFS. 

Unlike Terri, I didn't experience much pain, and what pain there was was easily managed by normal dosages of vicodin.  I stopped taking prescription pain meds after about a week.  The worst pain was the first several hours when I had to pee, after having my catheter removed, lol.  But also unlike Terri, my rhinoplasty was 2 hrs, and the rest of my FFS (done 8 months later) was 3-4 hrs.  Terri's surgery was 9 hours, all at once!  Also keep in mind that Terri had work done in her chin/jaw area, which is usually the most painful to recover from.

Sorry cej, but I don't think that Zukowski's surgical techniques just "somehow" make patients take longer to recover than Spiegel.  No, that's just baseless speculation.  A more plausible explanation is that Zukowski tends to recommend more procedures than Spiegel.  Thing is, quite a lot of patients simply agree to everything a surgeon suggests without really thinking hard about all the implications beforehand.  It's the number of procedures and the length of the surgery that really affect how difficult the recovery process can be (also, of course, an individual's personal pain tolerance and rate of self-healing).

There are some surgical procedures that are truly necessary to feminize a face (brow bossing removal and trachea shave, for example).  But some procedures are really not necessary, and they can make recovery more difficult, not to mention the added financial cost.  Does that make it wrong for a surgeon to suggest those procedures?  Or for a patient to want them done?  No!!!  There are plenty of cis women who get cosmetic surgery to make themselves look younger and more beautiful.  There is nothing wrong with that.  But you have to think really hard before the surgery about what you want done to feminize your face, versus what you want done to look more beautiful.  It is up to you, the patient, to do this research yourself.  It is a very personal decision and should not be taken lightly.

Quote from: Stephenie S on October 15, 2016, 05:53:40 PM
My goodness that was a heroic amount of work to have done at the same time and then recover from.

Yes, I think "heroic" is the right word. 

Terri, the worst is behind you now, and as more time goes by, you'll slowly start to feel more like your normal self.  I'm confident you'll be happy with the final look in the end!!

Thanks for posting that. Its a good addition to the community knowledge. I'm becoming more and more interested in this subject lately and I'm still learning a lot.

I'm unclear if you're happy with the aesthetic result so far?

Is this a typo? Three days?

Quote from: Maybebaby56 on October 15, 2016, 05:33:06 PM
It was a nine-hour surgery. After a three-hour recovery at the clinic, I was driven back to my hotel by a nurse.

I'm fairly put off by the the lack of proper pain medication. I don't see any reason to suffer pain as there's some really strong drugs like morphine available.

Quote from: AnonyMs on October 16, 2016, 08:08:34 AM
Thanks for posting that. Its a good addition to the community knowledge. I'm becoming more and more interested in this subject lately and I'm still learning a lot.

I'm unclear if you're happy with the aesthetic result so far?

Is this a typo? Three days?

I'm fairly put off by the the lack of proper pain medication. I don't see any reason to suffer pain as there's some really strong drugs like morphine available.

Hi AnonyMs,

I'm glad you asked about the results , because I should have specifically mentioned in my original post that I consider my FFS successful.  My face clearly looks more feminine now, even with post-op swelling.

Pre-op profile vs 12 days post-op:


As for your question about recovery, that was not a typo. I was out of recovery in three hours, and driven to my hotel room. Dr. Zukowski does most of his surgeries in his clinic.  He has a fully-accredited operating theater there.  There is an anesthesiologist and OR nurse present during the procedure.  The benefit is supposedly less cost and less risk of infection (hospitals have lots of sick people in them), but as I painfully learned, there is one huge disadvantage - pain management. It is not well managed by an RN in a hotel room. There is no equipment to monitor blood oxygen levels or any way to handle respiratory depression from opioid overdose, as there would be in a hospital. If I had to do this over again, I would have asked for a hospital stay. I have a low pain tolerance, and I would have asked for a morphine drip or demerol.  Dr. Zukowski is fully accredited to operate in one of the local hospitals, and will do the procedures there if you prefer. 

So, lesson learned.  The bottom line, though, is I am happy with the results so far if I look at it objectively.

~Terri

Quote from: EmilyMK03 on October 16, 2016, 07:49:34 AM
Terri, thank you for sharing your FFS experience here.  I'm sorry you've had such a difficult recovery though. 

Terri, the worst is behind you now, and as more time goes by, you'll slowly start to feel more like your normal self.  I'm confident you'll be happy with the final look in the end!!

Hi Emily,

I want to thank you specifically for the kindness and support you have given me the last few weeks.  Also, I want to give thanks to Happy Moni, who has also been very supportive and helpful.  Lastly, I want to thank my friends Jessie Ann and Keri (formerly known as Dodie) for their valuable input and encouragement.

With love and kindness,

Terri

Quote from: EmilyMK03 on October 16, 2016, 07:49:34 AM
Sorry cej, but I don't think that Zukowski's surgical techniques just "somehow" make patients take longer to recover than Spiegel.  No, that's just baseless speculation.  A more plausible explanation is that Zukowski tends to recommend more procedures than Spiegel.  Thing is, quite a lot of patients simply agree to everything a surgeon suggests without really thinking hard about all the implications beforehand.  It's the number of procedures and the length of the surgery that really affect how difficult the recovery process can be (also, of course, an individual's personal pain tolerance and rate of self-healing).

Spiegel and Z recommended the same list of procedures to me, and I did them all except upper lip lift (which I'll probably add later).
I had 6 hours of surgery. I do think Z defaults to more aggressive mandible, brow, and nose work, though of course both surgeons will deviate from their aesthetic if you ask.

Recovery times and procedures vary highly by individual and FFS is a procedure you don't want to do more than once so it's hard to do a controlled comparison between surgeons. I think FFS would have been worth it for me even if recovery had taken much longer, so I don't think it's a reason to choose one surgeon over another. If I ever get GCS, Thai GCS recovery times are way longer than US but I'd probably still go to Thailand because I couldn't handle the regret of getting a less great result to save myself a few months of discomfort.

Hi Terri, thank you for your help when I was recovering from FFS. It really made a difference when you shard with me your experience. You alleviated many of my fears. You helped me when I was depressed and questioning.

I stayed in the hospital 2 days and had a lot of pain meds. I slept the whole time. On the third day I went to the extended stay and had a horrible 24 hours with throwing up (dry heaves) and bad pain. I think the bad pain was from throwing up. I could not blow my nose as per the doctor and that was an issue after throwing up once. I took nothing in during that period. On the 4th day I awoke was able to manage. I did not take the oxycodone outside of the hospital. I would not be able to keep it down on the third day and the rest of the time for personal reasons. Also, If I could take the 3rd day then the rest would be much easier.

I heal super quick. Dr. Spiegel and their staff were surprised. They said I was the least swollen and least bruised of all his patients.  Yet I was swollen and bruised. I had extensive FFS.

I think your initial post-op photos are fantastic! I had FFS, including rhinoplasty, tracheal shave, lip lift and forehead contouring in September of 2015 with Dr. Deschamps-Braly (with guidance from Dr. O). There was noticeable change following the surgery, especially after about 2 weeks or so, but it was very difficult to pinpoint where exactly the change came from.

I'm trying to post photos but have no idea how, and I can't find help anywhere on site! 

The biggest issue I still contend with a year later is my nose. It still swells for what seems like no reason at all, and when it does it changes my features dramatically. I guess my advice is to be patient - everything I read prior to surgery suggested that the healing and "settling" takes upward of a year post-op and my experience suggests that advice is dead-on. I don't think my features are fully settled yet, and the best part of that is that I continue to feminize so the continuing change is all good!

BTW, I had very little sensation in my scalp and forehead for months. Post-op pain was most severe immediately after awakening - think ice pick through forehead!! The next most negative experience was nose packing and sleeping sitting in a recliner!

Congratulations!

Terri, I think you have a very good result!  I predict you will be over the moon come February.

I had it all done at once in Portland, back when Toby was still in Portland. So I stayed in his hospital wing for a week.  Anyways, 12 hours on the operating table, for forehead, nose, upper lift, mandible, and chin.  I was on morphine for twenty-four hours after that, and then they took me off it and gave me Percocet.

The following morning (like 6am) I was in such excruciating pain I wanted to commit suicide.  My previous "10" on the scale of 1 to 10 for pain (which was a root canal) was now a 3.  I was begging to go back in time and keep this from happening.  The nurse there kept me alive.  I remember her telling me how this would pass, and how beautiful I would be, that it really was going to be worth all this.  They got me on a high dose of Oxycontin or Vicodin, and some Xanax to calm me down.  It was a grueling week, but I got through it and got home safe and sound.

It took a good two months for the swelling to go down, and it wasn't until four months out that everything finally started to settle in.

This is major invasive surgery.  It's no walk in the park.  And it's totally, totally worth every bit of it. 

Terri,

You already look FANTASTIC!!   can wait to see your picture in another 2 weeks!

There is hope for me....

Emily

Quote from: Mia on October 16, 2016, 12:33:34 PM
I think your initial post-op photos are fantastic! I had FFS, including rhinoplasty, tracheal shave, lip lift and forehead contouring in September of 2015 with Dr. Deschamps-Braly (with guidance from Dr. O). There was noticeable change following the surgery, especially after about 2 weeks or so, but it was very difficult to pinpoint where exactly the change came from.

I'm trying to post photos but have no idea how, and I can't find help anywhere on site! 

The biggest issue I still contend with a year later is my nose. It still swells for what seems like no reason at all, and when it does it changes my features dramatically. I guess my advice is to be patient - everything I read prior to surgery suggested that the healing and "settling" takes upward of a year post-op and my experience suggests that advice is dead-on. I don't think my features are fully settled yet, and the best part of that is that I continue to feminize so the continuing change is all good!

BTW, I had very little sensation in my scalp and forehead for months. Post-op pain was most severe immediately after awakening - think ice pick through forehead!! The next most negative experience was nose packing and sleeping sitting in a recliner!

Congratulations!

Thank you for posting this, Mia. I am most concerned about my nose.  It was absolutely perfect on day 12, then I took the tape off and in the next couple of days I noticed significant swelling at the tip of my nose, and my perfectly shaped nose now had a bump at the bridge! The bump really worries me.  I hear the bone pretty much sets after six weeks. I try to do the massages Dr. Zukowski recommends, but nothing really seems to happen except for my nose getting sore.

As far as photos, I think you have to have 15 posts to do that.  I'm surprised Dena or Joanna or someone hasn't come swooping down out of the heavens to give you the standard introductory welcome.

I look forward to your posts!

With kindness,

Terri

Quote from: Rachel Lynn on October 16, 2016, 10:55:37 AM
Hi Terri, thank you for your help when I was recovering from FFS. It really made a difference when you shard with me your experience. You alleviated many of my fears. You helped me when I was depressed and questioning.

I stayed in the hospital 2 days and had a lot of pain meds. I slept the whole time. On the third day I went to the extended stay and had a horrible 24 hours with throwing up (dry heaves) and bad pain. I think the bad pain was from throwing up. I could not blow my nose as per the doctor and that was an issue after throwing up once. I took nothing in during that period. On the 4th day I awoke was able to manage. I did not take the oxycodone outside of the hospital. I would not be able to keep it down on the third day and the rest of the time for personal reasons. Also, If I could take the 3rd day then the rest would be much easier.

I heal super quick. Dr. Spiegel and their staff were surprised. They said I was the least swollen and least bruised of all his patients.  Yet I was swollen and bruised. I had extensive FFS.

His Rachel,

You are quite welcome.  As I mentioned, I got that same support from others, and I am glad I was able to provide some small amount of reassurance to you.

I have followed your 40+ page "blog" on your transition, and I must say you are a very brave woman. You have accomplished so much in so little time.  I have been in transition about two-and-a-half years, and I am only now trying to deal with the estrangement from my wife and sons, getting my name legally changed (Done!), gender marker changed with the SSA (Done!), and on to getting a new drivers license, coming out at work, and everything else.

I should be full-time by November, and then the clock starts on RLE.  Transition is so damn hard.

~Terri

Quote from: Sophia Sage on October 16, 2016, 12:53:36 PM
Terri, I think you have a very good result!  I predict you will be over the moon come February.

I had it all done at once in Portland, back when Toby was still in Portland. So I stayed in his hospital wing for a week.  Anyways, 12 hours on the operating table, for forehead, nose, upper lift, mandible, and chin.  I was on morphine for twenty-four hours after that, and then they took me off it and gave me Percocet.

The following morning (like 6am) I was in such excruciating pain I wanted to commit suicide.  My previous "10" on the scale of 1 to 10 for pain (which was a root canal) was now a 3.  I was begging to go back in time and keep this from happening.  The nurse there kept me alive.  I remember her telling me how this would pass, and how beautiful I would be, that it really was going to be worth all this.  They got me on a high dose of Oxycontin or Vicodin, and some Xanax to calm me down.  It was a grueling week, but I got through it and got home safe and sound.

It took a good two months for the swelling to go down, and it wasn't until four months out that everything finally started to settle in.

This is major invasive surgery.  It's no walk in the park.  And it's totally, totally worth every bit of it. 

Hi Sophia,

Thank you so much for posting this.  This is the message I wanted to get across.  I don't regret FFS one bit.  I consider my surgery a success. In a way, I'm glad I was so naive.  I may not have had the courage to do it! I'm about as tough as wet tissue paper.  Fortunately everything worked out.

With kindness,

Terri

Quote from: Emily R on October 16, 2016, 01:51:30 PM
Terri,

You already look FANTASTIC!!   can wait to see your picture in another 2 weeks!

There is hope for me....

Emily

Hi Emily,

Thank you for your kind words.  As you can see, the change from 15 to 25 days was minimal.  In fact, I think I look worse at day 25 than I did at day 15.  That is part of what makes recovery so tough.  You tell yourself, "Everyday I am going to get a little better", then you look in the mirror and that is not happening.

As others have told me, and I can attest to, post-operative depression is a real thing.  I was under anaesthesia for nine hours.  It has an effect on you.  Even Dr. Zukowski told me, "When you get home, you are going to hit a wall. Just rest as much as you can."   

Yes, Emily, there is hope for you. I am not tough, and I am not brave, and I managed to do it.  You can, too.

Best wishes to you,

Terri

Quote from: Sophia Sage on October 16, 2016, 12:53:36 PM
The following morning (like 6am) I was in such excruciating pain I wanted to commit suicide.  My previous "10" on the scale of 1 to 10 for pain (which was a root canal) was now a 3.

That brings back memories... I had the works with Dr. O back in 1999... the pain and discomfort post FFS was the worst I had ever felt... compared to that, SRS with breast augmentation was a walk in the park!

BTW I had consults with both Dr. O an Meltzer for FFS in 1998. I decided on Dr. O  back then because he impressed more. Meltzer was just getting into the FFS and I wanted someone with more experience. (I did use Meltzer for SRS)

It does take a long time to see the final result. In my case I was mostly there in about 6 months, but for some it is longer.

Quote from: Karen_A on October 16, 2016, 03:54:40 PMThat brings back memories... I had the works with Dr. O back in 1999... the pain and discomfort post FFS was the worst I had ever felt... compared to that, SRS with breast augmentation was a walk in the park!

Indeed!

SRS/BAS was about a 6 on the pain scale, compared to the 10 of facial surgery.  Quite the walk in the park!

Quote from: Sophia Sage on October 16, 2016, 05:37:29 PM
Indeed!

SRS/BAS was about a 6 on the pain scale, compared to the 10 of facial surgery.  Quite the walk in the park!

Results may vary.

SRS =8, Trach=5, FFS=4, blepharoplasty=2, Root canal=2, wisdom teeth=2, labiaplasty=2, broken rib=5. I had Ousterhout for FFS and the bleph, if it matters.