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facial feminization surgery (ffs) |
General overview and thoughts
I've been thinking about FFS for a long while. I'm one of those who is relatively fortunate not to absolutely need it but at the same time it would certainly help. The items I identified as being the most egregious were nose, jaw, Adam's apple.
Nose (rhinoplasty)
Nothing done on this yet. Looking into top doctors who can do Asian-style noses. Also looking to fix a turbinates problem.
Jaw (mandibular contouring)
 Before FFS (left) vs. Day 5 (right) | ||||||||||||||||||||||
One reason why I chose to return to Dr. Meltzer for jaw work was that I've seen photos of some of his patients and I think his FFS abilities are actually on par (or above) other doctors I've seen. His bedside manner rocks, he explains his technique patiently, and he is an all-around competent guy. Plus, his staff is great, transportation to/fro the airport couldn't be easier, and with options like Casa Doña it's hard deal to beat!
Wednesday, Surgery Day, was fairly uneventful. I was picked up by Robin and transported to Greenbaum around 10:30a in the morning. After being checked in, connected to an IV, and administered a strong cocktail of mind-numbing medicine they wheeled me into surgery about 12:30p. I only vaguely remember coming to and asking the nurse for ice chips. From what I could tell I was completely bandaged all around my head and there were two small drainage tubes coming out the corners of my mouth that made me drool a bit. (Ew.)
Morning couldn't come sooner and the following day I was discharged along with another SRS graduate in the early afternoon. Since I hadn't slept at all that night I was eager to settle back into Donna's leather couch and get some rest. I drank juice pretty much all day and tried to nap but it was really uncomfortable. Dr. Meltzer had changed my headwrap with one that was a bit tighter before I left from the hospital, and this new garb felt like it was squeezing from all angles. So I didn't get any sleep again.
Finally, on Saturday I removed the headwrapping per Dr. Meltzer's orders---he suggested I leave them on for 2 days not just 1 to keep the swelling down. While the pressure of the wrap was gone from my forehead and jaw, I realized how swollen up my cheeks were. I took the opportunity to run my tongue around the inside of my mouth to find the incisions. The sutures started from around the first bicuspids to about 1/2" behind my last molars on the cheeks just above the gumline.
Sunday was Day 4 and when I was supposed to start eating soft foods. I opted for some Indian ready-to-eat meals (the saag felt really good) and instant oatmeal. I also noticed that the swelling seemed to be going down quite a bit. One thing gross was that it feels like there's extra fluid "leaking" from the incisions. But the more that leaks the better (and less swollen) I feel. Looking in the mirror, I'm actually not too puffed out, which is a good thing because I need to "pass" in front of my roommates.
After about eight days the stich lines were dramatically improved to the point that I started spitting out piece of stiching that had dissolved/broken off. However the lingering jaw soreness (only when chewing) remained. The good news was that the swelling had pretty much subsided. Since I didn't really show bruising I think anyone would have been hard pressed to tell that I had surgery.
Pretty much all the swelling was gone by about a month later. But the two ridges left from the incision lines were still there. I pulled the sides of my cheeks away and found that there still are a couple pieces of stitching anchored deep near my back molars. The most annoying thing right now is that after eating anything I always have to swish with water otherwise I just can't get all that food unstuck. It's worse when I can't brush for a while---I know my dentist is going to kill me when she sees how much plaque has built up back there.
The medication schedule
You can download this schedule to print it separately.
time date medication notes (in days) Arnica
5x/dayCipro
2x/dayMedrol Dose Pack
Tapering dosePeridex Oral Rinse
2x/day-1 __ / __ 0 __ / __ Surgery week 1 1 __ / __ Drains out, hospital release 2 __ / __ Continue liquid diet 3 __ / __ Soft foods allowed 4 __ / __ Normal diet allowed 5 __ / __ 6 __ / __ 7 __ / __ week 1 8 __ / __ 9 __ / __ 10 __ / __ 11 __ / __ 12 __ / __ 13 __ / __ 14 __ / __
As an aside, I began to notice after a few surgeries and taking antibiotics for the flu that I had yeast infections. Starting this surgery I did something different where I am dilating with my anti-yeast cream. Hopefully it'll cut down on the yeast infections post-op.
Adam's apple (tracheal shave, thyroid cartilage reduction)
Though not very prominent I chose to get this done because I was bothered enough by it. I decided finally to go with a doctor who was local to me (so I wouldn't have to travel) who was recommended by other people. I hoped for the best and got a good result. However, I had a very strained voice which took over half a year to recover. My experiences:
2002.06.20: X-rays taken at a dentist's office. Needed for Dr. Ousterhout. Film and office time costs.
Consultation with Dr. Ousterhout. Looked at samples of his patients, got measurements taken, and received a price quote. I could buy a very nice car with the money I'd spend if I did all his recommended procedures! (But that's probably true if you went anywhere and got the whole works.)
2002.07.02: Additional consultations with FFS surgeons.
2003.01.15: Last consultation with Dr. Orisek, the FFS surgeon. The deciding factors included proximity to home and surgery technique. Surgery date is now booked. Estimated costs: $2,500 trach, $850 surgery center, $40 antibiotics.
2003.01.27: Pre-op visit. Got photos taken, my larynx examined, and I paid my money.
2003.02.04: $2500 was the surgeon's fee, $900 was the surgery center's fee, and $10 was the medication fee for an antibiotic (Cefuroxime) and a pain killer (Hydrocodone, generic for Vicodin). Surgery day. Tracheal shave / thryoid cartilage reduction (TCR) / thyroplasty. Granted, my Adam's apple isn't big but it is nonetheless present.
- 0720: Left house to go to surgery center. It's close by so we didn't have to rush. I was nervous, but kept my chin up.
- 0740: Got to center and went to the receptionist. Filled out a few forms, paid my surgery center fees, and went back to the lobby to wait. My ride pulled out a book and started reading.
- 0755: Nurse came in and took me through the doors. She requested I hit the bathroom once more then took me to a bed. I was given a gown, some socks, and a blanket. The nurse took my vitals and then tried threading an IV. She wanted to use the top of my left hand but we couldn't get a vein up. (Interesting note: ever since starting HRT the veins on my hands and arms have not been as noticeable.) She taped the entry point and then called another nurse in. The other nurse got the IV into my right arm.
- 0840: Another nurse came by and gave me a valium tablet. I swear to you I have no idea what it does for me because I didn't feel any calmer or sleepier. I remember while I had some minutes alone just feeling and playing with my Adam's apple, just to get a sense of its size and shape.
- 0855: Dr. Orisek came by and we chatted for a few minutes. He took out a pen and marked my neck up. My friend was invited in to say a last "hello" and then I was wheeled into the room.
- 0900: I was into the room with about 5 other women running around doing things. They told me to move to another bed and they started a sedative into my IV. I really didn't feel much of anything, but oh well. They propped me up and got my neck back. I guess the sedative was working because I sure didn't feel a thing. Dr. Orisek prodded and tugged and I couldn't really feel much going on. I could hear stuff but was groggy and wasn't paying too much attention. He would once in a while ask me to talk and so I did---he sometimes asked me to effect a Girl Voice to which I tried but didn't do all that well (but not like there was any contest to begin with). I grunted and said "ow" a couple of times when I felt he was in a bit deep. I had a blue cloth over my face so I could not see anything going on at all. At some point he sutured me and bandaged the site. They took the cloth off and transferred me back to the gurney. They let me just lie for a while and then propped me up. I'm pretty sure I took my first antibiotic around then, but I can't remember at this point. In a few moments they give me my bag of clothes and shoes and I put them back on. A wheelchair was pulled up right next to me and I got in. We went through a series of doors, down the elevator, and into my friend's car.
- 1110: We travelled back home. I was feeling queasy from the anesthetic, but I was still mostly conscious.
- 1130: We got back home and I slowly trudged upstairs. I dropped this and that onto my bedroom floor, changed into my jammies, and crawled into bed.
- 1730: I had already gotten up and down a few times. I had taken 1 5/500 hydrocodone (vicadin generic) but it didn't seem to do anything for me. I was bored, so I got on the computer, typed something, went down and made tea, drank some, went back to bed.
- 1950: Got up, made some soup, took my meds, dilly dallied for a while. I sorted out a bunch of papers, put away some of my computer manuals, crushed a few boxes, read e-mail, and did weird stuff. I was bored of sleeping, can you believe that? Swallowing hurt quite a bit but I had to do it to get food, water, and meds down. Watched Smallville at 9:00p. Watched Mulholland Drive. Talked online for a while. And then hit the sack around 2:15a.
- 0215: Went to bed.
- 1000: Post-op evaluation. Dr. Orisek removed the bandages, gave me some antibiotic ointment, and said see him in a week or so. He said the operation results were very good and I can't even feel where my Adam's apple was. I asked if he was anywhere close to damaging the vocal folds and he said no, this was quite far removed. But I will have intense soreness over the next few days as the swelling subsides and the site heals.
- 1330: Voice virtually nonexistant as I'm very very hoarse. But I made some fettuccine and was able to eat normally. It still hurts pretty bad when swallowing but it could be worse.
- 2130: Began composing photos from my archives of the progress of this procedure. I was going to place them in the Notes column but the side-by-side comparison to me is more telling. As you can see from the above before and after photos, even my shadow used to cast a prominent bump.
- 1400: Feeling much better. Zero nausea. Swallowing is getting easier. But my throat is itching inside and out. This is probably a combination between the reduction in swelling, the coughing I've been doing, and pre-surgery voice stress. All in all it just makes me gag---unfortunately I'm pretty sensitive in the throat area. I'm trying to keep the liquids going all of the time to ease the sensation, but sometimes it's hard. I'm starting to eat more non-soft foods like chips and stuff. Maybe tonight I'll get some real meat back in my diet. This may be TMI, but I've been finding that I've been passing a lot of liquids in the past 2 days. Almost all of my diet has been soup, water, soda, and some pasta---real soft foods.
- 1530: Sutures out. The doctor says that the results came out very good and I should be healing in no time. There are no special procedures I need to follow anymore---just let my body heal on its own. He did caution about one thing though: he noticed vocal nodules on my pre-op exam and said that my constant throat clearing will only prolong the healing of those. He suggested using my remaining Vicodin/Hydrocodone tablets (in half doses) to quell my need to cough and clear my throat. He also said that plenty of voice rest would be the best solution.
- Went in today because I complained about continuing voice hoarseness. Dr. Orisek took a look and noted the edema and nodules. He noted that the vocal structures were intact and that no damage was done to that, but that the inflammation is problematic. He prescribed a course of corticosteroids, specifically Prednisone.
- Returned for a checkup. My voice has been feeling a lot better and he confirmed visually that things are looking much better. But, he did say that the nodules are starting to cause major problems. I may need to have them removed some time in the next few years. Here's the funny part: so the nodules are causing the folds not to close properly leaving gaps. Well, my body's way of filling those gaps will be either to squeeze the folds closer together or to have my folds swell up a little. So, in order for me to achieve my girl voice I'll actually have to sort of injure the folds. Well, it made sense to me. What's more interesting is that these nodules are old ones, probably from years ago. So, my Girl Voice may actually be relying on the nodules being there! I just have to wait for the final bit of edema to go away before I get more of my Girl Voice back. He noted that now I just need to retrain my voice and it'll hopefully get better. I have faith and patience that it can be done.
- By now voice has pretty much returned but has a different quality to it. It's hard to describe but it's a lot more mellow.
- The scar is barely noticeable if at all. There is still some slight redness at the site of the stitches but that's about it.
- Voice has completely returned to normal. It sorta came back to full strength a while ago, but now it's pretty strong. The scar is completely invisible now---I have to look back at these pictures to remind myself where it was.
These were taken over time so you can see the healing process.
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