Facial Feminization Surgery

Prior to Transition



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Facial Plastic Surgeons


SRS Surgeons


"Feminization of the Transsexual"
Douglas K. Ousterhout,
M.D., D. D. S.





One day years ago, in the autumn of my seventh year, I was playing in the schoolyard at recess. The school bully walked up to me and shouted, "Hey, you. You play with girls. You're a SISSY."

Well, of course I played with girls. I felt I belonged with them. However, for some unexplainable reason, I felt compelled to defend myself to this moose. So, for the first and last time in my life, I started a fight.

"I am NOT," I answered, getting up and (gasp!) pushing him down. Then I realized what I had done, but it was too late. He came up swinging. One punch was all it took. Nose bleeding, I ran inside crying to the teacher.

That autumn day proved to be one of the more significant days of my childhood. It produced at least three long term results.

First, as mentioned, it persuaded me to always pursue a non-confrontational course.

Second, in my child's mind, I knew I had to keep my feminine feelings buried deep if I wished to avoid ridicule.

And third, I could never again breathe out of the right side of my broken nose.

Now in 1993, I still avoid confrontation. My therapist looked at my MMPI results and said, "I've never seen aggression scores so low." It helps to know this as I begin some of the necessary confrontations in my transition to a female life.

For I no longer hide my femininity. The doubts are gone and the issues are faced. Full time living is just a few months away.

And it is finally time to do something about that nose.

Actually I had several facial features which could stand a little improvement. The eyelids had fatty tissue looking like "bags" which were unattractive; the chin was receding and sharp like a man's. And then there was always that Adam's apple.

So I began asking questions and looking for gender community information about plastic surgeons. I had several requirements in mind.

First, I wanted a surgeon whose training was in ear, nose and throat surgery, not general surgery. I felt an ENT specialist would give me a greater likelihood for a totally good result.

Second, I wanted someone quite experienced in working with transsexual persons. I didn't want my new nose to have a great masculine arch.

Third, I wanted someone reasonably close to home, within driving distance. Atlanta seemed definitely to be the place I needed to begin my search.

With the help of references from the Montgomery Institute, I found a plastic surgeon in Atlanta who met all the qualifications. Dr. William Silver was very experienced and highly recommended. I decided to contact Dr. Silver for an initial appointment, because several of my friends had seen him at Southern Comfort 1992 and were very impressed with him.

I wrote in March 1993 and obtained an appointment for an initial visit in May. I explained what I wanted and gave both my male and female names. I received a very helpful letter from Dr. Silver's head nurse, confirming my appointment and assuring me the entire staff was sympathetic, understanding, and aware of my need for confidentiality.

At my initial visit in May I went dressed in a pullover top and slacks, but with my makeup on and hair styled. I was never made to feel uncomfortable by anyone in the office. Dr. Silver examined me and took some photographs. Then he sat down at his computer and showed a video image of my face in two views, before and after the changes he proposed to make. The computer's likeness of the results was impressive enough to raise my interest even more.

He recommended the following six procedures:
Rhinoplasty (reshaping the nose and straightening the septum. Insurance will pay for this part)
Blepharoplasty (removing fat pads from upper and lower eyelids)
Mentoplasty (plastic implant in chin to give feminine contour)
Tracheal shave
Lipectomy/liposuction of fat in "jowls" under jaws
Adding fullness to the upper lip with a Gore-Tex graft

The costs were as follows (discounted for multiple procedures; this is no guarantee of costs): Rhinoplasty $4500; Blepharoplasty $2500; Tracheal shave $2000; Mentoplasty $600; Lipectomy $1200; Lip $250. Insurance covered only the rhinoplasty. In addition, I had fees of $1000 for the facility and $1500 for anesthesia.

I looked at the picture and doubted I could ever look so feminine. After much discussion I agreed to the entire procedure and scheduled it for August 10. I made arrangements to be off work for ten days to allow time to convalesce.

I couldn't have done any of this without my friends, who took time from their schedules to spend with me in the Residence Inn as my private duty nurses.

On the day prior to surgery, I went to the PearleVision optical shop at the mall. I couldn't wear my contacts for over a week post op, and so I needed some good femme glasses. They were totally helpful and I got a very nice pair.

In the afternoon I had my preoperative visits with the anesthesiologist and with Dr. Silver. I had blood drawn for the HIV test. It was, of course, negative; but I was glad to get it drawn since I work around blood and incisions every day. I had been taking several pre-op medications prescribed by Dr. Silver including Stresstabs with zinc; cephalexin (antibiotic); and vitamin K to help prevent bleeding. So he gave me post-op prescriptions for the same, plus the all important painkillers.

That night I got a good night's rest; my last for six days.

Early the next morning, Tuesday, we drove to the hospital and I put on this darling little cotton gown, a little breezy in the back, and got a shot of Versed and Robinul (a sedative and something to dry secretions). Then an IV, and that's the last I remember till I woke up with my head feeling the size of a beach ball. I had a huge bandage that made me look like the creature from the black lagoon. A little nausea post-op but nothing serious. My friend got all the instructions for pain pills, dressings, etc., and then we were back to the motel. I napped off and on all afternoon and evening.

The worst thing was not the pain. It was not being able to breathe through my nose. I had no idea mouth breathing would fatigue me as much as it did. By Sunday my resting pulse was around 100, from exhaustion.

I couldn't swallow. Every time I did, I swallowed large amounts of air. Now that creates a miserable situation. With the help of Restoril, I was able to get through the nights...sort of.

By Thursday I felt better enough to get out for a few minutes. I bought some frozen pizzas and we had friends over for supper.

When I went for my office visit Friday I was hoping to get the packing out. But it was not to be. Dr. Silver said since I had so much work done, he wanted to give it more time to heal firmly. So only a few sutures out, the ones around the eyelids. The eyelids looked good. No more bags. The upper lip and neck also looked good. I worked myself into a frenzy for nothing, worrying about the tracheal shave. My voice was back to normal, after a few days' hoarseness from the endotracheal tube. Dr. Silver's surgical fellow, who is learning his procedures, got me cleaned up as much as possible.

The weekend was tedious, to say the least, with all the packing and bandage. I went to my Atlanta therapist and support group on Saturday. The group was very sympathetic but we did enjoy a laugh. They asked me if I had gotten the best of the fight. I said, "Yeah, you should have seen the other girl."

I was more than ready for Monday to arrive. I was at Dr. Silver's office early for the unveiling. He and his nurse softened the adhesive, then removed the splint and packing. I could feel myself relax automatically when my nose opened up; my pulse rate slowed to its normal resting level; I could breathe!

I looked in the mirror. Even with the expected swelling, the smaller size of the nose and a definite femme contour are obvious. I was extremely pleased. In fact the whole combination of six components went well. I have already commented about the eyelids and the tracheal shave. Well, the Silastic implant on the chin looks really good too. I didn't realize the receding chin problem I had had until I saw my new one. The contour of the upper lip is very slightly irregular, but it's obviously from swelling and should normalize in a week or two.

I began wearing my contacts again, building back up to a full day's wearing time over the next few days. I do have to use a little "suction cup" to insert and remove the hard contacts, but that's no problem. I can shower now. I have a saline nasal spray and some Polysporin ointment to apply around the nasal passages frequently. I can have my electrolysis Thursday as usual. The drive back to Jackson was nicely routine.

So life gets back to normal, except I wonder what I'm going to tell my colleagues at work who don't yet know my plans. I realize what I had doesn't compare to SRS (except in cost!) but it was very significant for me as I prepare for transition in a few months. I will have an easier time of it; plus, I'm simply very pleased with what Dr. Silver did. And, as the joke goes, the definition of "minor surgery" is "surgery on someone else". This was major enough for me for now.

If we are serious about a successful transition, every little bit helps. Not just the obvious essentials such as electrolysis and hormones, but the extras: vocal training, custom fitted hair pieces or additions, maybe even orthodontics. There are enough things like height, or hand and foot size, which we can't change. Plastic surgery can make a major difference in our favor. It deserves some careful consideration.