Facial Feminisation Surgery outcome carried out in the United Kingdom Results with Mr Keith Altman.
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My Facial Feminisation Surgery (FFS)
Of course I want to look like Marilyn Monroe or Carol Vorderman. But it ain’t going to happen. I have too much testosterone-damage. I transitioned at age 54 and had FFS two-and-a-half years later. By my mid fifties my body had masculinised horribly. What could I do about it?
Within a year of starting hormones, my body fat distribution had feminised quite a lot and I began to pass a lot better. By then I had also got rid of the dark hairs in my beard, using a technique called ELOS, which is combined intense pulsed light (IPL) and radio frequency. Most of it has shown little regrowth. The exception was the moustache, on which I have now had eight sessions of diathermy electrolysis. That has got removed most of it.
I never thought I would be able to afford FFS. Like many trans women I had a divorce to pay for (major ouch!) and my business, which was dying anyway due to the poor economic climate, did not survive my divorce. After splitting up, I bought a house in Cambridge, thinking that was a good place to find work, but ended up with a job in Bristol. It then took me over a year to sell the home in Cambridge. Once that money was in the bank, I began to investigate FFS.
By this time I knew that my face was not that masculine, but was masculine enough seriously to interfere with my ability to pass. I just hated looking at it in a mirror.
On my next routine check-up with Richard Curtis I asked him about surgery options. He suggested a couple of hair transplant surgeons and two FFS surgeons, one in England, one in Belgium.
All the hair transplant surgeon could do was to re-distribute my already sparse hairs, not create fresh hairs. It was £4000 for one session; and the killer line in their letter was that ‘many ladies like to have further treatments’. I took that to mean that it didn’t work terribly well. I do not have Wayne Rooney’s budget to keep trying. Besides, £4000 will buy you an extremely good wig. So I’m not going to bother unless I win the lottery.
It took a few weeks to set up a private appointment with Keith Altman, the FFS surgeon in Brighton (http://www.keithaltman.com/facial_feminization_surgery.php), mostly I suspect because it was the summer holiday season. Mr Altman has two secretaries, Gill and Debbie, who are both lovely people. I figured I’d start off in the UK and take it from there. The initial consultation cost £100. Of course, like all such people, he had before and after photos. To my slight embarrassment I recognised the first person whose pictures he showed me. She subsequently recommended him wholeheartedly.
I was going to need three weeks off work, about which my employer made no trouble.
I did feel I needed a second opinion. For this I turned to the Virtual FFS service offered by a trans woman artist called Alexandra (http://www.virtualffs.co.uk). This cost a little over £100. I got my ‘before’ photos taken professionally, by a photographer who was local, but not very local, to discourage village gossip. That also was not cheap: £150 or so.
The Virtual FFS assessment came back very quickly. It agreed with what Mr Altman said, namely that my face is not very masculine, but that it would benefit from brow lifting, cheek implants, brow bossing reduction and a nose job (rhinoplasty). Neither said that I needed any mouth, lip or jaw work.
This greatly encouraged me. The surgeon was not just trying to sell me stuff I did not need. Alexandra had sent me a picture of me which looked quite feminine. The question now was; could the surgeon recreate this look, or was it more cloud-cuckoo land?
At about this time I had my first visit to the GRS surgeon at Charing Cross. It was clear from this visit that the wait for GRS was going to be over six months, and he was not worried about how long I would need to recover from FFS before GRS. So right there in the Charing Cross Gender Identity Clinic waiting room, I called Mr Altman’s secretary and booked my FFS. I was offered a date two months & one week later.
The die was cast!
I had a further surgical consultation, which was a little more detailed. I also had to get a CT scan of my skull done beforehand. That was interesting. Brow bossing in most males (something like 90%) involves having hollow sinus cavities under the eyebrows as well as bone thickening. I just had bone thickening, and one small sinus cavity on the right hand side. Mr Altman said after the op that it was the smallest one he had ever seen.
I took the Virtual FFS images, and suggested that these would be a point for discussion, because I needed to manage my expectations: I still did not know how good an outcome to expect, and was a little cynical that the surgeons only ever showed their best-outcome photos.
Mr Altman said that what had been drawn was about what he could do. It was not an unrealistic expectation.
A month to go and it was all looking positive. I had to have a blood test for SARS exactly 10 days before the op. Organising that around business travel was a pain, because it had to be done at a Nuffield hospital.
Then I picked up Norovirus, and was violently ill five days before the op. Not a good sign. Luckily it passed as quickly as it came. Since it was December, I was dreading picking up a cold and having the op postponed.
A nice leisurely trip to Brighton was put paid to because for work I had to go to a meeting in London the morning I was admitted, and it snowed that day, just to make sure all travel arrangements were going to be ruined. By now I was very anxious about the op anyway, and really rather loaded with stress. How I concentrated on that meeting I do not know.
For the most part it irritates me when people tell me I was brave to transition. “No, dear, I was desperate. That’s what you have not understood.” I’m more polite than that, but it’s what I always want to say. Anyway, going to that hospital did require courage. It was going to hurt.
I got there with no further difficulties, and spent the rest of that day being poked & prodded. The only thing that made me cross was that junior doctors always without fail mess up taking blood. They hurt, leave big bruises and have to try both arms.
The next day was it. I met David, the anaesthetist, a really lovely man. He asked me about all my previous experiences with general anaesthetics. I had had one nasty experience once. He thought he knew what would have caused that and said he would use a different drug. That’s about the last thing I remember. There was a little complication about a leaking blood vessel, so they had to put me back to sleep to deal with it, but I have minimal memory of this. I woke up that evening. The painkillers must have been good. I was not in pain.
My father and brother came to visit. Mum had a tummy bug, so she didn’t come. Brother charmingly took one look at my bruised eyes and pulled a face. The rest of my head was bandaged up like an Egyptian mummy. But it was good to see them.
Mr Altman and David the anaesthetist were very solicitous and paid me frequent visits. They were both popular with and respected by the nurses – always a good sign in my opinion. Doctors can’t fool nurses for long.
For the next two days I was not feeling great, but didn’t feel terrible either. Having had the op on the Thursday I was discharged on the Saturday. My brother took me to my parents’, where I spent the next three weeks convalescing. I had been a little anxious about being under their roof for so long – the longest in 36 years – but it went fine.
With hindsight I realise that most of the discomfort I felt over those three weeks was caused by codeine-containing painkillers. They gave me indigestion and a fair bit of constipation. But they did stop the pain. The stitches and staples came out after a week.
I was back at work on January 2nd. I had changed my wig style to throw people off the scent. This worked. Most of my colleagues thought I had been using up holiday in December. By then there was still some swelling; and the bruising was subtle: a sort of jaundice yellow colour around the eyes. Both my boss and HR had assumed I would need more time off but I didn’t.
The six week check-up went off uneventfully.
Now, three months later, I have recovered enough to have ‘after’ photos taken. You can see for yourself what they look like.
The cost was £12,500. The benefits? First, I look in a mirror and see a woman not a trans woman. That is such a relief, and happened very quickly.
The second benefit took longer to appear, as I recovered and my face settled. It is that I pass a LOT better. I get fewer funny looks and cat-calls from kids. I get called madam and ‘the lady’ more often and with no uncertainty.
I look and feel prettier.
As I write, I am two weeks off the next challenge: GRS. It will be interesting to see how that compares, but at least I will go into it knowing what major surgery feels like.