Deciding Where to get FFS

After lining up consultations with a number of surgeons I was eager and nervous to meeting them. I wanted to know what procedures would benefit me the most. I wanted to hear the surgeons talk about how they perform the procedures and what suggestions or recommendations they would have for me.  I wanted to get a sense of the individuals to then make a decision and move on to start arranging for surgery.

Consultations With Local Surgeons

It was mid April 2016 and before that I had arranged for consultations with 2 local hair transplant surgeons, 2 local rhinoplasty plastic surgeons, Virtual FFS (a service that based on photos of your face it simulates various FFS procedures and produces a detailed personalized report), and remote videoconferencing consultations with 2 renowned FFS surgeons abroad.

To make the long story short, this is the chronological order in which I met the different surgeons either in person for the local ones or via Skype for the 2 FFS surgeons abroad. First I met the hair transplant surgeons. One on a Monday and the other on the Tuesday of the same week in mid April 2016. The first question I had for myself was to determine what would be the best procedure to change my hairline, between scalp advancement or hair transplant or a combination of both. This important question got answered on the very first consultation and then corroborated the day after. I was not a good candidate for a hairline advancement so a hair transplant was indicated for me. Meeting both hair surgeons was fantastic because I got all my questions answered and also important to me was getting a sense of each of the two people. My decision on where to get a hair transplant would come months later as it was dependant on my decision on what other FFS procedures to get done and where.

On that same week as the consultations with the hair surgeons I met the first local plastic surgeon on Thursday. The consultation went great for the most part. Two weeks later I was meeting with the second local plastic surgeon, and that meeting went even better. In all these 4 local consultations I went in quite nervous as I went presenting female as these were my first days doing so for work. By the time I met the second plastic surgeon I knew better what to ask, I felt more confident with myself and my presentation, and I also got a better personal connection with the surgeon.

The thing that didn’t work for me with the 2 local plastic surgeons is that they specialize in rhinoplasties, so their recommendation was to only do the nose. Even when these surgeons are trained as maxillofacial surgeons and they technically could do all the FFS procedures, they simply don’t have the experience. They themselves were not confident suggesting what other procedures I could benefit from apart from the rhinoplasty. When I asked the first surgeon about a trachea shave his recommendation was to make an incision right on top of the Adam’s apple and that was a red flag for me. I knew that the current techniques performed by more experienced surgeons make the incision higher on the neck, under the chin to hide it.

These first consultations with the local surgeons, apart from the importance they had on my decision for surgery, they also had a personal twist. Around these days in April 2016 I started presenting female at work. I went to all these consultations presenting female, but being the first few days, everything was new for me. I wasn’t as experience with makeup and wardrobe, and when I made all the bookings I made them with my male name. With the whole set of circumstances, between my presentation and the questions I had for the surgeons, I made sure they were clear where I was coming from. I was in my early stages of “transition” and my objective was to “soften” my features for a more coherent female presentation.

Videoconferencing With FFS Surgeons

The next consultation was via Skype with a renowned FFS surgeon and it felt leaps and bounds better than the 2 local plastic surgeons. It was palpable the experience and subject knowledge from this surgeon. He suggested a series of procedures he thought would benefit me, gave me an overview of how he does them and answered all my questions. As soon as I finished with him it was obvious that the local surgeons were not an option for me. They simply didn’t have the experience to trust them with my face.

Then the Virtual FFS report arrived with a detailed explanation of all the typical FFS procedures and their recommendation of which would benefit me, why, and what variation of the procedure would best suit my physiology. It was like a breath of fresh air amongst all the questions I still had. The report suggested having similar procedures as the first FFS surgeon had suggested. The difference is that the FFS surgeon also suggested a couple of other soft tissue procedures, and one major bone procedure that the Virtual FFS report did not indicate.

Less than a week later I had my Skype consultation with the other renowned FFS surgeon. In fact this surgeon represented a team of surgeons, FACIALTEAM, from Marbella in Spain, opposite to a single surgeon doing all the procedures. This consultation was the last one I had exploring surgeons, and it was the best for me. After the introductory small talk one of the very first things this surgeon told me was that he was going to look at my face from a clinical perspective and then said something along these lines: “opposite to all your friends and family that have told you that you’re fine and you don’t need anything done, I’m going to tell you what procedures can benefit you the most…” That totally clicked with me because every person I told I was considering surgery said exactly that; that I didn’t need anything done. The fact of having the consultation in Spanish also helped me better connect with the surgeon. When I finished this Skype call it was absolutely clear to me that my choice had to be either the other FFS surgeon or FACIALTEAM, but which? I just didn’t know at that point.

At first I didn’t like the idea of having to travel abroad for surgery. The expenses would be much higher just by adding flights, accommodations, and food for the amount of time I’d be away. I was also concerned on what would happen if there were any issues, for example if I had to stay longer, say because of an infection, or if something happened after I returned home. How would I deal with these situations. But knowing that the experience of these surgeons was so much more extensive than anything I could have locally, it was worth all that.

Deciding Where to get FFS

By mid May I had tons of information to process. I had met in person or via Skype with 6 surgeons all together and had learnt directly from the experts and the people that could potentially operate on me. Each surgeon had given me their quotes so I also knew how much it could be, at least with the procedures we discussed during each of the consultations. It was a lot of information to process. I really had to take a few days off from thinking FFS. I needed a rest to then come back with fresh eyes and put all the pieces together.

After taking a break for a few days from thinking FFS I felt I could come back and work on a decision. I discussed my consultations with my aunt and after reviewing all the information I had and considering how I felt about the surgeons, I chose to have my FFS with FACIALTEAM in Marbella. The decision came to a few specific points in order of importance to me:

1. Like the other FFS surgeon, FACIALTEAM had massive amounts of experience, but opposite to the other FFS surgeon FACIALTEAM ONLY does FFS.
2. It’s a team of specialized surgeons, so each individual has more experience performing his/her specific procedures, opposite to a single surgeon that does everything.
3. FACIALTEAM’s approach was slightly more conservative recommending not doing any soft tissue work during or prior any structural (bone) change. That kind of approach made sense to me and hinted me that they rather build a strong bone foundation than selling me procedures.
4. I simply had a better personal connection with the surgeon. Speaking in Spanish helped on this front.
5. And finally, for accommodations during recovery I had the option of Jenny’s Nest, which used to be a recovery house in Marbella with the sole purpose of accommodating transgender women as they recover from their surgeries. It was managed by Jenny, a trans woman aided by Nicola, another trans woman that had been FACIALTEAM’s patient not long before me. So the moral support that they could provide would be light years ahead from any hotel or nurse service. I could not imagine myself in a hotel room paying some nurse to be with me should I require something. The idea of a private villa and staying with other trans patients and care givers, in Marbella, was a no-brainer.

During the next few months my efforts focused on fine tuning which procedures to get done in Spain and working out possible surgery dates with my patient coordinator at FACIALTEAM.

In the end I had surgery in Marbella on the 13 of October, 2016 and a hair transplant back home 3 months later, on the 11 of January, 2017. As I write this, it’s work in progress. Certain parts are still healing and settling, like the way my nose feels.

P.S. I only mention FACIALTEAM because I chose to go with them. I didn’t mention the names of the other surgeons to show respect for their practice. I have nothing against them and my decision was based on my personal perception and my own subjective criteria.  If you want to know the names of the other surgeons that I saw and more details about my interactions with them, feel free to ask in the comments below and I’ll contact you directly.