Below is a series of small blog posts about facial feminization surgery (FFS) in Boston. You can skip them if you don’t like thinking about messing with faces or if you find diary-like entries annoying. I will try to return to less chatty, more reflective entries in the days after surgery.

Mary Jo and Joyce fly to Boston for FFS (6/21)

Flying to Boston was uneventful. I expected to be hounded by the Bedford Falls, small-town TSA officials for being a “traveling tranny,” or more precisely, someone whose photo ID didn’t match the way she looked. They studied my ID, the name printed on my ticket, and my face, then made some little initials on my ticket and passed me through, no body cavity search or deep interrogation necessary. I didn’t even have any special treatment in the metal detector, but Mary Jo was given an extremely thorough examination because she carried her cell phone through the metal detector in her pocket.

The only remotely interesting that happened was that in the waiting area, one fellow seemed to be staring at me, and looking away when I met his gaze. He was a college student, an athletic man in his early 20’s wearing a baseball cap and reading Sports Illustrated. “OK,” I said to myself, “so he reads you as tranny and doesn’t like it — big deal.” Turns out than when we’ve boarded, jock-boy works his way down the plane’s aisle and tells me he’s in the seat next to me. He squeezes in, looks out the window, and never looks back at me. Nothing bad happened, and for all I know, he didn’t give me a second thought. But I realized just how self conscious I still am, and remembered why I thought (and still think) FFS is a generally good idea — because not everyone I encounter will be college students and professors and because even if no one knows or cares about my transsexual nature, I’m the one who still feels self-conscious, and lowering my self-consciousness is going to be a very good thing over the long haul.

Switching planes in Dallas wasn’t hard, nor was the flight to Boston. We took the courtesy shuttle to our hotel and when we talked to the desk to check in, the man told me, “You two ladies are obviously going to want separate beds, but I’ve made a mistake and only have a king. What if you take that room for the same rate, and one of you can sleep on the pull out.” I guess I should have said something like “what are you talking about? We’re married.” But I didn’t even get his drift (i.e. women traveling together are clearly buddies and want separate beds) at the moment and thought the kingsized bed would be just fine, so we took it, getting the “Executive Suite,” two rooms, one of which has nothing but a conference table and a bar in it.

Violet Eggplant takes us around the city (6/22)

The next day, we met up with my Second Life friend, Violet Eggplant, and walked the length of Newberry Street, which has every posh shop and gallery you can imagine. We looked at Picasso lithographs (Mary Jo is particularly in love with one called Le Viol V — or The Rape 5), bought decadent Swiss chocolates, and got our senses blown away in a soap and bath-salts store called Lush, perhaps the most amazing establishment I have experienced in a long time. Laid out like a deli, this shop’s goods are displayed food-style so that your soaps look like rounds of cheeses, your facial masks are scooped out from salad bar containers, and bath salts are made to look like marble-breads. My olfactory system was in overdrive as we sampled and bought a range of goodies and were treated to some very nice hand salts, lotions, and creams by the proprietor. I didn’t see the bill, but I believe Mary Jo paid hundreds of dollars for our large bag of goodies, some of which we used in the bath and on our skin that very night, much to our delight.

After Newberry Street, we walked through the Park and into the North End of Boston, which contains the Old North Church (One if by land and two if by sea from “The Midnight Ride of Paul Revere“), old cemeteries, and perhaps hundreds of nice Italian restaurants. I had mushroom risotto, but no wine, as my pre-surgery rules forbid alcohol, aspirin, ibuprofen, and hormones, a prohibition that really pained me as this meal cried out for a big-bodied red wine. After dinner, we walked around a bit, bought pastries from Mike’s (which is enormously popular), and sat in a square talking and eating our newly purchased pastries. We parted ways and made vague plans to get together post surgery, which is frustrating for me — I’m having such a great time that it’s easy to forget that I’m not on vacation for more than a few hours more.

Boston Medical Center (6/23)

The next day, we took the hotel shuttle up to BMC, where we met my anesthesiologist, a very kind African man named Jean-Marie. He asked a very detailed set of questions about surgeries, medicine, and illnesses, and after an hour, he said he would see me the next day at 6:00 a.m. We next went to visit Dr. Spiegel (elsewhere in this blog known as Dr. East) and his capable and nurturing assistant, Kelly. We went over procedures, talked about the timeline, looked at a picture of my mother, had “before” photographs taken (with and without wig), debated whether this surgery forever prevents one from looking neutral or butch (he doesn’t believe it does), and learned that the surgery was pushed back to 9:00, so we get to sleep in a little bit.

Kelly said that 85-90% of their patients want to go home from the hospital by 4:00 the next day (still protesting that there’s no way to leave the hospital as late as 1:00 or 2:00), but there was no particular check-out time and that if I felt I had to stay, then it wouldn’t be a problem. But assuming I’m like those 85-90%, Mary Jo will pick me up and take me to the hotel on Wednesday afternoon, where the first day will be very cloudy, and the next two days will be fairly miserable, improving considerably by Friday, which is convenient, as that’s when Mary Jo returns to Bedford Falls to look after the kids and horses.

We got prescriptions for pain medication and antibiotics and good instructions on after-surgery care, and then left. Mary Jo can write about her impressions of Dr. Spiegel, but I myself was reminded of why I like him — he’s funny, intellectual, academic, and incredibly capable. Although I’m a bit nervous, he makes me feel quite confident that I won’t die on the operating table and I won’t look like a monster when I heal.

After we filled the prescriptions and bought a bunch of soft food, flexible straws, and ointments at the nearby Target, we had a small lunch and took an afternoon nap. We took a cab at 5:00 to meet our friends Nick and Barbara at a seafood joint called The Barking Crab, where Mary Jo ate just her second lobster in her life, pounding its shell with the rock provided for that purpose and reveling in the visceral experience, thankful that the restaurant provides bibs. Again, a nice alcoholic drink would have really completed my sesame-crusted tuna steak dinner, but I treated myself to flour-less chocolate cake to compensate. I figure that if I’m going to be sucking my food through a straw for a week and depriving myself of wines and scotches for two weeks prior to surgery, I deserve a rich and just dessert.

Reflections on the eve of surgery

I know why I think this surgery is a good thing for me, but I feel increasingly that I’m being selfish, vain, egotistical, and harmful to others. In other words, I feel good about my own psychology, my own identity, and my own self and its evolution that has taken me to this spot, and I also feel confident about the future that continues on this same general trajectory. However, I feel guilty for the anxiety, anger, confusion, resentment, or other negative emotions that are generated in others because of my changes. I wish my project did not require others to face issues of sex and gender and beliefs that they’d rather not face. Some of my family and friends are seeing my changes as positive and I’m overjoyed about those relationships, but I can also see the pain and sadness in Mary Jo’s face and in Slade’s email words and in Aunt DeeAnne’s averted gaze. I’m sorry for that pain and sadness, and hope it goes away, or at least fades just as surely as my GID fades away. Seen separately, the suite of procedures involved in FFS feel vain and perhaps unnecessary, but seen as part of this remarkable 2+ year journey, I think it’s a small but important segment of that trip — it’s the kind of journey where I don’t necessarily relish the twists and turns involved in getting there, but can’t wait to arrive at the destination.

Paid a visit to Dr. Simon today to get the results of my bloodwork from a few weeks ago. And after a year of HRT, I’m very happy to report that my numbers are terrific.

If you look at me as a man (but not for too long, please), I’m far, far below the normal testosterone (T) levels for men and I’m far, far above the normal estrogen (E1), estrone (E2), and progesterone (P) levels for men. In other words, I’m not a man any more, biochemically speaking. I thought something felt different 🙂

If you look at me as a normal, mature woman, my numbers are either average or well above average for E1, E2, and P. I’m still above the normal T levels for women, and we’ll be trying to bring that number down by half or more over the coming months.

There are so few concrete and objective measurements in this transition that I find these bloodwork results all very satisfying. I don’t know if I’m feeling “normal” because I’ve learned these numbers or if learning these numbers simply validates a “normal” feeling I’ve been having with increasing intensity as of late.

I have begun to feel as if all the pieces of my life are falling into place; I think they were mostly all there before, but the pieces didn’t fit just right, like a 500-piece jigsaw puzzle with a piece that you’ve sort of squeezed into a shape that kind of looks right, but really isn’t. Finding the right place for it is very satisfying, even if it leaves a hole you thought was complete elsewhere.

Dear Joyce:

I enjoyed meeting you at this year’s First Event in order to discuss facial feminization options. As we also discussed on a phone call in December, I believe that you would benefit greatly by undergoing an endoscopic biplaner browlift that will reduce the height of your forehead, lift your eyebrows, advance your scalp and sculpt your bone with burring. The biplaner approach does leave a fine scar in front of the hairline. The sensation to the scalp is preserved, however, and fat grafting is also performed to reduce the temporal hollowness and give the forehead a rounder, more feminine appearance. This would be combined with an upper and lower eyelid blepharoplasty, Medpor cheek implants, a vertical lip lift, a feminizing rhinoplasty and septoplasty, chin bone burring with soft tissue reshaping, a tracheal shave and a retroauricular variant neck and jawlift. Fat grafting to the lips would complete this. We also discussed otoplasty (ear pin back). This combination of procedures will give you a more beautiful, refreshed, youthful and naturally feminine appearance.


  1. Feminizing biplaner endoscopic browlift with orbital rim burring/scalp advancement and temporal fat grafting
  2. Upper and lower eyelid blepharoplasty
  3. Feminizing rhinoplasty/septoplasty
  4. Medpor cheek implants thru a lower eyelid approach with screw fixation
  5. Chin bone burring with soft tissue reshaping, tracheal shave and a retroauricular variant neck and jawlift
  6. Vertical lip lift
  7. Fat grafting to the lips folds
  8. Otoplasty (pin back of ears)

See also
Alexandra’s virtual FFS assessment of my face
Dr. East’s surgical assessment
My consultations with Drs. East and North in Boston in January 2008

Dear Joyce,

It was a pleasure (finally) meeting with you this weekend during First Event. Please do let me know if you have any questions regarding the surgical options we discussed–it is our pleasure to help! I’ve attached some information on the procedures we discussed.

We look forward to working with you in the future.

  1. Forehead contouring with scalp advancement and browlift
  2. Mandible and chin contouring
  3. Lip lift
  4. Rhinoplasty
  5. Upper and lower eyes
  6. Cheek augmentation

See also
Alexandra’s virtual FFS assessment of my face
Dr. North’s surgical assessment
My consultations with Drs. East and North in Boston in January 2008

In some ways, this entry will be relatively easy, as I’m going to relate how my due diligence on FFS surgeons culminated in my visit to Boston last week. On the other hand, it’s a hard entry because I have developed some opinions of some of my transgendered sisters that are not flattering in the course of this due diligence. I don’t want to hurt anyone’s feelings or pass any judgment on anyone, as this surgical decision is entirely my own. However, I will make general comments about the way certain transwomen look that will reveal my priorities for myself and my opinion of the role of beauty/glamour in society, and these comments may run counter to your own ideas of beauty. So let me apologize, dear reader, if you are the target of my criticism — I don’t know of any other way to explain my visits with FFS surgeons without bringing up these issues.

I won’t go into all my reasons for seeking some plastic surgery on my face — these reasons are pretty similar to other MTF transsexuals who would like to live a carefree life after transition. I did a virtual FFS (which involves retouching photos in Photoshop) about 10 months ago, and the recommendations of my surgeons overlap Alexandra’s recommendations with only a few gaps. I’m also working on an academic paper about the narrative role of FFS, in case you’re interested.

I had narrowed my surgeons to the top three, Dr. West, Dr. North, and Dr. East. All three have excellent reputations and have many, many fans and followers who swear up and down that their doc is the best in the business. I ruled Dr. West out early because of technique — he’s a big fan of cutting jawbones, removing the offending length or width, then screwing the remaining pieces back together again; the other two surgeons believe in grinding down bones whenever possible, and that appeals to me. Dr. West also the most expensive in the business, not that it matters that much, but I developed an early impression of his maximizing profits rather than maximizing help. There was also just something a little cultish about his followers that turned me off. So when I went to Boston, I was very eager to compare Dr. North and Dr. East by meeting with them individually, listening to their formal talks to the convention, and meeting some of their patients. In fact, the main reason I went to Boston was to make much faster progress on this research project, in addition to the fellowship at the conference.

Dr. North

Friday of the conference was reserved for my private consultations with both doctors. I slept late, got up, cleaned up, repeated what Jason had showed me on my face, and went up to Dr. North’s suite at 11:00 for my consultation. He ushered me into his suite and had me sit on the couch while he directed his minions. Dr. North is a 5′ 8″-ish Chicagoan who is a little chunky but who works out. He’s got a trimmed mustache and wears a nice suit and tie. He does 10 things at once: talking to me, answering his cell phone, flipping through folders, yelling at the door to come in, handing his people a couple of hundreds to get whatever they need to get the operation set up right, ushering me over to the mirror to illustrate a hairline or a muscle, pulling out pictures of his “girls” to show how good he is. He talks of himself and his technique frequently.

Although he listened to my questions, I never felt he understood what I wanted from FFS. I started off feeling a little put off by the steam-engine way he plows ahead and he just made it easier and easier for me to be skeptical. Not only did he want to do what he had written me about, but he volunteered that I ought to have my ears pinned back, one ear shortened, and quite a few other little things done to fix me. He reminded me that he also did boobs and butts. His philosophy is that we can to a lot better for a MTF transsexual than to make them “passable” — we can aim to make them beautiful. He answered all my questions about procedures and techniques and said I ought to come to his presentation that day to get the whole show. “Wouldn’t miss it,” I told him.
Palmer Girls
And I did just that. Wrote in my room a bit, then went down to one of the ballroom breakout rooms to watch the Dr. N show, where all his “girls” were going to show up as kind of a live before-and-after show. And they did. They reminded me of the Robert Palmer girls in their sameness: augmented cheeks, big eyes, thin necks, perky little noses turned up slightly–which are, by the way, the same recommendations he had for “correcting” my face. Although Dr. N was informative and intelligent, I found myself repulsed, frankly. I don’t want to be a clone, but a regular person. I watched his show until time for my appointment with Dr. East, then slid out the back for a bit.

Dr. East

With the Dr. North medicine show fresh on my mind, I went to the lobby, where I was supposed to meet Dr. East and Kelly, his assistant. They were just emerging from the elevator and I said hi, and they said let’s talk over here, and found a table in the hotel restaurant/bar. A little open, I thought, but we’re all friends here, n’est-ce pas? And while not everyone at the conference was interested in having FFS, there wasn’t a soul who wasn’t interesting in seeing the results of surgery that can make a square-jawed man look like a cisgendered female.

Kelly pulled a skull out of her bag and as she held it before placing it on the restaurant table, she briefly looked a little like Hamlet talking about poor Yorick. Dr. East, a mid-40’s, baby-faced academic from Boston University, had on a Jerry Garcia tie and an off-white dress shirt whose right collar was bent straight up in the air. I wanted to reach out and fix it, but thought better of it in case it was some sort of personality test. Dr. East is the antithesis of Dr. North. After looking at my face and my paperwork, he looked me right in the eye and asked, “What do you want me to do for you?” A question I had not heard from Dr. North, by the way. I told him I wanted to be real, authentic, legitimate, serious, academic, graceful, dignified and believable (with fame and glory and gravitas without gravity, if possible). He said that he could do all those things for me except fame, glory, and gravitas which I’d have to achieve on my own. Most importantly, he didn’t try to sell me anything, seeming to prefer a minimalist approach to Dr. North’s “full-package” approach.

Dr. North had recommended augmenting my cheeks with 3 mm pads screwed into the cheekbone, and I asked Dr. East his opinion. He said he thought that procedure was unnecessary, and said he knew exactly what I was talking about when I mentioned that I had noticed a sameness to North’s patients. As a professor, I said, I want to be taken seriously–he responded by pointing out a couple of his patients in the hotel bar, and they looked nothing like the North girls. After talking for a bit he said I should come see his presentation, which I did a couple of hours later.

Dr. North’s presentation is academic, focusing on the constructed nature of beauty and femininity. He is low-tech, but earnest. He took plenty of swipes at Dr. North and Dr. West, which were all along the nature of “I’m a university researcher and surgeon as opposed to a businessman.” He also made it a point in his presentation to talk about the beauty of the girl next door versus the beauty of a Miss America contestant. Having studied ratios of noses to eyes to foreheads for decades, he said his institution had developed a really good sense of femininity and youth, which are closely related as regards to these mathematical ratios.

Dr. East seems to employ the opposite of salesmanship, falling instead on research and experience. Of course, for someone like me, this approach did a better job at selling me on the idea that he is the right surgeon for the job. Therefore, I stand convinced that the masculine features of my face ought to be dealt with by Dr. East and not Dr. North, a conclusion that was one of the main purposes for going to Boston.

See also
Dr. North’s Recommendations
Dr. East’s Recommendations
Alexandra’s virtual FFS assessment of my face

Having had a particularly bad spell on Tuesday-Thursday, Oct 16-18, I decided to act. I called to make an appointment for a new primary care physician, which I made for about two weeks later — Since the UMC had several doctors who were taking new patients, I studied all their biographies and eventually picked the one with the biggest smile and the youngest tenure, and assistant professor for several years, Dr. Patricia Robbins.

Later that day, I drove over to Dr. Art Simon’s office, where a soft spoken, burly male nurse met me — the place was completely empty, and he explained that Dr. Simon was away today. I asked about his specialty, about whether I could self-fund or use my insurance out of area, and all of this was just great. I said he had a good web reputation, and the nurse said they had patients from as far away as Egypt. Wow, I said.

We made an appointment on the same day as my UMC appointment, a few hours later, so that will be an interesting day. He took some general information and asked what it was about. I thought about lying, but decided against it. I said I had Gender Identity Disorder and needed someone who understood hormones. The nurse said, ok, Dr. Simon certainly qualifies there. He gave me a questionnaire to take home and fill out for my appointment and sent me on my way.

This was a wonderful day for several reasons. First, I resolved the doctor issue, not just with one doctor but with two. Second, I had spoken with this nurse much more easily than the first time I sat down with my other doctor, indicating to me that I am feeling more at ease with my condition. I drove home with the window down, smiling and enjoying the day.

I learned that Dr. Clinton was giving up the practice because his costs were too high and he could still practice medicine as a traveling emergency room doctor. Since he’s a pilot, he’d be able to fly his plane to all these small towns — it actually sounded fun to me, and I would have been super enthusiastic if it weren’t for the fact that this was the one person in whom I had confided beyond the small circle of my wife and therapist. It was really, really hard to get up the nerve to go do see him, and I felt we were on a roll with the hormones and the medical side of my treatment.

So now I was faced with finding a new doctor. Dr. Clinton reassured me in a number of ways, some of which were reassuring. First, my files would be moved to the Kelly Clinic for 50 years, so they were safe and secure. Second, while he didn’t have any idea as to who might be a good PCP with sympathy for gender issues, he suggested the Kelly Clinic because a) they’re good people, b) they have my files, c) they’re new and need new patients, and d) they have some young residents who have probably been exposed to GID more than old farts. Third, we discussed my prescription and he said he was happy with my levels and that he’d write me a 12-month scrip at 60 pills per month, which would allow me to continue at my current levels for 24 months or I could double my dose and make them last a year. Since I was already thinking of doubling, this sounded good to me. This year, he explained, ought to be plenty of time for me to find a new doctor. Fourth, he’d still be my aviation medical examiner (AME), probably at a friend’s clinic and probably once or twice a month, so that aspect of my GID ought not to involve any doctor transition as he was already familiar with all my issues.

I said farewell, paid my bill, and left, feeling quite alone in the world. Where do you find a new doctor in this neck of the woods who knows about sex changes? I figured it would be a long and straining process. Still, one must try, so I filled my prescriptions, doubled my dose, and began my search.

I searched the web for “Bedford Falls & gender & doctor” and came up empty handed. I asked Chuck and he didn’t know, although he said I might like Art Simon because of his open mindedness and demeanor, but that he wasn’t on my insurance. I next broadened my search by studying the Kelly Clinic’s website and their doctors and their specialties. Most seemed to be good old boys from around here with a few exceptions. So, using my Yahoo account as Joyce, I wrote them and explained my situation and asked if anyone on the staff was familiar or could take me on. I got a reply back a few days later saying no, no one knew anything and good luck. Fairly straightforward rejection, but I figured maybe I had asked too specific of a question — maybe asking if anyone knows anything about GID is perhaps too narrow.

I did the same thing at the University Medical Center, looking through their typically bureaucratic website for some kind of contact info. I could only find a vague email about family practice, so I sent the same email to them, getting no reply. Well, I thought, I’m probably screwed.

I looked on the web for Art Simon, since Chuck had mentioned his name, and discovered that he’s not only a family doctor (independent), but he’s also a specialist in sex hormones and thyroid issues, and has a glowing reputation on the web with lots of endorsements. This was promising, I told myself.

I figured, well, I have time, with 12 months of hormones, and all, so I let things rest. But as October came around, my sense of despair grew and I felt almost pushed into doing something, anything, to sooth my tormented mind (too dramatic? Well, it felt like it at the time, ok.)

Serendipity arrived in the form of a flyer in my faculty mailbox for the family practice at the UMC and it had an email link called something like, which was not the email I had used before. Ok, I thought. Maybe they didn’t answer me because of the labyrinthine and outdated nature of their website. So I mailed my query to them again.

This time, I got a very nice note back from one of the staff who said that they had discussed this with family practice, and yes, from a general practitioner perspective, they were familiar and could help. She listed several doctors who were taking new patients. I was quite thrilled and studied their website looking at their pictures and specialties. One of the doctors the clerk listed was a nurse practitioner (Meredith) who everyone I know raves about, so I wrote another letter asking about which doctor should I choose, could I switch around between them if I needed something different, and could I also see Meredith instead of the docs. I got another fabulous note from a different woman this time who said yes, I could move around, even though I had picked a named PCP, and yes, I could see Meredith.