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.

2008 SURGERY ESTIMATE SHEET

  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

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