My Facial Feminization Surgery and Breast Augmentation

In late March of 2005 I underwent drastic facial feminization surgery (FFS) in an effort to finally be able to present the world with a less ambiguous image of myself. Since I've already created a few sections on this website that discuss my over-all transition, on this page I'll just focus on the FFS itself.

Ok, so first a little history. Ever since I first realized that transitioning was a realistic option for myself, my biggest fear was to do so and still not be accepted by the world as a woman. I dreaded the thought of walking down the street and getting clocked at every corner. I'm a very social person, and the thought of becoming some kind of pariah held no appeal whatsoever. Additionally, please keep in mind that I've always identified as a woman. Not as a man, and certainly not as a transsexual. I seriously didn't want to trade one wrong identity for another.

There are many of us out there who know that they will never pass, yet their need to transition is even greater than their need to visually pass with strangers. I really applaud those enormously strong and brave women, and my prayer for them is that someday our world will be kind to them. For myself, I already suffer from horrible depression and self-worth issues, so I felt that being visually accepted as a woman was a matter of survival as much as anything else. In fact, I had previously made the decision that if I couldn't be visually accepted, I would not transition. It's that much of an issue for me.

Personally, I felt that my biggest inhibitor to being accepted as a woman was my very masculine face. I was born with a caveman forehead and a huge, jutting jaw, and my hairline was that of a classic, middle-aged man. Of course I tried all the make-up tips and tricks. I wore an expensive, high quality wig (which I hated). But even when I spent hours working on my appearance, when I went out I was often clocked before I got three blocks from my doorstep. Many times this happened in very cruel and hateful ways. I didn't want to spend a lifetime being the recipient of such crap.

Now, I had previously heard of FFS from my research on the web and my interaction with other girls. Although there are some skilled surgeons out there, I was never quite satisfied with their results. I just didn't feel that their efforts would be sufficient to get me over my visual obstacles.

This understanding filled me with despair. I felt that I would never be able to transition and be accepted by society, and that I would be forever trapped in the wrong body. This was a very dark time for me.

And then something wonderful happened.

It was late Christmas evening. All of the family stuff was finished and I had gone to bed to relax. I had a wireless internet connection and I had my laptop with me. I was once again surfing FFS sites. That’s when I came across Lynn Conway's website. Lynn has spent a great deal of time compiling what she refers to as her TS Success Stories. These are women who for the most part have been accepted by society and are living full, rich, and fulfilling lives.

Many of these women are also very beautiful.

As I read her page and followed the links, I discovered a common thread in many of their stories. Most of them had been former patients of Dr. Douglas Ousterhout. They almost universally stated that their work with Dr. Ousterhout (or Dr. O as he is called by most of us) was one of the major turning points in their transitions.

Dr. O is a highly skilled plastic surgeon who was trained in facial reconstruction and oral surgery. He began his career rebuilding the destroyed faces of automobile crash victims as well as those affected by other serious trauma. Later in his career, he switched his focus to helping the transgendered. He has since performed over 800 facial feminization surgeries, and is often regarded as the best provider for these services in the world. He works out of a hospital in San Francisco, California.

That Christmas night, I flipped through page after page of beautiful, intelligent, and completely unambiguous women. I eventually started to cry.

I finally felt that there was hope for me.

I had long ago decided that I *wanted* to transition. Sharon and I had previously made our own decision to move forward together once I was ready, so that issue had already been resolved. My post-transition appearance was my biggest remaining roadblock. Now, after viewing Dr. O's results, I felt like that final roadblock had been lifted. Things started to move fast after that…

Really fast.

I think that the speed of things at this point took Sharon by surprise. I had always been willing to take baby steps as we moved forward. This was due to a number of reasons. First, I wanted to be fair to her and give her time to make up her own mind about things. Second, I am a fairly cautious person when it comes to major, life changing decisions. Finally, the issue about my appearance had always inhibited my taking action.

That all said, I felt that we had effectively addressed the first two issues quite a while back. I was now ready to move forward. And now that I felt that my appearance issues could be satisfactorily addressed, I felt the need to transition start to grow almost exponentially.

I think I wrote Dr. O's office that Christmas night. I requested more information about his services and fees, and I also asked how I should go about consulting with him. Well, as you can imagine, his entire staff were off work on holiday. It was about a week before I received my response. I was practically crawling up the walls by then!

I mostly worked with the doctor's head of staff, Mira. Believe me when I tell you, she is a dream! Well, my first task was to send a collection of different head photos off to their office. The doctor would look at those and then make recommendations as to the work that he could perform. Although I had the opportunity to make suggestions myself, I understood that in any event the doctor would be somewhat constrained by the materials that he had to work with… mainly my skull! Additionally, I also realized that the doctor had much more experience in this arena than I ever would. I was planning on heavily relying on his advice when it came to my appearance.

Due to the holidays and the doctor's otherwise busy schedule, it was a couple of weeks before I got his recommendations back to me. He was quite detailed in his description of the work that he could provide. He was also very explicit in stating that he could not promise beauty, but he would promise a feminine appearance. For an edited copy of Dr. Ousterhout's letter, please click here.

After reading his advice, Sharon and I had a large number of questions. We documented each of these, and sent them back for response. We also requested that Mira provide us with a collection of potential dates for surgery. As things progressed, we learned that a previous cancellation had opened up dates at the end of the coming March. Although Sharon felt we were moving a bit fast, she agreed to let us pencil in those dates.

Our questions came back with satisfying answers. Our next step was to make our final decision and then to come up with the funds to finance everything.

I must admit that I pushed hard for the surgery. Up to this point, I had been willing to take our time in making decisions. But now that I felt I truly had the opportunity to be free, I just wanted to tear down the walls to my cage and charge forward! In hindsight I realize that this was a little unfair to Sharon. My only excuse was my excitement and desperation to finally be free.

There is one final point on this issue that I want to make: At every point in this process, Sharon held and still holds the right of final veto. She is far more important to me than even transitioning. If she needed me to go backward even now, I would do so. I love her that much.

Well, we made our decision. Sharon and I decided to move forward. I told her that I would only do so if she could assure me that we would still be together afterwards, no matter what. She let me know that I wasn't getting rid of her that easily! She gave me a hug, she gave me her love, and she gave me her assurances.

What a wonderful woman!

Well, the bank wasn't as easy to convince.

Please, if any of you do business with Halifax Bank, go in to your nearest branch and cancel all of your accounts. In my humble opinion, those folks are dirty, rotten, bastards. They strung me along with assurances that everything was going ahead successfully, and then at the last moment decided to pull the plug. I swear I coulda shot someone over that whole fiasco. As it stands, I have a whole slew of other, less violent ideas that I'd like to act on. Sharon keeps taking the bricks away, though…

Thanks to a long-term relationship with one of our banks back in the US, we were able to get things put together in the last moments. Now that that matter was resolved, we were off to sunny San Francisco and my visit with Dr. O.

We got to San Fran a few days before the surgery in order to get adjusted to the time change and enjoy the sights of the Bay area. We had both been here previously, but it was a great couple of days to relax before our big change.

At this time, right before my surgery, we both felt a bit of loss at the prospect of my old face going away. Sharon is normally quite reserved. As she told me that she was going to miss my old face, she started to cry. This broke my heart and I almost considered stopping things right there. I asked her if we should still go forward. She nodded yes and we held each other.

Monday came, and with it my first face-to-face with Dr. O (pictured). Some people have criticized him as being abrupt and having poor bedside manners. I couldn't disagree more. Dr. Ousterhout was amazing. He took as much time with me as I needed. He made sure to answer all of our questions in great detail. His whole manner helped to set us both at ease. I was quite impressed.

Well, after poking and prodding around my head, he sent us off to get x-rays. The next day, we had another consultation with the doctor wherein he utilized the x-rays to describe to us in complete detail (too complete?) exactly what he intended to do during the surgery. Although this level of detail made me somewhat uncomfortable, I was glad for the information and the opportunity to ask further questions about the specifics of this very involved and complicated procedure.

Now, Dr. O was also going to be performing my breast augmentation. That was going to be the first procedure performed, and it was scheduled to take place on the day before my facial surgery.

I had previously had a number of interesting and surreal discussions with Sharon, my mom, my mother-in-law, and other women regarding the future size of my breasts. While I personally advocated for big 'ol hefty 'D' cups, they universally recommended that I go smaller. I finally ceded the issue to their greater experience, and I chose to go with 'C' cups. Secretly, I wish I had gone with the bigger wazoos (see photo), but even I must admit that buying tops that fit is already quite a challenge!

Well, since I had decided on the size, the doctor reached into his bag 'o tricks and pulled out a couple of 'C' implants. He told me to fill my bra with them for the rest of the day and night in order to give them a test drive! He advised me that I could change my mind whenever I wanted, but if I did so before the surgery it would make life a lot easier on all of us!

Sharon's mom, Martha, had come out to San Francisco to be with us during the procedure. Her presence and her love were very much appreciated. That night, the evening before my first surgery, the three of us had a nice time bouncing around the Castro district. And with those implants stuffed in my top, I really do mean that we were *bouncing*!

Although we were having fun, we didn't stay out too late. After all, I was going under the knife early the next day! So at about 9:00 that evening, I went off to bed. As I dozed off, I felt a mixture of emotions that ranged from those of a kid on Christmas eve, to a death row prisoner after his last meal.

Please understand that I had never undergone any kind of major surgery in my life. This whole process made me mildly apprehensive, in an abject terror sort of way. :)

Thankfully, I had Valium!

Well, the next morning arrived and we were all off to the hospital. The next hour or two were a blur. The staff at the hospital was fantastic and check-in was a breeze. Before I knew it, I was getting prepped for surgery. I was pretty nervous, but Sharon was by my side until they wheeled me into the operating room. Once there, the anesthesiologist explained what he was doing, and then he injected some medication into my IV line. That's the last thing I remember until later that afternoon when I awoke with a huge pair of knockers firmly tucked under my new bandages.

Let me tell you, having a pair of half liter bags shoved under your pectorals is an experience you won't soon forget! My pecs were so sore that it was impossible for me to lift myself upright in the bed. In fact, when I needed to use the toilet, I needed the orderlies to push me up from behind. The pain wasn't too bad otherwise. That was either because I am excessively tough, or because I was on a steady supply of Demerol! You decide…

That whole afternoon and evening ended up being a kind of a fuzzy, drug-induced haze. I had numerous conversations with lots and lots of visitors, all of whom Sharon assures me were never present. The positive side of all this was that I was completely unable to worry about the *big* operation that was to come the following morning.

My breast augmentation took a total of 3 hours. My facial surgery was scheduled for 10 and a half! I guess the doctor had his work cut out for him…

Once again I was being rolled into the operating room. I was getting ready to undergo one of the biggest changes of my entire life.

During that 10-hour marathon, Dr. O worked his magic on me. The few paragraphs will discuss some of the details of the operation. If you are squeamish about this sort of thing, you might want to skip ahead a bit.

Now, I don't really know the order of events as I was somewhat incoherent at the time. So I'm just gonna start at the top and work my way down.

As I mentioned previously, I had been blessed with a forehead that could be leased out as advertising space. To fix this problem, the good doctor placed an incision from a point above and behind my ear, around my forehead just at my hairline, and ending up at a similar point behind my other ear. He then folded my forehead skin downward over my eyes and started work on my huge caveman brow. The doctor removed an 11-millimeter thick section of bone from my brow, exposing a third sinus in the process. He reshaped the extracted bone and then placed it inside of my sinus, effectively closing that cavity. Following this step, he removed a goodly section of my forehead skin and pulled my hairline forward by quite a bit before suturing everything closed. This process effectively gave me a much more feminine brow and a more satisfying hairline.

Well, since the top of my nose had been previously attached to a forehead that stuck out like an awning in a sidewalk café, the doctor needed to reshape it as well. Since he was working on my nose anyway, I had him fix my deviated septum in the process. No extra cost! What a value!

The doctor did all of my nasal work from within my nostrils. This was nice because it left me with no externally visible scars on the side of my nose. While working on my nose, the doctor also shortened my upper lip. I had not previously known this, but women have less upper lip than men. Dr. O performed this procedure by placing a short incision just below and inside of my nostrils, and the drawing the lip upward. In doing so, the incision scar was hidden in the natural fold where my lip meets my nose.

Another step involved reducing my significant chin and jaw. Once again, the doctor was able to perform this procedure without leaving any visible scars. He accomplished this by making the required incisions inside of my mouth, at the line around my jaw and in front of my lower teeth. He then pulled my lower lip down and out of the way in order to expose my jawbone and chin. I have to be honest with you, but I'm not sure how much bone he extracted, or where it was removed. Guess for yourself from the photographs. When finished, he sutured my lower lip and associated skin back in place.

The last bit that needed work was my trachea. Dr. O was required to utilize an external cut in order to expose the required cartilage, but by placing this incision on the underside of my chin instead of on the middle of my neck, its visibility was significantly reduced. When finished, he had successfully removed my Adam's apple.

Afterward, I hope he had a nice nap. He deserved it after that ordeal!

Personally, I had a nice nap. I also deserved it after my ordeal!

When I woke, I was wrapped up like an extra from an Egyptian horror film. I can see the posters now… "The Bride of the Mummy!"

Sharon and Martha were waiting for me in my room following my operation. I can't recall anything from that period due to the heavy medication that I was on, but it was really quite a significant time. Jessica was finally set free.

I had to stay in bed for a while afterward, but I was up as soon as the nurses would allow it. I would shamble around the ward, all wrapped in bandages and dragging my IV behind me. I was too unsteady to go by myself, so Sharon or Martha would usually escort me.

I can't recall the exact chronology of things over the next few days due to the steady supply of Demerol. At some point, my chest bandages were removed and I was finally able to see the twins for the first time. Later, the bulk of my head bandages were removed, leaving only the wrappings on my nose remaining.

At around this time I was discharged. Sharon and I moved from the hospital to a near by hospice called 'The Cocoon House'. This facility was established solely for the aftercare of post-operative transsexuals such as myself. The house is run by a pair of nurses who are simply adorable, supportive, and caring. The only thing that they didn't have was a Demerol drip. This is a good thing because I could probably really get used to that stuff if I had it regularly available to me! I still had some pretty strong medications available to me, but luckily Sharon kept control of them. I probably would have gotten myself into trouble had the Percoset been on my nightstand instead of hers.

The day after I was discharged was Easter Sunday. This was going to be my 15th Easter celebration since I had been baptized, and Jessica's first Easter. With all of the beauty of the service, paired with its inherent meaning of rebirth and new life, well, nothing was going to keep me from going to service that morning.

Sharon and I woke as early as the drugs would allow and we proceeded to get dressed for church. Even though my nose was still all wrapped in gauze and my face was as swollen as an over-ripe melon, I wanted to look as nice as possible. After all, it was my first Easter service as Jessica! Getting ready seemed to take forever as I was moving through a fog the whole time. Finally we were ready to go.

The service was located at a Catholic church located only about 5 blocks away. Getting there was fine. The service itself was beautiful. But getting back… well, let's just say that my reserves had been consumed by that time!

I didn't realize this at the time, but the Percoset that I had been taking had somewhat of a cumulative effect. I was becoming more and more exhausted with each pill I took. It wasn't until a couple of days later when I could barely keep myself awake at the doctor's office that he learned how many I had been taking!

Now, it wasn't my or Sharon's fault. The package had been labeled 'one every 4 hours'. The pharmacist had neglected the 'or as needed part'. As a result, I was taking these very powerful drugs as if they were Tylenol. Wrong answer!

When I finally did start to take a different medication, my exhaustion started to lift.

We remained in San Francisco for a total of 10 days following my surgery before we returned to London. Before we left, the rest of my bandages were removed and the surgical staples in my scalp were taken out. That left me with a few self-dissolving sutures in my nose and my mouth. I could live with those for a few more weeks!

I was required to sleep in an inclined position for the next few months to help reduce the swelling. On the nights that I would neglect this, I would wake up with a puffy, balloon face. Not all that pleasant, let me tell you! Even now, some 6 months after surgery, I still have some swelling in my lower jaw and chin.

Other that the swelling, I still have some reduced feelings in my scalp and on my nose. Additionally, one of my nipples is somewhat sensitive in a negative way. Other that these minor side effects, I have been quite trouble free following my surgeries.


In closing let me offer a few comments on my results. Well, first, I've attached some photos to this page so you can ultimately be your own judge. Personally, I am quite pleased with the results of the surgery. That said, I would have liked to have received a little more in the beauty department. Dr. O had admitted that this was pretty much beyond his control from the very beginning. Since I occasionally get pulled (hit on) when I'm in the bars, my appearance concerns might only be my own insecurities talking. Who knows?

As far as being unquestionably feminine? Well, I know that I'm not there yet. I still get clocked now and again, which is always distressing. But the frequency is minimal, and I have been able to let all but the nastiest just roll off my back. I would guess that some of the reasons that I may still get read occasionally could be chalked up to the weight that I'm still carrying around my middle, my sometimes blokey mannerisms, my height, or a slew of other reasons. I'll lose the weight someday. Right now I'm still stress eating due to my workplace issues. But that's my own fault, eh?

I may go back at some point in order to have my hairline advanced even a bit further, but I haven't made that decision as of yet. If I do, I'll also get a little cyst removed from my forehead at the same time. The cyst started to form around a bit of the titanium wire in my brow following my surgery. It's really quite small, but I know it's there and I'd like to have it removed.

Weighing up all the pros and cons, I still would have made the same decision about surgery. Dr. Ousterhout is simply the best FFS surgeon on the planet, and my new face and breasts have given me the confidence to take this critical and much needed step forward in my life.

-Jess