Transgender

Forum











Jami Ward



Putting on a New Face
Part -1-

By Jami Ward
Read Part 2
Southern Comfort, 1997:
It's Saturday night, late, in Atlanta. OK, technically, it's Sunday morning, about 4 A.M., and a group of us are eating breakfast at Denny's after a really fun night out on the town. In the course of the conversation, someone says to me, "You look really tired. Are you sleepy?" Actually, although I am just a little sleepy, I feel pretty good, not tired at all. But it was a deciding moment for me because I knew what had caused the comment: my baggy upper eyelids make me look a lot more tired than I am. They also make me look older than I am, and they interfere with my vision. I had been thinking about having surgery on them someday to correct those problems, but that moment in Denny's in Atlanta was when I actually decided that someday had become sometime soon.

I had had a couple of consultations with Dr. Douglas Ousterhout at various gender events in recent years, and he had advised me on some things that I could have done surgically that would make my face more feminine and/or younger looking. These included the upper eyelid reduction (blepharoplasty), reduction of the bony forehead boss between my eyes, increasing the curvature of my jaw angle, eyebrow lift, full face lift with liposuction on my neck, cheek implants and a laser skin resurfacing. After returning home to Houston, I mulled over all this work that I ostensibly needed while spending a long time looking at my face and the faces of women around me. I first decided that I did not need any bone work done. The size of my forehead boss (bump between the eyes) is hardly noticeable and falls well within the norm for most women. The same holds true for the angle of my jaw, the width of my chin and jaw, and my cheekbones are just fine like they are - prominent, but not overly noticeable. So, that left the soft tissue work: the lift, tuck, peel and suck stuff. Since I was now determined to get my upper eyelids taken care of, I set out to find out just what that entailed and what else I might get done.

I decided to visit at least three different cosmetic surgeons and get evaluations/recommendations from each of them before going forward with any surgery. I would tell them what I wanted, what my situation was and see what developed from there. Oh, and I'll be going to see all of them in guy mode. (Note that I am going to see "cosmetic" surgeons, not "plastic" surgeons. The difference is a subtle one, but it can be important: plastic surgeons are generally concerned with reconstructive work and may not be as concerned with surface aesthetics. Cosmetic surgeons are concerned almost exclusively with making people look better - the aesthetics.) The first surgeon was one who had rebuilt my spouse's earlobe when our son, at the tender age of six months, had ripped an earring out of her ear. The second surgeon was one who was recommended by a transgendered friend of mine. The third surgeon was one I picked from an ad in a local fitness magazine, simply because I liked the way she looked and the idea of a female cosmetic surgeon intrigued me. In addition, if none of the first three worked out, I also had the names of three more surgeons. One of them was recommended by my dermatologist and two of them were recommended by the surgeon of a friend of mine from upstate New York.

Doctor 1:
This guy is a sanctimonious prick, and he and I do not hit it off at all. I tell him that I'm transgendered while showing him a nice head shot of Jami, that I want my upper eyelids restored to some semblance of normalcy and that I want a more feminine face. He replies that I need my upper AND lower lids done (I don't need or want my lower lids done), but he doesn't know what I mean about feminine facial features. However, at least he tells me what I need to do to get my insurance company to potentially pay for the surgery on my eyelids: go to an optometrist or ophthalmologist and have a "field of vision" test run to prove that I can't see as much as I used to. His assistant takes some pictures of me and sends me on my way, telling me to have the eye doctor send the test results and an evaluation letter directly to the surgeon's office. I'll have the test done, but I'll be keeping that paperwork I won't be back to see him.
Eye Doctor:
I make an appointment with my optometrist for the field of vision test. It consists of starting at a fixed point and pushing a little button whenever I can see a flash in my peripheral vision. It's time consuming, and because I can't blink during the test, harrowing and tiring. But after a couple of hours, I ultimately have a neat graphical printout of the actual vision field for both my eyes and an evaluation letter from the optometrist stating that my field of vision is compromised and that surgery is the only possible method of restoring it.
Doctor 2:
I like this guy a lot. He's had other transgendered patients, so he knows exactly what I mean when I tell him that I want a more feminine face. He studies my face, compliments me on having a good start on it naturally, and then he recommends the upper lid blepharoplasty, but coupled with a forehead lift to take out some of the excess in the upper lids. In his opinion, my eyelids need too much work to be accomplished with just the blepharoplasty on the lids themselves. Besides, he says, the forehead lift will eliminate the deep horizontal lines in my forehead and will move my eyebrows from their masculine location under my brow bone, up on to my brow bone, which is where they are situated on women. He also says that he can cut the nerves to the muscles in between my eyebrows. This will not only eliminate the vertical frown lines over my nose, but will keep them from ever coming back because I won't be able to pull my eyebrows together in the middle to create them. This is the same effect as "Botox" injections, only it's permanent. He does not think I need any work done on my neck yet, although he says the need is coming somewhere down the road in a few years. Finally, he says that he will do a light chemical peel around my eyes for free, just to blend the eye changes in with the rest of my face.

The eyelid reduction is very simple: cut across the eyelid on two lines near the middle, remove the excess between the incisions and then sew the new smaller lid back up in its crease line. However, we discuss the forehead lift in some detail. Because I've done my homework, I know that there are two ways to accomplish the lift. One is the "coronal" lift: to make an incision across the top of the head from ear to ear and basically just take up the slack down to the eyebrows, cut off the excess and then tack it all back together. The other is to make several small incisions inside the hair line around the forehead, do the work endoscopically (using a fiber optic system), and pull the muscles up under the skin, temporarily anchoring them to screws in the skull. The muscles and scalp reattach themselves and then the screws are removed. I have known people who had each of the procedures, and the latter was definitely the way I wanted to go. Not only are the scars much smaller, the surgical trauma is greatly reduced. Doctor 2 only does the endoscopic procedure, so that's a plus, although he says he's worried about where to put the incisions and the anchor screws, since my natural hairline is high. But, he says that it is his worry, not mine, and that it all is definitely doable: forehead lift, upper eyelid reduction, frown line removal and light peel. I give his assistant the paperwork from the optometrist and all my insurance information, and she takes some pictures. The doctor's office sends a letter to the insurance company stating all the reasons that they should pay for the lift and the tuck.

Doctor 3:
I like this lady a lot, too. She's very pretty and outgoing and physically smaller than I expected. She has heard of transgendered folks (who hasn't nowadays?) but I'm her first real up close and personal experience. I give her a brief rundown on transgenderism from my perspective and show her Jami's picture before we get on to the surgical specifics. After looking at the picture, she has only one preliminary comment: she wants me to give her makeup lessons. I reply that if she does the work, I'll be more than happy to take some of her fee out in lessons. Moving on, I tell her that I want a more feminine face and ask her if that makes sense to her. She laughs and says that the differences between masculine and feminine facial features is Plastic Surgery 101. She says that a surgeon in her line of work that doesn't know the differences and can't make one into the other has no business in the business. First, she recommends a forehead lift and upper lid reduction for the same reasons as Doctor 2. The only difference is that she does not do the endoscopic brow lift but only uses the coronal procedure. She then recommends small implants to remove two smile creases in my face, but not without a full face lift, also. She also recommends a full facial peel to eliminate enlarged pores, old acne scars and fine lines and just to smooth out my face some. And finally, she recommends that I let her pierce my ears while I'm out, too. It's a good thing I'm her last patient for the day because we ultimately spend several hours together. By the time I leave, she's become very enthusiastic about the idea of making me over in a feminine image, even to the point of talking about breast implants, liposuction and abdominoplasty for my waist and other body modifications. I'm flattered, but a bit overwhelmed. Like the other doctors, she takes a series of "Before" pictures. Like Doctor 2, she sends all the requisite paperwork to the insurance company.
Decisions:
When the insurance company finally responds to the doctors, the company agrees only to cover the cost of the upper blepharoplasty. Their reasoning, despite both the doctors' recommendations that the problem should be corrected by means of a forehead lift coupled with eyelid reduction, is that since the problem COULD be corrected by simply operating on the eyelids, that's all they will pay for. Since Doctor 1 is off my list and Doctor 3 does not perform the endoscopic brow lift, I opt to go with Doctor 2. In addition, he's said he'll throw in a couple of things (frown line removal and light peel) for free, and I feel good about him. Because I do want the brow lift for more reasons than correcting my eyelid droop (although that's also important) I opt to pay for the brow lift on my own. Doctor 2 has the least expensive price on the brow lift, too, although it is definitely NOT cheap. I schedule the surgery with Doctor 2, who has now become THE Doctor, to take place in six weeks.
Instructions:
I am required to read a multi-page list of things that can, but probably won't, go wrong, up to and including dying, initial every page of the list and sign it. In addition, I am given lists of instructions for both pre- and post-surgery. If I smoked (which I haven't done for 14 years), I would have to stop immediately. I have to stop taking any aspirin to ensure normal clotting ten days before surgery, stop drinking any alcoholic beverages a week before surgery, start taking acyclovir to suppress herpes virus in cold sores five days before surgery, stop eating and drinking at midnight before surgery, wash my hair and face well the morning before surgery, wear a top that buttons up, not a pullover, not wear any jewelry to surgery, show up at the outpatient surgery center at 9 A.M. for surgery at 10 A.M., arrange for someone to pick me up and drive me home afterward, and, oh, yes, have a nice day. Because I will be in Japan for two weeks until the Saturday before my surgery on Wednesday, the doctor issues me prescriptions in advance for the acyclovir, as well as the post-surgery pain-killer (hydrocodone), antibiotic and hydrocortisone ointment before I leave. I take the acyclovir with me to Japan and start taking it on the Friday before surgery.

The post-surgical instructions are actually much longer than the pre-surgical ones, but the highlights that strike me are the following: For up to a week after surgery, to minimize swelling, I am to keep cold packs on my face as much as possible, sleep in an upright position, and stay as upright as possible, not bending over. They actually recommend that bags of frozen peas can be used as cold packs. I have to continue to take the acyclovir for at least a week. I cannot take aspirin or drink alcohol for two weeks. For a month after surgery, I cannot fly on an aircraft, and I cannot exert myself physically in any way. No exercise, no lifting, no sex - nothing that will elevate my blood pressure or my heart rate. For me, no exercise means no skating. This does not sound like fun. And for the rest of my life, I cannot go outside without putting sunscreen on the areas of my face where I had the surgery or the peel, preferably on my entire face.

Day 0:
I'm very thirsty because I haven't anything to drink since midnight, and even though I only eat breakfast about every other day, today I'm very hungry - probably because I've been told that I can't eat. I put on jeans and a dress shirt (buttons!) and leave all my jewelry (one necklace, one ring) except my wedding ring at home. We drop our son off at day care, and my wife drives me to the outpatient surgery facility. On the way she asks if I'm nervous because I appear to be running off at the mouth - even more than usual. Hell, yes, I'm nervous! On an intellectual level, I know that there's nothing to worry about and that I will have a better looking face when it's all over and done. No problem. On an emotional level, though, I know that they're going to stick needles in my body and cut my face open during a bloody operation where I might just die. I have a really big problem with that.

I check in at the surgery facility at 9 A.M. After finishing the paper work, we move on to surgical prep at 9:30. The first thing that happens there is that I'm given two pills to take with just a little sip of water: valium and darvocet, basically a tranquilizer and a pain-killer. Then I'm handed a darling backless cotton gown in a tacky floral print and pointed in the direction of the restroom to change. I'm instructed to be sure that I remove ALL my clothes under the gown, although I can keep my socks on. I tell the nurse that's good because while my butt is fine, but I'm really self-conscious about my feet. I change into the gown, tying it in back, and stash my clothes in the charming set of matched luggage they've given me: two plastic bags. As I exit the restroom, my own personal gurney awaits, so I climb on and pull the blanket on it up under my chin. I'm cold in my ventilated attire, even with my socks on. I'm the only person in the prep area, so my wife and I yak with the nurse for a while. She tells me that this is also the recovery area and that she is also the recovery room nurse. By 10, the drugs have kicked in and I'm not nervous anymore. I'm not blitzed or anything, but I simply don't care what happens. Chemistry is a wonderful thing.

My surgeon comes out and introduces himself to my wife, and he evidently passes her inspection because she doesn't immediately start wheeling me out the door. We talk about what's going to be done and he answers a couple of questions that she has about the procedure. She tells me later that she feels good about him, too. The anesthesiologist comes out next and talks to me about the process of knocking me out. I express some concerns about the aftereffects of the general anesthesia, having been down that road a couple of times, but he assures me that there have been some remarkable developments in the field in the past couple of years that have dramatically reduced the anesthesia hangover effects. I remove my wedding ring and hand it to my wife as he and the nurse stick a needle in the back of my left hand, tape it in place and hang an IV in it. They are very good because I literally only feel a slight jab, and then nothing. Then the surgeon comes back in and draws on my face and my eyelids with a purple pen, marking the locations of my facial nerves and of the cuts he will make. When he's done, I look like a circus clown wearing war paint.

Finally, I'm wheeled into the operating room at about 10:15. The anesthesiologist, the surgeon and a nurse help me move from my warm gurney onto the cold operating table. I'm asked to untie the gown and make sure that it is not underneath me before lying down. I do as I'm told, then lie down on the table as they cover me with a nice warm blanket. This is a VERY good thing, as the room is about 55 degrees and except for my socks, I'm damn near naked. The surgeon and the nurse have me move around a little on the table to get into the right position. I'm still very calm about the whole thing. (Actually, by now I think I AM blitzed.) Then the anesthesiologist says, "You may feel a slight burning in your left hand in a minute where the IV is, but don't be alarmed. It's OK." I nod to him as I mumble some affirmative answer and close my eyes because the overhead lights are bright. My hand starts to feel warm and...

Part -2- next time...

TGF's Home Page