Donna’s FFS Page:

The Faces of Transition

The Faces of Transition: My FFS Page

Personal Thoughts, Experiences, and Photographs

I remember a time, not all that long ago really, when the prospect of actually beginning to transition was pure fantasy.  It was something "other" people did, as the thought I'd be able to successfully navigate the many difficulties involved made it little more than a frustrating mirage.  It was the mid 1990's, and the miracle of the internet had opened up a world of other transgender people to me - people who were sharing their stories, people who seemed to have crossed the mountain of fear and the desert of despair to arrive at the the nirvana of fulfillment and peace.

Perhaps the most significant obstacle (other than my own slow process of self-acceptance) in my mind is that I felt doomed to exile in a body that would never appear feminine.  No matter how many stories I read, though, as soon as I looked in the mirror any fantasy of moving forward was immediately deflated by my reality: my face was  too masculine to transition and nothing I did would change that.  Whether that was true or not is immaterial - it was real to me, and that mental block provided relative safety for several years.  I felt that my face would never, ever, in a million years allow me to live the kind of life I felt had been denied through a cruel consequence of birth.

My goal was simply to fit into the box that our society expects from women.  That's it.  As Dr. Ousterhout explains to his patients, his goal with FFS is to provide a face that - if the UPS guy knocks at your door first thing in the morning and you hop out of bed, wipe the sleep out of your eyes,  and open the door, that the guy says "Excuse me, ma'am, but...."  That's the kind of life I wanted, just to be was Donna, a woman, and to not have to explain or validate my gender to anyone.

My world changed the day I stumbled upon Andrea James' website.  Andrea had been an advertising executive, and her website back then is very different than it is now.  It was filled with detailed, step-by-step photographs and explanations of how a surgeon in San Francisco transformed her face from that of a middle-aged man to that of a totally feminine woman.  I was absolutely, totally, completely captivated that this was possible, and stunned at the results.  I spent hours reading, and carefully studying the photographs that she had provided.  And, little by little, as the last hurdle to accepting the fact that perhaps I could, in fact, transition faded I found myself feeling both terrified and exhilarated. 

Facial Feminization Surgery (FFS) is a touchy subject.  It is often perceived as being exclusive to those who are wealthy - it can often cost $50K or more depending on who does it and what you have done.  It conveys the same stigmas of vanity and self-indulgence that other plastic surgery procedures do in broader society.  People have very strong opinions on the subject.  I am not here to argue any of those things - I am simply here to share my own personal journey through photographs as a resource for those who might need one.

For me, the money I have spent on my FFS procedures have been the best investments of my life, and although there has been considerable cost, discomfort (that's the medical word for "pain"), and anxiety involved I'd do it all again in a heartbeat.  It's that simple.  The changes that it has enabled have been profound all the way to my core.

A picture is worth a thousand words, and to be perfectly honest when I look at these photos I’m still amazed that they’re all me.  I'm not planning to detail my experience with every single procedure I've had.  I'm simply here to share some photos, to share some lessons learned, and to leave it to others to do with it as they want.

Set #1
These are the pre-op photographs were taken the day before my first FFS procedure with Dr. Ousterhout in San Francisco.  At that point I had been on hormones for almost 2 years but it was obvious to me that no matter how much make-up or what hair style I wore there was little doubt that this face was a masculine face.  With the brow bossing, the prominent Roman nose, the big forehead, and the jutting chin, there was no escaping it.
I signed up for the complete package of FFS procedures:
Forehead III to remove the brow bossing
Scalp advancement
Rhinoplasty (nose)
Sliding Genioplasty (chin)
Trachea shave
I was in surgery for 13 hours, and recovery took months. 

Set #2
These photographs were taken 8 days post-op, a little over a week after the first set.  There is still a little bruising, and quite a bit of swelling (especially in the chin/jaw area).  The swelling takes several months to fully subside.  Even with the bruising, however, the changes are significant. 

Set #3
For those who have a significant widow's peak or a receding hairline, it may be necessary for a follow-up Forehead Revision surgery with Dr. O.  During the initial surgery he stretches the skin as tight as he can to reduce these things, but sometimes he can only go so far.  After 6 months the skin has stretched sufficiently to do the scalp work a second time to reduce these things even further.
I had expected this to be a relatively minor procedure, but it wasn't.  He completely re-did the scalp work.
These as my pre-op photographs before my Scalp Advancement procedure, taken 2 days after my 41st birthday.

Set #4
This set was taken during a visit to San Francisco just to say 'hi' to Dr. O and Mira.  It shows the results of the FFS procedures almost 3 years afterwards.  At that time I was living in Austin and working at Dell. 
The only additional procedure that I had done was to get hair transplants around the hairline incision to reduce the "straight line" affect and to further reduce the widow's peak problem.  I had 2,000 grafts in 2001 to give my hairline a more natural look.

Set #5
In September 2004 I moved back to Scottsdale, AZ.  Dr. Toby Meltzer had moved here from Portland, OR and does wonderful FFS work.  Over the next few years he did several procedures for me.
This photo is a "before" photo.  My most significant concerns were (a) thin little lips and (b) tired, gaunt look sometimes.

Set #6
This set was taken during after a lip shortening procedure, and a procedure to provide added volume to the lips.

Set #7
This set was taken 8 weeks after cheek (malar) implants, and a mid-face lift.  It was taken at the Southern Comfort Conference, and there is still a little swelling in the cheeks but nothing too extreme. 

Set #8
This set was taken after the swelling in the cheeks subsided.  This is the most recent "version". One of the reasons I'm very happy with the latest procedures is that my face doesn't look quite so long any more.  The cheeks give it some contour, and help to give it an overall rounder appearance.

Additional Notes
In January 2010 Dr. Ousterhout published a book titled “Facial Feminization Surgery: A Guide for the Transgendered Woman”  It includes a number of these photographs, as well as before and after photos of other FFS patients.  I was honored to be asked to write the Forward.  It’s the first book of its kind, and should be required reading for those contemplating FFS.
My “look” has changed significantly over the years.  A significant part of that is simply due to the passage of time, my weight, my hairstyle, and various other components unrelated to procedures or surgeries.  
I have a number of opinions on various topics related to FFS.  Feel free to write to me with specific questions....

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Set #1 - July 21, 1999

The beginning.  These are my pre-op photos the day before my FFS procedures.

Set #2 - July 30, 1999

Photos 8 days post-op, taken before leaving the hospital.

Set #3 - February 24, 2000

After 6 months of healing. Pre-op photos taken the day before my forehead revision.

Set #4 - March 18, 2002

Two years gone by.  Photos were taken on a social visit when I stopped by Dr. O’s office to say ‘hi’.

Set #5 - October 2004?

Photo taken prior to a lip-lift procedure with Dr. Meltzer

Set #6 - March 18, 2002

Two years gone by.  Photos were taken on a social visit when I stopped by Dr. O’s office to say ‘hi’.

Set #7 - September 2007

Photos taken at SCC - 8 weeks post-op on cheeks and upper face lift with Dr. Meltzer

Set #8 - December 2007

A couple of months later.  More “official” post-op photos taken in Dr. Meltzer’s offfice.

Set #9

Misc. head shots 2008 - 2009.  My “look” continues to evolve.  These are some of my more recent favorites....

Feb 2009

September 2009

April 2008

July 2008

Some Pre-FFS Photos

Various faces from my life “before” - 40 years.