On 19 July 1999, Dr. Douglas Ousterhout, MD, DDS performed facial feminization surgery on me in  San Francisco. This was serious stuff (click for photo of me 2 days after surgery). The operation took 9 1/2 hours. Dr. Ousterhout performed several key procedures during this session, primarily focusing on three areas: forehead, nose, and chin/jaw. In a combination procedure, he lowered my hairline, raised my eyebrows, and contoured the bony part of my forehead to give it a feminine shape, primarily by reducing the bossing over the brow. He reduced the length of my forehead (distance from brow to scalp) from 9cm to 5.5. Although my nose was in pretty good shape, the repositioning of the forehead dictated work on the nose to make it fit with the new forehead position. Plus I'm happy with the other changes he made to my nose, although I hadn't really planned on them. The chin/jaw work was a combination to reduce jaw flaring, mass, and chin size and shape. He said I had the second largest chin and I believe the largest head he had ever worked on (but I've heard that since that time more fatheads have come along and broken my record). But he was able to reduce the length of my chin by 11mm.

Mira, patient care coordinator, and Dr. Doug Ousterhout

There are several sites which go into great detail regarding this surgery, preparations, and just about every aspect of getting a new face, so I will not attempt to duplicate them. For detailed accounts, see:

• Beginning Life's facial surgery link portal - the best departure point to explore the experiences of many.
• Lynn's Excellent Account (very graphic!) - Lynn's site also discuss in detail practical aspects of making the trek to San Francisco, complete with maps. She also goes into the deeper issues (why, how, etc). By far the most comprehensive discussion of facial feminization surgery.
• Andrea James facial surgery section (the woman who inspired many). This site gave me the hope to realize what was possible.
• Nicki puts on a brave face - A detailed discussion of her experience. A worthwhile read.

For an interesting discussion of  facial geometry from a gender perspective, as well as skeletal differences, see Annie Richards' site.

You can hear a lot of spirited debate about the relative benefits of hormones, electrolysis, facial surgery, and other ways of making the face appear more feminine. I believe it varies from person to person, so the relative benefit differs. However, I also believe that many people are unaware of or under-estimate the profound effect that cranio-facial (the bony part) structure has on people's sub-conscious gender perceptions.

Won't Hormones Feminize My Face?

The following photo series  tells quite a bit.   The first photo is of me before starting any transition treatments, circa 1994. The second photo is one month before facial surgery (June 99), but after a year of hormone therapy and 3 years of facial electrolysis. There is quite a bit of softening but I clearly looked male...maybe at that point a bit boyish even though I was 42. The 3rd photo was taken 1 month after facial surgery, in August 1999. HRT and electrolysis do a lot, but they didn't quite get me there. Note that the difference between photos 1 and 2 are 5 years, and 2 months transpired between photos 2 and 3. HRT and electro = gradual change. Facial surgery = warp speed.

For a more detailed multi-year sequencing, see this link. It gives you a glimpse of the relative effects of electrolysis, hormones, and facial surgery.

Male Mode after Facial Feminization Surgery

If your facial feminization surgery is highly successful (some call it facial SRS because of the magnitude and impact of the change it produces), you may even find it difficult to pass in male mode even if you try. I needed to pass male for about 5 weeks after my surgery, and I was not successful. Here's a photo of my attempt. This photo was taken 10 days after my surgery. I was bruised and swollen, and put on my manly clothes and used my manly voice. Don't forget I'm well over 6 feet tall and no lightweight as well. Yet, I was consistently perceived as female unless I insisted otherwise. After a day or so of trying to pass male, I simply gave up (I do have a few amusing stories about this. here's one).

This before and after shot series tells a lot. They were taken by Dr. Ousterhout's assistant, Mira. The left series was taken 3 days before surgery, and the after series 6 months later. Makeup (very light), lighting conditions, etc. are identical.  Click here to see a larger version of the photo below.

Here's another before after pair taken early and late 99. Here I tried to get the variables the same and let the surgery effect speak for themselves. Similar hairstyle, and no makeup.

Epilogue - 3 Years later

Transition consumes your life when your in the middle of it, and for me the aftershocks lasted quite some time. But life does settle out, and I welcomed a sense of normalcy that began to settle in. The facial surgery was without a doubt an absolutely critical factor in the success of my transition.  I can't stress this enough. As for the after-effects of the surgery, the numbness faded in my face and forehead, but the top of the skull above the suture line is still numb to some degree, although quite a bit of feeling has returned. It still feels a little tight up there, too. But these are things I have to think about to notice. The biggest problem I've had is inside my nose. I have a dryness that causes, ahem, for lack of a better term, bloody boogers. There, I said it. It's not a major thing, but a fairly constant nuisance.

A lot of people go for various tweaks and so forth after having the major facial re-arrangement, but so far I haven't felt the need, except for the hairline problem around the temples that two scalp advances didn't quite solve. But frankly, it feels good not to be going to surgeons, and it takes a while for the bank accounts to recover from all this. Meanwhile, I am able to satisfactorily cover that area with my hair, although it does limit my hairstyle choices. Maybe when the finances recover and time and gravity have a little more time to operate, I might want to do something more.

So, as this is mostly a photo essay of my journey, I'll close with one more photo. This one was a work picture taken two years post-op during a busy day. I rushed in to the company photo studio to have a mug shot made for my division. It's a pretty good representation of what I look like on a typical day... a bad hair day, even. Although I'd like to put up a series to go with those above for comparison sake, perhaps this will at least give a glimpse of long-term results.