לין קונווי: ניתוח נישוי פנים ((FFS   Copyright © 2000-2010, Lynn Conway. All Rights Reserved [version of 10-20-10] English Español Deutsch Français Português Русский
Post-FFS photo of Lynn: March 29, 2000

 

בעשרה בנובמבר, 1999, עברה  לין קונווי - Lynn Conway  ניתוח נישוי פנים (FFS). הניתוח בן 10 השעות נעשה ע"י ד"ר דוגלס אוסטרהאוט (Douglas Ousterhout, M.D., D.D.S.), בקמפוס דייויס של המרכז הרפואי קליפורניה-פסיפיק בסן-פרנסיסקו. דאג אוסטרהאוט הוא המנתח שהיה החלוץ ביישום הטכניקה הניתוחית האגרסיבית של שיחזור עצמות הפנים עבור נשים טרנססקסואליות. 

 

מטרת הניתוח לנישוי הפנים FFS הינה להעלים או לצמצם רבים מן העיוותים הבין-מיגדריים בעצמות הפנים, שנוצרו אצל נשים טרנססקסואליות MtF בעת הזיכור (masculinization) שגרם הטסטוסטרון בשלהי גיל ההתבגרות. כדי להמחיש את מה שאפשרי כיום להשיג, קיראו על חוויות הניתוח והתבוננו בתמונות המדהימות של לפני/אחרי באתרים של  אנדראה ג'יימס ,  בקי אליסון , ג'ינה ,  מדליין ,  ניקי ,  סאלי , ו‑ רחל , אשר כולן מנותחות של ד"ר אוסטרהאוט. לקישורים נוספים אודות FFS, ראו גם את  הדף של דיאנה על הניתוח  עם ד"ר אוסטרהאוט,  הדף של ג'סיקה על הניתוח  עם  ד"ר שפיגל במרכז הרפואי האוניברסיטאי של בוסטון , ו- דף ה- FFS  באתר  beginninglife.com    .

 

היתרונות של FFS החלו להיוודע ברבים, כשיותר ויותר נשים טרנססקסואליות עברו ניתוחים אלו בתחילת שנות ה-2000, וזה הוביל לדרישה ליותר נגישות ויותר תמיכה רפואית לתהליכים אלו, כפי שמתארת אנדראה ג'יימס  מכתב גלוי ל- HBIGDA (אגודת הרי-בנג'מין) מה-16 ביוני 2006 :

 

"אני קוראת בדחיפות לאגודת HBIGDA וכל אנשי הסיוע המקצועי לתת משקל גדול יותר לנושא הקול והפנים ב'נהלים לטיפול'. ואני קוראת לכם במיוחד לשקול להביע תמיכה בצורך הרפואי בתהליכי נישוי פנים לאלו שנחשפו להורמונים זכריים במהלך ההתבגרות...." -  אנדריאה ג'יימס 

 

האתר שלפניכם כולל נתוני רקע, יומן אירועים וכמה תמונות הנוגעות להתנסותה של לין בעת שעברה ניתוח נישוי פנים, בתקווה שחומר זה יוכל להועיל לאחרים השוקלים ניתוח שכזה.

 

 

טיפים ורמזים שונים	הבעות תודה	רקע על FFS
מידע על ביה"ח דייויס	יומנה של לין על ניתוח ה-FFS	מדוע עברה לין FFS
מפות ומידע על תחבורה	תוצאות מוקדמות של הניתוח	החלטה והכנות
בית ההארחה  Cocoon	יומן ניתוח מתיחת פנים - FLS	הערה על בית  Cocoon
אוכל, מגורים ושירותים	התוצאה הכוללת של  FFS/FLS	קישורים למידע נוסף על FFS

 

 

שיפור בעזרת הרמת העור באמצעות ליזר -  LSR

 

 

מעט רקע עלFFS :

 

כבר בסוף שנות ה-80 הבין ד"ר דוגלאס אוסטרהאוט שאצל נשים טרנססקסואליות (MtF), ההשפעות של זיכור הפנים (facial masculinization) עלולות להיות מעוותות לגרום נזק חברתי ממש באותה מידה שגורם עיוות פנים חמור אצל נפגעי תאונות, ועיוות פנים מסיבות גנטיות אצל ילדים. מאחר שהיה לו ניסיון ניתוחי נרחב בעצמות ורקמות הפנים, בשיחזורים ובניתוחים פלסטיים ואסטתיים, וכן "ערכת-כלים נרחבת של טריקים ניתוחיים" שהיה יכול ליישם כדי לפתור בעיות שכאלה, היה ד"ר אוסטרהאוט חלוץ בבחינת שיטות חדשות לניתוחים אגרסיביים ביותר לשיחזור תווי הפנים של נשים טרנססקסואליות. 

 

רבות מן הטכניקות הניתוחיות בהן השתמש ד"ר אוסטרהאוט לבצע FFS מתוארות בספר הלימוד שכתב "עיצוב אסטתי של שלד הפנים" Aesthetic Contouring of the Craniofacial Skeleton, Douglas K. Ousterhout, Ed., 1991.. הטכניקות שלו מרחיקות לכת הרבה יותר מהניתוחים הקוסמטיים המסורתיים (כפי שניתן לראות ב  שרטוטים ותמונות מתוך הספר, של ניתוח הסרה ועיצוב מחדש של חלק גדול מעצמות המצח וארובות-העיניים  כדי להעלים את בליטת-הגבות הגברית).

 

במקרה של נשים טרנססקסואליות, מתמקד ד"ר או (כינוי החיבה שלו - Dr. O. - המתרגמת) בדרך להתאים את נתוני המימדים של כל מערכת פנים לטווח הנורמאלי הנשי, בהתבסס על מספר מדידות פיסיות אנתרופולוגיות. כתוצאה מדרישות ההישרדות במהלך האבולוציה האנושית, חלה התאמה של הפנים האנושיות אצל הזכרים, כדי להגן עליהם בעת ציד ולחימה, שעניקה להם עצמות-גבות בולטות ועצמות סנטר/לסתות כבדות. אבל, הפנים האנושיות אצל הנקבות התפתחו (בדומה לפניהם של ילדים) מותאמים לצורך הסתתרות/בריחה טובים יותר, ע"י כך שיש להם שדה ראייה חופשי יותר בשוליו (כשהעיניים יותר בקידמת מבנה הפנים, וללא בליטת עצמות הגבות). הבדלים אלו במאפייני המין המשניים נוצרים ע"י השוני בהורמוני המין הנמצאים בגופם/ן של בנים ובנות לאחר הבגרות המינית.

 

תחת השפעת ההורמון הזכרי טסטוסטרון, מתחיל הזיכור המהיר בתווי הפנים של הבנים במהלך הבגרות המינית, וממשיך להתפתח בשנות העשרים שלהם, וכן מתפתחת צמיחתו של שיער הפנים והעמקתו של הקול. הסרת המקור לטסטוסטרון (האשכים) מונע השפעות אלו של זיכור על הפנים, כפי שניתן לראות ב פרופילים של שתי בנות היג'רה באתר של טקשי אישיקאווה   Takeshi Ishikawa's  (במשך הרבה מאות שנים בהודו, מספרים גדולים של נערות טרנססקסואליות בגיל העשרה עברו מרצונן החופשי סירוס והסרת הפין כחלק ממהלך ההצטרפות לכיתת ההיג'רה; לאחר מכן הן חיות את חייהן כ"נשים" ב"משפחות" של כיתת ההיג'רה). לשתי בנות ההיג'רה בתמונה שמציג טקשי יש עצמות-גבות שאינן בולטות, עצמות סנטר ולסתות קטנות, ומצח המתמזג בגשר האף בקווים חלקים. בהיעדר הטסטוסטרון, תווי פניהן נותרו כאלו של ילדים ונראים ממש כמו אלו של נשים צעירות ויפות אחרות (על אף שלבנות ההיג'רה אין בדרך כלל יכולת לקבל הורמונים נשיים).    

 

אך מה ניתן להיעשות כדי לסייע לנשים טרנססקסואליות האנוסות, עקב הנסיבות, לגדול כבנים וכך נאלצות לסבול זיכור פנים? אפשר לעשות ניתוח נישוי לפנים שעברו זיכור, הכולל עיצוב מחדש של תווי המצח, הקטנה או העלמה של בליטת עצמות-הגבות, בניית חיבור חלק מהמצח לעצם-האף, הצרה וקיצור של עצמות הלסת והסנטר (תוך שינוי מיקום הסנטר לזווית חדשה) וכן עיצוב מחדש של הגרוגרת לסילוק הבליטה המכונה "התפוח של אדם". אבל, כמו בניתוח שיחזור לנפגעי תאונות דרכים ולילדים עם חיך-שסוע ושאר עיוותי פנים, ניתוח FFS זה הינו אגרסיבי במידה קיצונית. 

 

 

מדליין  - לפני, במהלך ואחרי  ניתוח נישוי הפנים  שלה ע"י ד"ר דוגלאס אוסטרהאוט. המהפך הוא ממש בולט, וכיום מדליין הינה אשה יפהפיה.

 

 

איש אינו בוחר לעבור ייסורי ניתוח קיצוני שכזה "מסיבות קוסמטיות". המטופלים חייבים להיות חדורי מוטיבציה, ונכונים ליטול כמה סיכונים ממשיים, כאבים, סבל וסיבוכים. תקופת ההחלמה לאחר ניתוח ה-FFS הינה טראומטית ועתירת כאבים, וזמן רב לאחר הניתוח עוד נמשכות תופעות לוואי רבות: ירידת נפיחות נוקשה עלולה להימשך חודשים, עלול להיגרם חוסר תחושה באזור הסנטר שנעלם מאד לאט, ובקרקפת יהיו אזורים שבהם תאבד התחושה לשנה או יותר, ולעיתים אף לתמיד.

 

אבל, בכמה מטופלות טרנססקסואליות שאצלן העצמות בגבות ובלסתות הן מאד גדולות, משמעות הניתוח אצל ד"ר אוסטרהאוט יכולה כמעט להיות ההבדל בין חיים סבירים לבין גהינום עלי אדמות, ז.א. בין לזכות בנקל בקבלה כנקבה רגילה ובין לסבול בהתמדה מלעג פומבי כבד בגלל המראה שלך. בהרבה מהמקרים היותר אופייניים, הניתוח ממיר את תווי-הפנים המקוריים של "טרנסית" בתווי-פנים נשיים, נעימים למראה.

 

לדוגמה, בחנו את המקרה של  סאלי , כפי שניתן לראות בשלוש התמונות הבאות. התמונה הראשונה (משמאל) מראה אותה בעת שעוד היתה נער, והיא מאד יפה בתמונה זו. התמונה השניה מראה אותה לאחר שנתיים של הורמונים ואלקטרוליזה. הרבה נשים טרנססקסואליות היו חשות נפלא ביותר אילו הצליחו לעשות את השינוי המיגדרי כמו מהתמונה הראשונה לשניה, ולעומתן הרבה היו עשויות לחשוב שהן "נראות כעת ממש נפלא".

 

אבל, על-אף שבתמונה השניה תווי פניה מרוככות ונשיות כלשהו, עדיין תבחינו שהיא נראית "טרנסית". עצמות-הגבות הבולטות, הסנטר הגבוה ועצם הלסת הרחבה והבולטת, אשר גרמו לה להיראות יפה בתור נער, מקלקלים עכשיו את המראה שלה בתור אשה. התמונה השלישית מראה אותה לאחר שעברה FFS נרחב ע"י ד"ר דאג אוסטרהאוט. עכשיו אנו מבינות את הליקויים בתמונה השניה, ולמה שם היא "לא הייתה יפה". מהפך ה-FFS, על-אף שהוא עדין, הוא מאד עמוק. עכשיו היא אשה יפה להדהים, אפילו ללא איפור. כאן זוהי תוצאה מצויינת. לא כל התוצאות תהיינה כל כך מדהימות. אבל, לעיתים קרובות מאד תוצאות אלה משנות את כל החיים בהשפעתן על היכולת "לעבור" ועל ההערכה העצמית.    

 

 

תמונות של סאלי:

משמאל לימין: לפני המעבר המיגדרי; אחרי שנתיים טיפולי הורמונים ואלקטרוליזה; אחרי FFS עם ד"ר אוסטרהאוט.

 

ובכן, מה לכל הרוחות קורה פה? מה גרם להופעה שלה להשתנות עד כדי כך? את התשובה נראה כשנביט באותם שינויים ממש אבל בפרופיל. למרות שאנו כמעט אף פעם לא מסתכלות על עצמנו בפרופיל, זהו הכיוון שממנו אנשים אחרים נועצים בנו מבטים לעיתים קרובות. ואלו הם תווי-הפנים שלנו בפרופיל שהכי קובעים  את יפי-הפנים, ובחצי-פרופיל - את השיוך המיגדרי. לכן, אלו הם הפרופילים שלנו שתכופות מאד מסגירים תווי-פנים "טרנסיים" ולעיתים קרובות מונעים מנשים טרנססקסואליות להיראות יפות.

 

שתי התמונות הבאות מראות את סאלי בפרופיל, לפני ואחרי ה-FFS שלה. השינויים הם באמת מדהימים. המראה שלה לפני FFS היה מאד לא-מחמיא לאשה, על אף שהיא נראתה "בסדר" במבט מלפנים. אחרי FFS עצמות-הגבות הבולטות שלה נעלמו והומרו במתווה נשי מעוגל; אפה עוצב מחדש בקו המשך למצח המשופץ; שונו מן היסוד הגובה והזוית של הסנטר שלה; ובעצם הלסת הוקטנו מאד הרוחב וההתנוססות לפנים. 

 

 

מבט-צד של סאלי לפני (משמאל) ואחרי FFS (מימין)

 

 

רק בפרופיל רואים בתמונות אלו בבירור את השינויים הדרמטיים שבוצעו בשלד הפנים במהלך ה-FFS. שינויים אלו, במבנים עשויי-העצם שמתחת לפנים, יכולים לבטל הרבה מן הנזק שנגרם ע"י הטסטוסטרון במהלך תחילת ההתבגרות שלה. לסאלי יש לבסוף תווי פנים דומים לאלו שהיו יכולים להיות לה אילו הייתה עוברת את תחילת ההתבגרות שלה בתור ילדה: עם אסטרוגן, ובלי טסטוסטרון. התוצאות הסופיות הן נפלאות והן באמת משנות את כל החיים, כפי שניתן לראות בתמונה הבאה. תוצאות אלו מעידות עד כמה זה חשוב לחברה שלנו לעזור לנערות טרנססקסואליות מוקדם יותר בחיים – כך הן תוכלנה להימנע מלפתח תווי פנים כל-כך גבריים אשר מצריכים ניתוחים כל-כך כואבים וכל-כך יקרים כדי לתקנם.

 

 

סאלי כיום – אשה יפהפיה

 

 

מהרבה בחינות, ההשפעה העצומה על חיי הנשים הטרנססקסואליות ועל סיכוייהן לאושר בחיים, כתוצאה מהמצאת ה-FFS, דומה לזו של המצאת ה-SRS. האשה היכולה בדרך זו 'לסובב לאחור' את תהליך הזיכור של פניה חווה משהו עמוק בהרבה מאשר תרגיל ראוותני וייפיוף ההופעה. במקום זאת, הניתוחים האלו, האגרסיביים במידה קיצונית, עניינם ריפוי ממצוקה, קבלה עצמית, ולבסוף שלווה במציאת מקומו האמיתי של האדם בחברה. להבנה מעמיקה של התהליך הזה, ראו את המאמר של  רבקה קסטל (Rebecca Kastl)   " 'עוברת' או 'לא‑עוברת' "  . ואז הקשיבו למילותיה של חברתי  אמילי הובי  (Hobbie (Emily :

 

"לפני הניתוח שלי - כשיצאתי לרחוב לא הצלחתי להימנע מלהיחשב 'משונה' בעיני כמה אנשים ולא חשוב עד כמה הפגנתי אושר ושלווה. אני לא מדברת כאן על 'לעבור', אני מדברת – כאדם - על איך שאנשים ראו אותי. אני רוצה שאנשים יראו 'אותי' בבהירות, ולא דרך מסך של ספק 'מה זה יכול להיות?'. לפני הניתוח שלי עם דאג, ככל שהייתי נערה שמחה ונמרצת, הקווים והגבנונים בפניי שלא היו שייכים 'לי' כירסמו בביטחוני העצמי, והיו 'לא במקום' ממש כאותו תלתל שיער שמזדקר מראשך ולא ניתן להשכיבו בשום אופן. 

 

אני בטוחה שאם הניתוחים של דאג לא היו קיימים, הייתי מסתדרת הכי טוב שאפשר, אבל אני חושדת שלמרות כל האושר שהייתי מפיקה מחיי, ההבדל בין מי שאני באמת, לבין מי שהפנים שלי אומרות שאני, היה מכרסם בי מבפנים. מי יודע.

 

מעבר לתוצאות, זה מאפשר לי לא סתם לעבור דרך החיים והחברה – הכי טוב שיכולתי לקוות לפני הניתוח – אלא לקחת את החיים באופן פעיל, למצוא בתוך עצמי שלווה שאחרים רואים וקולטים, או את היכולת לכך. זהו מעגל נפלא המגביר את עצמו, כאשר הנינוחות השלווה בתוך עורי שלי מקרינים ממני לאחרים, אשר בתמורה חשים את הביטחון העצמי שלי ומשקפים אושר חזרה לעברי ----,"   

 

 

עבודתו של ד"ר אוסטרהאוט על נשים טרנססקסואלות התרחבה במהירות רבה במהלך אמצע-סוף שנות ה-90 כאשר השמועה אודות המהפכים המצויינים התפשטה בין היועצים שטיפלו בהן. השמועה התפשטה עוד יותר מהר כאשר תמונות "לפני-אחרי" החלו להופיע באתרי אינטרנט שעסקו בטרנססקסואליות, בצירוף מידע איך להתכונן לניתוח היסודי הזה וכיצד להתמודד איתו.  אנדריאה ג'יימס(Andrea James)   הייתה האשה הטרנססקסואלית הראשונה שהציגה באינטרנט תמונות שכאלו על תוצאות ה-FFS שלה. התמונות שלה הובילו את ניקי, סאלי, לין והרבה נשים טרנססקסואליות נוספות לראות את מלוא המשמעות של ה-FFS ולהחליט לעבור בעצמנו את הניתוח. עד לחודש מאי 2001, ביצע ד"ר אוסטרהאוט ניתוחים אלו של שיחזור‑פנים נרחב לכ-525 עד 550 מנותחות טרנססקסואליות.

 

הרבה מטופלות בתהליך המעבר המיגדרי MtF עוברות כיום FFS ממש לפני המעבר החברתי אל תוך שנת ה‑"התנסות בחיים ממשיים" ( Real-Life Experience - RLE). דבר זה יכול לשפר במידה אדירה את קבלתן המהירה כנשים במהלך ה-RLE, משום שהן נראות ממש הרבה יותר נשיות בהופעתן מאשר לפני ה‑FFS. שימו לב ש  אנדריאה ,  ג'ינה ,  מדליין ,  ניקי ,  סאלי  ו רחל  היו כולן בשלב מוקדם במעבר המיגדרי שלהן MtF כשדאג עשה עבורן FFS.

 

קבלה טובה יותר במהלך ה-RLE מאפשרת להרבה בנות לעבור חברתית מזכר לנקבה "באותו מקום עבודה", דבר שעוזר להן להבטיח רציפות הכנסה בעוד הן מתכוננות בעקבות ה-RLE לעבור ניתוח לשינוי מין SRS. למרות שניתוח נישוי הפנים הוא יקר למדי, ההימנעות מאובדן הכנסה יכולה בכמה מקרים לפצות על הוצאות ה-FFS ואף למעלה מזה. וגם, הניסיון הראה שהוצאות ה-FFS מוכרות כהוצאה פטורה ממס (בארה"ב – המתרגמת), מאחר ש-FFS הינו חלק מטיפול רפואי כולל של שינוי מין ואינו נחשב כניתוח קוסמטי מבחירה (כמו בישראל – המתרגמת). 

 

משרדיו של ד"ר אוסטרהאוט ממוקמים בקמפוס דייויס של המרכז הרפואי "קליפורניה פסיפיק". כתובתו היא:

Douglas Ousterhout, M.D., D.D.S., 45 Castro Street, Suite 150, San Francisco, CA 94114, USA; Telephone: 001 (415) 626-2888; e-mail link.

 

אם אתן מעוניינות לקבוע פגישת ייעוץ עם ד"ר אוסטרהאוט, התקשרו למשרדו ובקשו לשוחח עם האסיסטנטית שלו, מירה קוֹלוּצ'יוֹ. לחומר רקע נוסף על ד"ר אוסטרהאוט ועל הטכניקות הניתוחיות שלו, ראו את האתר http://www.drdouglasousterhout.com

 .

 

 

 

מדוע עברה לין:FFS

 

לין הינה אשה טרנססקסואלית מנותחת בגיל "55+", שעברה ניתוח לשינוי מין (SRS) מזכר לנקבה (MtF) לפני המון שנים ב-1968. היא ברת מזל בכך שתמיד 'עברה' לחלוטין כאשה, ומאז ועד היום היו לה קריירה וחיים נפלאים כאשה.

 

ולמרות הכל, לין לא שכחה מעולם את התופעות המחרידות של זיכור הפנים שהחלו לקרות לה בהיותה בשנות העשרה, על אף שבמקרה שלה התופעות האלו היו חלשות יותר מאשר אצל הרבה טרנססקסואליות אחרות. ניתוח ה-FFS המודרני סייע לה "לסובב את גלגל הזמן לאחור" דרך אותה חווייה נוראית, ולבטל את מרבית ההשפעות הפיזיות המזיקות הללו. וכך, נועד ה-FFS שנעשה ללין להעשיר את ניסיון חייה ולהעניק לה תוספת קטנה של אושר ונוחות פסיכולוגית בעודה הולכת ומתבגרת.

 

ניתוח ה-FFS של לין כלל קידום של קו השיער, עיצוב מחדש של המצח, העלמת בליטות הגבות, מיקום מחדש של הגבות, עיצוב מחדש של האף, עיצוב מחדש של הלסת והסנטר, והקטנת בליטת הטרכיאה בצוואר. כל אלו נעשו בניתוח אחד ממושך, הידוע בקרב המנותחות של "ד"ר או" בכינויו המאיים "העבודות". התוצאות הינן עדינות ומדהימות כאחד. לין עדיין "נראית כמו לין", במיוחד במבט מלפנים. אבל היה שם מהפך של ממש, במיוחד כשרואים זאת בפרופיל. לין דומה עתה הרבה יותר לאיך שאחותה הייתה נראית, אילו הייתה לה אחות.

 

לין מקווה שהמידע והחווייות המתועדות כאן יעניקו סיוע נוסף לאלו המתכננות עתה לעבור את הניתוח הזה. אם את שוקלת לעבור ניתוח זה, ויש לך שאלות נוספות מיוחדות, את יכולה ליצור קשר עם לין בדוא"ל, דרך כתובת הדוא"ל בעמוד הבית שלה. לין מקווה גם לשמור אתר זה מעודכן ושימושי ככל שניתן. אם ברצונכן להעביר משוב, הערות או הצעות, אנא צרו עימה קשר.      

 

למידע נוסף אודות לין, הכולל הרבה תמונות מוקדמות יותר, ראו את אתר הבית שלה בכתובת:

http://www.lynnconway.com

http://ai.eecs.umich.edu/people/conway/conway-Hebrew.html : עברית

האתר ההוא כולל כתבות בעיתונות, אודות חייה ופועלה המקצועי, בכתובת:

http://ai.eecs.umich.edu/people/conway/Media/Media.html

אחת מהן, בעברית, תמצאו בכתובת:

עברית : http://ai.eecs.umich.edu/people/conway/Media/Maariv/Maariv.html

וכן גם הסטוריה אישית מפורטת, בכתובת:

http://ai.eecs.umich.edu/people/conway/RetrospectiveT.html

 

 

 

החלטות והכנות:

 

תמיד הייתי 'נערת שטח' (outdoor girl), ובמשך השנים עשיתי המון טיולי תרמילאים, טיפוס על מצוקים, ריצה, חתירה בנהרות קוצפים בסירות קנוו (whitewater canoeing), תחרויות אופנועי-שטח, וכיוב'. כל השנים האלו בשמש ובפגעי האקלים, בד-בבד עם הזדקנות טבעית, חרצו לא מעט קמטים על פני וצווארי. בראשית 1999 החילותי לחפש מידע אודות מתיחות-פנים ושיטות העלמת-קמטים כדי להצעיר את הופעתי.

 

חיפשתי גם אתרים של טרנססקסואליות אחרות כדי למצוא מידע על ניתוחי פנים, ונתקלתי בתמונות המדהימות באתר של אנדריאה ג'יימס. בהתבוננות בתמונות "לפני/אחרי" של אנדריאה ומנותחות אחרות, במיוחד תמונות הפרופיל, התחלתי להבין ממש עד כמה תווי הפנים של בליטת-הגבות/הלסת/הסנטר יוצרים את ההופעה המיגדרית של "טרנסית". בבת-אחת קלטתי את העיקרון של FFS וראיתי עד כמה ד"ר אוסטרהאוט הרחיק לכת בפיתוחן של הטכניקות הניתוחיות החדשות האלו.

 

במהלך נסיעה לקליפורניה ביוני 99, ביקרתי את ד"ר אוסטרהאוט להתייעצות, לראות מה הוא עשוי להצליח לעשות עבורי. על פי הוראותיה של מירה, עשיתי יום קודם לכן סידרה נרחבת של צילומי רנטגן של פניי, במכון רנטגן במרכז סן-פנסיסקו. דאג בחן את פניי ואת הצילומים, וקיימנו דיון על כל האפשרויות. האזנתי בקפידה להמלצותיו הראשוניות שבמהלכן הוא שירטט על גבי הצילומים את העיצוב מחדש שניתן לעשות למצח, לבליטות-הגבות ולגשר האף שלי, וכן ללסת ולסנטר שלי. כאשר הבנתי כמה הרבה שיפור אפשר להשיג, התחלתי לחשוב ברצינות לעשות זאת. בעקבות ההתייעצות, התקשרתי בשובי הביתה בדוא"ל עם כמה מנותחות קודמות שלו ללמוד עוד על ההתנסויות שלהן ועל התוצאות.   

 

עד אמצע יולי כבר החלטתי שאני באמת צריכה לעשות את זה. אני בכל מקרה הצטרכתי מתיחת-פנים, וכעת זה היה ברור לגמרי שלעשות מתיחת-פנים בלי לעשות קודם את העיצוב מחדש לעצמות תהייה שגיאה עצומה, משום שהיתרונות של מתיחת-הפנים ירדו לטימיון אם אי-פעם בעתיד אעשה FFS שבו עיצוב מחדש לעצמות.  

 

עברתי הרבה ניתוחים במהלך השנים, והיה ברור מקריאת תיאורי המנותחות האחרות ש-FFS יהיה מייסר במיוחד בהשוואה להתנסויות הקודמות שלי. זה הלך להיות בבירור יותר סבל מאשר ה-SRS הטיפוסי. אבל למדתי כבר שכל עוד את מוכנה נפשית לכאב ולטראומה, ואינך נפגעת מהם נפשית באופן קשה, לבסוף הזכרונות הרעים הופכים לנחלת-העבר די מהר. במקרה זה, היתרונות נראו כבדי משקל הרבה יותר מהמחיר.

 

חזרתי לראות את ד"ר או באוגוסט 99 להתייעצות של תכנון מפורט. החלטנו שאקבל את "העבודות", כלומר את הסידרה המלאה של ניתוחי FFS, שיבוצעו כולם במהלך ניתוח ממושך אחד. יום הניתוח שלי נקבע ל-10 בנובמבר. שילמתי את המיקדמה. זה הלך לקרות.

 

בין אוגוסט לאוקטובר, הייתה לי הזדמנות לפגוש אישית את  סאלי  ו ניקי , שתי נשים שעברו את "העבודות" עם ד"ר או. נדהמתי מהשינוי שהניתוח חולל עבורן, ולמדתי מהן המון דברים אודות הניתוח וההחלמה. זה כלל שפע של טיפים מעשיים המתייחסים להתכוננות, לסידורים, מה לקחת, דברים מעשיים אודות בית החולים והסביבה, ומידע רב על ההחלמה ולמה לצפות במהלכה.

 

למשל, בהתבסס על המידע באתרים ועל השיחות עם סאלי וניקי ומנותחות אחרות, התחלתי לחשוש מקלסטרופוביה משהות של חמשה ימים עם מילוי-אף בתוך ראשי. הפגתי מעט את חששותי ע"י כך שניסיתי "הרצת-מבחן": ערב אחד ענדתי מצבט-אף לשחייה, ואז אכלתי ארוחה והלכתי לישון. אכילה ושתייה היו מסובכים: היה די קשה לבלוע, ואוזניי נפקקו ונפתחו חליפות כל הזמן. אבל בהדרגה התרגלתי לזה. למרות שזה היה מטרד גדול, התחלתי לחשוב שאולי מילוי-האף לא יטריף את דעתי אחרי הכל.  

 

בעודי אורזת למסע, חושבת על מה לקחת ומתכננת את כל הסידורים לנסיעה ולהחלמה, שקדתי הרבה על האתרים של מנותחות אחרות. היו לי הרבה שאלות קטנות שלא ידעתי עליהן את התשובה, והרבה שאף לא ידעתי לשאול. החלטתי לנהל יומן ובו הרשימות שלהלן, לחלוק עם האחרות מאוחר יותר.

 

[הערה: כמה מהתמונות שלמטה די מזעזעות. בחרתי לכלול אותן כדי להמחיש למנותחות עתידיות איך הן תיראינה בראשית ההחלמה. יש לקוות שזה יסייע למנותחות להקטין את הלם "המבט הראשון במראה"].

 

 

 

הערה חשובה אודות בית ההחלמה "COCOON HOUSE" 

 

משעברתי FFS ושוחררתי יומיים לאחר מכן מהיחידה לטיפול נמרץ של ביה"ח דייויס, היו לי כמה אפשרויות למקומות לשהות בהם בהמשך ההחלמה שלי, כשבוע או משהו כזה. היו כמה מוטלים מקומיים  (ראו להלן) , וכן המקום המכונה "חדרי-אירוח" בתוך ביה"ח דייויס. היו אלו חדרי-אישפוז בקומה שבאותה תקופה הייתה פנוייה למעט "אירוח". עבור 60 דולר ליום יכולת לשהות שם ולקבל שלש ארוחות ביה"ח שחולקו בכל יום. 

 

חדרי האירוח היו נוחים, והיו בקירבת מקום למשרדיו של ד"ר אוסטרהאוט. אבל היו להם כמה חסרונות – כמה מנותחות חשו מאד בודדות בקומה בלתי מאוכלסת זאת. כמוכן, האוכל של ביה"ח לא נראה לכמה בנות. בדצמבר 2000 חדרי האירוח שבו לשמש את ביה"ח דייויס, ומשרדו של ד"ר אוסטרהאוט אירגן הסדרים למעון/בית-החלמה לאחר-ניתוח במקום חדש, שכיום הוא בבעלות שתי אחיות חדר-ניתוח מדייויס. הנה הדוא"ל שנשלח ע"י מרי-לו (Mary-Lou), אחת מבעלות המקום - "Cocoon House" ("בית המחבוא"), המבשר על המקום החדש:    

 

לין, הרשי לי להציג עצמי (מרי לו) ואת שותפתי טריסיה. אנו אחיות בי"ח העובדות בחדרי הניתוח של קמפוס דייויס, במרכז הרפואי סנטרל-פסיפיק. כששמענו על סגירת חדרי האירוח, החלטנו להפוך את שתי היחידות שלנו לחדרי אירוח עבור המנותחות של ד"ר אוסטרהאוט. המטרה של טריסיה ושלי היא להעניק לכן סביבה תומכת, בטוחה, נוחה וללא-עישון. איננו מספקות סיעוד!!! אנו אחיות שסועדות!!! (We do not provide any nursing care!!! We are nurses who care!!!). אנו מספקות מיני מזון הנחוצים למנותחות המחלימות מניתוח נישוי פנים, כלומר מיצים, מים מינרליים, מעדני-חלב, רפרפות, מיני רסק פירות, מרקים, סוכריות-על-מקל. כל חדר מצוייד בטלויזיה ווידאו, במערכת סטראו עם נגן תקליטורים, טלפון (לשיחות מקומיות בלבד), תנור גז, מקרר, מיקרוגל, מעבד-מזון, מכונת קפה, מייבש שיער, וכספת לחפצי-ערך. יש לנו חצר אחורית נחמדה לשימושם הבלעדי של האורחים ובה עץ לימון! בית ההארחה "המחבוא" נמצא כמייל אחד מביה"ח, התחבורה הציבורית נוחה מאד (עולה דולר אחד). השכונה (עמק נו) הינה מוכוונת קהילה ובה מגוון תרבויות. בשונה ממרבית סן-פרנסיסקו, האזור שלנו שטוח!!! מסעדות, חנויות מכולת ומרבית השירותים קרובים מאד לבית. בכבוד רב, מרי לו.  

 

עבור כ-125דולר ליום, "בית המחבוא" ("Cocoon House") החדש מעניק מגורים משובבי נפש, ארוחות, וקשר זמין עם הצוות במהלך ההחלמה, לקבלת סיוע בהרבה עניינים מעשיים. זהו באמת סידור חדש נהדר. התקשרו למירה במשרדו של ד"ר אוסטרהאוט לקבלת מידע נוסף, ולהסדרת שהייה ב"בית-המחבוא" לפני ואחרי הניתוח.

 

ביומן שלמטה, אני מדווחת על ההתנסות שלי אשר כללה שהייה ב"חדרי האירוח" הישנים שבביה"ח דייויס. אלו שתעבורנה FFS בעתיד צריכות להביא בחשבון את ההבדלים הצפויים עת תחלימו ב"בית המחבוא" (או במוטל) לאחר שתשתחררו ממחלקת הטיפול הנמרץ. למידע נוסף על כך, ראו את  "האתר של בית המחבוא" 

 

 

קישורים למידע נוסף אודות FFS:

מאז הוצג דף זה לראשונה בשנת 2000, יותר ויותר נשים טרנססקסואליות עברו FFS כדי להשלים את המעבר המיגדרי שלהן יותר חלק ויותר בהצלחה. כתוצאה מכך, מספר מנתחים פלסטיים בולטים ברחבי העולם החלו לעשות את סוג ניתוח-הפנים שדוגלס אוסטרהאוט היה החלוץ בו, ונעשים מומחים בניתוחים אלו. בכל שנה, יותר ויותר נשים מציגות את סיפוריהן ותמונות של תוצאות FFS, ובכך עוזרות לאחרות שבתהליך המעבר המיגדרי להבין טוב יותר את החלופות של מחיר/סיכון/תמורה הכרוכות במעבר ניתוחים אלו. כל הפעילות הזאת הובילה להצגת הרבה יותר מידע אודות FFS באינטרנט. הקישורים הבאים יסייעו לכן להתחיל לתור את כל המידע הזה (כל האתרים הם באנגלית – הערת המתרגמת): (All sites are in English – translator's note) 

Andrea James' FFS information page, with links to many FFS information resources.

Beginning Life FFS page, with many links to patients' stories and photos and to prominent FFS surgeons' websites.

Diane's page about her FFS surgery with Dr. Ousterhout.

European TS information site: This site provides information on FFS (and SRS) surgeons in many countries (and in many languages).

Facial Feminization Information.

Yahoo FFS Support Group.

Vicki Estrada's photo-diary video about her Facial Feminization Surgery with Dr. Spiegel in Boston  NEW

Victoria Escher's page about her FFS with Dr. Ousterhout (including before/after photos) NEW

אתרים של מנתחי FFS בולטים:

Douglas Ousterhout, M.D., San Francisco, CA

Jeffrey Spiegel, M.D., Boston, MA (link to FFS page, also see many photos at this link)

Mark L. Zukowski, M.D., Chicago, IL

Frans Noorman van der Dussen, M.D., Antwerp, Belgium

Suporn Watanyusakul, M.D., Chonburi, Thailand

Bart van de Ven, M.D., Ghent, Belgium (procedures, before/after photos,)  NEW

Marcelo Di Maggio, M.D., Buenos Aires, Argentina (more, more, more, more, more, more)  NEW

הבעות תודה:

 

הרבה תודות לד"ר דוגלס אוסטרהאוט על שהבין וטיפל בבעיות עיוות-הפנים של נשים טרנססקסואליות עקב הזיכור, על שהשתמש בכישורי היצירתיות וההמצאה שלו למצוא דרכים כיצד לפתור בעיות אלו, ועל שהשתמש בכישוריו הניתוחיים היוצאים מן הכלל כדי לבצע נישוי אמנותי לפניהן של הרבה הרבה נשים טרנססקסואליות.

 

תודות גם לסייעת ומנהלת המשרד של דאג,  מירה קוֹלוּצ'יוֹ , המקיימת קשר הדוק עם כל המנותחות כדי לעזור להן להתכונן ולהקל על קשיי ההחלמה שלהן, ואשר מפקחת על כל ענייני המשרד הרפואי הגדול של ד"ר 'או' להבטיח את פעילותו חלקה. אני רוצה להודות גם לאנדריאה ג'יימס,  סאלי ,  ניקי , ג'סיקה וקרוליין על כל הסיוע האישי והעזרה באתרי-אינטרנט שהן העניקו לי בעת שהתכוננתי ל-FFS.       

 

 

מנתח-מומחה ד"ר דוגלאס אוסטרהאוט	האסיסטנטית של דאג, מירה קוֹלוּצ'יוֹ

 

 

DIARY OF MY FFS SURGERY AND RECOVERY:

 

11-8-99: I flew to San Francisco one day early to avoid any possible problems with flight delays. Stayed one night in the Metro Hotel (see locator maps) near Davies Hospital. It was beautiful weather today. I enjoyed a nice walk and scouted all the neighborhoods around the hospital to locate the Safeway grocery store and drug stores store, the Muni light-rail-transit stops, and various other services and restaurants, as useful info for my boyfriend Charlie when he arrives.Went downtown and had dinner with my friend Rom and her partner.

 

 

11-9-99: Went to Davies Admitting shortly after noon, and checked into my hospital "Guest Room" where I'll stay tonite.Checked in with Dr. O's office at 3:00 pm for final surgical planning, taking of the "before photos", some lab work, paying of fees, etc. Filled some last minute prescriptions at a nearby pharmacy on the way to dinner. Then walked over to have dinner at Chow with Dr. O's recent patient Carolyn, who had just had the same surgery a month ago. Got some good tips and hints from her. Called Charlie. Went to bed early.

 

 

11-10-99. Surgery Day: Went down to Admitting at 6 am. Signed in and then am wheeled downstairs to prep for surgery. I'm calm, rested and ready; I guess all those work-outs at the Y are paying off. My last physical checkup showed BP of 110/60 and pulse of 72. Now a lot begins to happen. It's all very smoothly efficient, and everything is kind of a blur from here on. The IV line goes in. I remember being rolled into the operating room, and talking with Dr. O for a little while. Then, the lights go out.

 

The next photo shows me after just awakening the evening in the ACU after 10 hours on the operating table today. I have a full face bandage on, and drain tubes are being used to drain blood and ooze from down within the jaw/chin wound. I'm alert and don't feel too badly. Of course I realize that this is just a temporary respite before my body starts reacting to what has happened to it!

 

 

 

11-11-99: Here I am in the ACU the day after the surgery. Dr. O has removed the full face bandages. My body has begun to notice that something extraordinary has happened, and is reacting accordingly. My face is very swollen now, and I've slowed down and am settling into grinding my way through the next week or so.

 

 

This next photo is late in the afternoon of of the 11th. My Charlie flew into SF midday, and arrived just after my full-face bandages had been removed. I was a bit groggy here, but was I ever so glad to see him and hug him. My face is now very swollen, but I'm very aware that there are no major problems so far. I'm not vomiting, my voice sort-of works, my throat isn't sore, I can see straight and I don't feel particularly weak. Wow, I think I got lucky - - .

 

 

Evening of the 11th. Here I am with my morphine pump handy. It's keeping me pretty happy. Luckily I have a hearty appetite, and the pureed food tastes great right now. I'm feeling awake and am not in much pain now. However, I'm not totally in contact with reality either.

 

The facial swelling continues to increase, puffing my cheeks way out. My hair is a soggy, bloody matted-down mess. Hmm, the next few days are going to be interesting. Let's get some food down while the getting's good.

 

 

I learned right away that eating was going to be a chore, because of the nose-packing interfering with swallowing and also the very limited amount that I could open my mouth.

 

Then, sometime this afternoon my IV must have backed out of its vein, because my arm started hurting. I looked at it and saw that the forearm was all puffed up from fluid being pumped into it. I realized what was wrong right away and called a nurse, and she replaced the IV into my other forearm. No harm done, but I've learned from many past surgeries that it's a good idea to stay alert for such things, and to buzz for help right away.

 

I'm also learning lots of wierd things, such as how wonderful the "suction tube" is. Like the thing at the dentist's office that sucks spit from your mouth. The problem now is huge gooey blood clots and ooze up in behind my nose and up into my sinuses. What makes it worse is every time you swallow anything with the nose packing in place, some of that wants to go up in there too! All that aggravates the psychological impact of the darn nose packing.

 

At first I tried to snucker that stuff down into the back of my mouth. It was tough to do, because it was so slimy and stuck up there. Then I accidently discovered what happened if I stuck the suction tube back in there and caught the end of some stuff with it. Wow, it would instantly pull a whole octopus-like gorpy bunch of it out of there. What relief! Way cool! By the time I left the ACU on the 12th, I'd half-filled a quart reservoir with "stuff".

 

Charlie stayed over at the Metro Hotel on Divisadero tonight, the 11th. It's just a few blocks away and an easy walk to Davies. Tomorrow when I move from the ACU into my Guest Room, Charlie will move in with me too.

 

The Guest Rooms are on the third floor of Davies, and although without nursing care they are provided with hospital food services, and are a short elevator ride and walk from Dr. O's offices. These rooms provide comfortable, convenient, inexpensive accomodations once ACU nursing care isn't needed.

 

[Note: Patients (and partners) would now move to Cocoon House, the new post-FFS recovery facility that has replaced the Guest Rooms]

 

11-12/13-99: Moved from the ACU into my Guest Room midday on the 12th. It was great to unpack a bit and get more of my things within arms reach. What's especially wonderful is that Charlie can now stay with me all night, sleeping in the second bed in this room. I encouraged him to play tourist in SF for 6 to 8 hours each day, so he'd have some fun too. But having him return each afternoon or evening and spend the night was wonderful.

 

Any patient's spouse, S.O., or friend could do the same - - you can get two keys, and the keyrings are passes through the Davies Emergency Room area at any time, day or night.

 

I also met JoAnne, another of Dr. O's patients today. She's in a guest room just a couple of doors away. We were now able to keep each other company for a while each day.

 

The next photo shows Charlie and me in our Guest Room. The flowers behind my head were sent by my friend Nicki. On the shelf to the left of Charlie you'll see two "good luck" photos that I brought with me. One is of Charlie holding one of our cats. The other is one of my friend Sally bravely showing two "thumbs up" while in her full-face bandage during her surgery here.

 

 

 

11-14-99: The very worst seems to be over now, and I've settled into the grind of day-to-day coping with heavy dull pain. Also, my nights have been pretty fitfull and I haven't been able to sleep but for a couple of hours at a time. The bruising on the upper face doesn't look too bad now, and the swelling now is mainly a problem in the jaw, chin and trach areas. I've taken on the "chipmunk" look as my friend Sally calls it. My swollen cheeks make me look like I'm an expressionless chipmunk with a mouthful of stuff in her cheeks - - .

 

I've taken to walking around on the 3rd floor (the Guest Room floor). It's 150 yards around, and is a nice, quiet relaxing walk. You can circulate for a mile or so without seeing anyone else, since it's almost unoccupied except for other patients of Dr. O. You can tell how many are here by looking for food trays outside the rooms before/after meals.

 

I almost always left my door open, so I'd see people once in a while. One of the food servers, undoubtedly new, once brought my dinner into my room and said "I'm not sure what's going on on this floor. I bring food up here and leave it outside rooms, but never see anyone here". I said "This is the Twilight Zone" in a very solemn voice. That seemed to reassure him a lot.

 

It was also very, very comforting to have a number of close friends visiting me now. My friends Jorge and Susan visited me yesterday; I'll be staying with them one night before flying home on the 19th. Today Rom and her partner Luccia visited, as did my friend Terri Wanke. I've also received lots and lots of phone calls which, along with the visitors, have really cheered me up.

 

I've now begun to get into a very excited state, because as of today I can see how amazingly this surgery is going to affect my forehead and browridge. Along with the Vicodin pain pills, all this has made me extremely hyperactive when on the phone and with visitors. The nose packing and the associated breathing and drinking difficulties are a continual nuisance, but they didn't make me crazy or claustrophobic like I'd worried they'd do. I'd brought a few Valiums just in case, but didn't need to use them after all - - - .

 

Brief description of the overall operation: Dr. Ousterhout had made a large initial incision that accessed Lynn's forehead and brow area. This 19 inch incision ran vertically up from the top of each ear for about four inches, and then horizontally circled the forward part of Lynn's scalp (the photo below shows staples reinforcing stitches that hold together a part of this incision). Pulling this large flap of skin downwards exposed the forehead and browridge, part of which which Dr. Ousterhout then sawed out and worked on outside of Lynn's head.

 

Those forehead and browridge bones were sawed into sections, and then reassembled with Titanium wires into a flatter form. Dr. O then ground the surface to a smooth, convex form. After he reshaped and resized the forehead/browridge, he wired it back in place using Titanium wires and dissolving screws. For more details on this unique browridge procedure, see some details and photos from Dr. Ousterhout's textbook.

 

Dr. O then exploited the initial incision to advance Lynn's hairline: He removed a section of skin and then stretched the scalp aft of the incision forward to meet the original incision line. Most of the incision within the hair-covered areas was reinforced with staples after being stitched.

 

 

In addition, Dr. O had reshaped my nose, in particular the bone and cartilage of the nose ridge-line, so that it contoured nicely into the new brow and forehead contours. He then made some detailed refinements of the nose tip. In the process, he straightened out my nose, which had been badly broken years ago and was quite out-of-alignment left to right. In the photo above, the nose is shown protected with internal and external splints, internal packing and an external bandaging.

 

The jaw and chin area is covered by a bandage compressing the area where the jawbone has been sectioned both horizontally and vertically. During the "double-sliding genioplasty", pieces were taken out of the jawbone to reduce its height and width and to change the angle of the bone underneath the chin area. The reduced pieces were then put back together with Titanium plates, screws and wires. Before reattachment, the jawbone was then slid forward into a position that will yield a nice, small, properly-positioned female chin, and then wired into place.

 

The jaw and chin work is accomplished through a large incision all around the base of the gums on the inside of the mouth between the teeth and cheeks. This wound area will be quite painful for at least two weeks after surgery, and will remain very swollen for many more weeks after that. It's a nuisance to clean your teeth after meals, but they have to be kept very clean to avoid post-op infections. I'm sure glad I brought a child's tooth brush that could easily slip down into the wound area without stretching things too much. I think that Mira provides these toothbrushes to most patients now.

 

Finally, Dr. Ousterhout opened a small incision up under my chin, through which he removed sections of tracheal cartilage to eliminate my "adam's apple". Although mine was a modest one and hadn't been a problem before, we knew that it would be visibly quite obvious after my later face-lift surgery. The trachea reduction area is also bruised and swollen in the photo, but not too painful, yet. I didn't lose my voice during early recovery as some have reported, although I had to keep it rather low and soft to avoid pain from the tracheal wound area.

 

Even though my whole face is swollen, bruised and discolored in the above photo, those who know me can already visualize how much Dr. Ousterhout set my forehead back and recontoured it to remove my browridge. Notice the higher eyebrow position, and how much less my eyes appear to be set back into my face than in earlier photos of me.

 

 

Some comments on my surgical recovery so far: I was very lucky with this surgery: I didn't step on any of the land mines that some of the other patients have previously encountered (extended periods of vomiting, severe sore throat from the 10 hours of intubation with a breathing tube, anxiety reaction to the nose packing and mouth-opening restrictions, double vision for extended periods, high-fever reaction to the surgery, loss of voice for extended period, weight loss due to lack of appetite, extreme tiredness for many days, etc.). Thus my appearance and attitude returned towards normalcy fairly rapidly.

 

However, the FFS was a major shock to my system. It was a real grind to deal with the heavy dull pain from day to day. You should expect major difficulties in sleeping for the first few days, and you probably won't sleep all the night through for the first week to ten days. My bowel movements stopped for three days (effects of surgery and antibiotics). I'd worried about constipation, but on the fourth day post-op I had a large full movement without trouble (probably thanks to taking Metamucil in some water at my morning meals each day, and a couple of Ex-Lax's on the 3rd and 4th days).

 

The basic activities surrounding eating are made quite difficult due to the effects of the nose packing, the pain and swelling in your lower gums, and the very limited amount you can open your mouth ( I could just barely fit my thumb's smaller dimension between my upper and lower teeth).

 

For the first four or five days, you'll probably really need to take a Vicodin pill once every four to six hours. You'll know when you need to take one. After that, I reduced the dosage to a half-tablet every six hours and then tailed that dosage off as the days went by.

 

Anyone contemplating this serious surgery should prepare very thoroughly and get in good shape physically. By learning what to expect day to day from web sites and discussions with previous patients, one can take things to help cope with possible problems, and one can also avoid becoming unnecessarily frightened by and anxious about the ongoing wierd things that occur during recovery. Visitors and phone calls are good distractions from the daily grind while in the hospital.

 

 

11-15-99: Still spent a very fitfull night. Woke up in pain, and took a Vicodin. Then got some more sleep. Felt OK by breakfast. Sort of tired and dazed, but not too bad either. Stomach a bit upset by a too-full feeling, since still not eliminating quite enough to keep up with intake.

 

Finally washed my hair for the first time this morning. Did this by sitting and leaning back at the sink, using lots of towels, and care not to get any of the facial bandages wet. Took a long time even for a crude shampooing to get most of the blood and goop out, but I felt ever so much better afterwards.

 

Mira called and said to come to Dr. O's offices at 4pm for first bandage/stitch removals. Charlie came with me (and watched) as Mira removed the nose-packing, some of the inside nose stitches, some of the trachea stiches, and the jaw/chin bandage. Dr. O came by and he removed my forehead stiches. I'd worried about pain from some of these procedures, but all were done very quickly and with only minor, quite tolerable pain. I must say though that the packing removal procedure was scary, as length after length kept coming out. I kept wondering when it would end, and if there would be pain somewhere along the way - - . It turned out that the anticipation about these procedures, especially about the removal of the nose-packing removal, was worse than the reality.

 

I was feeling well enough by now that Charlie and I decided to get out of the hospital for a while. We walked from Davies down to the N-Line Muni light-rail stop just a block away from the hospital, and took the Muni downtown to the Powell Street Station. We explored the San Francisco Shopping Centre, which you can enter from that Muni subway station without going outside. It's a neat place to shop, and you can get there from Davies via the N-Line with little walking or exposure to the weather (or from Cocoon House via the J-Line).

 

We also walked around for a while in the Market Street and Union Square area, and browsed in some of the department stores there. I reminisced about the time 31-33 years ago during my transition when I drove up the Peninsula from Palo Alto each week to undergo long electrolysis sessions in an office just off Union Square.

 

We took the L-line Muni subway back towards Davies, and got off at Market and Church near the Safeway store. We bought a bunch of deli goodies at Safeway, and walked back to our room for a nice evening meal. I had to squash my sandwiches down flat so that I could fit them into the side of my mouth. But it was great to be able to eat with the darn nose-packing out!

 

Slept better that night. Went to bed at 10pm; woke once at 12:30 to go pee; then slept all the way thru to 6:30am the next morning. Ah that felt nice!

 

 

11-16-99:

 

Felt better after the good nite's rest. Charlie packed, and we talked a lot. He had to get back to Michigan and his work. Went down to the lobby at 10am. His "Super-Shuttle" arrived right on time at 10:30 to get him to the airport plenty early for his 12:50 flight. I was sad to see him go; he'd been wonderful through all this, and it had been quite an ordeal for him too - - .

 

I got a nice sandwich and some fruit at the corner mart near Davies. Also checked out the cafeteria down on "B" level of the hospital, and started bringing tasty items up from there too, helping to improve my appetite again, which had finally languished after 5 days on the hospital food.

 

The rest of that day I spent lots of time on the phone with friends - - and I called Charlie that eve when he got home - - our three kitties had been lonely for us, so he gave them hugs for me too - - .

 

 

11-17-99:

 

Awoke early. Started organizing my stuff a bit, since I'll be leaving tomorrow. About 9am, Dr. O called and asked if I could come down early today to have him remove my nose splints (a day early). I took a Vicodin and went down to his offices.

 

Dr. O first removed the remaining "X" nose bandages, and it was then time to remove the internal plastic "splints" from way back inside of each nostril. I was quite apprehensive, since I'd read that others had experienced great pain during this procedure. However, although it seemed like he was pulling large "bones" from deep inside my face out through my nose, it didn't hurt all that much. As with the packing, the anticipation was worse than the event. However, I was sure glad to get that over with - - - .

 

Dr. O then handed me a mirror, and I got my first look at my new face. Albeit with a lot of swelling and bruising still remaining, I was amazed at how much improvement was already visible. The new noseridge contoured very gracefully down from the new female browline to create a wonderful new impression. We chatted for a while, and he carefully went over various aftercare information: wash face with fingers (no washcloth) for a while, since the nose is numb and you want to put even pressure of each side while the cartilage is still soft; NO EYEGLASSES for six weeks, until the nose cartilage firms up; no activities that would raise blood pressure for another two weeks, after which I can resume normal exercising; no wearing of hats that would put pressure on the forehead bones for six weeks (bony softness must firm up first); etc. With all the bandages finally off, I was OK'ed to take a full shower that day (although the hospital showers are so strong that I was still very careful not to have it directly spray on my face and head).

 

That evening I got really cleaned up and dressed nicely for the first time since the operation. I put on a skirt and sweater instead of the khaki's I'd been living in the past week. By now, my normal make-up covered most of the bruising, and made me look and feel better too. My friends Dick and Peggy came to visit me, and we walked over to the Thai House, a few blocks away on Noe Street for a great Thai dinner and a wonderful evening of conversation. I was still very swollen and in some pain, but it was really nice to get out to dinner with my good friends.

 

 

11-18-99:

 

This morning I packed, and then went to Dr. O's offices to have Mira remove the staples from my scalp, and to have her take some initial "after" photos. We went over some planning and logistics for my next trip out for the face-lift on 2-24-00.

 

Left Davies at 11am; my friend Jorge picked me up; I'll stay with Jorge and his wife Susan down in San Carlos tonite, and they'll drive me to the airport tomorrow for my flight home.

 

 

11-19-99:

 

After a nice evening and meal and a good night's sleep at my friends' place, they drove me to the airport for my flight home. It was great to get back to Michigan, and see Charlie at the arrival gate at the airport. The trip was tiring, and I was so glad to get home, see our kitties again, and to be able to sleep in our own bed there. Before going to bed I weighed myself. Amazingly, I still weighed 155#, which was my set-point prior to deliberately gaining 5# during the two weeks before surgery. I'd thought that I might lose more weight as, others have reported. But that didn't happen. Now I need to work a bit to take my set-point down to 150# , where I've wanted it to be before (and long-term after) the face-lift surgery in February.

 

 

11-24-99 (2 weeks post-op)

 

My first week home I took it very easy. I was still very swollen in the jaw/chin area, and in some pain. I also tired very easily. So it was a time to just relax, eat well, and get a lot of sleep.

 

 

12-1-99 (3 weeks post-op)

 

Although the swelling hadn't really gone down much, I felt much better this week. By late in the week I resumed light work activity, and also resumed moderate workouts at our local Y every few days.

 

 

12-8-99 (4-weeks post-op)

 

Although everything was healing well, and I was set to return to normal activities, I hit a problem this week. On Dec. 6th a small lump appeared at the lower right corner of my chin. By the 7th it was quite swollen. I called Mira, and Dr. O prescribed CIPRO.

 

This localized infection wasn't under control by the10th, and my face looked a little wierd due to the swollen lump under the right side of my chin. On the 11th Doug prescribed Augmentin, a different antibiotic. About 48 hours later the infection eased and the swelling began to go down. Then late that day, it came right back again! Doug reassured me that at the worst the local infection might need to be drained to help the antibiotics work, and that this minor procedure could be done in Ann Arbor, by a plastic surgeon at UM Hospital who is a friend and colleague of his.

 

The swelling, pain and appearance effects messed up this week for me. I mostly hunkered-down and stayed at home. So, do not count on being "fully effective" even this long after such major surgery. Minor complications can happen. Don't get your activities too tightly scheduled. Be prepared to deal with contingencies.

 

 

12-15-99 (5-weeks post-op)

 

During the next week I continued on the Augmentin. Late this week the swelling eased. Dr. O prescribed some more Augmentin for me to take for another week, to be completely sure of clearing the infection.

 

 

12-22-99 (6-weeks post-op)

 

All signs of infection went away this week. I went off the Augmentin mid-week and finally began to resume all normal activities. The bony swelling in the jaw and chin is now down quite a bit, although it is irregular and lumpy in places. Almost all the bony pain is gone now. My chin was still quite numb, but my lower lip was more sensitive again so that I didn't "drool" as much when I eat. I still couldn't open my mouth very wide (only 20mm), so eating still involved cutting things into small pieces and inserting things into the side of my mouth.

 

My appearance when made up, happy and smiling was very nicely feminine now. Even given the limitations due to healing and recovery, and how funny and sore my face felt to me, many people at gatherings felt compelled to comment on "how well I look!" Folks clearly noticed nice changes, but weren't able to interpret them and figure out what happened. They're thinking maybe I've lost weight since they saw me last? Or perhaps I've been doing a lot of exercising? I also caught glimpses of acquaintances staring at me in profile in a state of slight confusion. They were probably trying to figure out why their recollections were so far off-base. It was fun to experience these reactions, which helped to keep the smile on too!

 

12-29-99 (7 weeks post-op)

 

The jaw and chin swelling dropped off rapidly this week. There were still a few random bumps of swelling left, but I'm finally seeing what the jaw and chin will eventually look like. It's wonderful! I couldn't be more pleased. The reduction is far more than I'd originally thought could be done, and the appearance of the chin is really very cute. Also, the banding and swelling from the tracheal wound went down a lot, and I could now also see how much Doug reduced my tracheal "bump". It's gone completely, and there will be nothing but a nice smooth neck contour showing once the face-lift is done. Wow, I ever so thrilled with the results now! I should post some photo updates sometime soon - - .

 

1-10-00 (2 months post-op)

 

Back to near normalcy now. There is still some lingering jaw swelling and numbness in my chin and left cheek, and some "banding" in my neck tissues where the trach incision was made. The swelling is down enough now to get me worrying again about needing the face-lift.

 

2-10-00 (3 months post-op)

 

Almost time to go back to Davies for the face lift on Feb. 24th. And it's a good thing: As the FFS swelling went down further, the need for a face-lift became ever more obvious. A lot of new wrinkles and sags are showing now, unless I keep a big smile on my face!

 

On the other hand, I'm finally able to open my mouth much wider ( 30mm ), and can thus eat things more normally, including eating sandwiches without flattening them first!

 

 

 

LYNN'S INITIAL FFS SURGICAL RESULTS:

 

This section provides some photos of and comments on the results of my FFS surgery as the results become increasingly evident during longer-term recovery.

 

First we'll see some initial "after photos" taken of me on Nov. 26th, when just 2-weeks and 2-days post-op. It's amazing how fast I'd been healing just the prior few days. I'm still quite weakened at this point, and have to take it easy. But, almost all bruising and discoloration have disappeared over the last couple of days. What's left can be easily covered by regular make-up.

 

Of course, there is still very heavy, hard swelling underneath the jaw and chin, which shows up as large lumps in the following photos. There is still quite a bit of numbness in the lower lip, lower jaw and chin, and also in the forehead and brow area. As the numbness gradually recedes it is replaced by dull heavy pain and a wierd tinglyness as the nerves begin to recover their functions. As of this point, I can't yet control my lower lip movements or my chin's facial muscles, making the effects of the swelling much more noticeable in person than in photos.

 

However, I am thrilled at the results we're seeing, even now at this very early stage with LOTS of swelling and pain remaining (mainly in the jaw/chin area). My friends will immediately see the huge difference in my appearance in profile. I've never ever shown photos of me before in profile, or even front-on photos without my hair down over my forehead. The elimination of my old browridge, recontouring of forehead and nose-ridge, and reduction in size and narrowing of the chin changes all that.

 

I can't wait to see how it's all going to look when the jaw and chin swelling goes down completely. Dr. Ousterhout really performs miracles with his FFS surgeries. Time will tell, but I think he's done it again - - for me.

 

Nov. 26, 1999:  Lynn at 16 days post-FFS (still with LOTS of jaw/chin swelling)

 

 

Also, I noticed a very interesting side-effect of the noseridge and browridge reduction: My peripheral vision has been greatly extended up, to the sides, and (in binocular vision) across the nose, because those bony areas are no longer blocking so much of the view. It's like shifting from an older car into a newer one that has a much wider, higher windshield.

 

As an update, here are some snapshots, including one of Charlie and me at Christmas dinner while visiting with my brother and his wife in Wisconsin, and another taken in San Francisco in February. Even though these photos are limited in resolution, my new facial contours are quite noticeable in the semi-profile views taken at 6-1/2 weeks post-op and 3-1/2 months postop:

 

Charlie and Lynn, December 25, 1999	February 22, 2000

 

Of course, there's still some more to do to complete my FFS project. It takes several months for the bony swelling to shrink back to where it's not noticeable. With that shrinkage, all the bone removal means that I must get a face lift, because at my age my skin will not shrink back all the way as the swelling goes away. You can see the loose skin down in the front of my neck and around my eyes in the detailed 2 weeks + 2 days "after photos" above. For a while, in late January and February of '00, I'll actually look lots older because of all that loosened skin. However, that problem will be solved by Dr. Ousterhout on Feb. 24, 2000, when he works on me for another 6 hours on the operating table to do my face-lift and some skin-tightening around my eyes.

 

 

 

LYNN'S FACE-LIFT SURGERY (FLS) DIARY:

 

In many older patients, face-lift surgery may be necessary as a follow-up to FFS. Some patients may have already needed a face-lift prior to FFS, and/or their facial skin may not adequately shrink and tighten up after the FFS's reduction of facial skeletal dimensions. In such patients, a face-lift can produce dramatic overall results, making them not only look more feminine, but much younger too.

 

Dr. Ousterhout requires a wait of at least a 3 months after FFS before doing the face-lift surgery, in order to insure adequate reduction in bony swelling after FFS. During the final month or so of that wait, you will not look your best due to all the wrinkles and sags. By then you'll be highly motivated to get on with the face-lift!

 

On February 24, 2000, Lynn underwent face-lift surgery and blepheroplasty (upper and lower eyelid surgery) by Dr. Ousterhout at Davies Hospital in San Francisco. For a detailed diary regarding this surgery, including photos and tips and hints, see the following subpage:

 

LYNN'S FACE-LIFT SURGERY (FLS) DIARY

 

The physical impact of face-lift surgery was far less severe than was FFS. Readers can see the difference for themselves by comparing the photos of me during early recovery at that face-lift site, with those of me during early FFS recovery. The first four days or so after FFS were quite an ordeal. The photos taken during early FFS recovery show me in great pain, with an extremely swollen face, grimly hanging on and sweating-out the passage of time. In contrast, the photos at the Face Lift page show me bouncing back pretty quickly during early recovery. While there was pain, bruising and swelling after the face-lift surgery, it was quite tolerable and nothing in comparison with trauma of the initial FFS.

 

Here we go again! Lynn shortly after face-lift surgery, February 24, 2000

 

Five days after her face-lift surgery, Lynn is feeling just fine. February 29, 2000

 

The face-lift and eye-lid surgery put the "frosting on the cake", and a few weeks later the amazing overall results of the FFS and FLS surgeries were finally revealed.

 

 

 

LYNN'S OVERALL FFS/FLS SURGICAL RESULTS:

 

Following are digital camera snapshots of my FFS/FLS results, taken March 29, 2000. My facial skin is still very tight, and there's still some minor bruising and some swelling remaining in my cheeks at 5 weeks postop from the face-lift surgery. Although I'm having a little trouble smiling and making facial expressions, the overall results of the surgeries are now becoming clear.

 

I'm very thrilled with these results, which not only make me look very female but also much younger than my actual age. The effect of FFS on feminizing my profile seems almost unbelieveable to me. Then the face lift removed the jowls in my cheeks and large wrinkles in my face, and also the "turkey neck" folds of skin under my chin. The blepheroplasty removed the large bags of skin over and under my eyes. I'll probably undergo laser resurfacing to reduce the finer facial wrinkles too, but that will wait for another year or so. Doug has worked his miracle for me, and it's truly wonderful!

 

March 29, 2000: Lynn at 4-1/2 months post-op from FFS, and 5 weeks postop from face-lift surgery [Lynn's skin is very tight, and she's having trouble smiling, but the results look great already]

 

 

Following is a photo taken two months later, on May 29, 2000. My skin isn't so tight now, and I've been getting used to how my new face "works". I've been exercising my facial muscles a lot, and I can make more relaxed, natural smiles and a normal range of nice facial expressions again. Now the result looks really wonderful to me!

 

 

September 2000: Lynn after FFS and FLS (with no make-up on)

 

 

Note: Lynn enhanced the results of her earlier FFS and FLS surgeries by undergoing Laser Skin Resurfacing (LSR) surgery by Jeffrey Dover, M.D. in Chestnut Hill, MA (near Boston) in early 2002. This surgery was done to rejuvenate the final appearance of the facial skin by removing many fine wrinkles, age-spots and other sun accumulated damage (compare photo above with the one below). The results are subtle but powerful in "4-D", i.e., when seeing the skin close-up and in motion (as when speaking and making various expressions). When performed by a top laser surgeon such as Dr. Dover, LSR surgery can greatly improve skin tone, not just by removing defects but also by making the skin much softer, smoother, "plumper" and generally younger-looking. For additional information about laser skin resurfacing see:

 

LASER SKIN RESURFACING (LSR)

 

 

Lynn on her honeymoon in August 2002 - post FFS, FLS and LSR

click on photo for more detailed view

 

What did people notice?

 

It's was a lot of fun encountering friends and colleagues after FFS/FLS. While at several important functions at Univ. of Michigan, many folks who hadn't seen me for a while seemed strongly compelled to say something, usually something like "Gee Lynn, you look GREAT! What've you been doing? Lose some weight?". I'd usually reply "yep, been working out and lost some weight. I'm also really having fun and enjoying retirement too!"

 

But I noticed something else too. At cocktail parties and at gatherings at UM, I noticed out of the corner of my eye that someone is staring blankly at my profile. If I turned smoothly and looked up at them, I'd catch a puzzled look on their face. It didn't occur to them that someone can be physically "morphed" in this way, so they were probably wondering "why their memory is failing them so badly"! Such observations raise all sorts of interesting questions about appearance and identity, and the resulting effects on one's social role and the expectations of others.

 

This reminds me of the effects on others of the dramatic physical morphing that occurred during my hormonal and social transition years ago. Many acquaintances suddenly "caught onto the paradigm shift" at some point, and "perceived the new identity". But a few family members clung to their memories of the "old me" and could never quite "see the new person", even after so much morphing had occurred that I was unquestionably a woman to strangers and to new friends. The better someone knew you before transition, the longer it took for them to realize that the old you was dead and gone, and that your now-female body was inhabited by a newly visible spirit who had fully taken it over.

 

Seems like people look you over very closely when first getting to know you, in order to establish who/what you are. Later on they rely on those first impressions, taking them for granted and not easily noticing important changes. Fascinating stuff, eh!

 

In the end, what counts is the inner effect on oneself, and the potential of medical procedures such as FFS for enhancing healing, self-acceptance and inner comfort. Recall the words of Emily:

 

" - - - Results aside, it allows me to not simply move through the world and society -- the best I could hope for beforehand -- but to actively embrace it, to find a peace within myself, or the possibility for it, that others see and perceive. It is a wonderful resonant cycle as the relaxed comfort in my own skin radiates from me to others, who in turn sense my centeredness and reflect happiness back at me - - - . "

 

 

 

VARIOUS TIPS AND HINTS:

 

My first recommendation for anyone considering this surgery is that you thoroughly check out the other FFS websites, especially Andrea's, Becky's, Madeleine's, Nicki's, Randi's and Sally's. Those sites contains lots of useful information, to which I'm adding some further tips and hints in this site.

 

Be sure to be psychologically prepared for what you are getting into:

 

It is very important to realize that FFS is not a typical cosmetic surgery procedure. The level of pain and trauma is going to be very high. While a few patients breeze through FFS with little difficulty, an equal number are highly traumatized by the experience. Also remember that nursing and hospital care in general "ain't what it used to be". Davies is an excellent facility, but to some extent you are "on your own" when recovering there as in most modern hospitals, and you need to be psychologically prepared for that and able to keep a positive outlook in spite of any difficulties during recovery.

 

For most patients FFS is a very gritty, tough ordeal. By being well prepared, you can help make the best of it, and reduce the psychological impact of pain and trauma during recovery. Knowing what to expect during recovery, and knowing in advance a lot about the hospital and the local neighborhood and services, will enable you to retain a feeling of control. You'll find ways to do many things for yourself, instead of having to go without or rely too much on others for help.

 

If possible, arrange in advance to have visitors, phone contacts, companionship:

 

Visitors and phone contacts with friends can really help to ease discomfort and pass the time during the initial recovery phase. I recommend if at all possible that you have a family member, friend or spouse stay with you, especially the first four/five difficult days of recovery.

 

There are usually several of Doug's patients recovering in Cocoon House at the same time, and by getting to know these patients you'll find additional companionship and mutual support during recovery.

 

I got to know one other patient while I was recovering from FFS at Davies in Nov 99, and met three more while there for my face-lift in Feb/Mar '00. My friend Anneliese met four other patients while she was there: two from the U.K., one from Italy, and one from Illinois. Anneliese benefited from their help when her luggage was misplaced over a weekend following her surgery, and she needed to borrow pain meds and other basic items.

 

Some helpful drugstore items:

 

Be sure to take one essential item: A child's toothbrush for cleaning down in the painful, swollen gap between your lower teeth and cheeks. You'll have to clean food particles out of there to avoid infections, and also to avoid painful irritations. Another very helpful item: one of the new mild, soothing lip balms such as Vaseline "Lip Therapy" or ChapStick " LipMoisturizer". My lower lip was very swollen and numb for many weeks. The lip balm helped me avoid drying, chapping and painful peeling of the lips.

 

If your eyes tend to drying, take something like Allergan "Liquid Tears" or "Refresh Tears" - - - I used Oxygene toothpaste and mouthwash, available from dentists who often recommend them for patients undergoing gum surgeries. These are gentle-tasting, non-irritating but very effective antibacterial agents - - - There is soap provided in the guest rooms, but you need to take our own shampoo - - Also, I used Metamucil every day - - and then took some Ex-Lax on the fourth and fifth days to help restart full digestion, thus avoiding constipation from the effect of all the antibiotics.

 

Some info about food:

 

For the first two days or so, you'll be on pureed foods. I had a good appetite and that stuff tasted great. Still tasted great as I shifted to "ground foods" the next day. Those not having jaw/chin surgery may transition quickly onto "regular foods", which are a nice treat compared to pureed and ground foods. I was on the regular foods during my later face-lift recovery and found those meals quite good.

 

Although the hospital meals seemed great for a few days, all of a sudden my appetite declined (I'd had no bowel movements from the 9th to 13th). By the 13th, the ground food didn't seem so appetizing anymore. Finally the Metamucil and Ex-Lax worked, but then I began to really hunger for other more normal foods. Charlie brought back some nice sandwiches, bananas, etc., from the produce/sandwich store on the corner of Castro and 14th, just one easy block away (I'd found that I could flatten the sandwiches with my hand, and then could nibble them into the side of my mouth). During the rest of my stay, we often walked over there to get nice food items. We also made some meals by walking down to the Safeway store and getting some real treats in the Deli there.

 

[Note: Those staying in Cocoon House have new options for food and local services - see the Cocoon House webpage]

 

I also discovered the cafeteria on the lower "B" level of the main Hospital building. They serve breakfast and lunch there, and have lots of produce, sandwiches and other stuff available throughout the morning and afternoon hours. This is a nice source of food variety, especially on rainy days when you may not want to go outside.

 

The Cafeteria's hours are as follows (see Schedule sheet posted on wall-board in corridor leading into cafeteria for any updates; don't pay attention to the large, older sign out in front of that corridor):

 

Hospital Cafeteria Schedule:

Breakfast 7:00-9:30 M-F

Lunch 11:30-1:30 M-F and S-S*

Dinner 4:30-6:30 M-F and S-S*

*Selection may be limited on S-S.

 

By the 15th, I ended up usually mixing some nice foods from outside the hospital, or from the cafeteria, in with my regularly served Guest Room meals. There were always things on the hospital meals that were tasty, but other things that occasionally weren't once my appetite was back to normal.

 

By the 5th day post-op you may begin to feel like eating a meal out once in a while. There are many nice restaurants nearby Davies to chose among, including Chow, the Bagdad Cafe, the Thai House, etc., all within easy walking distance (except that you need to take it easy on the last hill-climbing block back to the Hospital). Since the N-line light-rail/subway station is only one block from the Hospital, you could also easily make trips to downtown for dinner.

[For info about restaurants near Cocoon House see the Cocoon House information pages]

 

Some notes about San Francisco's weather:

 

For a month-to-month profile of the weather in San Francisco, and access to the current five-day forcast, see URL: http://www.sfvisitor.org/visitorinfo/html/WeatherForecast.html

 

That site says: "San Francisco is blessed with a temperate marine climate and enjoys mild weather year-round. Temperatures seldom rise above 70°F (21°C) or fall below 40°F (5°C). Morning and evening fogs roll in during the summer months, but rarely persist. Visitors are most comfortable with a light jacket or coat handy, or in a suit. An all-weather coat will take the chill off cool evenings. Lightweight summer clothes are seldom practical in San Francisco."

 

Translate this as follows: There are two seasons in San Francisco, the dry season from late April till late October when it hardly ever rains, and the rainy season from late October till late April when it frequently is rainy and blustery. In summer, the City is frequently covered by fog, due to on-shore ocean breezes during the day, and although the temps may be in the 60's it can seem very damp and very cold. The best weather occurs in early fall when it is sunny but not foggy, and then intermittently during sunny day breaks between the winter rainstorms.

 

Be sure to take a good windbreaker and lightweight but warm insulation, any time of year. I always take a GoreTex parka and light fleece jacket when going to San Francisco, even in the summer, to be used separately or together depending on the situation.

 

Some notes about "appearances":

 

Charlie and I went downtown on the evening of the 15th (5 days post-op) when I still had the "X" nose bandages on and while my face was still very black and blue. During that whole trip, including buying a few things in some stores, and metro rides to and from downtown, no one ever stared at me or even seemed to notice my messed-up face. Now that's San Francisco! People there are very nice, and try to avoid making other folks feel uncomfortable regarding their appearances. So don't let all the bandages keep you from getting out and around town, if you really do feel up to it (but see note below re "passing").

 

By the time I left the hospital on the 18th, my bruising was down enough that I could cover it almost completely with regular daytime make-up. I had taken some Clinique "Continuous Coverage" (in 08 Creamy Glow color), a concealer often used by plastic surgery patients. I didn't need to use it after my FFS surgery, because my bruising went down so quickly and regular day-time makeup was adequate for concealment. Others might find such a concealer useful if they have persistant very dark bruises after FFS, in locations such as under the eyes.

 

[ Note: I definitely needed concealer after my later Face-lift/Blepheroplasty surgery. I felt well enough to want to get out and do things within a few days of surgery, but my eye and face bruising were worse than with the FFS. I was very glad to have concealer with me then. If you are especially concerned about the visibility of bruises or if you have a tendency towards excessive bruising, I recommend using "Covermark" concealer and powder. Covermark is an amazing concealer system originally designed for people who have facial birthmarks, etc., and provides total coverage of any discoloration.]

 

Interestingly, I found that I was most self-conscious about my appearance not while bruised and bandaged out in SF, but during my first week back home. My bruising was almost gone, and could be completely concealed by regular daytime make-up. So now there was no obvious "reason for" the still very apparant, large, lumpy swelling beneath my chin, nor for the difficult time I was having making normal facial movements in the area of my lower lip and chin. For the first time I began to notice people occasionally staring at my face. Of course, this was in Michigan, and not San Francisco.

 

Some comments for those concerned about "passing" during recovery:

 

Many of Doug's patients are TS's in early transition. Some will be concerned about issues of passing. You're not going to look your best after surgery, and this adds to the passing difficulties that some will face. You needn't be worried about such issues while in Doug's area, or in the recovery area, the ACU hospital rooms or in Cocoon House. Sure, there might be pronoun problems with nurses or staff who don't know you, but those will just be accidents and not intentional, and you shouldn't be concerned. One nice thing about Cocoon House in contrast to a motel is that your stay there can be very private until you are healed up enough and well enough to make yourself presentable again to the outside world.

 

Then too, while in Cocoon House you'll very likely be able to meet and chat with T-girls staying there at the same time. You can always do this on a first name basis if you'd like to remain in stealth. This is a nice way to find more companionship during recovery without passing being an issue.

 

However, you shouldn't have the impression that "anything goes" without attracting public comments or insults just because Davies is in San Francisco and the Castro District. There are mean-spirited bullies in every city. For example, one incident was reported in the Davies main hospital lobby where a recently operated TS with facial bandages and in great pain was verbally harassed and brought to tears by workmen/deliverymen from outside the hospital. Of course, one of the reasons many transsexuals go to Doug is because his work can help them get beyond all such harassment.

 

Some early-transition patients go thru FFS in "guy mode" or androgynous mode, just to make the whole thing simpler and less stressful from the passing point of view. As a result of Doug's work, they may find themselves being "ma'am-ed" while travelling home, even if they are still in guy's clothes. Of course that's such a nice result, it usually feels good. For many patients a selection of very comfortable and somewhat androgynous clothing may be the best choice.

 

Getting back to the office and to work:

 

In my case, I felt up to doing some light office work by 2 weeks post-op, but was still in a lot of pain and tired easily. I could only do a 1/2 day here and there. By 3 weeks post-op I was able to resume "quiet, normal activities", but still felt in some pain and didn't want to handle any real stress, since I still tired rather easily. A reasonable bet for resumption of full, normal-stress work activities might be somewhere between 3 and 4 weeks post-op for most patients who get "the works".

 

Getting back to regular exercise:

 

Regular exercise is important to me. I think that being in good physical condition helped carry me strongly through the difficult early stages of recovery. But by 2 weeks post-op I began to feel "exercise withdrawel", a lousy messed-up feeling from the forced inactivity. However, after this surgery one must be careful not to raise your blood pressure until you are fully healed, for fear of hematomas or edemas in the wound areas. Dr. Ousterhout advised that I could resume my regular exercise regimen (jogging, aerobics, strength machines) at 3 weeks postop, but he also said to carefully "listen to your body" for any signs that it wanted you to slow down a bit.

 

I returned to most normal activities, including some moderate exercise, during the 4th week post-op. I hit a complication (infection) during the 5th week post-op that threw me back into relative inactivity again for a couple of weeks, but after that I was very active.

 

 

 

INFORMATION ON DAVIES HOSPITAL:

 

Here's some info on the Davies Campus of the California-Pacific Medical Center, also known locally as "Davies Hospital". The Davies address is: California Pacific Medical Center, 45 Castro Street, San Francisco, CA 94114. Main telephone: 415-565-6000.

 

In order to get oriented, let's look at a photograph of a model of the Davies complex of buildings. In the following photo we are looking from WSW towards ENE, i.e., looking over the hospital towards downtown San Francisco. The 5 story building in the upper left is the main hospital building and is called the "North Tower". The main entrance drive from Duboce Avenue enters from the left and heads towards the Garage entrance (the covered Garage is the building on the lower right, you can see parking spaces on its roof).

 

 

The main hospital entrance into the North Tower is just off the main entrance drive. You can see a dark blue car parked in pull-out area, with someone walking towards the entrance. A helpful information assistant is located just inside the entrance. Admitting is just inside the entrance to your left.

 

The ACU hospital rooms where you'll spend the first two nights are on the second and fourth floors of the North Tower building (the old "Guest Rooms" were on the third floor). There is a cafeteria used by staff, but available to ambulatory patients, down on "B" level, two levels below the lobby. There is also a small gift shop just off the main Lobby.

 

The North Tower hospital building is connected on its "A" level (one floor below the lobby) with another building (the South Tower) to its south (the one in the upper right in the photo). You'll note a circular drive in front of that connector, with a grey car parked in front of it. The covered entrance into A level just behind that car takes you into the corridor where Dr. Ousterhout's offices are located, just a short distance to the right of that entrance.

 

The other covered entrance off the circular drive, underneath the North Tower hospital (towards the left), is the Emergency Room entrance. Ambulances usually enter from Castro Street (from the bottom of the photo, and go down the drive from Castro into and around the circle to the ER Entrance. The ER Entrance is open 24 hours a day.

 

Note that there is a large, park-like veranda stretching from the main hospital entrance area on the Lobby level all the way around to and over the Connector building. If you feel like getting out and taking a short walk on a nice day, be sure to explore this veranda. Davies is located up on the slopes of a hill, and the views towards the East from the Connector overlook much of San Francisco, stretching all the way to downtown. There are some benches out on top of the Connector, and it's a great place to relax on a nice day.

 

Note that Davies is contained within a block bounded by Duboce Avenue on the North (towards the left in the photo), Noe Street on the East (top), 14th Street on the South (right), and Castro Street on the West (bottom). There's quite an elevation gain as you climb from Noe to Castro on either Duboce or 14th when walking to the hospital. Be sure to take that hill climb into account on your walks to/from the hospital. You may be in a weakened state, tire very quickly and have difficulty returning. The hill is also steep enough in places to cause walking difficulties if you're on meds and are unsteady on your feet.

 

 

 

MAPS, DIRECTIONS AND TRANSPORTATION:

 

For general maps of San Francisco, see http://www.sfvisitor.org/. For information on all types of public transportation in San Francisco and the Bay Area, see http://www.sfvisitor.org/visitorinfo/html/PublicTransit.html

 

Directions to Davies Hospital:

 

The map below shows central San Francisco, stretching from the Castro district in the lower left, thru the Civic Center district in the middle of the map, up towards the Union Square and Financial District in the upper right.

 

The hospital is located in the Castro District, about 2 miles southwest of downtown San Francisco. It's easy to reach by automobile or public transportation.When driving north from the peninsula, take Route 101 all the way to its end as it swings out towards the west. Route 101 exits directly onto Fell Street, heading west. Take Fell Street west about 6 blocks to Scott Street; turn left on Scott, and go south about 5 blocks until it ends at Duboce Street. The entrance drive of the Davies Campus is just a short distance across Duboce and slightly to your right. The entrance drive ends at a covered parking garage.

 

 

The Muni N-line light-rail public transit passes within one block of Davies on Duboce Street. This line travels out from downtown via Market Street and Duboce. You can connect to the N-line at any of the main downtown BART stations, such as at Powell Street.

 

San Francisco's Muni system includes buses, trolley cars, cable cars and light-rail/subway transit. Muni maintains an excellent overall system map that is "zoomable" on the web. This map will help you find ways to interconnect among the various types of public transit in San Francisco.

 

Access to Davies from San Francisco Airport is easy: Take a "Super-Shuttle" van, which stops just outside all arriving terminal areas. The cost is about $12 to $15. The Super-Shuttle can be scheduled to pick you up at Davies when it's time to return to the airport.

 

I often save money when travelling to the Bay Area by flying into Oakland Airport over in the East Bay. Air fares there are often only 1/2 to1/3rd of what they'd be when flying into San Francisco. Then too, Oakland Airport seldom suffers the flight delays so common at SFO during stormy, rainy winter weather. From Oakland Airport you simply take an AirBART shuttle ($2.00) to connect to the Bay Area Rapid Transit (BART) system at the Oakland Coloseum Station, and then ride BART to the Powell Street Station in San Francisco ($2.75). From there take the N-line Muni subway to Davies Hospital ($1.00).

 

 

Davies Hospital Neighborhood:

 

Following is a map of the neighborhood surrounding the Davies hospital campus, including pointers to some useful services (North is "up"). Some key items to identify are the Safeway grocery store (open 24 hrs) and the Rite-Aid drug store, located on the corner Duboce Avenue and Church Street, about 1/3 mile east of Davies. [Update: The Rite-Aid pharmacy is no longer there - however, there is a pharmacy in the Safeway grocery store right across the street from the old Rite-Aid location]. There is a laundromat on Duboce (hours are 7-9pm, 7-days). There is a new Walgreen's drug store on Market Street close to Davies.

 

 

 

There is a Muni N-Line stop on Duboce Avenue just outside of Davies Hospital. This fast light-rail line will get you downtown easily and quickly. Note that the N-Line has the added advantage of continuing on to the Caltrain Station at 4th and King Streets. The Caltrain line provides rail service up and down the peninsula side of the Bay Area.

 

N-Line light-rail stop at Duboce Park, 1 block from Davies:

 

There is a station for the Muni K, L and M light-rail subway lines located near the intersection of Market and Church. All these lines run into downtown San Francisco. The K, L, M and N Muni lines connect to the Bay Area Rapid Transit (BART) system at the downtown Muni stations, with Powell Street Station being the main connection point. BART provides very rapid service across to the cities in the East Bay area, including to Oakland Airport (using the Coloseum BART stations and then the AirBART shuttle into the airport).

 

The F-Line surface trolley cars run along Market Street, stopping at every major intersection. The colorful vintage F-Line trolleys will take you all the way downtown, and although slower than the Muni light-rail subways, the F-Line now continues on all the way around the Embarcadero to Fisherman's Wharf, a major tourist attraction with all its shops and restaurants.

 

F-Line vintage trolley car on Market Street:

 

Note that for $10.00 you can get "3-day passes" and for $15.00 you can get 7 day passes at the info booth at the main Powell Street Muni Subway Station downtown (and also at the Cable Car info booth just above that station). These passes enable you to ride all San Francisco public transit (except BART) as much as you want for three/seven days, and are a real bargain if you and/or someone staying with you want to play tourist for a while.

 

 

 

LODGING, FOOD & SERVICES DURING RECOVERY:

 

Most of Dr. Ousterhout's patients move to the Cocoon House residence for recovery after being released from the Davies ACU several days after FFS. By staying at Cocoon House when several other patients are recovering there, you can feel more at ease about many practical recovery needs. This is especially valuable if you don't have someone staying with you during your recovery after FFS.

 

The Inn on Castro is a wonderfully luxurious Bed and Breakfast Inn near the corner of Market and Castro. The Inn is a great place to stay for any trips to the area. It is also an excellent alternative as a place to stay while recovering after FFS, especially if you have someone coming with you who can help with practical things during your recovery.

 

Beck's Motor Lodge, on Market Street near the intersection with Sanchez St. (2/5 of a mile from Davies), and the Metro Hotel, on Divisadero Street between Oak and Page Streets (about 1/2 mile from Davies) are inexpensive, convenient places to stay for those wanting to stay in the area a while before surgery or after recovering in Cocoon House. These places are also excellent alternatives to the expensive downtown hotels for vacation trips to San Francisco.

 

All these lodgings are described below, along with some listings of restaurants and services near Davies hospital.

 

 

COCOON HOUSE - A Recovery Residence for Dr. Ousterhout's Patients:

 

This is a recovery residence for Dr. Ousterhout's patients, located at 3877 Cesar Chavez Street about 1-3/4 miles SSE of Davies Hospital. Many restaurants, grocery stores and most conveniences are located within walking distance of the guest house. Local taxi companies are providing prompt service, and public transportation to the hospital is also very convenient. Anyone can bring a partner or a friend to stay with them at Cocoon House during recovery. A single is $125 per day (including soft foods), and double occupancy is $175 per day.

 

Cocoon house is operated by Mary-Lou and Tricia, who work as nurses at the Davies Campus in the Operating Room. Upon hearing of the closure of the hospital's "guest rooms" they felt they could turn two rental units in their home into a environment suitable for healing. Mary-Lou and Tricia are wonderful people, and they provide a very safe, comfortable and supportive environment for FFS recovery. Although they do not provide nursing care of any kind at Cocoon House, help with hair washing is offered, and they've also consulted Dr. Ousterhout and Mira on specific guests needs when healing from FFS surgery, i.e. foam wedges, etc. Mary Lou and Tricia reside in the house and can be reached by cell phone.

 

A comprehensive description of this new facility is now posted on the web (see the Cocoon House website). Included in that description are details of nearby restaurants and services. Most of Dr. Ousterhout's patients now stay at Cocoon House during their recovery after release from the Davies Hospital ACU. Contact Mira for for more details and to make arrangements to stay at Cocoon House.

 

 

Cocoon House

 

 

Cocoon House (lower right) is about 1-3/4 miles from the Davies Medical Center (upper left)	There are many shops and restaurants along Market St. in the Castro District near Davies, and along 24th St. in Noe Valley near Cocoon House (blue strips in map below)

 

 

 

THE INN ON CASTRO:

 

The "Inn on Castro" is located at 321 Castro Street, San Francisco, CA. 94114 (phone: 415-861-0321). It is about one block from the corner of Market and Castro as you go uphill on Castro towards Davies Hospital. Thus it is a short uphill walk from there to Davies and Dr. Ousterhout's office (about 1/3 mile).

 

The Inn's owner, Jan (pronounced "Yan"), is a gem to match Mary-Lou and Tricia, and the accommodations are even more spacious than the Cocoon House (as such, it's a bit more costly too - with rates for rooms with baths from $135 to $185 per night). It's a Bed & Breakfast and the breakfast is amazing, the atmosphere international and friendly.

 

Stunningly decorated with contemporary furnishings, the Inn is a restored Edwardian building. The individual bedrooms are warm and inviting and brightly accented with original paintings. They have large bay windows for bright, cheery lighting. Large bouquets of fresh flowers are abundant throughout the Inn. The cozy living room, with its fireplace and deeply tufted Italian module seating, is a marvelous place to unwind in -- just great to curl up with a good book and enjoy a brandy, compliments of your hosts. The Inn serves a full breakfast each morning in the adjacent dining room.

 

Jan has hosted many of Dr. Ousterhout's patient's and he and his staff are supportive and understanding regardless of where one finds themselves with regards to transition or life afterwards. The Inn's extensive website at URL http://www.innoncastro.com/ contains lots of useful information, including photos of the rooms, and also some information and photos of the Castro District too. The Inn on Castro is conveniently close to the K, L, and M line subway station at Market & Castro, and also to the Market Street F-line trolley cars.

 

 

The Inn on Castro

 

 

Note that Jan also has three very nice apartments near the Inn that are also available for short term rentals. Apartment 1 costs only $115 per night for two people staying four days or longer (Apts. 2 and 3 are $160 a night for two people for four days or longer). Apartment 1 is an excellent modest-cost option for someone who has a companion coming with them to help take care of them. Here is a report from "Kathryn" about her stay at Apartment 1:

 

"Mira recommended the Inn and I found out that not only do they offer rooms in the Inn proper, but Jan has 3 apartments in the Castro district also. I rented the cheapest one which was $100/night for 4 days or longer. This apartment is at 88 Caselli and is the lower level apartment of Jan's building. The apartment was beautiful with a private entrance, spacious living and dining room, and a separate bedroom. I took the bedroom of course and there was plenty of room for my friend to set up her queen sized air mattress. There is a full kitchen, TV (with cable), stereo, and a spacious shower with a really nice adjustable shower head. The apartment has sliding glass doors that open into a small garden/courtyard.   I never saw or heard anyone else during my 7 days there. It was a nice, quiet relaxing place to recover. It is about 0.9 miles from the hospital and I had no problem walking there the morning of surgery. It's pretty close to the Cala Foods & Walgreens on 18th St. Jan is a sweetheart, he just told me to leave my bags and groceries in the room when I went to hospital and he would store them and have them waiting for me when I returned a few days later. My friend drove from LA and had little trouble parking in the area. Parking was quite plentiful in front of the building but there are restrictions during the weekdays. She either had to move it once or twice during the day or just park a block or so away where there are no parking restrictions. Anyways, that's my experience and I would highly recommend the apartment especially for anyone who has a friend coming to stay with them." - Kathryn

 

 

For current information on room rates at the Inn on Castro, and for rates for the apartments too, see the Inn's Reservations Page. The Inn on Castro is highly recommended as a place to stay if you have someone coming with you for your FFS. It is also a wonderful place to stay for later vacation trips to San Francisco too!

 

 

Beck's Motor Lodge:

 

Beck's Motor Lodge is located at 2222 Market Street, San Francisco, CA 94114 (phone: 415-621-8212; toll free reservation line: 800-227-4360). It is located near the intersection of Market and Sanchez Streets [see the Davies Neighborhood Map above]. This location is in the heart of the Castro District, which is San Francisco's largest primarily gay residential area (the majority of folks staying at this motel are rather manly gay men). The neighborhood is an upbeat, safe and friendly area, full of nice townhouses, neat restaurants, interesting clubs and bars, and many small shops.

 

This AAA 2-star rated motel is comfortable, moderately priced, has convenient free parking, and is within easy walking distance of Davies Hospital. Thus this motel is a particularly convenient one for short advance-visit trips for consultations with Dr. Ousterhout. The distance is about 2/5 mile of a mile (if you use the short-cut shown on the map), and the route is along fairly narrow streets somewhat sheltered from wind/rain. Rooms with a queen-sized bed are about $85-$95 per night plus taxes. The Lodge offers a 15% discount for referrals from Davies (check with Mira on this), so your actual cost may probably be around $80 per night, which is quite reasonable.

 

Television sets in Beck's are hooked up to a full Cable-TV system with lots of channels. All rooms have a small refrigerator (convenient for multi-day recovery stays), and the Lodge is close to the many restaurants and stores along Market Street between Castro to Church Streets. Thai House, Chow, Bagdad Cafe are all within just a couple of blocks. The Safeway, Walgreens and Rite-Aid stores are also nearby, as are the K, L, and M line subway stations at Market & Church and at Market & Castro. The Market Street F-line trolley cars pass right outside the Lodge on Market Street, and stop at all major intersections including those near the Lodge.

 

For the quietest rooms, ask for the third floor. There is elevator access in the rear of the motel. There is an outdoor patio in between the 2nd and 3rd floors. The patio overlooks Market Street, and is a nice place to sit and relax outdoors in good weather. Because of its central location in the Castro District, Beck's Motor Lodge fills up virtually every weekend. Be sure to make confirmed reservations well in advance if you'd like to stay there.

 

Beck's Motor Lodge

 

 

The Metro Hotel:

 

The Metro Hotel is located at 319 Divisadero Street, San Francisco, CA 94117 (phone: 415-861-5364). The Metro has long been used by Dr. Ousterhout's patients, and the staff there are familiar with the situation of TG/TS gals recovering from facial surgery, as are many of the small nearby restaurants and services on divisadero. The Metro offers Dr. Ousterhout's patients a 10% discount off the already reasonable rates, so you'll be able to stay here for only $53 to $55 a night.

 

This is a small "european style" hotel that is comfortable, inexpensive, and within fairly easy walking distance of Davies Hospital (about 1/2 mile). The Metro is not as close to Muni light-rail and trolley lines as Beck's Motor Lodge. However, the #24 Bus Line on Divisadero Street just outside the Metro Hotel goes south over onto Castro Street and can take you directly from the hotel to/from Davies Hospital with very little walking. In that respect it is even more convenient to get to Davies from there than is Beck's.

 

The Metro's location is just outside the Castro District. It isn't as close to good restaurants and other services Beck's Motor Lodge. However, the Metro Cafe located in the same building offers nice breakfasts and lunches, and there are numerous small produce/grocery marts and ethnic restaurants nearby.

 

The Metro's interior rooms are quiet, but have windows opening out to blank walls of adjacent buildings. I like the front rooms that look out over Divisadero; they aren't as quiet, but it's pleasant fun to relax in their big bay window and watch the street scene below. Television sets in the Metro are hooked up to a full Cable-TV system with lots of channels. The hotel seems quite secure; the lobby is locked after 10pm (you'll need your key to get back into the lobby).

 

This hotel is an even less expensive alternative to Beck's Motor Lodge for a place to stay during consultation trips, or if you arrive a few days early for your surgery, and/or as an alternative to Cocoon House for the latter part of your recovery period.

 

 

Photo and locator map for the Metro Hotel

 

 

Davies Area (Castro District) Restaurants and other services:

 

There are many neat little restaurants and cafe's in the Castro District near Davies, and many other services such as drug stores, laundries, etc. (See the Davies Neighborhood map above).

 

The "Bagdad Cafe" at Noe and Market is open 24 hours a day, and has a wonderful friendly atmosphere. You'll get generous helpings of good food here at reasonable prices. It's also a great spot to just drop in, get a cup of coffee, and people-watch the passersby on Market Street for a while, any hour, day or nite.

 

Another neat restaurant for lunch or dinner is "Chow", located near the corner of Market and Church. There is always a happy, warm atmosphere at Chow. The food is good and the prices moderate. It can get crowded on weekends and even during the week by 6:30, so our best bet is to go a bit early. The Thai House (hours are 5-10), at Henry and Noe just two blocks from Davies is another nice restaurant, with excellent Thai food and an intimate atmosphere. There is also a very nice produce and sandwich shop at 14th and Castro (Courtney's Produce, hours 6am-8pm 7 days), a very short walk from Davies.

 

 

 

 

 

 

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