I Had Facial Feminization Surgery

It was as though the world was determined to keep me from getting what I needed. Work exploded. I had an emergency wisdom tooth extraction. A surgery scheduling error set me back three weeks. I needed to borrow money from a tuition fund that my grandfather had left me in Waco, and we’d decided that what the simple folk of Merrill Lynch didn’t know about me wouldn’t hurt them. I assumed my former identity for the first time in half a year, acting as my own receptionist and hiding in the lab’s darkroom to take their calls. Like a lot of my life, it’s funny now because it worked and everything’s fine. To cut my risk of bleeding and clotting problems, I stopped taking estrogen, a skin-crawling first in sixteen months. I told my father – hey, going to get some stuff done at this place and time, it’s all fine, but I’d love a visit.

My father was an unhappy, emotionally abusive man throughout my childhood, but children can normalize just about anything and I blamed myself for feeling uncomfortable and afraid around him. When I started to come out, I felt obligated to help him understand me. It wasn’t the best plan. My transition was an unacceptable departure from his script, a sign that I must have some “underlying” problem that would be intelligible to him. I just needed to take his money and go backpacking in Sweden, or do some other horrible privileged white shit. As a boy! Had I really considered how a tall, big-headed, big-boned emm-tee-eff would get along with the straight world?

When I told him about the surgery, it was clear that nothing had changed. First came the good old referendum on my personality. This time, he fixated on my qualified distaste for Andrew Solomon’s appearance on Katie. H-how could I? That guy’s book was great! Then it was time for Dad to Help Out with, not even joking, top google results for “facial feminization surgery.”  Have you ever seen bad plastic surgery? It’s gross! I had interrupted his secret honeymoon in Bali to tell him that I was getting major surgery, and this was very selfish, very thoughtless indeed. And so near my little brother’s birthday, how could I? My insistent, fulminating transsexualism only proved the depths of my bitterness, my narrow-minded self-loathing.

Telling my father that he’s an abusive, neglectful parent – that I have to see him as a problem to manage, in an ironic reversal of our relationship over all those years – was the one thing I’d held back. It was the easiest thing I’d done all day. That was the last thing I’d let myself think might get through to him, and the last unfinished business between us. He said that it was “very sad” that I felt this way, and that he sure hoped it gave me strength. He wrote again, hours later, to say that I was making it all up. My “uncontrolled anger” could only mean that I’m in “deep trouble.”

Maybe he’ll be hit by lightning and wake up a better person. I’m not holding my breath. Right now, it’s enough to have that person out of my life.

I felt like an enemy of the Old Testament God as my plague of WASPs continued. My mother had made friends with an older trans woman through her work, Helen. Helen was a wealthy woman who’d transitioned later in life. She’d been a little more interested in me than I was totally comfortable with, but I know what it’s like to want to be there for people. We’d gotten on well the first time we’d met in person, and I hoped she’d be a good friend to talk to during an increasingly nutso part of my life.

We met for drinks nine days before the surgery. I brought this up and mentioned how bullshit everything had become, and regretted it very quickly. Helen was on me like flies on shit. She had decided against getting FFS, and naturally that made it “the riskiest” trans-related surgery, it was “the last thing you do.” Had I worked with her guy? Why hadn’t I worked with her guy?

I was stunned. I was talking to someone who’d had breast augmentation and SRS. The risks of each are considerable, they happen to scare the hell outta me, and neither is something I want for myself if I can help it. But who fucking asked me? It’s none of my business. So what the fuck?

I did my best to be kind, and I think it was a mistake. You’re not going to change my mind, I said, and I’ve just disowned my father, this isn’t the sort of conversation I can have right now. But holy hell. The woman had fucking pulled rank on me, babbling about “the view from fifty thousand feet up.” I guess Lasik is better than I’d heard, if you can even fuckin’ see me from there. She started up again via text message at seven thirty the next day. I’m not sure what she was expecting, but she didn’t like the result. Good.

It was wearing me down. My mom and stepdad are kind, smart people, and they’re my heroes, but their anxiety reached a fever pitch. I found myself being asked – What about the laryngyscope? What about the bone paste? These weren’t bad questions. A lot of them were really good ones. But it felt like far too late for me to worry about that shit. We reached a low point when I found out that they’d quietly gotten in touch with the Big Name who’d dumped me. I was expected to fly out to see him, “just in case.” I was angry. I didn’t have a lot to actually worry about, but I didn’t want to see them that freaked out when it couldn’t change my decision.

My parents’ distress was impossible to completely ignore. It’s like when toddlers take a fall and look to see how adults react before crying or not. I had been ready, and still was, but between this and everything else I was feeling a lot less lucky. Insurance was no longer a sure thing and I wanted to be able to support myself and my partner through our move if that and her job hunt came to the worst, so it was prudent to cut costs. Thyroid cartilage fell off the list.

I’m not sure what to say about that. It was never that big of a deal. I’m sure that I can find a way to do it if I really need to. I was phenomenally, singularly lucky to be able to make even these decisions for myself. Most people don’t have access to even basic medical care in this wasteland. I was only looking for some of what others take for granted, but I still knew that I was getting a lot.


On Friday the 22nd, I fasted from midnight, tossed and turned until dawn, and rode with my family to a surgical center in San Rafael. I handed over a cashier’s check and my advance directive. I changed into robes, met my nurses and anesthesiologist, and got stuck with an IV. The mood was difficult, but better than I’d feared. We’re strong people, and just as importantly, it was six thirty in the God damn morning.

I was conscious in the operating theatre for maybe fifteen seconds. I hopped onto the table, extended my arms as directed, and thanked the nurse at my left shoulder for going ahead with the obvious crucifixion joke. Before I could wonder if she said that every time and if it had started to bother people, I was drugged unconscious and summarily catheterized.

A small incision was made under my chin, through the soft tissue envelope that lines the skull. Retractors positioned the surgical window over the anterior of my jaw, below my lower lip. An osteotomy was created, defining a wedge of bone. This was removed, and the new bottom and top halves of my chin were joined together with titanium. At our pre-op appointment, I’d asked Dr. T if I could keep the osteotomy “to make earrings and impress my Goth friends,” and he’d offered to give it a shot. I’m told that the on-site pathologist balked, and they run the show. This was too bad – as you can guess, I am my Goth friend.

An incision was made along my hairline to the bone, and bleeding was stopped via electrocautery. The entire upper third of my face was peeled down, stopping at the eyelids. A bone burr was used to progressively remove portions of my frontal brow and orbital rim bossing, terminating at the earliest transition from white- to off-white bone tissue that marked the safe limit for this procedure.

My face was returned to its original position, then stretched subtly to effect a brow lift at the upper outside edges. Excisions were made at the hairline to compensate for the lift, and then at the lateral edges. This repaired and reshaped the bald strips that had given it such a recognizable “M” shape.

After a 6.5 hour operation, I came to in the same room where I’d gotten the IV. My view was squeezed in, obscured on all sides by ACE bandages and a head cast. A drain and collection vessel hung from the cast, its point of origin a length of surgical tubing that extended from under one corner of the hairline incision, along at least six inches of scalp. There was the predictable soreness everywhere that had had a tube shoved in it, and my jaw and forehead felt like God had wiped His ass with them. They also felt different. I could touch them, gently, and be sure. Holy shit. Whatever had been done to my brow was more than I’d let myself expect, but still totally familiar. Okay. I was at my parents’ house by four in the afternoon, and back home the next day.

Recovery has been fantastic. I’m still fighting my insurer as they try to defraud me. But the time leading up to surgery was hell and I’m bouncing back faster than I’d ever expected. The pain is non-negligible but well managed. Sometimes, I can feel tiny spaces between the soft tissue and bone where things are still snapping back together. It’s awesome. I have nerve damage that numbs my scalp and parts of my lower front teeth, with small patches waking up periodically to remind me that they’re pissed off. It’ll probably heal completely in time, driving me bonkers every step of the way. I’m not even slightly worried.

There’s so much ignorance about how people like me relate to surgery – first off there’s this obsession with SRS, “the” surgery, the “sex change” surgery, blah blah blah. And people tend to project that obsession onto us. Most people don’t understand what it means to want life-altering surgery. Most people are fortunate enough not to have to. Few are in a position to make it happen on their own.

I’m less sure about my other concerns. I feel flipping great about my choice of surgeon. People develop very personal relationships with providers over this, and it is a very personal situation, and maybe that’s fine. It’s hard not to see an element of Stockholm Syndrome in the obsession with the few famous surgeons, especially after my run-in with Helen.

I haven’t talked much about the results yet because I want to say this as clearly as possible, and because I want to end on a good note. So here it goes: the surgery fixed me. For all the noise, the fear, the second-guessing, and the waiting, it was as simple as that. I don’t need to hold my breath until I’m fully healed, although I’m sure there’s more to look forward to. I was better the second I woke up. Parts of me have a different weight. I protrude into the world differently than I did before, and it’s fucking cool. I can feel it when I talk, smile, and laugh.

I’ve been very diligent about recording my transition. Our doctors may no longer advise us to tell our children that we’re dead and move to the other side of the country, but the world still says that transition is incompatible with normal life. It’s something you keep a secret. Being public was a way of showing that I wasn’t afraid, even if I was kind of obviously vulnerable.

It was also a way to preserve evidence. When I was in a particularly bad mood, I could remind myself that I often looked or sounded just fine, and probably even did at the moment. It helped solidify the idea that dysphoria is a pathology. It wasn’t a part of me that I needed to trust or accept, and it wasn’t other people saw. It was something to ignore and wait out until I was myself again. You can probably imagine how I felt about recovering from major surgery, smartphone in hand. Maybe I could shoot a time-lapse!

I’ve done some of that, but it’s felt a lot more like work than it used to. I think that I’ve spent less time looking in the mirror this week than at any other point in my adult life. I’m not avoiding it. God knows my eyebrows have needed attention after a few days in a head cast. But I just see myself and don’t have to fucking look for it any more. I feel secure about my identity in a way I’ve never been able to before.


Getting FFS has been what lets me take it for granted. The idea that I’m female can become something unremarkable and basic about me, even if just in my own head. I understand if that doesn’t make sense: I’m very tall, I spend more time than most on hair management and have hands that would make Lana Kane blush. My breasts are “totally excellent” but may or may not ever quite match my ribcage. And, oh right, I can pee standing up. But call the cops, I don’t give a fuck. I’m grateful.

Olivia is a scientist, cooking enthusiast, and latent telepath currently evading the authorities in San Francisco, CA. She likes sour patch kids and carries a waiver of discretionary termination in seven systems.

Special Note: Autostraddle’s “First Person” personal essays do not necessarily reflect the ideals of Autostraddle or its editors, nor do any First Person writers intend to speak on behalf of anyone other than themselves. First Person writers are simply speaking honestly from their own hearts.

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Olivia has written 2 articles for us.


  1. you. are. stunning. like, jaw-dropping. your strength and inner beauty are also awe-inspiring. what a woman, holy moly.

  2. “and have hands that would make Lana Kane blush.”

    I’m dying, that is so funny! You look wonderful. Thank you for sharing your story. :D

  3. Thank you so much for sharing your story – it was an amazing read.
    And I have to second Sass, you are crazy beautiful. I would kill for those cheekbones, you heartbreaker!

    All the very best for the rest of your recovery

  4. Fascinating. Thanks for this perspective. I especially liked your funny one-liners (“I am my Goth friend”; “swarm of WASPs”), the way you kept your language technical, and, most of all, how your sheer happiness is palpable. Congratulations!

    • Love your happiness, strength and sense of irony/humour. More power to you and glad it’s past now.

      Every bit of technology that gives you an edge in this grimdark is welcome ;)

  5. This is a beautiful story and you are an incredibly beautiful woman, thank you for sharing!

    • ahahaha, thanks, I love that part too. I even asked the radiology tech “uh, dude, should I take these off” but SOMEONE had a sense of humor sooooo

      The best part was I honestly had no idea they’d show up on the film until I had to get them burned to a disk like a month later. “Oh right, I was wearing those, oh man”

      • I’m planning on getting ffs also, been on hormones almost a year now, and I was wondering what your insurance company was because most of them have language in their policy that specifically discriminates against transgender people.

        • Well, as per my post below… my policy actually does have language that should cover FFS, and my insurance reps told me and my doctor, repeatedly, that they would cover it, and now they’re refusing to. Exclusions like you mention are illegal in my state, but they’re still all over peoples’ policies, because health insurers will not care until someone makes them care. Specifically, someone who’s dealing with serious medical needs and has a lot more on their plate than “spend months sending calm but firmly worded letters to every tom, dick, and harry at wellpoint”

          It’s a truly ghastly system, for pretty much everyone, because everyone gets sick. I hope to live to see it burn to the ground.

          • Excuse me Olivia … but don’t you mean Transsexuals which actually belong outside of the transgender suffer from Gender Dysphoria. Most transgender people do not suffer from this precise medical condition. There are 14(+) sub-categories under the transgender arena and it was our so called supporters from the LGB community who threw Transsexuals into the mix of those in the transgender box back in 1999. Though I have many transgender friends even they know the differences between being transgender and Transsexuals who suffer from the precise medical birth condition called “Gender Dysphoria”. There are tens of thousands of us Transsexuals who refuse to be placed in the transgender box so as not to be confused to be CD’s, DQ, GQ’s, GN’s GV’s, TV’s, She/males, or any of the rest of them who do not suffer from our natural birth affliction. I have needed and gone through FFS as well including having had Gender Corrective Surgery (GCS) which used to known as SRS and still is by a few clinics out there. If you seen a Trans specialist and told him that you was transgender, they would first ask you of which category so he could determine the seriousness of you needs. I was a Transsexual prior to my correction and was never referred to as being transgender in any of my medical documents or letters. I hope this will be an enlightenment and of some use to you in better understanding yourself.

          • I am aware of the ideology you’re putting forward, but as “one of the freaks,” I’m not terribly inclined to adopt it. You are simply mistaken about the categorization you reference and what you imply about it determining the “seriousness” of my needs is inaccurate and offensive.

            How you see yourself is entirely up to you. As for myself, I am aligned to no small extent with the framework delineated in the most current standards of care. They are freely available to you if you have any confusion as to what is expected of providers in this field.

          • As someone who is transsexual and identifies under the transgender umbrella (i.e. doesn’t identify with the gender/sex assigned to me at birth), I see no point in drawing such a distinction in coverage. I don’t think it’s any more likely that insurance will cover it for me if I advocate against allowing it for others who don’t have precisely the same (but have at least some of the same) gender and body feelings as I do.

            Basing treatment on proving how bad you want it, and establishing a corresponding hierarchy, is drawing a pointless distinction. It’s derived from patriarchal gatekeeping in the medical community, and I refuse to participate in it.

          • Just to be clear – I am glad to hear that you are able to have your identity preferences accurately reflected in your medical documentation. This is as it should be, and is consistent with the standards of care.

            What you have to say about the gender dysphoria of people who are not you is not accurate, and it is not particularly kind. People suffer from gender dysphoria in a variety of ways, the necessary treatment is extremely variable and personalized, and how people come to understand these situations will similarly differ.

            Medicine must meet people as they are and treat their needs first and foremost. This is a sacred idea to me. You complain of being “boxed in” with “shemales” as if legitimizing broader experiences of dysphoria threatens and constrains you. That must be very painful for you to feel, but it simply isn’t true. We can all live with dignity and receive the care we need. Giving that to other people takes nothing away from you.

            I don’t doubt that you fear a society which might accept Good Transsexuals but won’t accept Freaks. That scares me, too. But it doesn’t make that right, and it wouldn’t make it right or healthy or even tolerable for me to contort myself to some unreachable “normal” and hope for scraps from society’s table.

            No one is forcing you to hang out and blast Jack Off Jill with us, but I’d appreciate if you don’t go around telling people that we are less worthy of medical care than you. Cheers!

          • “If you seen a Trans specialist and told him that you was transgender, they would first ask you of which category so he could determine the seriousness of you needs.”

            …loosely translated, “some people deserve basic medical care, but I think most of you don’t, and I’m going to ground it in a ‘trans specialist’ backpedal.” Because almost every ‘trans specialist’ is white and male, that means women should ground their legitimacy in what white men say.

            Wow, do you run the support group in this town?

            I played the Good Transsexual I’m Better Than Anyone Else game for years. It was destructive, hurtful, and bordering on actively sociopathic toward people like me when I did it, and I don’t think it’s any different when someone else does it. That said, I’m really sorry that I ever did things like that, understand it might be unforgivable, and I will tell you that doing something about my internalized self-loathing around being trans helped. It helped a lot.

            When you tell people they’re less worthy, you mark them as disposable. When you mark people as disposable and build walls to keep them out, you get how the “trans community” looks today.

            And if you are the person who runs the support group here, can you quit leaving fifty-line hate comments on my blog? If you’re not, well, you’re sure channeling her.

  6. This is super interesting. Thanks for writing it!
    I still can’t help reading FFS as ‘For Fuck’s Sake’ though. Old habits die hard…

  7. Thank you so very much for sharing this. You are an impressive and evocative writer, and I feel privileged for the opportunity to be your audience.

  8. You look very pretty, I just wish I could look at “the results” without being flipped off or having you sticking your tongue out. We’re here to read your essay and learn about your experience, not to judge you.

    • “do you have any other pictures? I’d love to see a more neutral expression” would have been fine. Condescending to me about how I choose to represent myself and my passage through a very frightening, difficult experience is not. Sometimes I cope by being a shitty teen. It works for me. Deal with it, mom.

    • And look, it’s not that I don’t care what you think. I wrote this article mostly for myself, but I would very much like it if it could also be helpful, or interesting, or just entertaining to other people. If you, or anyone else, has follow up questions, wants to see less silly pictures, whatever, I’m all ears.

      But I simply did not do any of this to look pretty for you. It’s puzzling and frustrating to be spoken to as though I did, particularly by someone who’s just read an article that was more or less designed to get that exact point across.

      • it’s cool how we can depend upon getting our fucking bodies policed literally everywhere, including on Autostraddle, in the comments of an article about FFS.

      • it’s also cool how you get sniffy scare quotes around “the results” like its just, like, your opinion, man

        • Wow you are reading that comment really pessimistically! Have a little more faith in your fellow straddlers! “The results” could just as likely (and I think more likely) refer to an informal results section.

          I think that’s a little harsh to say that she’s policing her body and is scared of the results. Again, just my opinion.

      • In Gina’s defense, I don’t think she meant it aggressively. I think she was commenting that you are gorgeous, and then separately commenting that this is a generally supportive site and the default to defensive pictures isn’t necessary here. Anyway, that’s how I read it. Hope I’m not overstepping.

        In other news, I found this article really interesting and it’s a story that I’m glad is getting out there. Thank you for sharing your experience, and I agree with everyone else: you look beautiful and your confidence shines through.

        • That is how exactly how I intended it, Jen, but clearly, whatever I said came out the wrooong way and I apologize to Olivia for any transgressions or boundaries I crossed. I’ve gone through FFS myself and know what a physical and emotional ordeal it can be, what a mountain it is to climb to be able to pay for it, and how life affirming it can be. Now I’m going to shut my mouth before I stick my foot in it again.

        • Thanks! Glad to hear.

          That’s actually one of a few extra pictures that I’d included in my draft. It looks like the AS editors went with that one, which I’m cool with. But there was also a recovery timeline and a few other shots.
          I didn’t take that particular series for the article, it’s more that trying to duplicate old pictures is kind of a thing I do. the “before” pictures were just from goofing around about a month earlier, cracked me up when I found them during recovery, and the rest is extremely inconsequential history. They were actually a bit of an afterthought. Like I said, I’m considerably less motivated to document myself these days.

    • I think the finger-up, tongue-out photos are adorbs, personally.

      It seems to convey a giddy silliness that is hard won and well-deserved, AND it also says “fuck y’all” to anyone who doesn’t like it.

      That’s my few cents, anyway.

      Olivia, I send hugs, high fives and FUCK YEAHS. Thank you for this article.

    • oh my goodness you poor darling. what in gods name will happen to you if you look at a photograph of a woman asserting agency over her own fucking face, you know, in keeping with the rest of the article you didn’t bother to read, instead of conforming to the rictus of the Acceptable Woman as curated by Dr. Professor Gina from Pee Dee Ex

  9. Another reason your story is helpful – I can share this with a friend who was trying to understand why some doctors and parents are helping young transgender kids who are pre-puberty to halt the onset of puberty until they were older and could decide how whether they wanted to transition.

    My friend just couldn’t quite understand why that would be a desirable thing – this really helps clarify why something like that would be important.

  10. 100000% off topic but GIRL GIVE ME THOSE BROWS OFF YOUR FACE RIGHT NOW. You’re Chicago-based? Who’s your brow person?

    • I can’t tell if AS is letting me message you back or not, but just to clarify: eyebrow waxer, not browbone surgeon.

      in other news I am a big dork.

      • ahahahaha oh gosh I was wondering the second I sent that, sorry. I go to M&M thread salon in union square, which is a really friendly and inexpensive family-run place that has gotten me kind of hooked on threading. But I’ve also been doing my own for, shit, almost a decade now, and tend to alternate depending on whether or not I feel like I’m losing the shape, etc. I’d recommend shaping them on your own, very slowly, like over months even, and then relying on a salon for clean-up :-) You said Chicago, though, right? Is threading a thing there?

        • possibly the dumbest i’ve felt all month and this has been a DUMB ASS MONTH

          i feel like i usually have the shape under control (i am verrrrry serious about brows), and then i lose focus for two weeks and suddenly two sperms are having a cockeyed conversation on my forehead. my skin is super duper sensitive so waxing’s out, but threading’s supposed to be fairly gentle, right? and yes, it is a thing here for sure – an old roommate swears by a place not too far from Loyola if you’re looking for recommendations when you arrive

          • Thanks! I’ll have to ask :-) Threading’s always seemed very gentle to me, but some people I’ve talked to seem to have had the impression that it was very painful, so idk. It seems like any hair removal method is going to vary a ton from person to person…

          • chiming in to say that threading is pretty gentle compared to other methods– it can be painful at first for people who’ve never done it before or have a lot of hair to remove, but if you do it regularly, it should be fine for you. threading also allows for a lot of precision in shaping, so if you’re all about maintaining your brows, i think you’ll like it a lot!

            source: i’m an indian-american girl, threading is like a rite of passage :’)

  11. Olivia, thank you so much for sharing your story with us! This is the first I’ve read about FFS and I’m glad that your article was the introduction. The hints of unexpected humor were perfect. I would totally want to keep any excess bone, damn that pathologist! I am that person that still has all her baby teeth & kept all her wisdom teeth.

    You look adorable in those last photos! I’m in awe of your cheekbones. So glad that you are more comfortable in your skin. Hope all your insurance woes are resolved soon (those fuckers).

  12. This article makes me ambivalently happy and sad at the same time. I am so glad for you that the facial reconstruction surgery helped you to see yourself as you do in your mind’s eye. I am so glad that you recognize yourself as beautiful, in spite of whatever the world and even loved ones may say to your face (because you are indeed beautiful).

    I wish that my friend Kate had had your confidence, or that she could in some way see herself as beautiful, instead of as a monster. Her family and the world convinced her that she was a monster because she was born intersex, and then transitioned from the sex arbitrarily assigned to her at birth. Because of that conviction, she committed suicide the saturday before last.

    It makes me wonder what can be done to help make trans* people feel ok, to feel less like suicide is the best option. Her death started up a discussion about whether transitioning led to her death or if not transitioning fully led to her death or what. About whether transitioning to a different gender presentation is enough, or whether SRS is necessary to feel complete. These are of course intensely personal questions

    • I am so, so sorry to hear about your friend. I think that the questions you raise are less difficult than you might first imagine. In fact, you nailed it in your own words. People think they are monsters and that their lives are not worth living because they are betrayed and rejected by their families, friends, and society. That’s what kills trans* people, more than anything. How you interpret your pain is not set in stone. People are not born thinking that a congenital defect (with respect to those who see their difference otherwise) makes them a monster or robs them of any life worth living. They have to be taught that.

      I don’t know if gender dysphoria might still be fatal in a world that didn’t oppress trans* people. I think it would still be a tough thing to live with. But I can say personally that it has never made me feel so worthless, doomed, or ashamed as internalized stigma.

      Small note – I would suggest you reconsider the idea of “transitioning completely,” if you meant to imply genital reconstruction as a “complete” or “finished” transition. Everyone has their own understanding of what is complete for them. Some people need some surgeries, some need others, some don’t need any. Sometimes it can change as people grow and develop throughout life. There is no “enough” that fits every trans* person, and peoples’ assumptions about this can really injure us.

      • “People are not born thinking that a congenital defect… makes them a monster or robs them of any life worth living. They have to be taught that.”

        Simply put but so true!

  13. I’m so glad I read this. Very well written! 10/10, would read again.

    Seriously though, thanks. I’m loving the trans* content on Autostraddle lately; it’s been so helpful and eyeopening to (cis, white, priveleged) me. Not only did I learn a lot about FFS, which I had never even heard of before (and yes, I am also struggling with not reading it as for fuck’s sake), but this also challenged some preconceived notions I didn’t realize I’d picked up about transitioning and the many ways in can look.

    Thanks for sharing your story, Olivia!

  14. Hey Olivia I would LOVE to chat with you about all the fun and joy of FFS sometime. I have gone through this as well. The shift and the sudden (well, after the swelling goes down) difference can be so incredible. And I still put my chin on my hands sometimes for support when in class and I am surprised at the difference in the subtle shape of things. Been nearly a year for me.
    I even posted an immediately after video blog of myself looking like a Mrs. Potato head, drain and all, babbling about the process. It will remain as a testament to why you shouldn’t vlog when on a lot of painkillers :)
    (Which I was definitely on despite claiming I wasn’t, I am vague on the details).

  15. You look beautiful – thanks for sharing your story! I’m sorry you’re having to fight your insurance company, that is never pleasent. I didn’t realize there were any plans that covered FFS, so that is good news – even if actually getting reimbursed is proving difficult. I hope you win the battle! I’m happy that more plans are starting to cover trans* related surgeries, even if it’s still pathetically few. It’s frustrating to see friends denied medically necessary procedures because they are classified as “cosmetic.”

    • CA law forbids exclusion and limitation of transgender medical care. If you live in that state and have health insurance, you are legally entitled to have FFS and anything else in the WPATH SOC covered. No matter what your stupid fucking policy says.I believe a couple other states are now like this, not sure.

      The bad news is that health insurance is necessarily a monstrous criminal enterprise. I hope to publish a follow-up article about how I won my own fight against Anthem, but that… might take a while, lol. I’m happy to help with what I know about insurance law if you have any questions.

      • Hopefully other states will follow, especially my home state of NY. Glad you prevailed against your insurance company! That can be a challenge, even when the law is on your side. And I would love to read that follow-up article – the insurance industry is so crazy in this country. I know lots of people who have had trouble being reimbursed even for simple things that are clearly covered.

        • Sadly, telling the story of “how I won my own fight against Anthem” was meant as a purely aspirational statement – I haven’t curb-stomped those miserable bastards yet. But I genuinely think it’s going to happen. If I’m really lucky I’ll prevent them from just paying me and then pretending it never happened and going back to business as usual. I suppose we’ll see…

          • Oh no, I misinterpreted your statement – Good luck!! I feel like insurance companies count on people just getting frustrated or confused and giving up – if you keep at it I’m sure you will win. It’s ridiculous that they are making you jump through hoops like this though. I hope we get some genuine reform soon. The Affordable Care Act has instituted some positive changes, but it’s basically a band-aid.

      • > CA law forbids exclusion and limitation of transgender
        > medical care. If you live in that state and have health
        > insurance, you are legally entitled to have FFS and
        > anything else in the WPATH SOC covered.

        While CA Health & Safety code section 1365.5 et. al. (the Insurance Gender Non-discrimination Act) does prohibit insurance discrimination based on gender identity and the California DMHC (Department of Managed Health Care) recently issued a guidance letter to health insurance companies reminding them of their obligations to that effect, (a mere 6 years later…) I think it may be premature to say with certainty that all plans are currently required under state law to cover FFS.

        Cases like yours may decide this and it may depend on specific language and coverage in the plan. Plans are allowed to have what is called “non-discriminatory exclusions” which could impact trans health care in some cases, though it’s unclear how this interacts with the criteria for “medically necessary”. It is also unclear whether DMHC’s guidance will result in new less obviously discriminatory exclusions popping up immediately after removal of the illegal ones. It is sticky and I’m not sure it’s safe to say it’s a done deal yet.

        Just thought I’d mention that so others reading are aware that it’s still an area where coverage has the possibility to be more unreliable than we might hope and it might be a good idea to be careful.

        Obvs, I look forward to hearing how things go and am rooting for you. I think often in the past, persistence has been a notable factor in whether an individual trans person gets something covered. But in any case, it would be particularly notable if you ended up pursuing DMHC’s IMR process and ended up getting good results with it.

        Note: If it isn’t obvious, I’m not a lawyer, I just occasionally read California state codes for fun and track trans-related laws in our state closely. So who knows. I just wish there was a lot more clarity around this subject than there is and it was cut and dry.

        • You’re quite correct, I’m not aware of any precedent here and how this goes for me might determine a lot. My impression is that as usual, it comes down to whether anyone’s willing to listen to us honestly or not. My EOB says that cosmetic exclusions do not apply to transgender surgery under my plan, Anthem’s representatives repeatedly told me that my surgery would be covered, and Anthem’s internal documents reference WPATH SOC V7 as the evidentiary basis for medically necessary gender reassignment before slipping in a little “psst psst ps the following services are not medically necessary because we say so:”

          So I think for me, the evidence of discrimination is more or less ironclad. Citing a set of standards of care and only covering the prescribed services you feel like covering is the very definition of arbitrary limitation of coverage. And I’m trying not to get too cocky, but I don’t see how this could not set exact the precedent I hope for in terms of what other patients are understood to be entitled to. The rationale for coverage of SRS and HRT is exactly the same – these services treat gender dysphoria, a serious medical condition.

          Having been raised by two lawyers, I grew up with the understanding that if I have to be in this kind of dispute, I have in a very real sense already lost. And that’s true, it’s fucking wretched to have to contort yourself around the Reasonable Person’s idea of how one documents and demonstrates oppression. What happens will basically hang on “is someone willing to take this fraud seriously or not” and not any objective, True legal empiricism. I have no idea what will happen here, but I’m keeping my hopes up :-)

  16. I was already loving this (even if I had to skip the surgery details because thinking about blood, tubes, cuts, etc. makes me queasy and light-headed), but then you referenced Archer and you might be my favorite. Just FYI.

  17. Omigod, this was the coolest fucking article ever. Your radiographs are so cool omigod omigod omigod #osteologygeekout (This is so appropriate that I’m in the bone lab right now as I read and write this)

    Also, you remind me of Katharine McPhee which is bomb.

  18. I’m amazed at your strength going through this! I think about getting FFS done in the distant future and my head starts to hurt and I get tired.

    I found that so much of your piece resonates with me. Especially the parts about holding yourself hostage in the mirror (I am late for EVERYTHING without fail, and this is most of the reason) and always worrying about your face in public. I’m constantly freaking out about how my hair falls over it and such, trying to keep from wearing things with high necklines to keep attention off my heavy lower jaw.

    I also worry about the surgery itself. I want my face to still be “mine,” just a female version. It’s obviously more complicated than that in practice, but it’s important to me to preserve “family resemblance” (even though I hate my family). I have two friends who went through FFS, one all at once and the other in stages with different surgeons. This isn’t nearly enough to make a decision on a surgeon. I have a long time to decide, since I’m a law student and I’m more than broke right now (and likely to be for the next decade or so), but I don’t know how I’ll do it even when/if I could afford to.

    • I still think about that – which of all the possible outcomes would I accept as “myself”? How specific were my needs, really? What I needed was to be able to recognize myself “as female” – if I needed it badly enough to get surgery, was limiting myself to something subtle a dangerous act of vanity? I liked a lot about how I looked, it just also caused me pain. It’s hard to think that any radical difference would disappoint me if I still felt the same basic freedom I do now, but I really can’t say. I went into this knowing at least one person who’d had extensive FFS and looked wonderful and still couldn’t see it in herself, which was very sobering. Really, what I knew is that if I didn’t try something like this, it definitely wouldn’t improve.

      I think the good news is that it actually is a misconception that plastic surgery can easily make someone look “totally different,” although of course how people evaluate things like that is going to be bitterly subjective. I will never know how accurate my observations about this process really are, in a way – things have turned out very well for me, but I can’t say how likely that was to have happened, only that it did. I think it’s a call people can only really make for themselves, you know? I hope that whatever you end up doing, you get exactly what you need.

  19. Thanks Olivia, this piece of writing is well done. The more I read this series, the more I find myself really happy about some of the amazing writing that has shown up. Not only is Autostraddle covering new ground, most of the writing involved is spectacular.

  20. Ugh, I identify SO HARD with your thought processes during the research and decision process and before that. I transitioned 5 years ago (holy shit) and still think about getting FFS. For all the reasons. Argh.

    Would love to hear more as you heal :)

  21. Holy shit. This is amazing. Love your style of writing and am pretty much blown away by how cool it is that something like FFS exists. Good on ya mate!

  22. Thank you for this article. I have had several friends talk to me about FFS in the past, and I’ll admit to having a great deal of concern. I recognize now I just need to STFU and be supportive.
    I had jaw realignment surgery as a teen to correct a really bad open bite, and had to get a titanium plate similar to yours, and it sucked. It took over a year to heal and several more to get use to metal plates in my face. Any time someone would bring up FFS, I could only think about how much it physically hurt. But that is such a small part of the whole process and I need to remember that.

    So instead I will give you this small bit of advise: the metal plate in your chin will get cold when the temperature drops or there is a lot of wind. Having the inside of your face get cold is weird, so I recommend starting a scarf collection if you don’t have one already.

    • So far, I haven’t noticed anything, but thank you. I think they just used pins in my case, and I may even be able to feel them under my jaw, unless I’ve gotten *really* lucky and that’s the button that releases a swarm of attack nanites…

  23. IMO you were stunningly beautiful before and are stunningly beautiful now. I know a little bit about plastic surgery, having had some procedures myself and your choices are yours and should be respected.

    You are a total babe and I can see you would have an amazing career as a fashion model (but don’t, that industry is crazy).

    Thank you for sharing your story.

  24. I’m scared I’m breaking some rules or something by asking this. This was a great article. I stumbled on it because even though I did some searches a while back, now I’m seriously looking for an FFS surgeon to schedule a consultation with. It sounds like you definitely recommend going to several to figure out who suits you, but for what it’s worth, the attitude of the one you found sounds exactly like that kind of person I would like to start with :) If you can’t let me know somehow who it was, could you at least give me some advice for tracking down where to start? Consultations are expensive =/ And maybe its different from when I looked in to this a couple years ago, but… the lawyer at the TG law center, at least back then, told me that, as of then, no FFS surgeries had ever been covered and paid towards by any insurance companies. Not sure if it was his client, but he mentioned someone who had just many tends of thousands of dollars trying to take an insurance company to court, and unfortunately lost. I’m hoping things have changed in the last couple years, and I sincerely hope you win your fight.

    • Hey there! I’m glad you liked the article, and you’re absolutely not breaking any rules by asking for specifics. It seemed “maybe not a good idea, as a gut feeling” to name names, etc. in the public article, but I’d be thrilled if there’s any way I can help you. I’ll send you a PM with my email address, please just bump this comment thread if you don’t get that and we’ll find some other way.

      I can certainly tell you who I worked with, and will add that I didn’t pay for a single consultation – of course, for a lot of complicated reasons I was also comfortable making more decisions earlier, without necessarily meeting every surgeon I talked to in person. If you like, I can tell you more about my own process. It might help you winnow a large number of options down to just one or two you’d like to consult with face-to-face.

      Things are a bit better than they were even, idk, 5 years ago – I’m fairly certain some FFS coverage has been successfully used, in the “in the history of ever” sense. But it is absolutely new legal ground and I have no idea how my case is going to go. I’m hoping to mail the documents out this week – all 65+ pages across 4 CCs, christ – so I guess we’ll see! Thanks again for your support and kind words.

      • Would you mind if I contact you about your selection process, as well? Even though I can’t afford it in the foreseeable future, I still want FFS and just moping about my nasty man-face is worse than spending some time actually figuring out what surgeon(s) I want to go with. The problem is, I have no idea how to go about deciding on a therapist.

  25. Olivia, in years of reading,this is, without a doubt, the most amazing and informative piece i have ever read about ffs. though not in the market myself (absolutely nuthin’ could help this ol’ dilapidated face, though i am considering a little nip/tuck action), it’s a subject that comes up a lot in conversations with my younger sisters. I’ll be passing this along and linking it a few times so it can spread around.
    your joy is palpable and i congratulate you on your fortitude, not only in the face of the pain of the procedures and recovery, but especially in your strength of conviction in the face of the many naysayers expected and unexpected.
    additionally, the lengthy comments section (yes, i read it all)is a worthwhile experience in openness and self-assuredness.
    (deep thanks to autostraddle, too, for welcoming #girlslikeus and giving us space…)

  26. It’s amazing what a Rorschach Test your article is, bringing out a lot of issues that it throws back for people. Thanks for taking the trouble to track, document, and report on your experience to all of us.

    I couldn’t possibly classify what kind of transperson I am, but I like very much your defense of all of us, whatever position we are in.

    I think it’s great that you finally have a face that feels like the you inside, and I admire your bravery and persistence in getting it done. Much sucess in the future.

  27. Moron is an ableist slur that has been used to justify systemic violence and oppression of autistics and developmentally and intellectually disabled people, and it really hurt me to be punched in the gut with it out of nowhere here. Please stop scapegoating disabled people for the actions and attitudes of evil, malicious, callous, arrogant people who have a vested interest in ignorance. you’re killing me. and please don’t gaslight me, i can’t take another gaslighting from a self-anointed activist space this week. just please take my word for it that I’m super totally a person and have feelings and there isn’t some evil/funny/nonhuman/disposable part of me which was separarely abused for being disabled vs the important/heroic/salvageable/human part of me that was abused for being trans*. I’m really disappointed and tired and sick of being hurt by people who claim me as part of their community.

  28. I was doing some research for transop.com and I stumbled upon your essay. I imagine that many others have enjoyed it and found it inspirational as they consider or plan facial feminization surgery. Your cheeks are so stunning that I had to read the essay again just to make sure that you didn’t have cheek implants placed. Kudos for the perfect natural cheekbones! Your results were great, too. But, it’s too bad that the doc didn’t let you have some of the bone from your chin. Those would have made some killer earrings!

  29. Thank you for sharing. I go in for my own ffs July 1st. just 2 short months away. I am by turns elated and terrified. I can hardly wait and I want to run away and hide.
    Its good though. A new chapter in an old book. A 2nd chance at life in a world that grants very few. I hope I can manage my own as well as it seems you have.

  30. Not only reconstructive surgery is helping people that has similar problems, medical improvements like facial feminization surgery is giving a lot of people a chance of being what they would like to be, despite of the fact that anyone should love herself like you do.


  31. as a non-transitioning male to female, I absolutely loved your story. I think you are absolutely beautiful, feminine, articulate and brave. Having been called names, threatened, fired from my job, because of who I am, Not what I did, I am so very proud of you as a woman and a sister.

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