selfaware soup

Face Off, Face On

They literally peeled my face off, it hurt and cost a lot, and it was totally worth it – my facial feminization surgery and recovery in 2022

2022-12-19

Content warnings: medical transition, surgery, scars, bruises, skulls

They literally peeled my face off, it hurt and cost a lot, and it was totally worth it – my facial feminization surgery and recovery in 2022

I went through one of the most significant steps in my life in 2022. It changed on a fundamental level how I view myself, how I relate to my body and how I navigate the world. I’ll try to go through the whole process here, but let’s back up to about a year ago …

Before

This is what I looked like to most people about a year ago, and this was only possible with quite a lot of make-up and constantly straining my facial muscles in order to force my face onto a shape that caused less dysphoria. And aside from the dysphoria, safety was an ever-present issue. When you get “clocked” (recognized as trans) by a random stranger, you never know how they will react. The most common thing that happened was people just intensely staring, which seems harmless but imagine hundreds of people every day, in the street, in stores, at work and on public transport looking at you as if you’re some kind of alien, with a mix of disgust, hate and obsession. That, every day, for years and years, is really hard to deal with. And then there’s the risk that someone will act more openly aggressive to you. I’ve had to deal with anything from insults and people intrusively taking photos of me (some covert and some more obviously) to threats and physical assault. And all that was while I put a lot of effort in every day to not stand out too much. And all this was in Berlin, a place that’s probably on the safer end for trans people compared to other parts of the world.

Without any of that effort I looked like this:

These pictures show the face I saw every morning in my bathroom mirror and I can barely recognize myself in them. They were taken in order to plan facial feminization surgery (FFS).

I started my medical transition with hormone replacement therapy and permanent facial hair removal since early 2018 and while those certainly did a lot a reduce my dysphoria, I never got to a point were I could confidently say “Yes, this is my face.”. There always remained a bit of that feeling that I’ looking at someone else who only kind-of resembles the actual me. Now, I never thought that face was ugly or anything, it was fine, it was just someone else’s.

I thought I could probably live with that, there wasn’t anything I could really do about it anyway. FFS is very expensive and health insurances in Germany don’t cover any of it. But then through plain luck by starting a new job that paid partially in stocks at just the time time before their stock tripled in value over the course of a year or so, that expense became a possibility.

Today there’s pretty much only one place on Europe that offers these kinds of procedures and has an overall positive reputation: a company called FacialTeam in Marbella (Spain). After extensive online research I found mostly very positive reviews and experiences with them and the worst report I could find what still kind-of neutral. Back in 2021 there was also Dr. Bart van den Ven’s clinic in Antwerp where I had gotten a minor procedure done in 2018 (tracheal shave) but reports from his patients for FFS were very mixed, ranging from very positive to catastrophic, and I also hadn’t been very happy with how he handled patient’s recovery. He would have been the cheaper option but it seemed too risky with such a major operation so I went with Marbella.

Turns out, once you go private and pay out-of-pocket for healthcare, things are very expensive but also can go very quickly compared to the waiting periods and bureaucratic battle you have to endure with German public health insurances. Within a few weeks I had an online consultation via Skype with one of their surgeons, sent them the above photos and shortly after I had an offer and a potential surgery date in February of 2022.

Travel

This was the first time I traveled long distance during the pandemic and that was certainly unnerving with a major surgery coming up and depending on a negative Covid-19 infection status, but after a few flight hours I arrived in pleasantly warm spring-like weather on the Spanish mediterranean coast. I was picked up at Malaga Airport (AGP) by the clinic’s taxi service and dropped off at my hotel. Marbella is quite beautiful, at least the old part of town near the hotel.

Booking accommodations was all handled by FacialTeam, they usually cooperate with this one hotel in the city and offer taxi service to and from the clinic since it is a 12km drive.

Booking your own accommodation and transport was an option but it wouldn’t have saved much cost and added a lot of stress. Not worrying about the logistics was absolutely a blessing. I would just get a text message from my coordinator at FacialTeam reminding me when I had to come to the pickup point at the corner down the road from my hotel room and the taxis were always in time and drivers were very friendly and not bothering me with anything. I was quite happy being left to my own thoughts in those drives.

Preparation

I had a full day in Marbella before the actual surgery, which was mostly for taking CT scans of my skull and a detailed consultation where I would go over the planned changes with one of the surgeons. Based on the photos I had provided a few months earlier, they had prepared a sort-of preview where they would show what could be possible and which to base the actual planning on:

For the most part I was quite happy with the proposed changes and they had already considered the wishes I had mentioned in the first online consultation. Most importantly that I didn’t want a super small nose and to maintain some of the pronounced edges of my face as I think it fits me quite well regardless of feminization.

It was a good conversation that removed a lot of my anxiety and gave me a lot of confidence. I had some worry that the result would be too “girly” because I had seen a lot of examples from people who had FFS (not just in Marbella but all over the world) and I think that would really not have fit me at my age and it would have been weird to try and make me look younger than I am.

With that all done, there was just one more night to sleep. These are the last selfies I took pre-surgery. On the night before, doing my usual make-up routine one last time and one on the morning of the operation at the clinic.

Surgery

I was in surgery for about eight hours, the longest I’ve ever been. Even bottom surgery “only” took six hours. Here’s all the individual procedures and major steps they did:

• a large incision on the top of my head
• remove a long strip of skin along that incision to harvest hair follicles from
• peel off the skin from the incision all the way to the bridge of the nose
  (yes, that is as scary as it sounds, they literally peeled half my face off)
• Forehead reconstruction
  • shave off some bone along the eyebrow line
  • remove the piece of skull that covers the frontal sinus (behind the forehead)
  • place that piece a bit further inward an fix it in place with titanium mesh and a screw
• enlarge the orbits of the eyes by shaving off some bone on the outer edges
• reconstruct the shape of the nose by removing and shaping bone and cartilage
• shave off bone at the chin to reduce it
• remove some skin at the eyelids to prevent them from dropping
• transplant the harvested hair follicles into their new place long the corners of the hairline

The changes around the nose are made through a small incision across the septum and the chin is done through an incision on the inside of the mouth just under the lower lip.

Afterwards I spent some time in the wake-up room but I can’t remember any of that. I’m usually very disoriented after general anesthesia. At some point I was brought back to my hospital room, got my intravenous pain meds and could rest.

Recovery

This is what I looked like in the first two days while staying at the hospital:

Warning, these images can be quite graphic. Click the images to reveal them.

Day Three and After

On day three I was transferred back to the hotel to continue my recovery there with daily visits by a nurse who would take care of cleaning scars and especially the hair transplant which needed daily treatments and continuous moisturizing. I had to set an alarm through the night for spraying water on the transplant every few hours. This and sleeping on my back were be far the greatest annoyances apart from the actual pain which was manageable with a lot of ibuprofen.

The next few days were pretty uneventful and had the same routine: I’d wake up early because my back hurt too much to sleep, then get visited by then nurse, followed by breakfast and then various combinations of naps, short walks and watching a lot of Youtube videos because I couldn’t focus on anything long like a movie. That’s been the same for me every time I recovered from surgery.

FacialTeam organizes regular group sessions with a psychologist and other patients which was in part very helpful because I could see other’s who were a few days further ahead in their recovery process and it gave me a lot of reassurance, especially in the early days when my face was a swollen mess. On the other hand, I often don’t do well in groups of strangers so I didn’t attend too many of the group activities.

Day Seven

One week after surgery I was finally allowed to wash my hair again. Until then it wasn’t possible because of the fresh scars and hair transplant and my hair felt and looked terrible as it was still soaked with all sorts of things from the surgery and recovery.

Day Eight

The next day the nose bandage came off an I was able to see my new nose for the first time, and that was really exciting. I was very happy that day. Even though I was still swollen and covered in scars and bruises, I could already see the new shape of my face underneath it all. My face no longer looked like that of a different person, but mine, just somewhat damaged.

That was also the day that we took another set of photos in their studio at the clinic and have the final consultation. We compared the photos and CT scans from before and after, talked about recovery and proper after-care, and that was it. I was released and would
spend one last night at the hotel and visit the beach one last time before heading back home.

Analysis

One of the most interesting things during the final consultation was comparing CT scans. It added a whole other layer to understanding what had just happened and made it feel a lot more “real” somehow.

Warning: these images are 3D scans of my actual skull, they can be unsettling. Click the images to reveal them.

You can pretty clearly see what changes to the bone structure were actually made, flattening the forehead, reducing the chin, enlarging the orbits, and the nose reconstruction. The 2D profile image includes soft tissue so you can see you the bone structure affected the actual shape of my face.

The grid-like structure is the titanium mesh that’s now embedded in my skull an will remain there indefinitely.

Long healing

Recovery wasn’t done after I returned home. It’s a months-long process that still isn’t 100% finished as I write this almost 10 months later. It took weeks for the bruising to fully go away, about 3 months for the hair transplant to actually grow new hair, and about equally long for the numbness in my forehead to disappear.

The chin and nose are taking the longest. Both still feel stiff and more sensitive than before but it’s slowly getting better. I’m not in actual pain anymore and the remaining side effects are mostly small annoyances. For the chin I had to wear the stretchy bandage around my head until six weeks post-surgery for at least eight hours per day.

Some things could possibly stay forever though. For example when I pluck my left eyebrow, I feel the sensation on the side of my head instead. A assume some nerves got crossed there and will now just stay like that.

After

These were all taken between 6 weeks and 3 months after surgery:

At the three-month mark, visible changes had slowed down so much that there wasn’t much to see on a week-by-week basis anymore. After that is more when I look at a photo that is a few months old that I still notice small changes here and there. It’ll probably be up to two years post-surgery until everything is actually fully healed. It’s a very invasive procedure after all. As I said, they literally peeled half my face off.

Cost

I want to also make transparent how much this all has cost me because that is absolutely a major barrier for many people to access this kind of healthcare. I haven’t kept track of all the travel and food expenses (Marbella is an expensive town) so I have to estimate those but they make up a very minor portion of the total so it doesn’t make much of a difference.

TOTAL: 40,300.00€

There’s no way around admitting: this is prohibitively expensive for most people and I was only able to do it through plain luck. I might as well have won a lottery.

It was still absolutely worth it. The positive effects of FFS for me can’t be measured in money. I am so much more at peace with myself. I’m more confident, and my overall body-image has also shifted to way more acceptance. I wear the clothes I want to wear now without thinking much about wether they will draw too much attention. I can just go downstairs to the corner shop to pick up a snack whenever I feel like it without going through a whole routine first. I can go on a video call without much preparation time. I can finally just exist as I am.

The gain in safety is also substantial. I no longer fear that I might be the next news story of a trans woman who got assaulted and beaten up on the subway. I can now leave the house without first needing to carefully craft makeup that hides those “wrong” facial features and then still fear being clocked and experiencing harassment and violence just for existing. Now I “only” have to deal with all the other bullshit that a very tall and obviously queer woman faces in public spaces but an entire category of hate and suspicion from random people that I had to deal with on top of everything is now mostly a thing of the past and it has made my life so much easier and less exhausting. I feel like it has finally opened up enough capacity to deal with some other important issues in my life that I before just didn’t have the energy for.