Gender Reassignment Surgery and Facial Feminization Surgery (FFS): 3 Tips From Doctors on RealSelf

Four Doctors

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RealSelf recently sat down with some of the nation’s leading doctors who specialize in facial feminization surgery (FFS) and gender reassignment surgery. These medical providers have spent years refining techniques and pioneering surgery for a population of patients they say is only growing. Read their answers to some most commonly asked questions from the RealSelf community.

What to Look For in a Doctor

Picking a doctor is important no matter what you’re getting done, but when it comes to FFS and gender reassignment surgery, our doctors say be extra cautious. There are plenty of surgeons who may say they’re up to the job, not realizing that applying traditional plastic surgery techniques can result in less than satisfactory results.

RELATED: Transgender Men and Women Who Got Surgery and How It Changed Their Lives

“More plastic surgeons may be saying ‘Yes, I’ll do it’ who may not necessarily have experience doing it,” says Dr. Daniel A. Medalie, who first began working with transgender patients in the mid-1990s. “That doesn’t mean they’re bad surgeons. It just means they haven’t done a lot of trans surgery.”

There’s a level of finesse involved when working with those transitioning to a new gender, say doctors on RealSelf. “I knew all the steps but I had to put them together in a different way for my transgender patients,” says Dr. Richard Tholen of his early days working with transgender men and women. For example, you can’t just do a traditional mastectomy on a trans man and expect the results to be the same as they would be for a non-transgender woman. There are too many other factors, like skin elasticity and hormone therapy, to consider."

“Make sure the person you’re going to, gets it,” Dr. Medalie suggests. “[They should] understand the operations ... If they can’t do something or are uncomfortable doing something, [they know] when to say no.”

Dr. Jeffrey H. Spiegel, who has worked with more than 1,000 transgender patients interested in FFS, seconds that opinion.

“You don’t want someone who’s limited,” he says. “When your car’s not working, you don’t want to go to a mechanic who says, ‘Well, I can fix your car as long as it’s a problem with the battery.’ You have to be able to fix the car.” Translated into plastic surgery terms: Find a doctor who recognizes that a change to the nose might mean a change to the cheeks which might mean a change to the brow. “That’s the key: experience and someone who can do all of it,” says Dr. Spiegel of FFS.

How can you tell if your doctor does? Before and after photos. “Look for someone who can show you enough before and afters and who can show you enough historical evidence of their experience,” says Dr. Tholen, who annually does more than 40 procedures with transgender patients.

Top Doctor Toby Mayer agrees that it's best to be cautious about picking a doctor. “People think [plastic surgery is] the same. Like a Corvette. Whether I get it at that dealership or this dealership, it’s the same. It’s not the same. There’s a skill level.”

Know Your Risks

There is no one surgery that summarizes the transition process but all of them carry some amount of risk, explain the doctors.

“There are certain risks involved with anything that we do,” says Dr. Harrison Lee, who practices FFS. Depending on the individual’s preference, FFS can include procedures ranging from an Adam’s apple reduction to a nose job to jaw surgery — which means a range of potential complications.

A forehead reduction can lead to sinusitis while changes to the jaw can mean permanent numbness of the lip and chin. When reducing the Adam’s apple, the voice may alter and after a mastectomy there may be widespread numbness of the chest.

The best advice: Know what you want and know what might happen as a result. Come prepared with a list of questions for your potential doctors and don’t be afraid to quiz them about their own surgical stats. Have they had a lot of revisions? Patient complaints? Complications?

Find Someone You’re Comfortable With

This advice matters no matter what you may or may not be getting done: You want to be comfortable with your doctor.

“[There is] such a need … for doctors who are not only skilled in transgender surgery but sympathetic to the fact that [trans men and women] really had a tough time getting to the point where they’re ready to have surgery,” says Dr. Tholen. “The last thing they need is either an office who looks at them askance or individuals in an office who think they’re weird.”

A good test to skip that kind of unnecessary awkwardness is to ask friends who’ve had work done for their recommendations. Then schedule a consultation and use it as an interview. Is the doctor up to the job of giving you what you want?

“Plastic surgery is plastic surgery,” explains Dr. Medalie. “People come in, they have certain expectations, they’re going to have an operation, and they’re supposed to benefit from the operation.”

It’s the benefit they see come from working with trans men and women that stays with doctors long after the final appointment. “People who see us are often frustrated, sad, often depressed and then afterwards they feel whole and complete,” says Dr. Spiegel. “That’s a recurring theme. Afterwards they feel like they were almost reborn.”


RealSelf transgender community members share their stories on the RealSelf blog

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