Facial Feminization Surgery: The Procedure

You read about Rebecca’s preparations for FFS, now she discusses the day of the surgery! Please be mindful that there are images containing hospital rooms, some blood, bruising, medical equipment, and mentions of previous assault.

Rebecca is an activist who has worked with local legislators and community leaders to advance transgender rights, acceptance, and safety in all aspects of society. She has also recently joined the Client Advisory Board at the Center for Transgender Care at Northwell Health.

The day before my surgery, I took a car service into the city in the afternoon, checked into my hotel and settled in. The hotel was about 10 blocks away, so I planned to walk to the hospital on the morning of my surgery.

I arrived at the hospital at 5:30 AM and checked in, which took approximately 20 minutes. Then I went to the pre-surgery area, changed, and met with my surgeon and anesthesiologist. When the team was ready, I walked into the operating room and got onto the table. I remember seeing what seemed like endless pictures of my CT scan on the wall from different angles, and the virtual planning had already been done. I was only on the table for a minute, and it was lights out. The next time I opened my eyes, I saw a clock hanging on the wall in my hospital room.

The first thing I thought was that I couldn’t believe I had finally done it. All those mistakes and flaws on my face that I saw, all that masculinity, were finally gone forever, and euphoria set in.

For my surgery, the following procedures were done:

1. Frontal sinus setback
2. Bilateral supraorbital contouring
3. Bilateral orbital reconstruction
4. Bilateral brow lift with hairline lowering
5. Osseous genioplasty (narrowing, shortening, advancement)
6. Mandibular angle and inferior border reduction
7. Mandibular contouring
8. Bilateral tarsorrhaphy
9. Open rhinoplasty
10. Cartilage grafting (bilateral spreader grafts, columellar strut)
11. Submucous septal resection with inferior turbinectomy
12. Submental fat excision
13. Platysmaplasty
14. Tracheal shave
15. Upper lip lift
16. Upper and lower lip augmentation
17. Custom PEEK malar implants
18. Bilateral submandibular gland resection

While in the hospital, I didn’t experience any pain or nausea. However, the dressing around my head was very tight, and it felt like I couldn’t breathe, even though my oxygen level was 100 percent. A few years ago, I was assaulted in my sleep at another hospital. Because of that experience, I battled constant anxiety for the two days I was recovering in the hospital and couldn’t sleep for more than 30 minutes.

Everything was really swollen, including my lips, which were covered in healing ointment, making it tough to eat or even drink water. That said, I recommend that anyone having this surgery make sure to eat a full meal the night before.

My stay in the hospital was from Friday afternoon until Sunday morning.

A friend of mine picked me up, and on the ride home, I was in a constant state of reflection on how important this step was in my transition, and it was finally completed.

I felt a sense of privilege knowing I had this procedure performed while many others were unable to because of financial or legal constraints.

There was also a sense of relief knowing that, regardless of any anti-transgender legislation that may become law, my feminine features can never be taken away from me. I had struggled with my appearance my whole life, and it was a major part of my dysphoria. So it's difficult to put into words what it feels like when something so burdensome changes permanently overnight.

Stay tuned to hear the last phase of Rebecca’s surgery!