When I was researching FFS I found these kinds of posts really helpful so I figured I should put one together.

This is a long post. I didn’t edit too much because I wasn’t sure what people would find useful.

I won't share pics. Sorry. FWIW my results are comparable to other DB patients I've seen in this sub.

Tl;dr - I had a great experience with DB and would recommend him. They really take care of you. My results were dramatic — even before swelling went down. Recovery was pretty easy. Not much pain or bruising. I was back to work in three weeks.

Consultation

DB only does in-person consultations because they want to see your X-rays before making recommendations.

The X-Rays are taken at a lab down the street from his office. I say “x-rays” for simplicity. There were about 10 different kinds of scans done. It took about an hour. I had to take off my wig, which wasn’t fun, but I survived.

Next, I walked over to DB’s office. The office was beautiful, and the staff very friendly and helpful. I got the impression that they really care and that they pay attention to detail.

I was introduced to Zhanna, DB’s physician’s assistant. She guided me to a private area where she took photos of me. Then it was time to meet DB.

DB is a really sweet guy. He exudes competence and at the same time he seems to genuinely care about his patients.

He asked me what I’d like done, and I said I didn’t have a ton of preconceptions, but I wanted to look as feminine as I could in a natural way. He then went through my X-rays pretty thoroughly and drew up a plan: type-3, rhinoplasty, genioplasty, jaw contouring, lip lift, neck lipo and fat grafting.

Next, he explained each procedure, showing me before/after photos as well as surgery photos. (If you’re not comfortable looking at photos of surgeries in progress, you may want to ask him to skip those.)

He told me how many times he’d performed each operation, what the possible complications were, and how many of his patients had experienced them. He seemed really up-front with everything,

Throughout this I was able to ask him whatever questions I needed to. It wasn’t rushed.

After our conversation was over, I sat in a dentist chair while DB took some measurements of the outside of my face. It didn’t take long.

Then, I said goodbye to DB and was ushered into another room where I met my patient coordinator. She gave me the quote for the work DB had suggested, and we talked about insurance and scheduling. We talked abut possible scheduling but I didn’t book then because I needed to talk it over with my partner.

Price / Insurance

They ask you not to publish the fee, so I won’t. Based on his reputation, I expected it to be higher. It was comparable to Keojampa.

DB’s office doesn’t bill insurance directly. You have to pay them cash first, and then get reimbursed by your insurance. However, they did submit the reimbursement request on my behalf.

My insurance ended up covering about 20% of the total. It covered all hospital and anesthesia fees, but very little of DB’s surgical fee.

Deciding to Book

I decided to go with DB for a number of reasons:

• I really liked all the before/after shots I’d seen. I felt his results were super-feminizing, yet natural looking.
• He and the whole staff exuded competence, kindness and attention to detail. I felt certain they’d take good care of me - even after they had my money.
• I really liked that he doesn’t prescribe heavy painkillers and that walking is such a big part of the recovery plan.
• The wait time was relatively short (a few months) and San Francisco was within driving distance.
• His patients online tend to be huge fans. I didn’t see any patients of his who had nightmare recoveries.
• He and his team are really fast. He estimated 5 hours for my FFS. Other surgeons take almost twice that amount of time. I don’t have any data to back this up, but it seemed like that would lead to less risk and an easier recovery.

Preparing

They sent me a big document called the "master surgical packet" which contained detailed instructions for what to do before and after surgery. Here’s a brief sample:

• Go to the dentist and have my teeth cleaned
• Go to quest labs to have blood taken
• Begin a moderately low-salt low-carb diet
• Start taking some supplements and stop taking others.

I knew I was going to be alone for most of my recovery, so I did a lot of work to make sure I had everything I needed. Items like:

• Meal replacement shakes
• A wedge pillow for elevated sleeping
• A travel humidifier.

You can see my full packing list at the bottom of this post.

Day before surgery

The day before surgery I had a lot to do:

1. Pre-op hospital appointment. - St Francis required everyone getting an operation to be covid tested. Because I was coming in from out of town they let me do it the day before. While I was there they also took my insurance info and entered my medical history into their system. They were super nice and respected my pronouns even though I was not very femme-presenting.
2. Pick up my prescriptions - There is a walgreens pharmacy really close to DB's office. They send your prescriptions there. I was surprised to learn that there were TEN of them. The bag I left with was so big it looked like I had takeout for a family.
3. Pre-op DB appointment. The first part of this appointment was with Zhanna. She presented me with a goodie bag full of chap-stick, scar-cream, and other post-op stuff. Then she gave me a sheet that explained every aspect of post-op medication and care. We went over it in detail and she answered all my random questions.

After Zhanna, I met briefly with Dr D. He had a sheet for each procedure to be done that he was filling in - asking me questions to confirm things. He said it was his map of the moves he had to make during the procedure, which seemed pretty cool.

I was kind of nervous the day before surgery, but after leaving DB's office I felt noticeably better. He and his staff really give off the vibe of people who know exactly what they're doing and really care about you.

Surgery Day!!

Going to get surgery alone in the time of covid…what a surreal experience.

I was picked up from my airbnb by Dr DB's uniformed driver at 5:30am. The car was a black Mercedes and its interior looked like a jet. I was wearing sweatpants, a plaid flannel shirt and orange crocs.

The driver dropped me off in front of a small door, which was the ER entrance. It was a gray, worn, institutional space. Empty, except for a few other people checking in for surgeries. After a few minutes wait, I was led upstairs into the staging area.

This was a little room made out of curtains, with a bed and a table. I had to get undressed and put on a surgical gown which seemed to be made of out of tissue paper. My clothes and phone went into some orange bags which were trying really hard not to look like trash bags.

It was at this point I started crying. I wasn't sad or scared or upset. I think my nervous system was just in overdrive and had all this energy it had to dump. So it came out as crying. After a minute I started looking at videos on my phone of my daughter doing silly stuff and the crying turned into uncontrollable laughing. So that was a win.

Then the parade of dignitaries began. First Zhanna showed up and asked about me. Then Dr DB, with his reassuring air of competence. Then the anesthesiologist came in and explained how that was going to work. Finally a nurse came to wheel me into the OR.

It was immaculate in there. There was some surprisingly nice music playing. My photos and X-rays were up on one wall. I could kind of see how everything was laid out. Everyone had their job and was going to do it well. Someone told me to think of something I 'd like to dream about. The next thing I know I'm in a recovery room looking out the window at downtown San Francisco.

My day and night at the hospital

I woke around 4pm, asked for my phone and listened to music.. I wasn't in any pain. I couldn't really think. So I just laid there.

DB provides a personal nurse for over-night. She arrived at 7pm and was an enormous help. I had to do three things.

1. Walk on my own. As soon as I could walk down the hall and back I was able to have my catheter removed.
2. Drink enough water that I was peeing and not becoming dehydrated. This is harder than it sounds when your face is swollen.
3. Sleep, somehow, while sitting upright and wearing a neck pillow filled with ice. I later learned this was called a "jaw bra"

The nurses job was both to encourage me and to untangle me. Simply going to pee meant I had to have my leg massagers unstrapped, the side of the bed lowered, and my IV stuff disconnected.

But also it was incredibly nice having someone familiar with these surgeries around to reassure me that I was doing well. And to answer questions like "If I lift myself out of bed is my face going to pop off?"

When morning came, the nurse removed the drains and cleaned the incisions. There was a slight issue where one of the drains was stuck on a stitch. Dr DB fixed that easily enough. Then Zhanna wrapped up my head like a mummy.

I checked out of the hospital at 10am. If I was doing this all again, I would 100% make sure I had a personal nurse overnight.

On my own

I’d never had surgery before, so I was worried I might react badly to anesthesia. I wanted someone to check on me for a few days after surgery, so I hired a home nurse.

DB’s office recommended a company called “Solos concierge nursing.” My nurse mallory picked me up from the hospital, took me back to the airbnb and made sure I was comfortable, that I was taking my meds on time, etc.

She was really caring, and super excited about how great my results were going to be. As someone who had just gotten surgery alone and was wrapped up like the mummy, it was so wonderful to have that support.

I hired her for a total of three days. If my recovery had been less smooth I would have definitely extended that.

Was hiring a home nurse necessary? Because I recovered quickly, I would have probably been ok by myself. But if there had been complications, I might not have been ok, so I think it’s good insurance if you’re traveling solo for surgery.

Recovery Overview

I feel like I had a relatively easy recovery. It was more a matter of discomfort than pain.

The first 2 weeks of recovery were pretty regimented:

• Two hours or walking daily (broken up into small chunks throughout the day)
• Every four hours drink a Huel meal-replacement shake
• Every 4 hours take my meds (Except at night)
• Relax during the day and try to sleep at night.

The main challenges for me:

• Fatigue - everyday easy things became exhausting. It was both mental and physical. I brought my laptop thinking I’d check email, but just couldn’t do it.
• Voice - my voice became very hoarse and deep, due to both intubation and the swelling/numbness from my chin and jaw work. It recovered in about 2 weeks.
• Facial muscle control - It was impossible to smile or show emotion on my face - anything that involves fine facial motor control for about 2 weeks. Eating was uncomfortable and messy for 3-4 weeks.
• Breathing - I couldn’t breathe through my nose for about 10 days.

Recovery by procedure

Forehead

I had type-3 forehead reconstruction. It was covered by a cast until my second followup. Once the cast was off, the change was obvious. My overhanging brow was just gone, and my face looked so much more open.

There wasn't much pain or swelling. My incision was raised and bumpy for about 6 weeks then flattened out. This is normal, and a result of deep sutures that minimize tension on the surface levels of the skin.

I couldn't wear my wig for 10 days after surgery. If I had my own hair I wouldn't be worried about the scar showing. After 8 weeks it's already becoming a lot less noticeable.

DB prescribed rogaine to prevent shock hair loss. After a month I ran out and lost a little patch close to the incision.

Lip lift

The lip lift was not a big deal. I had sutures under my lip, which they took out after 7 days. Starting at 10 days I had to apply scar cream to them.

The lip lift made a huge difference to my appearance. I was worried it would look unnatural, but it doesn't. The scar from it is right under my nose, and is becoming less visible with every week.

Fat Graft

I had fat taken out of my inner thighs and injected into my cheeks, lips and wherever else DB thought it should go. It looks very dramatic at first. The injection locations are prominent. After a week or two it softens and looks more natural.

I had huge bruises on my thighs where they took the fat that made it a little painful to sit on hard seats. The pain went away after a week. The bruising took about a month to go away completely.

I like the results of the grafting.

Nose

I had rhinoplasty. My nose was covered by a cast for 10 days. I couldn’t breathe through it until they removed the cast.

There was no pain. Swelling wasn’t super visible. I didn’t even realize it was visibly swollen until my nose suddenly looked smaller one day. It did feel very hard and not flexible. It still kind of does 8 weeks in.

For 4-5 days after surgery I had to wear gauze under my nose to catch leakage. It eventually slowed and crusted up the inside of my nostrils. Q-tips helped with this.

I had to tape my nose for 6 weeks after surgery to limit swelling. I wasn’t allowed to blow my nose for 6 weeks. They told me the nose takes months to fully heal.

I’m really happy with my nose now. It basically looks like the feminine version of my original nose, which is want I wanted.

Chin / Jaw

I had the height and width of my chin reduced, and my jaw contoured. They made the incision for this in front of my bottom teeth.

My lips and lower face were very swollen. It was hard to eat or talk — anything that involved opening my mouth. My lips wanted to peel a lot. Swelling peaked on day 3 and was significantly better by day 10. By week two I could open my mouth 2 finger widths. By week four I could comfortably do three finger-widths.

My chin and lower mouth area were very numb for the first three weeks. After that it started gradually getting better. By week 8 most of the sensation has returned.

I was on a liquid diet for 10 days, but I continued it for an extra week after that because I couldn’t open my mouth very far and couldn’t chew with my mouth closed. It started getting more comfortable on week three. By week 8 eating feels normal and I’m able to eat all the foods I normally would.

One unexpected effect of all this is that my my normally feminine voice turned very masculine for about 2 weeks.

Recovery Timeline

Days 1-3: Things get harder

• Energy: When not walking I was totally exhausted, mentally as well as physically. After getting back from one 30 minute walk I sat down and passed out for two hours.
• Swelling: Increased for the first three days. The upper half of my face wasn't a problem. The lower half of my face was the worst. My lips looked like overdone influencer lips. My bottom lip was especially tender.
• Pain: Stayed between 1-3 out of 10. The most painful area was actually on my inner thighs where they took out fat to use in the fat graft.
• Breathing: I couldn't breathe through my nose. My teeth are unusually sensitive now and when cold air hits them, they hurt.
• Speaking: I could talk for maybe 5 minuted before my jaw became sore. I sounded like tom waits, but was too tired to be very dysphoric about it.
• Bruising: On my face I had a small light yellow bruise. On my inner thighs (fat graft donor area) I had very large dark bruises.
• Eating: I was able to drink my huel from a cup. I couldn't use a straw.
• Sleeping: It was difficult to sleep due to the required 45 degree angle and not being able to breathe through my nose. I had to use a lot of vasaline to keep my lips from cracking. A humidifier and biotene rinse helped with dry mouth. I got maybe 5 hours of sleep a night.
• Emotions: I was in kind of a survival mode, so I wasn't feeling a lot of feelings. I felt a little foggy from the anesthesia and meds. I had moments where I felt cranky and sick of dealing with swelling, etc, but nothing dramatic.

Days 3-6: Things start to get better

• Energy: Still getting wiped out after walks, but I'm able to go longer distances. I finally have enough energy to hook my switch up to the tv, but don't play many games because I don't have the mental energy.
• Swelling: Has started to decrease. Every morning it's a little better.
• Pain: Unchanged. 1-3 out of 10.
• Breathing: I still can't breathe through my nose.
• Speaking: I no longer sound like Tom Waits, but now sound like Bain. It really annoys me. My jaw still gets really tired after a few minutes of talking.
• Eating: I'm still only drinking huel, but it becomes a little easier every day.
• Sleeping: Not great. Maybe 5-6 hours a night with lots of wake-ups.
• Emotions: My daily walking is actually a source of real joy. Even though it's much harder to walk than usual, I feel wonderful when I'm done. I noticed my mood tends to sour after dark, so I started going to bed at 8pm.

Day 6: Postop appointment 1

Here's what they did:

• Removed my mummy bandage
• Took out some gauze from my nose that I hadn't realized was there
• Removed the sutures from my lip lift
• Washed my hair and cleaned me up
• Ultrasounded my face. It doesn't feel like anything, but apparently it helps fluids drain and swelling go down.
• Gave me a vitamin B shot, which is supposed to be energizing

They left the splits and cast, but it was no nice to not be wrapped up any more. Dr D. also came by and said hi briefly.

One thing I didn't plan for was the big, very visible incision line on my head. I normally wear a wig, but couldn't for a few more days. I only had a hoodie to cover it, which worked long enough for me to duck into walgreens and buy some soft headbands

Days 8-10

I don't look like a mummy anymore! I just look like I've had a nose job.

• Energy: This is the first day that I start to feel like myself. I can go for long two-hour walks now, though it wipes me out for the rest of the day.
• Swelling: Continues to get noticeably better every day. My lips are much smaller.
• Pain: I completed my course of pain meds, so pain actually increased a little. It wasn't unbearable.
• Breathing: I can breathe through my nose now! It gets stopped up at night for some reason, so that's annoying.
• Speaking: Still sounding like Bain. My endurance is getting better though.
• Eating: Drinking the shakes is no problem.
• Sleeping: The lack of sleep is starting to wear on me. My butt is getting numb from the elevated sleeping position.
• Emotions: I'm feeling great now that the mummy bandage is off.

Day 10: Postop appointment 2

Here's what they did:

• Took the cast off my forehead and nose
• Removed these plastic splints from my nose
• Took out sutures from my fat donor site

This was the first time I'd seen my new forehead and nose. It was surreal. I was super happy with the results -- even with all the swelling.

Zhanna took my photo and then Dr. D. met with me in his office where he showed me side by side my pre and post op photos. He was really sweet and gave me a big hug.

As I left, they gave me a little goodie bag with some treats as well as a letter to show to any authorities who might challenge my ID.

Days 10-15

I've done all my appointments, completed most my medication. My family met me in San Francisco and we drove back to Seattle.

• Energy: It almost feels like my energy level has gone down. As I get ready to leave and meet up with my family, I suddenly have to do a lot more. That leaves me exhausted.
• Swelling: Continues to get noticeably better every day. My lips are normal size now. As my facial swelling decreases, I see areas around my jaw that are not decreasing quickly.
• Pain: No pain
• Breathing: I can breathe through my nose perfectly.
• Speaking: As I regain control of my facial muscles, my voice starts to become more normal. I meet up with my family and start speaking more, so my endurance gets much better.
• Eating: I can eat soft food. At first chewing is so much work and my jaw feels really tired after a few bites. It gets easier every day.
• Sleeping: While driving home we stayed at an airbnb. I was too lazy to get out my wedge pillow, so I used regular pillows and ended up flexing my neck too much and herniating a disc. Now I’m still sleeping badly, but it’s from back pain, not a stopped up nose. Progress?
• Emotions: This was emotionally one of the more difficult periods of recovery . Previously I'd been mostly alone, and only responsible for food, meds and walking. I handled it all really well. But now I'm starting to get back to a normal life, I can see just how much less capable I currently am and it's frustrating. Also, I found myself feeling kind of deflated. I spent months researching FFS, planning a trip, getting to know people, etc. Now it's just suddenly over. I like my results and have no regrets. I just feel the letdown that always happens after a big project is done. While I don't currently have post-op depression, I can totally see how it happens.

Days 16-18

• Energy: Still fatigued
• Swelling: Keeps going down. I have more mobility in my face.
• Pain: No real face pain. Just occasional jolts as nerves come back online.
• Breathing: Can breathe ok. Nose is getting clogged with crusty stuff.
• Speaking: Voice is back to normal
• Bruising: Face bruising is totally gone. Thigh bruising is mostly gone.
• Eating: Eating isn't terrible, but not perfect. The numbness at the bottom of my mouth makes it hard to feel if there is food down there. It's also hard to chew with my mouth closed.
• Sleeping: It’s bad, but not because of FFS.
• Emotions: Annoyed .

Days 18-21

• Energy: Mostly back to normal! Still a little spacey. I’m able to start back to work.
• Swelling: Keeps going down.
• Eating: Better, but I can only open my mouth around 2 finger widths. Still chewing with my mouth open.
• Sensation: Partial sensation has returned everywhere on my jaw. My left temple is starting to get sensation. My right temple not. Top of head, no sensation for a few inches behind the incision.
• Sleeping: It’s bad, but not because of FFS.
• Emotions: Annoyed .

Week 3: Normal life seems possible

• Energy: I feel totally back to normal
• Swelling: Keeps going down and my range of facial expressions has really increased.
• Breathing: A little stopped up, but it may be due to allergies. The crusting gets better.
• Eating: I can open my mouth 3-finger widths and can finally chew with my mouth closed. Also, I don’t feel quite as fragile when chewing.
• Sensation: Definitely improved. Chin is still a little tingly. Scalp is still numb.
• Scars: My scars have started to get a little pink, which is normal but annoying.
• Emotions: Dealing with my back pain has been taking all of my emotional capacity.

Weeks 4-7: Normal life is definitely possible

• Swelling: Jowels. Nose. Occasional swollen feeling in chin when I wake up.
• Pain: None
• Breathing: My nose is always a little congested, though I can breathe fine. I’m allowed to blow my nose and sneeze at 6 weeks.
• Bruising: Gone
• Eating: Feels totally back to normal by week 7
• Sleeping: Fine
• Incisions: My forehead incision looks a lot flatter by week 7. I have had a little hair loss next to the incision on one side, though that's normal.
• Emotions: I'm not really thinking about FFS much.
• Sensation: Numbness is gone from chin. Right temple is still numb, but the numb area seems to be slowly shrinking.

3 months: It feels done

Life is back to normal. At three months I’m no longer prohibited from doing intense physical activities.

• Swelling: Much better, but not completely gone. Occasionally I’m surprised because my jaw and chin suddenly look smaller than I remember them.
• Pain: None
• Breathing: Fine
• Bruising: Gone
• Eating: Fine.
• Sleeping: Fine
• Incisions: Incisions have healed and are flat. They’re still a little pink but not bad.
• Emotions: It feels like this experience is over. I occasionally feel impatient about the long-term jaw swelling but it’s not a big deal.
• Sensation: I have sensation everywhere except right behind the forehead incision.

My FFS Packing list

Because FFS was a new experience for me, I wasn't sure what to pack and I benefited from people sharing their lists on here. I thought I should share my own for the benefit of future generations. :)

A couple of notes:

• I won't include things my surgeon (DB) told me to bring (like probiotics) or obvious things (like my id).
• I traveled to a different city, but I drove so I could take a lot of stuff.
• A lot of these items could have been obtained after I arrived if I had flown.

Ok, let's get started!

Nutrition

• Ready-to-drink HUEL:\ * this was what I used for my liquid diet. It worked well. The ready-to-drink was very convenient because I didn't have anyone to make shakes for me. I wish I'd gotten more flavors. I drank four bottles per day.
• Bottled water: You'll need to drink a lot of water. Having a case of bottled water was really handy. It's also sterile so it's better for cleaning incisions than tap water.
• A small (8 oz) reusable cup: With swollen lips and jaw it's hard to tilt your head back. A small cup is much easier to drink from than a bottle or larger cup. Some people suggest using a syringe, in case a cup is too messy.

Medical

• Medication log sheets - I had to write down all my meds. I used -its. It would have been nice to have real medication log sheets.
• Salt - For making saltwater to rinse your mouth after eating.
• Stool Softener - After surgery you will probably be constipated. These can help ease you back to normal.
• Qtips - for cleaning sutures
• Kleenex- I like the travel packs.
• Medical tape and small soft gauze pads - If you have your nose done they'll send you home with a little drip pad to catch draining fluids. If it fills up, you'll want to change it.
• Vaseline - When you have to breathe through your mouth, your lips get dry. Regular chapstick was too hard for my swollen lips.
• Humidifier - When you're sleeping you will want your room very humid to keep you mouth from drying out. I got a little travel humidifier on amazon.
• Biotine - It's a rinse that lubricates your mouth and keeps it from drying out as easily.
• Wedge pillow - You'll have to sleep at a 45 degree angle. I got a memory foam wedge pillow on amazon to help with this.
• Heating pad - With all the weird sleeping arrangements my back was sore. It was really nice having a heating pad to loosen it up.
• Cold Gel Packs - I mostly used these when I got hot after walking, but they were nice to have.

Apparel

• Hip Bag / Fanny Pack with a key fob - I took this to the hospital and on a lot of my walks. The key fob made it impossible to lose my key - which could have easily happened in the post-anesthesia haze.
• Comfy clothes to lounge in. You want big neck openings.
• Several "walking outfits." I found that walking after surgery can be as sweaty as running before surgery.
• A "nice" outfit - I didn't bring one but wish I'd been able to look a little nicer at my followup appointments.
• Soft headbands and hats - If you have forehead work done you will have a scar that will scare young children. You won't be able to wear a wig or shave your head.
• Some way to hide your mummy bandage, if you care. I wore a hoodie at first but eventually just rocked the mummy look.
• Walking shoes and lounging shoes
• 3-4 large, soft masks. They'll get dirty.
• Velcro mask extender - Lets you wear normal ear-loop masks when your head is wrapped like a mummy.

Msc

• Switch with the hulu app and HMDI cable - It was nice having golden girls constantly playing on the big tv.
• An extension cord with multiple outlets and USB charging.
• LED Tea light candles - I packed these on a whim and they were super useful. Not only can they make your airbnb seem cozy, but you can use them as night lights so you can take your pills at night without having to turn on big lights.
• Ziplock bags - I ended up with lots of loose items and could have used a variety of these.
• Paper towels - for the first week after surgery eating was pretty messy. I went through 2 rolls of paper towels.
• Nose hair trimmer - I had to do that the night before surgery.
• Pepper spray - I had to walk two hours a day. For the most part I had no problems, but I did get followed by a creep for a few blocks. I didn't pepper spray him but it would have made me feel a little safer to be carrying it.

Things I thought I would use but didn't

• Straws - My lips were so swollen I literally couldn't use a straw
• Neck Pillow - I forgot to bring it.
• Games - I bought lots of games for my switch before leaving, but I was too wiped out to play them much.