Well I’ve been dragging my feet on writing this for a while now, my excuse being that I want to be completely healed before I actually share my opinion. Nine months out and that line of thought is wearing thin, so without further ado…

My Facial Feminization Surgery with Dr Toby Mayer

What I had done: Hairline lowering, brow lift, orbital ridge recontouring, rhinoplasty, cheek implants, lip lift with fascia transfer, chin shave, and tracheal shave.

I'm happy to answer any questions, but I find this less than compelling to write about (says the person that wrote 1000+ words) so I'm probably going to be patient so that I can provide the lion's share of my answers in one go.

The Good : For the most part I’ll try to let the photos speak for themselves: https://imgur.com/a/zBvXZhW . Everyone I talk to who’s seen my face has good things to say, ranging from surprise that I’ve had any work done to telling me I look gorgeous. I guess the closest thing I have to objective data on this is my dating profile blows up as soon as I turn incognito mode off – I’ve had people ask me if I was cis on Grindr, and that throws me for a loop.

In a general sense I feel a lot better about my appearance now. I’m more confident and feel less compulsion to put a bunch of work into my appearance. I’ll wear a mask and pajamas to the corner store as an example, but even then I’m getting gendered correctly without anyone having to hear my voice. Been a long time since I’ve gotten misgendered, even at work when I start slipping into guy voice around halfway through my day. Had a person be legitimately surprised to hear that I’m trans. I’m pretty open about my identity so I’ll never be closeted barring dangerous circumstances, but it’s nice to know that’s an option – and being the cis passing token trans woman helps people take me seriously when I get outspoken about trans equality.

Everyone at Dr Mayer's office was wonderful. I had my nosed bumped roughly 2 weeks post op and the nurse Frankie (sp?) got back to me almost immediately and was very reassuring and patient with me (it was a very light bump, I was being paranoid). Keely the surgical coordinator was both prompt and very nice through our entire interaction and all of our follow ups, I remember gossiping about her dogs a little bit and it was delightful. I found Dr Mayer himself amazing, he’s been doing this by his own admission for half a century now. You’d have no idea given how energetic he is, clearly he’s very much in love with the work he does. He’ll explain what he does and why he does it, though if you have any questions beforehand it’d be best to have them written down because it is easy to forget them with how the flow of his face to face appointments go. He is very proud of the work he does, and he makes that clear – never seen another surgeon do that, I wonder if it’s a plastics thing.

The Bad : So as a baseline I’ve only had a couple of other surgeries, and neither of them gender confirming, just a pilonidal cyst excision and a vasectomy (no, the absurdity isn’t lost on me). I’m going to be honest, the recovery for FFS SUCKED . Dr Mayer told me I could go back to work in a month without any weight lifting restrictions, but I was on 10 pound restriction for that first month if I recall correctly. Breakthrough pain was perfectly manageable on roughly 20mg of opiates the first day, tapering down from there. I took a total of 90mg (18 pills) of oxycodone + NSAID + the steroid (methylprednisolone IIRC), which was adequate to keep my pain sufficiently controlled. But you're still just dirt tired for weeks.

The worst of it was the cheek implants, you aren’t allowed to use a straw or do anything that generates oral suction for a good long time. I used a straw for the first time two months post-surgery (well outside the danger zone) without thinking about it and had a small panic attack after the first sip. And they just hurt, outside that. You have to shower a few times in the first week to wash JUST your hair, and that is really annoying with all of the considerations you have to put into it (taping a plastic covering over your face to keep it dray). Have to sleep with your head elevated for a few weeks.

Otherwise be mentally prepared to both look and feel bad for a bit, that’s totally normal for any gender affirming procedure and it’s why trans people’s mental health typically dips immediately following an intervention like this. Whatever your self-care routine is, make sure it’s adjusted to the limitations you’ll have and make sure it’s low energy so you can still engage in it while you are wiped out by the healing process.

I wish the communication around some of the aftercare had been more prompt. While I was under the knife my care person was given some print outs pertaining to each procedure I had done with the relevant considerations and limitations on them. Dr Mayer’s office touched base with me 2 weeks prior about getting x rays sent over - they could have emailed the electronic copies of these print outs at the time and I think that would have made my recovery easier. Dr Mayer also stopped my pre existing scheduled medications due to clotting concerns, and I would have liked a heads up there – I can only discontinue one of those guys without risking some awful side effects, and I think that a patient with less medical literacy that me may have missed that (ie. the majority of patients).

I don’t have any complaints with my results. The tip of my nose is a bit asymmetrical, and I think that’s because I had to go back to wearing a mask while still healing. I got the masks with a substantial wire in them so I could shape them away from resting on the bridge of my nose, but I guess the tip wasn’t spared. It can only be seen from certain angles, and even then it’s subtle. Really doesn’t bother me one bit, perfection was never the goal, and I don’t think the Dr Mayer’s technique was at all the problem.

What I would tell myself if I had a time machine:

· Button up tops and elastic waist pants are going to be the entirety of your wardrobe for a while.

· Soft pasta, light soups, pudding, applesauce, and peanut butter are good sources of calories that are easy to eat while chewing is difficult.

· If you start feeling light headed while walking around it may be because your food intake is inadequate to retain enough water and drinking some chicken bouillon will offset that.

· I had no trouble drinking from glasses or cans.

· It is VERY easy to take for granted how much dead skin you remove from your lips by passively chewing on them through the day, and that isn’t an option while the worst of the swelling is around. 3-4 times a day, take a washcloth with lukewarm water and gently clean your lips.

· Make sure the place you are staying is ADA accessible, meaning ground floor accommodations or elevator. I had to take the stairs to my air BnB unit and it sucked.

· I tolerate opiate pain medication really well, and I still spent most of the first week just zonked out. Make sure you have some sort of passive entertainment around for your recovery.

The Ugly : Nothing. Look at the damn photos, I’m gorgeous.

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EDITS:

7/29: The healing around the cheek implants inside of my mouth were a bit asymmetric from one side to the other, and that did concern me. But after a few months out it was fine. If you are getting laser hair removal, you have to pause that for a bit after the implants are placed (2 months, I believe. Don't quote me.) I still don't let technicians remove hair directly over them because 1) I'm paranoid, and 2) I had enough work done prior that the hair at that level is completely translucent, so it's a moot point.