Appearance After FFS (Facial Feminization Surgery) (1)

As with all of my blogs I share them with Marcie prior to publication. She often has valuable input but has never asked that I not include ideas that may be uncomfortable to one or both of us. This particular topic had a greater potential of creating anxiety in her due to my blunt honesty. Still she agreed that I proceed. In fact, she encouraged me to do so because she expects this topic to be of particular value to others.

Before facial feminization surgery (FFS) I understood her desire to, as her surgeon had said, “freshen up her face”. A face lift, a modification of her brow to a more feminine shape, augmentation of her cheek bones, and a lifting of her eyelids that were impeding her vision seemed reasonable in her quest to appear more like a woman to others.

I didn’t understand the need for her second surgery to narrow her jaw or to narrow her chin and pull it forward (correcting a small overbite). With makeup and longer hair I perceived her to be quite feminine without these added changes. She did not agree. She understood better than I did the difference the width in her face made in the perception of others as to her gender. After surgery I understood better.

For her first surgery, (facelift, brow modification, lip lift, and eyelids) most entailed incisions in her face, heavy bandages, and elastic facial support. As a nurse, I’ve seen a multitude of patients with incisions, wounds, dressings, and other body modifications due to surgery or injury. I knew what bruising, swelling, drains, and open wounds would look like. With this surgery Marcy fit into these models. I recognized her face despite the changes. I knew she would look more like a feminine version of herself once the healing was complete, and she did.

This was not the case with surgery on her jaw, chin, and cheekbones. This work involved her lower face. There were no visible incisions. This time the incisions were all inside her mouth. She wore a jaw support, but had no bandages to hide the impact on her face. The changes to the appearance of her face hit me hard.

The bruising was extensive. She appeared to have a blue-red ‘beard’. Of greater impact was the swelling. Her face reached out to and almost over the support bands going under her chin and up over her head. Although probably an exaggeration, her face seemed at least a half inch wider on each side.

Coming out of surgery the second time she looked much more masculine than she had ever looked, even before she identified as trans. What was worse, she now looked like some guy I’d known in the past. Even Marcie recognized this guy. What was most disconcerting was the fact neither of us could remember who he was and still can’t.

These changes knocked me for a huge loop. Where was my beautiful wife? This was not the person I’d married. I’d managed to accept previous changes she’d made to feminize her appearance using makeup, hair, clothes and breast forms. I could still recognized my spouse underneath these modifications. This remained true even after her first surgery. But not with the second.

I hadn’t expected this. I knew that recovery from surgery takes time, even as long as six months to a year. I’d seen pictures of those immediately post op and saw the swelling and bruising, but I didn’t know the people in these pictures. I didn’t appreciate how far their appearance may have come from baseline. I wish someone had warned me that I might not be able to recognize my wife because of the changes.

While the bruising and swelling decreased slowly, the stranger in front of me didn’t depart. Even at Day 12 post surgery her overall appearance remained masculine. I noted in my journal that

this surgery was supposed to make her more feminine and IT DID NOT. I’m thinking that will change once the swelling goes down. The surgery should have brought her jaw and chin in, but the swelling took it out. It did something strange to her mouth as well. Her smile is a little lopsided. Worse than that, it’s just strange. I hate to admit it but she just isn’t attractive at the moment.

By the beginning of the second week things were starting to look better. The bruising had receded to a great extent, although her dime sided blue-red opaque spots remained on each side of her chin. The mottling was taking up less and less of her jaw. The swelling was also down, enough that a woman was beginning to appear.

Her lip distortion was receding as well. Changes in her lip didn’t bother me as much as some of the other changes because I’d seen this with the first surgery where the center of her lip was raised up into a peak. Early on I was afraid this was a permanent change in her face. I thought the change in curvature was a result of the surgery itself. Thankfully no. I realized later it was swelling that was pulling the top of her lip up toward her nose, not her surgeon’s intervention.

After the second surgery the swelling in her lip returned, but it was different. This time I was better able to cope and recognize it as temporary.

I’m sure I’m driving her nuts with these detailed descriptions and maybe even increasing her stress. But this is who I am, a nurse who chronicles slight changes in healing that are positive signs. Everyone is different, but knowing this kind of minutia ahead of time would have helped me. I would have been able to better see the road map ahead than with just the comment I received that “the swelling will go down after three or four weeks”. This bland comment was not enough to tell me what to expect.

That said, I’m not sure that everyone would have appreciated knowing this information. So if you want this type of detail, you may need to ask. When listening to what the surgeon and others have to say, remember that everyone’s progress is unique. Finally, the staff may have tried to tell me some of the things I mention, only to have me forget it or have Marcie take a different path.

I have wondered if a catalogue of alternative pathways after surgery would be helpful. I could have looked through it and said, ‘oh, that’s how Marcie’s face is evolving. She will improve.’ What I remember from the pictures I did see online was that they displayed the more optimistic healing experiences. I didn’t see any pictures of those with complications that took longer to heal. I’m sure most, if not all, patients do heal, but not necessarily on the same timeline.

At this point I’d like to leave others with the idea that at least in my experience, the changes in appearance after surgery to the top of the face are different and less traumatic to me than those to the bottom. At the time of the writing of this post Marcie is only six weeks out from her second FFS. I will follow up on these thoughts next time at a point where she’s had more time to heal.

My next post will be in approximately three weeks. At that time I will follow up on her healing from the second part of her facial feminization surgery.

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