Last June, I attended a lecture given by Dr Douglas Ousterhout, on facial feminisation surgery. At the time, I reported that, "I must say that the idea of facial surgery scares me half to death, but Dr O's presentation was very impressive ... I think that after meeting him, were I to seek out FFS I would be inclined to favour him as my surgeon."
Last weekend, along with zoeimogen and the_local_echo, I attended an event in London which was set up by patients of his main rival, Dr Mark Zukowski, where he was giving a similar talk on his clinic and technique.
Before the main event though, my erstwhile speech therapist, Christella Antoni, was giving a talk on "The importance of voice feminisation for a successful transition".
The three of us turned up at the venue and mingled for a little while. I knew a few of the people there, including a couple of women who are patients of Dr Z. I was surprised by the number of transwomen who were there who I didn't know. There's a trans "scene" in London, and most of us involved either know each other directly, or know of each other at least. You see the same faces at lots of different things. This one was different, in that there were a few "scene" people there, but we were outnumbered, I think, by a lot of transpeople who aren't active in it. I suspect many of them had travelled to London specifically to attend this presentation, but I also couldn't help noticing (and this might have had something to do with the topic), that perhaps a majority of those attending were those who I have heard, perhaps somewhat unkindly, referred to as the "leopard-print tights brigade".
The circles I tend to inhabit in London are very much queer-oriented, and perhaps that has something to do with it - we each present in a way that reflects who we are, and our social circle, and this served as a reminder to me that the trans and other queer people I associate with in London represent a particular kind of experience of what it is to be trans or queer. Move in certain circles long enough and it can seem like that experience is universal, but it's not.
Anyway, I digress. Before the presentation started, one of the organisers stuck her head round the door into the lobby area where we were mingling, and asked, "Does anyone know anything about Apple Macs?" Content to carry on socialising and not make this my problem (thanks Dr Demsky :-) ), I was set to ignore this, until I was volunteered by someone else anyway! Oh well - I didn't particularly object and if following along meant I got a sneak preview and perhaps a chance to network, I didn't mind at all.
I was led up to the front of the room where the presentation was to happen, where there was a 17 inch Macbook Pro plugged into a large flat screen high-def TV on the wall. Someone was fiddling with it, apparently trying to find Christella's Powerpoint Presentation that was on a USB flashdrive plugged into the Mac, and failing. The person held out his hand on seeing me and said, "Hi, I'm Mark Zukowski", before explaining what the problem was. It didn't take more than a few moments to find the file and get it up and displaying on the second monitor, and as I was doing so, Christella, who had been turned away talking to someone else at that point, turned round, noticed me and said hi. We had a bit of a chat before I went back to join the others. I do like Christella, and not having seen her since the presentation where I heard Dr Ousterhout, back in June '07, it was nice to briefly catch up with her.
It wasn't long before her presentation began. She started by emphasising that she'd not chosen the title herself, and that she didn't feel that voice feminisation was something that trans women should feel is necessary, but for those who wanted help with it, she was available to offer her services. This is part of why I like her - it's really nice to encounter someone involved in the medical side of transition who makes informed and positive noises about transgender identities and transfeminism. I know I wasn't the only one to notice, and appreciate that aspect of her talk.
Quite a few of us in the room were either former, or current clients/patients of hers, and there was one point where, in order to demonstrate someone she was saying about individual voice differences, she went round the room asking a few people she knew to say the phrase, "Any Day" out loud. When she got to me, I found myself, in a somewhat Pavlovian fashion, repeating it in my "speech therapy voice". Those word sounds (being the sort that featured heavily in the exercises I used to drive Sylvia up the wall with) exercise particular bits of the voice which Christella concentrates on in her voice training.
There was one amusing bit in the Q&A at the end of Christella's session, where she'd been talking about teaching a voice that one can use to shout at a bar and still sound female. One woman asked why she was having trouble shouting, to which came the response, "That's because you've only had one session!"
Anyway, we then moved on to Dr Zukowski's talk. In addition to having a very different surgical style (which I'll get to in a minute), his personal style seems very different to Dr Ousterhout's. They both excuded the image of a surgeon at the top of their game, but I felt that while Dr O presents his technique in a gently persuasive, "this is the result of a lifetime's work, this is the only way to do this, here's why" way, Dr Z is rather more, "this is what I do, these are the results, I stand by my work, take it or leave it."
Dr O's backgrouns is in cranial-facial surgery - he's first and foremost a skull man, and I get the impression that he bases his technique on what shape the skull needs to be, and then the rest will follow, perhaps with the addition of a facelift later to tighten things up.
Dr Z has a background in cosmetic surgery, from the U.S. Navy. He presents his approach more in a "I'll work on the bone and soft tissue to do what needs doing to make you beautiful". There are huge differences in the way they work as well.
Dr O makes a cut across the bottom of the hairline all the way to the bone, peels the face back to work on the skull, and then puts the whole lot back, perhaps with a section removed to reduce the height of the forehead. I believe he does similar things for the jaw. He tends to work aggressively on the brow bone which covers the frontal sinus and makes up the upper orbital rims, often reconstructing the covering for the frontal sinus from bits of bone fragment and bone cement.
Dr Z works endoscopically. He makes the same cut (or for less major jobs, just makes a series of slits) in the forehead, at the hairline, but doesn't go all the way to the bone. He suggested this tended to preserve blood supply and nerve sensitivity, resulting in much better sensation afterwards. The use of the endoscope (especially since I got rather intimate with one in my sinuses less than three weeks ago - there is no visible swelling and no external cuts) strikes me as a technique which is ... kinder, less scary, maybe?
One thing that I got from both of them is that they both feel that they personally are the best in the business, and I don't think there's any love lost between them at all. Dr O, in his talk, was making references to things which "cannot be done endoscopically", while Dr Z talks about "older surgeons (Dr O is in his mid 70s, Dr Z looks about 3 decades younger) who can't adapt to new technology".
There's a whole FFS community online, where proxy wars seem to get fought as well, with one particularly splendid example being this letter (page 1, page 2) from Dr O to Dr Z, and the reply (page 1, page 2), apparently copied to Dr Z's lawyer. Heavy stuff indeed!
I said in the post I made back in 2007 that after seeing Dr O's presentation, were I to chose FFS, I'd likely go with him. I'm no-longer so sure. I have friends who've had surgery with both. In each case, the recovery sounds horrific, and makes vaginoplasty look like squeezing a zit in comparison (this scares me half to death - I found the recovery from vaginoplasty to be really emotionally tough, and even the recovery from my recent sinus surgery is not something I'm enjoying a whole lot). The results from both are impressive, but on balance I think I prefer what I've seen from Dr Z. I'd desicribe the Dr O results I've seen as "classic" and "formal" - think wife of a prominent US male politician, perhaps. The results I've seen from Dr Z are more what I'd describe as "cute". I think "cute" would suit my personality better.
Were I in the market for FFS, the thing that would really swing it for me though, is that Dr Z's approach seems less invasive, and he seems a lot more open to just doing individual bits of the face (e.g. just the forehead, or just the jaw and chin, etc.), whereas Dr O seems to push the "we need to do the whole lot as a complete system" line.
I don't want FFS. I'd like to look nicer than I do, and ideally I'd like to be "unreadable". That's not just vanity speaking (although it is partly - I lost my 20s, the time when most women look their best, to gender dysphoria, and I do regret and resent that somewhat); I think it would be psychologically beneficial as well.
But it's a hell of a thing, and there are stories of it going wrong, and I really don't think my body would react at all well to much more surgery (2 general anaesthetics in as many years is exacting a heavier toll on me than I thought it would - perhaps I'm not built to take that kind of punishment). It also costs a fortune.
Part of me wants to have a consultation with Dr Z, just to see what he'd have to say. The rest of me wants to run as fast and as far in the other direction as possible. This is something that, I fear, will vex and preoccupy me for some time to come.