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A Tale of Two Surgeries

A Tale of Two Surgeries

My shockingly different experiences with top surgery and facial feminization

Published Mar 22, 2026

“NGC 6357/Pismis 24 (Chandra/Webb)” by NASA's James Webb Space Telescope, CC BY 4.0

Recommended Listening: Saint Vitus - Born Too Late

Thanks to my parents - they were incredible caretakers for the two major surgeries I got within an 8-month span

At the start of 2023, I had done almost everything I could in the social and legal sectors of my life to realign my existence with the person I wanted to become. Things are better, certainly, but I'm not satisfied. I feel apprehensive — everything in the social and legal realms had been quick. Heck, I got a name change court order 7 days after filing the paperwork. The world of hormones and medical transition feels much more uncertain, permanent, and slow. I make a pros and cons list, and remain uncertain. Eventually I decide to go to the local Planned Parenthood with all of my questions, and just try it out. Most of the changes aren't permanent anyway, and the ones that are will take a long time to manifest. I start Hormone Replacement Therapy (HRT) in May of 2023.

I never liked my face. After I realized I was trans I started getting laser hair removal to get rid of my stubborn facial hair. I think this will solve my negative feelings. It does not. I push it to the back of my mind as another of life's unfixable problems.

By December 2023, I am disappointed in the chest growth I have gotten (yes, I know, I'm impatient). I've seen the statistics, too — most people don't get much, but getting augmentation means committing to multiple surgeries throughout my life, as implants are not lifetime devices. I am scared and uncertain, but I know that every decision I have made so far in service of my transition has been worthwhile. I know I can trust myself and trust my desires. And still I worry about bad results, complications, or bad luck worsening my quality of life.

I hear about Facial Feminization Surgery (FFS) online. In October of 2024, as I stare at myself in the mirror, I make a note to ask my Top Surgery Surgeon if he knows any good FFS surgeons in Ohio. Whenever I look at myself in the mirror, it feels wrong. I loathe the face that stares back. I had hoped that laser hair removal would be the remedy, but after two years the feelings remain. I know what I want, but I don't want to want it. Everything I have heard about the surgery includes the fact that it is an extremely difficult recovery.

I start looking up in-network surgeon in Ohio. It's not an uncommon procedure for cis women, and there are plenty of options in the Columbus area. My laser technician had her top surgery done by my eventual surgeon and she had a great experience.

I don't know a single person who has gotten FFS, and I don't know anyone who knows anyone who has gotten it. I call local LGBT centers and ask if they know any reputable surgeons, no luck with that. One of my dad's old coworkers knows a surgeon by positive reputation only. In all of Ohio I find five potential options who take my insurance. Several of these surgeons are very experienced, even award-winning, but due to the nature of FFS, few people agree to have their pictures shared. The most I see is four low-quality pictures on one surgeon's website. I look on trans forums, google endlessly, make an interrogation list of questions to ask each surgeon, all in an effort to find someone who I can confidently trust to irrevocably alter my face. Unfortunately it seems like the only way to get concrete information is to schedule consultations and hope I pick well.

I schedule a consultation with the surgeon my laser tech recommends. This process is easy, I just co-schedule a laser session and the consult on the same day and do a single trip up to Columbus. I end up liking the surgeon a lot, and I decide to move forward with them.

I see a Reddit post speaking highly of a surgeon in Columbus. I look them up and call to schedule. They do not do FFS anymore, but another surgeon in the same office does. I try to schedule with them.
Here's a series of emails from the surgeon's office (identifying info redacted). When I reach out, I am told there is an indefinite waitlist for consults due to a resignation in the office, which is fair enough:

Two months later I check in:

I don't hear back that week, and get this reply when I follow up again a full month and a half later:

This delivery failure likely means my contact is no longer employed. I then wonder if they were laid off at the management meeting, or resigned out of frustration from trying to get anything done in this system. At this point I write off this provider and continue looking.
I start making phone calls and schedule three consultations. I schedule them close together so I can decide quickly and not make multiple cross-state trips. The first surgeon I consult with has done maybe 20 FFS procedures in their very short career, and only five since becoming a full doctor. The second surgeon is very renowned for their work, has many awards and decades of experience, but during my consult we are not able to communicate well. I like the third surgeon but they are scheduling in April/May, and I am planning on moving to Chicago then. I could made it work, and I schedule for a tentative April surgery date just in case. Suprisingly, in November I get a call that I am still on the waitlist with the surgeon I had originally emailed, and they can see me in February for a consultation. I say yes, and am told to expect a call for scheduling. Soon after, I get contacted for an appointment in December.
The December consultation is pretty standard. They even make a very good impression and are my favorite surgeon so far. But when we are alone, the surgeon tells me that they are moving out of state in April, and will try to see everyone currently doing consults, but can not guarantee it, and do I still want to schedule a surgery? I say yes, they are my top pick of the consults I've done. Plus, I have already gotten through the scheduling nonsense once, it'll probably be much easier for the surgery itself.
My job instructs me to train 50 employees in CPR by the start of May. I know that I will be moving in May, and aiming to take four to five weeks off for surgery in March or April, though I do not disclose this information. I make plans to train 50 employees in CPR by the end of February.

I need to be on HRT for one full year for insurance to authorizate the surgery. The surgeon says they can schedule me as soon as mid-May, slightly past my 1-year HRTiversary. However, my insurance plan year runs June 30-July 1st, meaning that if I can wait, it might make more financial sense for me to schedule in July in case I end up wanting FFS later. It just feels like the strategic move.

The first week of February I receive a letter from the hospital (addressed to my deadname? That I had legally changed over a year before?? And that had been updated in the hospital's system when I had the consult in the first place???) announcing that the surgeon is leaving in April and that I should make alternate plans unless I am already scheduled for surgery before that date. I start making alternate plans.
On Wednesday, February 19th I miss a call from the surgeon's Head of Scheduling, and get a voicemail telling me they have a March 5th slot open if I can call back. I call back the same day, no answer, I leave a message. I call the next day, the proposed date is in two weeks and I really need to know if I'm taking a month off of work and asking my parents for prolonged supportive care with less than two weeks notice. I send a MyChart message to the surgeon, they refer me back to the Scheduler. I call the day after, she's out of office. I call the general office, asking to speak to someone else. I am told that, as Head of Scheduling, I am required to go through her. I ask to talk to her supervisor and file a complaint about her response times, given the time pressure on me. After hours on the phone, talking to multiple supervisors, and begging to work with ANYONE ELSE who will actually pick up their damn phone during business hours, I am told she was acting within acceptable response times and she remains the singular point of contact and exclusive gatekeeper to schedule for this doctor.
I hear back from her on Monday, February 23rd. The March 5th surgery date is ten days away. I don't know if I'm having surgery. She tells me that March 5th is no longer available, but March 12th might be. I plan as if it is. I wait to hear back. I call her to check in each day. Three days later she calls back and I manage to answer in time. It is clear she dislikes me now. It is clear I don't care. I now have a surgery date.
On March 7th, five days before the surgery, I check my insurance page. The surgery hasn't been approved yet. I call the insurance company, they say to call my doctor, who says to call my insurance. I finally talk someone who knows what they are doing and they say that my insurance has missed its own internal deadline for a decision, and they will expedite it. Monday, March 9th, three days before the surgery, I get a call saying it is (mostly) approved.
I get a call on March 10th, two days before the surgery. The surgeon wants to discuss options with me, now that we have an insurance decision. I can do most of what we discussed, but the two procedures denied by insurance would cost $6500 out-of-pocket, each. There is no time to appeal the decision. I don't care enough about the denied procedures to pay that much.
I volunteer weekly with queer teenagers. I tell them, "Hey kids, it's my last time being here for a while, I'm going to get a gender affirming surgery that will help me be happier in my body, and I'll be coming back looking a bit different." One says, "We'll miss you and that's really exciting". Another says, "I hope you don't die! You're fun to have around". Ah, the duality of teenagers.

I wake up at 3am on July 8th and drive 90 minutes to Columbus. I arrive early at a small surgery center where I wait outside for half an hour for the building to open and listen to a Magic the Gathering podcast. When the building opens I am second in line to check in. I am brought back to the prep room, given a gown and told to hang out.

I get off work on March 11th and drive 90 minutes to Columbus, meeting my parents at an AirBnb in the area. We have a nice takeout dinner and spend time together. I try to sleep early. We wake at 4am to drive to an absolutely massive hospital building. We check in at the lobby, take some silly pictures, and then get shuttled around to complete financial forms and wait in processing rooms. Finally I am brought back to a hospital room, my vitals are taken, and we wait for half an hour for something to happen.

My parents arrive not too long after, then a nurse comes to check on me. We have a nice chat as she tries to put in my IV. Apparently I have small veins that are hard to IV, and she activates a heat lamp to make it easier. The heat lamp makes me nauseous so I ask for it to be turned off after the IV is set.

The first nurse of the day comes in and asks me what I am here for. I am tired (it is 4am), hungry (can't eat before anesthesia), and anxious, so my parents start to answer. She snaps at them that she is asking the patient. I, tired and hungry and anxious, answer, and she leaves. The second nurse comes in and asks when my last period was. I say I don't have periods. She asks if I have ever had periods. I say no. She asks me to take a pregnancy test. I tell her I can't get pregnant. She asks again. I tell her I promise I can't get pregnant. She leaves the room, confused. The third nurse comes in and immediately coughs. She promises she isn't sick. After her third cough I ask her to put on a mask because I am about to go in for surgery. She objects, but puts one on, not covering her nose. She tries to insert an IV in my wrist. I tell her that she should probably insert it in my elbow crook because doctors generally have a hard time finding my veins. She says it's fine, and proceeds to painfully poke me five times with a needle, failing to find the vein before leaving the room. On the verge of tears, I ask my parents to request a different nurse for me. A fourth nurse comes in and is cheery, pleasant, and does the IV in my arm with no issue before leaving.

The surgeon arrives and we chat about the plan. I also talk with the anesthesiologist and review what I should expect. After a final pep talk and hug from my parents, I am wheeled back into the surgery suite, and the last thing I remember is moving from my wheely bed onto the cold metal operating table, and one member of the surgery team making a joke (sadly I do not recall the joke).

The anesthesiologist comes in, and we chat about the plan. I like him, thankfully. The surgeon and the rest of the surgeon's team arrive and I am relieved that they are all friendly and seem competent. Soon after, memory stops.

-----[Time lost to anesthesia]-----

I wake up in the recovery room — I feel very tired and my chest feels tight. I am wheeled out to my parents and am able to climb into the car with assistance. We are told to come back the next day for a post-op appointment before I am fully discharged. We go back to a hotel where I have some water and Goldfish, and then need help to lie down on the bed. When I wake up, I need my parents to lift me into a sitting position, as my chest muscles have just been surgery'd.

I wake up in a hospital room — I can't see out of my right eye, I can't breath out of my nose, and I feel the most tired I've ever been. I am so thirsty. The fifth nurse of the day keeps misgendering me, to the point where I make the effort, through exhaustion and stitches, to tell her to stop. We are told to come back to Columbus in a week to get the stitches out, my parents are given discharge care instructions and a phone number to call with questions. They are told to take me to the ER if anything seems dire. We go back to the AirBnb where I eat a small amount and then get nauseous. My parents are overwhelmed with how rough I look and concerned that I cannot see out of one eye. They call to ask if that is typical, the surgeon says no and to keep an eye on it.

The next day, I have a post-op appointment with the surgeon and get cleared to go home. I nap most of the way. When we arrive, I can't lift anything, being relegated to T-rex arms (my arms could not go above my torso) and a strict weight limit. I need help getting up from my bed for the first three days, and showering after that. The pain is manageable, I'm mostly just very sore and very tired. I spend a lot of time playing PokeRogue, the Pokemon roguelike, and watch the entire Dimension 20 campaign Mentopolis, featuring Hank Green and Freddie Wong, it's honestly not a bad recovery experience. I am totally fatigued for about three days, but my energy comes back quickly after that, and once I am able sit up by myself, recovery is just a matter of resting and keeping myself occupied. My sibling took care of me on the fourth day while my parents were out, and by then care mostly consisted of reach high shelves and helping me prepare meals.

The next day, we drive home. We stop at a gas station so I can use the restroom. My dad chats with the clerk, who expresses concern for how bad I look and says I'm a trooper for getting through such a serious procedure. When we get home I start noticing how uncomfortable my nose is. I have gotten a functional septoplasty (to fix my crooked septum and help me breath out of my nose better), which means I have silicone stents in my nose for the next week. This is the worst aspect of recovery, being incredibly uncomfortable the entire time. I was planning to boot up a new roguelike game and pass the time watching another Dimension 20 campaign, but the physical experience is so uncomfortable that all I can manage is putting on a Youtube video or podcast and trying to sleep.

After one week, I'm feeling pretty great. I call the medical number because I have a swollen lymph node under my arm that I want to check on. They say not to be concerned, it happens sometimes and it should resolve itself. It does.

Whenever I remove the headwrap for suture cleaning it feels like my face is going to slide off. I'm swollen everywhere. My nose has silicone stents that feel awful. There's so much blood. The third day passes, my energy isn't back and I am dreading another four with these nose stents. My right eye opens on the fourth day once the swelling has gone down enough. I'm supposed to keep my nose flushed, but it's a nauseating (noseating) process. My parents have a strict medication schedule for me, where I have to take pain meds, antibiotics, and anti-inflammatories every four hours. I wake up several times in fairly intense pain regardless. I'm exhausted and not able to do much other than sleep for the first 6 days. I can't wear glasses for the first week, so my vision has been blurry in addition to only having one eye.
On day seven, my parents drive me to Columbus for the followup appointment. My sutures are removed, along with the infernal nose stents. The process feels weird and uncomfortable, but I CAN BREATHE AGAIN. The surgeon says I am recovering well. The second week of recovery is much easier than the first. My nose feels the most functional it's every been, it's weird, but better. The medication schedule softens as I finish the antibiotics and the strong pain meds.

My insurance is billed $39,000. They pay $11,000 and I pay $1200 out-of-pocket.

My insurance is billed $180,000. They pay $25,000 and I pay $1800 out-of-pocket, having hit my out-of-pocket maximum for the year between the two surgeries (strategic planning for the win).

I return to Athens and go back to work after two weeks of resting. I still can't lift anything substantial or exercise for another few weeks, but no other restrictions. All of my queer friends tell me I look amazing. No one else comments.

On the third week of recovery, I call a realtor in Chicago to start looking at apartments. My partner and I have exactly one month to find a new apartment (the search on Zillow has not gone well so far). I also need to return to Athens to help pack up the house (my partner has been doing this singlehandedly since I left), finish at work, and actually move. The fourth week of recovery, I fly to Chicago, planning to stay with a friend and tour the realtor's recommendations. My mom meets me there to help with tours. One of the houses we arrive at is already rented out, apparently the landlord's realtor failed to communicate that. This is particularly unfortunate as it was our second favorite. We end up finding a very suitable apartment on day five of seven, and quickly move forward with signing. I am required to hand-deliver a money order to some far away suburb to pay the move-in fee. They will not accept a check, cash, or digital transfer, despite accepting digital transfer for monthly rent payments. This is the first of many times my landlord will make strange and upsetting decisions, but the house is nice so we deal with it.
On week five I return to Athens and start my job again. My queer friends tell me I look amazing. No one else comments. I give two and a half weeks of notice to work that I will be moving, and thoroughly catch up on tasks so they're not left floundering.

I'm thrilled with the results, my chest dysphoria is gone. The process was difficult, but honestly not too bad. I'll have to do this again in 15-20 years, but that's fine.

I'm thrilled with the results, my facial dysphoria is gone. This is the hardest thing I've ever done, between the surgery itself and the absurd obstacles to making it happen. I thank god I never have to do this again.

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