Chapter 09 ~Time Flies…


April 18, 2018

It feels like it wasn’t that long ago that I started looking into Facial Feminization Surgery (FFS). In the grand scheme of things it actually wasn’t that long ago. But, it’s already been six weeks since I had the surgery.

I also remember back when I started taking estrogen by patch. I thought to myself, “This is it! This is the beginning! It’s going to take a long time before my body will change.” But I was already making plans for how I’d change and how happy I would be. My skin would soften. Fat would redistribute in my face and body. My facial hair would slow and become finer.

10 days later I had the mini-stroke and I felt the crushing blow of uncertainty. It felt like I was cut off from what had taken so long to find and accept. I suddenly had tests and procedures, and appointment after appointment with this doctor or that. I was eventually able to see some forward movement by that November, just 4 months later and not very long after all, but when you’re waiting for a bus in the rain it feels like it will never come.

It’s been almost two years since my false start with hormones and accompanying medical mishap. I’ve come a long way, I’m on my testosterone blocker and am at the full dosage that is recommended for mtf trans-women. It took a while to increase the dosage to the full level because of the potentially harmful side-affects with the rest of my health concerns.

I have to remember that I’ve made a lot of progress. I’ve been living full-time as Tiffany for almost 8 months now, my name and gender have been legally changed, and I’ve had facial feminization surgery.

Tomorrow, April 19th, will begin the next phase of my transition. I have an appointment to consult with a plastic surgeon on top and bottom surgery.

Being transgender is very different today than it was 30, 20, even 10 years ago. I only know this from reading about other folks and their experience transitioning. I feel that the public is more accepting of transgender, gender-fluid and non-binary people today. It feels to my like anyone under the age of 30 has grown up with trans and gender fluid people in their midst and so the taboo doesn’t exist as it had decades ago.

The options for surgeries and surgeons has grown too. However, not every trans-person chooses to undergo top and/or bottom surgery. There has been greater acceptance for those choosing to not undergo these very expensive and time intensive procedures. It is also extremely inappropriate to ask a transgender woman or man if they’ve had either top or bottom surgery. It is a very personal part of one’s transition and unless the information is offered up it shouldn’t be asked about, and if learned it should never be given out freely to any one else.

Reputable doctors (most doctors) follow the WPATH “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People.” These standards of care were first drafted in 1979 and are periodically revised. The latest standards were revised in 2011. (You can read the actual standards here: These standards require specific goals or steps in transitioning. For instance a letter from a mental health professional documenting ongoing therapy and gender dysphoria is required prior to medical intervention for hormone replacement therapy. Another requires a letter from a mental health professional for breast augmentation or chest reconstruction. Two letters are required for genital surgery. These are the safety checks and balances that have been adhered to by health professionals to aid in the physical and mental well being and transitioning of trans and gender nonconforming people. Prior to these guidelines there were no global standards for following a path to assist in the development or transition. All of the doctors on my team follow these guidelines.

So let’s talk breasts and vaginas…

Breast augmentation for a transgender woman is not “required” or even sought by all whom are transitioning. First of all a transgender woman must complete a period of hormone replacement therapy (HRT) for a period of time if possible. This is where I have a conflict. I am not a viable candidate for HRT because of my risk of strokes from taking estrogen. Secondly. if you are a transgender woman looking to get breast augmentation you will want to seek out a plastic surgeon that is familiar with transgender woman and the difference in anatomy between a trans-woman and a cis-gender woman. Also, there are options for your breast augmentation or “top” surgery. Your surgeon will go over options such as saline or silicone, tear-drop or round, and most importantly size! You will want a size that fits your frame. Some insurance companies cover this procedure and some don’t. I am still investigating whether or not mine does. I think they do. I hope they do!

Now for the biggie, bottom surgery, or as some call it “The Surgery!” I am by far not an expert on any of this. I am just in the process of investigating it for myself and trying to determine if any of it is right for me, or if the risks out weigh the benefits. When it came to my facial feminization surgery the benefits did outweigh the risks, and I’m happy to say they paid off! But back to bottom surgery.

As I understand it there are several methods for creating a “neo-vagina.” The most popular is penile inversion where the skin of the penis is used to create the vagina, kind of like turning a sock inside out. If this hasn’t made you squirm, you can see a computer generated example on Vimeo of how this surgery is performed by clicking this link.

The second method is by using a portion of the sigmoid colon called Rectosigmoid Vaginoplasty, or Sigmoid Colon Vaginoplasty. This is, as I understand it, a longer and more expensive surgery as the procedure to remove a section of sigmoid colon is also required. And, there a more draw-backs to this procedure.

The latest in the arena of vaginoplasty surgery is in using a portion of the peritoneum, a membrane that covers the abdominal organs. This is known as pull-through peritoneal vaginoplasty. My understanding is that the greatest benefit of this method is that the peritoneum is self-lubricating unlike the other methods.

There is a fourth type of bottom surgery. I’ve read it referred to as “limited-depth” vaginoplasty. It involves the reconstruction of the urethra into a female form and creates the appearance of a full vagina but without the full depth and need to dilate, which is a process of using dilators to exercise the aperture and prevent it from closing. Think removing your earrings and the holes closing up!

All of this is so new to me. I’ve been reading some great articles of trans-women who have gone through bottom surgery. They give invaluable first-hand knowledge of the physical and emotion sides of what one goes through. Recovery for these surgeries is somewhere along the lines of 6-8 weeks, that’s for bottom surgery and not breast augmentation.

I’m excited and apprehensive about my appointment. I just keep it in my head that this is just a consultation. I’m not being pressured into anything and in the end the choice is mine.

I’ll post an update when I know more!

– Tiff

One thought on “Chapter 09 ~Time Flies…

  1. Pingback: My Surgery Consultation (caution: graphic surgical terminology ahead!) – It's Tiff

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