Friday, May 7, 2010

21 days later

It has been a roller-coaster week.

On Tuesday I came in to work for the first time since surgery, sans facial garment, just for the afternoon. I had some minor stage fright coming in, but cubemates and friendly passers-by were curious and supportive, although I fobbed off too many explanations by explaining that I was stressed about things and didn't really want to talk too much about them. I came for lunch and stayed through dinner, realizing with the increasing discomfort that not wearing the facial garment was a bad idea, but decided that I should at least try to dress it up a little before wearing it into the office. I returned home via a craft store - I'm not sure I've ever been in a craft store before; there's lots of... stuff - where I eventually picked up pipe cleaners, feathers and and random doo-dads. By the time I got home, I barely had time to experiment with sewing A onto B before bed. But it felt good - between being back at work and generally taking some kind of control of my appearance again, things felt like they were looking up for the first time since the weekend's crash.

Wednesday morning I finally spoke to Dr Zukowski (his pager had apparently gone through the wash on the weekend, hence the lack of response to my despairing message on the weekend) and felt reassured on the source of pain under my left jaw, although attempting to get a straight answer out of him as to whether there were any more implants that I should be worrying about for MRI was unsatisfying. A more successful day at work followed, this time in the facial garment pimped out with a draped silver and white feather boa thing that was meant to look like a mohawk with a trail down my back, but apparently was more often mistaken for a tiara.

You take what you can get - I preferred having people stare at that than my face. Most people here handle the damage and the garment with admirable aplomb, though there's a subset that I'm on more of a nodding basis with that seem to not recognize me or process my face in time to return a nod when walking past. On balance, the human component has been pretty good so far, which goes a long way towards disproving my thesis that the causes of the anticipated emotional crash (that I'm pretty clearly in the throes of) aren't related to that side.

That afternoon I drove up to SF, where my therapist convinced me that Valium was a good thing, and I shouldn't refuse it on principle, particularly when I'm having panic attacks and anxiety. Apparently it's made for it. I don't have a good reason for wanting to be off the stronger medication, other than the aforementioned principle and sheer stubbornness. I took my craft supplies to Noisebridge afterwards and flailed around with velcro tape, staplers and hot glue - did you know that staples are not crafty, but hot glue is? Crazy! - while the other attendees of the regularly scheduled craft night took gentle pity on me, and Trista even knocked up some ears for me in no time at all, which are currently my favourite accoutrement, and I've been wearing them around all day today (Thursday). Impromptu dinner with friends followed, during which my impaired speech didn't slow down either eating or talking (although perhaps it should have), and then a drive back down to Mountain View. My housemates in SF are relative strangers, and I derive more comfort from Tortugan company, even when they're asleep, so it may be a while before I'm staying in the city again. The night hours are still tough; if I have any energy left when alone, it spends on brooding.

Thursday is now wrapping up, soon to bed for the night. The juddering drive up and down 101 yesterday took its toll - extra soreness this morning, and wondering for a while early this afternoon if I oughtn't return home and return to Vicodin. But caffeine and ibuprofen won out and now that evening has arrived, after two meals for the day, I'm feeling entirely comfortable.

At this stage, for the most part my face is functional - the lower face is completely numb, from the lower lip on down, although I appear to have full muscle control and even temperature sense. The upper lip is not numb, but with the extra fat grafts and cheekbones in my mid-face, it moves in an unexpected way, and me attempting to smile - although less painful than it used to be - is an awkward sight.

So, to return to my thesis on the causes of this notorious crash, I'm now of the opinion that the cause is purely chemical - it comes when you wean yourself off the hard drugs, return to the OTC pain medication, and have to confront your own healing face in the mirror, angst about the process and fears for the future.

As far as the surgery itself goes - well, with my head clear of all the happy drugs, the picture is pretty stark. My great fear (one of... amongst my greatest... oh look, I'll just come in again) was over-feminization - that he would overshoot my goal of androgyny. I think this is likely to have happened.

Worse, I think it was done with full intent. Rather than work with my aversion to the hairline advance and scale the rest of my face appropriately, I think he reduced both nose and chin too much intentionally, with the plan that I would come in for the hairline advance to make everything match up again afterwards.

The first few daily post-op visits he started off with saying "hey - everything is going well, it all looks great, but you're really going to regret not having the forehead done!" Seriously. And then at the final visit before I returned home he confided in a reassuring manner - "don't worry - we can bring you in as soon as two and a half or three months to get the forehead done; it will be ok." So I think we just wound up with an enormous disconnect - I thought he understood that in aiming for androgyny, I was looking for smaller changes in pursuit of that goal; but it seems that despite repeating the mantra "ideal in both boy-mode and girl-mode" many times, he was just shooting for the Mk 1 Zukowski Face.

During the conversation before the surgery, while reinforcing how important it was to do the scalp advance, that it was the single most important and effective procedure, he had said that if I couldn't afford it, then that would be different, and something could be worked out with the remaining procedures. But it seems that since I could afford it, he decided that I should; if not now, then soon afterwards, and he worked the rest of the procedures appropriately. Looking at the way my face is developing, it's hard to see what he would have done differently if I had been aiming for maximum feminization. It seems it would be hard to make the chin any smaller, or the nose any more girly in profile - again, features that he'd assured me would be tailored to the face, long and strong in my case - and not a cookie-cutter approach.

And to add insult to injury, judging by what he wound up charging me on the day, he changed his mind on his verbal promise to honour the $750 deposit I paid a couple of years ago during a previous abortive tilt at this windmill.

Everything does, of course, depend on the final outcome. If I like it, even though it isn't what I wanted, things will be fine. If I don't like it - well, I started with a face I didn't like anyway, so it isn't a huge loss, but I'll probably stay upset for a while.

Should I have walked out on the day, when he refused to pay any further attention to what I wanted? It's a tough question. I'm pretty sure that if I had done so, I'd be kicking myself now, wondering if it would have worked out just fine, and I'd just wind up at the same stage again at some later point - not to mention having forfeited the non-refundable $15,000 deposit on the surgery. So continuing with the surgery was probably the lesser of two evils.

Could I have left myself with more choices instead? Definitely. I chose Dr Zukowski based partly on the consistently high regard in which he's held on ffs-support, the facial feminization support list, and partly on his endoscopic brow technique (the one that he refused to perform on me at the last moment). In retrospect, a better thing to do would have been to attend more of the conferences where multiple surgeons present on their techniques, and spent more time with more of them in person.

With that said, Dr Zukowski has such an aggressive sales technique and denigrates the other surgeons so thoroughly that I may well have wound up making the same choices anyway. After all, he has a lot of experience, that same high regard, and he had convinced me that he understood my goals in this exercise and would work with them effectively, and it wasn't until that hour before surgery that I had the first inkling of things going wrong (as opposed to the typically baseless fears that I'm prone to). So it's hard to say for sure whether I would have had the wisdom to choose a better doctor for my purposes - I do feel a pang of regret for not going ahead with Mr Carlisle in Melbourne years ago, and his affirmatively softly, softly approach to things, but life intervened and sent me to the US at exactly the wrong time.

That all sounds moderately dire, and it shouldn't - or at least, it isn't the whole story. It does make me angry, and it's the thing that I brood about most when left to my own devices, but fundamentally, I'm in a good position. Friends volunteer to spend the quiet hours with me to prevent brooding (and I'm daft for not taking advantage of this). I'm finally shaking off that feeling of helplessness and lack of control that the whole disastrous process has engendered - the satisfaction I feel at being able to put kitty ears on my bandages is way out of proportion to the aesthetic effect, and I've bestirred myself to order silicone gel for scarring despite the doctor's disdain for anything other than massage.

The surgery has not compromised me financially (well, as long as Greece doesn't drag the stock market further south, anyway), and, assuming no complications arise, the net result will be at worst a face that I don't like any more than the previous one. Which is a poor return on $30k of investment, but it isn't even the most expensive lesson I've learned in life (although it's definitely in the top 3 ;). It is in fact entirely likely that I'll like this face more than the old one (again, assuming the asymmetries I see now are an artifact of healing), if for nothing more than the novelty.

And, as a male - at this stage, I'm thinking of this entire exercise as more of a gender exorcism than a gender affirmation - my physical appearance is less important in life than it could be otherwise, and that only becomes more true as I get older.

Also, let's not forget that this is the classic post-surgery crash period; it's very possible that I'll be more upbeat about it this time next week - and looking at my 21-day photos, they don't look as bad as the mirror (poor lighting is everybody's friend).

The quiet nights are still hard, but for now I have Valium; and the adventure continues tomorrow.


  1. Looking at the photos you've most-recently posted, your face looks (to me!) remarkably androgynous. The nose does balance that interesting line between male and female, and the slightly-more-female-oriented chin seems to balance well your eyes/forehead. I think it looks cool. But then again, I'm not the one who has to look in the mirror every day. I just wanted to let you know that, as an outside observer and someone who's used to giving the lascivious-eyeball to guys, girls, and everyone inbetween.... it looks great!

  2. I agree with the above. I think the swelling is working to over-feminise a little at the moment, which may be one of the sources of your anxiety, and the swelling really will go down even more from here, even 21 days out.

    I think it's looking great, and despite your misgivings about Dr Z's intentions (and yah booh sucks for reneging on honouring that deposit - that's sneaky!) I really do think he has delivered the face you want - it might just take a few months to settle.

    Patience, grasshopper. :)

  3. Glad to be able to provide support in my sleep :)