Patients' Voices

Choosing FFS Procedures, the Franches way

By mid June 2016 I had already decided I was going to have Facial Feminization Surgery (FFS) with Facialteam. To get to that point I had gone through a somewhat demanding process of first research, and then elimination. Read all about “How I Chose The Best Surgeon for Me“.

In this article, I get into the unplanned steps I followed to define which FFS surgery procedures I actually had done.

In my particular case I started my FFS research project without knowing what elements made my face appear male. Because of that, I didn’t know what FFS surgery procedures would be the most effective for my facial features. The only element I knew for sure would benefit me and I wanted changed was my hairline. In general I first decided where or with whom to have FFS, and then in consultation with the surgeon I decided on my personalized plan of surgical procedures.

My Personalized List of FFS Surgery Procedures

I am aware that other people know or believe they know what procedures they need and then look for a surgeon. I was the other way around yet acknowledge that other people would do things in a different order. Each of us have our own separate paths and the best way is what works for you.

Here is what I knew after having my initial consultations with various surgeons as well as a report from

  • I knew I had decided and was going to make surgery arrangements with Facialteam. This meant traveling to Spain and having to find post-op accommodations between having surgery and being discharged to return home.
  • I knew that a hair transplant instead of a scalp advancement would be my best option to change my hairline.
  • I knew the bare minimum to “soften” my face would be a rhinoplasty, lip lift and chinplasty.

What I had to Learn about FFS

  • I didn’t know if having a hair transplant done in Marbella at the same time as FFS was the best option for me.
  • I didn’t know about surgery date availability nor if I was ready/prepared to commit to a surgery date.
  • Something I really didn’t know was that the process of fine tuning my list of procedures would be littered with doubts, wondering and waiting. By not having a full understanding of the details of FFS Surgery procedures and having time in between quotes and communications with Spain, my mind would start wondering fueled by questions and doubts.

I wasn’t doubting my decision on having surgery. Rather, I wanted to make sure that whatever I decided to get done would be the best for me.

The First FFS Quote

Before deciding on Facialteam I met with a number of surgeons to see what they would suggest and for me to interview them to determine where to go for surgery. When I met via Skype with Dr. Simon from Facialteam, we had what I felt was a frank discussion about what he thought would be the minimum I could have done with a good softening effect (for some reason I’m not too keen on the word “feminizing” but that’s really what it is).

In this early stage I had several concerns:

  1. On one side I was still grasping the concept of having surgery.
  2. Then the recovery factor had always been something I have lots of “respect” for, so less procedures seemed to make more sense. Fewer things done would mean a simpler recovery.
  3. And last but certainly not least there was the cost involved in FFS surgery. The more procedures added to a surgery the higher the total cost, and I still had to add traveling and post-op recovery expenses like accommodations and food.

After that first Skype consultation with Dr. Simon, Laura, my patient coordinator, sent me a quote which included just three procedures;

  1. Nose feminization surgery
  2. Lip feminization
  3. Chin feminization surgery

A separate line item for the hair transplant was optional for me to consider.

As I started my FFS research in 2015 I saw some reports on the media about a couple celebrity transitions and somehow I had a cost expectation that would be upwards of 50,000€. When I received the first quote from Laura with the 3 basic procedures (rhinoplasty, lip lift and chin), hospital fees, anaesthesia and pre and post-operative costs I was relieved that it was way lower than the sticker shock I had braced for.

My Request for EVERYTHING

The 50,000€ figure I had in my head was not my budget. It was more like a worst case scenario that I was expecting to fight with. Then, after receiving the first quote I started wondering if I could add more procedures or even get EVERYTHING done!

As I reconsidered the first quote my mindset went from the extreme of “let’s do the least” to the opposite side which was “let’s do everything under the sun.” Two driving forces fueled that new mindset:

  1. the difference between my super high price expectation vs. the quoted price and
  2. if I was going to pay for flights to Marbella, accommodations, be under general anaesthesia, have surgery with one of the best FFS teams in the world and go through recovery, it kind of made sense to add as much as safely possible.

Questions, Doubts and What-ifs

This fantasy came from not having all the expert details I needed. Seeing the online information took my feet off the ground and created a distorted, misinformed vision of what surgery could do for me in one operation.

“At that moment I didn’t realize how unrealistic my new mindset was but nevertheless I went and asked my patient coordinator for a new quote for everything.”

A few days after that unrealistic request Laura sent me an email with a new quote and an explanation that the surgeons did not recommend doing any soft tissue procedures until after the bone structure had changed. This second quote added a forehead feminization and jaw feminization with a separate line item for an optional simultaneous hair transplant.

The recommendation from the surgeons made sense to me and put me at ease. To me it meant that they were not just trying to sell me procedures. I got the sense that they had my best interest in mind. Almost as if they had the perspective of the patient with the knowledge and experience of a surgeon.

During all this time I struggled with making the decision of the hair transplant. On one side, if I were to have a forehead reconstruction, it made sense to add the simultaneous hair transplant. But on the other hand, if I didn’t do anything to the forehead, adding a hair transplant would push my surgery sometime, probably into April of 2017 instead of the end of 2016.

I’m Not a Surgeon Nor an Expert

At this point I was trying to decide based on my understanding of the procedures and their relationships.

My problem was that my understanding was all based on what I had read online and from a number of YouTube videos from past patients talking about their experience.

I didn’t have enough information to make a decision so I had lots of questions; lots of “what ifs”. With so many questions I could not make up my mind about the hair transplant and the forehead reconstruction. In early July 2016 I then asked Laura for another Skype consultation with Dr. Simon. I needed to hear from the expert, the surgeon, to help me clarify my questions and my what ifs.

In the meantime I kept coming up with questions and various quote requests that I sent to Laura, who basically told me to hold my horses until I spoke again with Dr. Simon.

The point I’m trying to make is that without truly understanding how the surgeons work and what is actually possible with surgery my mind kept hypothesising. I also didn’t want to ask past or prospective patients for their thoughts because I knew they were no experts either. So whatever feedback I could get from these 3rd parties would just confuse my head further and my hypothesis would be flawed anyways.

During this back and forth conversation, Laura was extremely professional in answering what she could or referring me to the upcoming Skype consultation with Dr. Daniel Simon.

Just as when I decided where to have surgery, to fine tune my list of procedures I needed to speak with the surgeon again. Then, once I felt comfortable with my list of FFS Surgery procedures, I could reserve a date for surgery.

Follow-up Consultations before “finalizing”

With all the questions I had gathered over the month between consultations, when I spoke a second time with Dr. Simon we were able to get into the details of how they work, what was possible during surgery, etc. This time the discussion was more technical. Dr. Simon’s explanations, specifically about my concerns with the hair transplant and forehead reconstruction were clearly addressed. Just as in the first consultation both the surgeon and I agreed on a plan. This time it would not include a forehead reconstruction nor a hair transplant.

I finally could see my plan of action inside my head. By this time I had also spoken with the local hair transplant surgeons to discuss the possible logistics of having the hair transplant done locally. When I finished the Skype consultation with Dr. Simon I now had all the technical information. I felt really confident with my choices made in conjunction with the surgeons:

With Facialteam:


Hair Transplant sometime after returning from Spain

Mentally it was a big relief deciding on my personalized list of ffs procedures. On the other hand, a few times it felt daunting how much I had achieved and the prospect of surgery. But with all the information I had gathered mainly from my conversations with Dr. Simon and my exchanges with Laura, it was easier to come to terms with the idea of surgery and feel the excitement of fixing a date.

About Franches

Hello, It’s Me is by Franches, author and owner of, a blog of thoughts and experiences with a transfeminine perspective. Working in the educational field and with experience as a teacher, she has taught at some of North America’s most prestigious digital media schools, holding an MBA and BSc. in Industrial and Systems Engineering. Her FFS surgery procedures with Facialteam took place in October 2016.