Patients' Voices

Top 3 criteria for FFS Surgery, the Franches Way

Deciding to go through surgery, especially the first surgery, was a difficult process for me. A good facial gender transition was the ultimate objective. However, the decision on what to get done and how to choose where to go was daunting. Lacking a guidebook, I had to learn as I went. While doing my research for facial gender transition and other surgeries, I didn’t know it then, but I was basing my decisions on 3 major criteria: results, peace of mind and the cost.

Surgery results, peace of mind and cost

Some time after my facial gender transition, I was researching breast augmentation. I realized that I was anchored to the same 3 criteria I had for facial feminization. Early on, I hadn’t been able to tell what I wanted nor which options would be best for me. The overwhelming amount of information confused me. Based on my FFS experience I started to write my criteria down on paper. It was then when I discovered that I had already used the same criteria to go through my FFS. I now believe it can be applied to other kinds of surgery.

Interestingly enough, the order of importance of my 3 criteria differed between my Facial Feminization Surgery (FFS) and Breast Augmentation (BA). Facial gender transition surgery was my first major surgery ever so I had no prior experience. For the BA, I had the facial gender-affirming surgery behind me and with it the order of importance of my criteria changed, but more about that in the future.

The Results of an FFS Transition

How in the world could I know I’d be getting the best facial gender transition results? This question kept bugging me so I identified a few indicators to manage this dilemma.

Surgery is not something you can try before buying, like with a pair of shoes. I needed to feel confident about my decision, for which reason I craved a fair level of awareness and understanding. I knew I’d get the best results for ME if I had an absolutely open communication channel with the surgeon(s). The indicators, some objective and some subjective, helped me reach that fair level of confidence in the selection process. Here were my criteria in finding the right center for my facial gender transition process:

  • The surgeons’ experience in facial gender transition procedures

It’s easy to get an idea of the surgeons’ experience by learning about the percentage of similar procedures that make up their practice. As they say, “practice makes perfect”

In my very personal case I was also interested in learning about their experience with trans patients, depending on the surgery. I personally prefer, for certain procedures, that the surgeon has lots of experience with MtF trans patients. Many of the techniques involved in facial gender transition surgery are not necessarily common in other plastic surgeries. Examples would be forehead reconstruction or trachea shave. Similarly, I prefer a breast augmentation surgery done by someone with lots of trans patients.

  • Facial gender transition and aesthetics

I believe the sense of aesthetics is very personal and sometimes difficult to define. I learnt to differentiate what I wanted from all that I liked. For example, there are a number of women I consider very beautiful, but when I paid attention to their attributes, they were not exactly what I wanted for myself. Putting it bluntly they were attractive to me but their physical aesthetics were not representative of my personality. It was clear that my objective was not a tall, young, lush blond hair girl with fairly full breasts, very plumped lips and cheeks with round arched brows and a long neck.

  • Finding my own Standard for facial gender transition

These are all very beautiful characteristics that at first I was curious about. However, after a little thinking and being realistic, I figured for my age, genetics and personality, I really needed something different. I’m not saying that going modest or bold is better or worse than the other. I’m mean that each of us has to try to define what works for ourselves. Then we can look for surgeons that have already created results which align more with our own ideas.

As I developed a basic understanding of the aesthetics that I thought would work for me, I turned to the surgeons’ online samples. I was looking for examples where their results were similar to the aesthetics that would work for me.

  • Discerning Aesthetics and personal Feminizing potential

Mind you that at the beginning I was looking for a general sense of aesthetics rather than a set of procedures. Looking at the surgeons’ online cases I couldn’t tell what procedures would work best for me, but I could tell from those past patients, which general results I related to and which I didn’t.

To find a surgeon and ensure the best results I think it’s a soul searching process. Really separating the aesthetics of what we like from the aesthetics of what we can achieve for our unique personality. Once we have that general sense it becomes easier to match those objectives with a surgeon that can help us get there.


With “accessibility” I mean the level of communication I feel I have with a surgeon. Let me explain it this way. For me to get the results I want, I have to be able to communicate my desires to the surgeon. Not only that, but I have to make sure that the surgeon reflects back those desires to me. In other words, I want to have access to the surgeon within reason.

If I feel that the communication channel is constrained, or too limited then the chance of a misunderstanding increases. When it comes to results, the last thing I want is a misunderstanding. A little bit of a note here: surgeons are really busy people so it’s not like I can just text the surgeon at 11pm and ask “You up?”. But I do expect to at least be able to speak with the surgeon at pivotal moments before and after surgery, in short, to have access upon request when appropriate.

References from the experienced and expert in ffs surgery

Without references my first steps towards surgery would have been impossible. With so much information gathered from online sources, eventually I need to discuss my understanding of that information with someone who truly knows. References to surgeons and past patients often led me to other better references that were able to help me make my decisions for surgery.

For me, getting a reference to a surgeon from a past patient is a bit of a tricky situation. The quality of that reference, or the personal value that I associate with a reference is a function of how much I know that person providing me the reference. It’s very different when someone I know very well gives me the name of a surgeon, compared to a stranger, for example.

Again, ordering my thoughts, I established 3 levels to evaluate a reference:

  • Top level references:

These would be professional references. For example, my hair transplant surgeon making a referral to another dermatologist for skin treatment with laser. I value that reference a lot because I trust their professional opinion, specialist knowledge and recommendations to obtain other expert points of view.

  • Mid level references:

First hand references from people I personally know. As I said earlier, the better I know the person making a reference to a professional they have been to and received services from, the more valuable to me. Then a notch down would be from someone that had first hand experience, but that I don’t know as intimately.

  • Low level references:

These would be the typical “a friend of mine went with…” It’s not as if such reference would not have any value to me but my level of skepticism would be higher. Nevertheless a surgeon’s name is a great starting point that could lead to finding the right provider.

My peace of mind

My criteria for results blended with my peace of mind as they are intertwined. To gain peace of mind, I needed to trust more than just the surgeon or surgeons. I also sought to feel confident in the facial gender transition procedures selected, protected during the vulnerable postoperative period and secure about what were realistic results. Peace of mind to me even includes being at ease if things were to go wrong somehow.

While evaluating the decision to have surgery or not, three types of peace of mind became clear:

Peace of mind during FFS recovery

I was very respectful of the recovery process after FFS. Somehow I knew that surgery was just a blip in time. A few hours under anesthesia and then the recovery would start. It would not all be fun and games. For me, peace of mind during recovery meant a level of assurance that if I experienced discomfort, I would have access to professional support. During my research phases, I asked about the discharge process, the aftercare, the options for accommodations, emergency resources, and insurance coverage.

To be honest, for this first surgery I didn’t even consider my peace of mind once I was back home. I did think of how I’d get home (flying), but the part I neglected was the accessibility I may or may not have to the surgeon(s) once I was home. For subsequent surgeries, I knew the accessibility I enjoyed was in fact a blessing during the post-operative months. That open line of communication helped me remain at ease knowing the evolution was going according to plan.

Peace of mind with the results

As I said earlier, results and peace of mind sometimes blur together. My confidence in the facial gender transition outcomes was very dependent on my research. It lead to HOW I selected both the procedures and my choice of surgeons. These are topics I will delve into further in the future posts of this guest column, so stay tuned.

As someone attentive to minute details, I’ve learned to live with how I have healed. Little things that I see here and there, for example a tiny difference in my rhinoplasty scar between the left and the right side. I know that no one can see it, even if I ask people to pay attention to the site of the scar. It’s about being happy with the results as a whole. Minuscule imperfections are inevitable with such invasive surgery.

Peace of mind when things go wrong

What would give me peace of mind if something went wrong? You have to be prepared for the eventuality of complications. As humans, we tend to convince ourselves that unexpected things happen to others. Especially “if we did our homework” or “if we chose the best in the world.” Truth is, surgery is a controlled trauma on the human body. It is never 100% predictable. That’s a risk we take.

I achieved a sense of security about possible complications when I knew I had an open communication channel with the surgeon. They had my best interests in mind regardless of how my body might react. They were open to helping me achieve the ideal results given whatever situation might arise. The necessary emergency protocols and insurance were all properly in place.

The cost of facial gender transition

The cost of ffs surgery often appears to be the easiest criteria to understand. It looks like there are no grey areas and can be as simplistic as a number, that can be very easy to compare. In effect the cost of surgery is a very complex criteria better understood if I use the label “value”.

When trying to weigh different quotes from different surgeons it became difficult for me to compare apples to apples. Each surgeon breaks down their costs in a slightly different way depending on their own accounting and place where they operate. Also, each surgeon has their own approach to surgery that may include more or less procedures than other surgeons. Some quotes will include things that other quotes would not include like hospitalization or medications. And then there are other expenses like traveling costs, accommodations, food, incidentals, time off work, etc.

Cost vs. Value in facial gender transition

With all this complexity in mind I am of the idea that cost and value need to be seen from a holistic point of view. The importance of cost is a function of whether you are lucky to gain health insurance coverage, able to save, or qualify to access loans– while for others it may be the defining factor. In my personal case I had no insurance coverage. Yes, cost is key, but if possible, it should not be seen as a single defining factor.

When I started my surgery research, cost was my number one concern. As I learnt about my options, it started to appear less important. Once I saw value and results more related to my peace of mind, then the monetary figure became easier for me to digest. It was, after all, a long-term investment in my face, in my future.