My surgical journal: Scalp Advancement, Brow Shave, Brow Lift, and Trachea Shave

Background

In summer 1996, I began researching the possibilities available for facial surgery I sought. I wrote to Dallas Denny at AEGIS for recommendations, and she sent back two names of doctors who had specialized to some degree in facial feminization: Toby Mayer at the Beverly Hills Institute of Aesthetic and Reconstructive Surgery, and Douglas Ousterhout in San Francisco. I wrote to both for information and was impressed in different ways.

While I was waiting for the info to come, I had consultations with several Chicago plastic surgeons, all of whom I found completely unimpressive and clueless about what I wanted done. At $75 to $150 a pop for consults and tens of thousands for surgery, I wasn't going to waste any more time consulting with surgeons who had not had considerable experience with transsexuals.

I had actually heard of Toby Mayer for his innovation in a hair replacement procedure called the Fleming-Mayer flap. The folder of information they sent was very professional, very slick, and very thorough. It had a lot of information for general patients, and a very good article by Dallas Denny on the specifics of facial work for TSs, originally published in Chrysalis Quarterly.

Dr. Ousterhout sent me his informative "Feminization of the Transsexual" brochure, along with a letter requesting a consultation in person along with x-rays before he could make specific recommendations and comments. This made a lot of sense to me. I began researching both physicians' published work and was deeply impressed with a book on plastic surgery Dr. Ousterhout had edited and contributed to. It was from that book that I decided on a consultation with him first. Once I had that, I was certain I was going to him.

Dr. Ousterhout's practice

Dr. O. has a practice that encompasses many varied cases: men and women of all ages, children, people who have been in accidents, people with birth anomalies and bone deformities of the face, etc. In fact, he spends much of the summer in Sacramento doing work on kids. A pretty amazing guy, I thought.

At the time I went in, Dr. Ousterhout's practice was approximately 10% trans women by his estimate. He told me in 1999 that it was about 50%. I believe that probably makes him one of the most experienced surgeons with facial feminization, along with Meltzer and Schrang. To me, that is very important.

1999 update

I had my jaw and nose done in late 1997, just prior to coming out at work in early 1998.While the facial surgery was just part of the reason I think I've had good fortune in my transition, I feel my ability to be accepted as female made everything much easier. I believe this allowed me to keep my job and have a smooth transition without bathroom issues and other common workplace problems. I also believe it allowed me to get my SRS moved way up to four months after going full-time. Finally, I believe it allowed me to go through life without facing the sort of harassment and ridicule that I had seen decimate the self-esteem of some TSs I knew whose appearance made them visibly gender-variant.

2001 update

It took me several years, but I've now paid off all the debt I incurred to my face work. I still contend it was the most important thing I did in transition. I honestly feel that I would not have had the success I've had in my career and social life had I not done this.

2003 update

Still happy, and I still contend it made my transition go well. Not everyone has the same results, but in my case, there's not a day it doesn't pay for itself.


Note: The essay below was written between October, 1996 and January, 1997. Much has changed for me since then, including going full-time and having vaginoplasty. I've left it as I wrote it and made notations where necessary. For more recent surgical accounts, please visit The BeginningLife.com section on Facial Feminization Surgery (FFS).

My Forehead/Hairline Problem

I'm halfway into what I plan to be a gradual transition. I very rarely go out en femme, and I'm not out at work yet. Even though I occasionally got "ma'amed" while wearing a hat, it never happened when I didn't have one on because of my receding hairline and heavily bossed brows. Brow bossing is the bony ridge above the eyes that is much more prominent in males than in females. Luckily for me, my hair is very thick overall, and it's not thinning on the crown. Spironolactone had halted any further recession at almost 9.5 centimeters from my brow to my hairline, but I already had a very masculine hairline with typical M-shaped recession. I felt it was time to feminize my forehead.

I don't plan to transition at work until absolutely necessary, because I don't want to jeopardize my source of income, and I'm not 100% sure what their reaction will be when I tell them. Fortunately, I have a job where the dress code is extremely casual. I can wear a baseball cap all day, every day, without anyone thinking much about it. I started wearing one every day this summer so people would get used to seeing me that way and would kind of forget what my hairline was like. Plenty of the men at work have long hair as well, so I've been growing mine out for about a year with just a few comments, but no suspicions as to what's going on.

Wednesday, November 13

Dr. Ousterhout mentioned in his literature that he was the editor of a book entitled "Aesthetic Contouring of the Craniofacial Skeleton." I called a university bookstore to order a copy, only to find out it was $350. Yikes! I decided it would be better for my budget to read a library copy, and I tracked down a medical library that had one. I had to get a special petition and jump through a lot of hoops, but I was glad I did. It's a fascinating book that includes everything from chapters on art history, anthropological studies of skull proportions and sculptural representation of the human form, mathematical principles behind aesthetic theories, and of course, detailed descriptions of many surgical procedures. Many chapters had graphic photographs, especially the ones on reconstruction work done on those with severe facial injuries and congenital deformities. But hey, it's a medical text. If you'd rather not know the details, most doctors probably prefer that you don't read that stuff anyway. After reading his book, though, I had pretty much made up my mind to have the surgery done with him. I felt anyone who edited and contributed to such a thorough and impressive book was the best choice. One of the chapters he wrote was called "Feminization of the Forehead," and was quite interesting and informative. I almost thought of the consultation as a formality at that point. Trust me, he's one of the country's few experts on this rare specialty.

While at the medical library, I happened upon a good primer on plastic surgery put out by one of the plastic surgery societies. It included lots of good illustrations, defined terms, and listed accepted ranges for various facial angles and proportions in men and women. It also explained how to do a radiograph tracing and use the tracing to determine aesthetic proportions. Armed with all this info, I went home and made tracings onto graph paper and played around with this and that angle until I felt I'd come up with a new profile I liked. The differences from my starting profile were only a few millimeters here and there, but the profile I'd created was decidedly feminine. It was remarkable how such subtle changes made such a big difference.

Tuesday, November 19

I flew to San Francisco for my consultation, and because of weather delays, I had to cab it from the airport to Dr. Ousterhout's office. Ch-ching! They had been kind enough to schedule me in despite their having just come out of surgery. I filled out some forms for their office assistant and then chatted a bit with the office manager Mira, who still had her scrubs on. All of my contact to that point had been with Mira, so it was nice to put a face with a voice and name.

Dr. Ousterhout came in and we had a nice get-to-know-you-a-little chat. He made a number of measurements and compared them to the radiographs. While he did this, I explained exactly what I wanted to have done around my eyes and at my hairline. In his letter following up the photos and radiographs, he said it appeared I had a Type II forehead, but upon actual examination, he determined I was in the Type III range. I was actually glad about that, since it's possible to make greater changes with the Type III procedure. He told me he was confident he could make dramatic changes that I'd like.

Because my trachea is very prominent overall, I asked if he could do anything about the cartilage besides the Adam's apple. He said that there's too much danger of damaging the vocal cords for him to be comfortable doing the lower part, and he felt I needed the upper cartilage in my trachea for support. Since I know some people whose voices have been damaged by overzealous trachea shaves, I resigned myself to the fact that it would be one of those things that I have to live with, like being tall and broad-shouldered. That was a little disappointing, but it was offset by what he felt he could to for my forehead and hairline.

Then Jeri, another of Dr. Ousterhout's surgical assistants with whom I had chatted on the phone, took some "before" photographs from many angles, and she had me hold up measuring devices for several more shots. I brought my own camera, and she took some with mine as well.

Then I sat down with Mira and had a combination friendly chat/discussion of prices. It's rare that the two can be combined easily. She laid out three plans for the surgeries I wanted to get: all at once, and divided a couple of ways. Dr. Ousterhout's prices were a little higher than the other surgeons, but I felt so much more confident in him than anyone else that the difference absolutely seemed worth it. While I would have loved to have gotten it all done at once, I didn't want to saddle myself with that much debt. Plus, I felt the forehead and trachea procedures would not be that noticeable if I continue wearing a hat and got a new pair of glasses. I don't want to come out at work until absolutely necessary, and the nose and jaw changes will make a huge difference in my appearance which would be impossible to cover. This time next year, I'll be in a better position financially in case the jaw and nose surgeries cause enough uproar to force me to come out at work. Besides, I work mostly with men, and they don't notice anything.

So, I signed on for the forehead and trachea. Because I was so impressed after reading Dr. Ousterhout's book the week before, I had called and asked them to hold a surgery date on December 12 until I could come out for my consultation. Dr. Ousterhout's schedule books 2 months or so in advance (even faster for summer months), and I wanted to have the holidays to recover before returning to work in January. We confirmed that date, and I had to pay 20% of the total fee as a nonrefundable deposit to reserve the operating room, with the balance to be paid prior to surgery. Luckily, they take credit cards, which was great for me- I charged enough on my American Airlines credit card to get halfway to a free round trip.

Mira gave me the following instructions for the two weeks before surgery:

  • Don't take excessive amounts of vitamins C and E.
  • Don't take pain relievers, especially aspirin or any products containing salicylates. They thin your blood and can cause excessive bruising. This includes medicines like Pepto-Bismol.
  • Because of the trachea shave, discontinue electrolysis around the trachea 10 days prior to surgery.

Mira said they wanted me to stay 10 days after surgery to have the staples removed and told me the hospital has guest rooms available to patients at a very reasonable rate. She reserved one for 12/10-12/23, and I made my flight and vacation arrangements.

I flew home that night on an evening flight. Next day when people at work asked if I got all my errands done, I truthfully said yes, but I failed to mention my errands had taken me to San Francisco and back.

Tuesday, December 10

The three weeks since my consultation had flown by. I got to the airport and had over 2 hours of delays before touching down in San Francisco. Because of the difficulties I'd had before, I thought it would be best to get there a day before my pre-surgery consultation. I took a van shuttle to Davies Medical Center and signed in with admissions. It's a medium-sized hospital, and they were very nice about everything. I checked into the guest room (basically a hospital room- linoleum floors and all). The rooms locked and seemed quite secure. I had a very nice view, too. They have a common area down the hall with a refrigerator, an ice machine, and the world's slowest microwave available for guests. Items in the fridge will remain there untouched if you put your name on them. They offer wake-up calls, and local and toll-free calls are free; other calls must be channeled through the hospital switchboard. I used a calling card, so there was no bill from the hospital for phone. The room I was in had two adjustable hospital beds that had controls on the rail for raising the head and feet (very handy later when I had to sleep with my head elevated) and remote television control. They get all the networks and local stations, PBS, CNN, TNT, ESPN and a Hispanic station. There was a rolling tray that fit across the bed (perfect for holding a laptop), two dressers and chairs, a closet, and a bathroom. They had bar soaps and a soap dispenser and towels and washcloths. The giant red DON'T WASTE WATER sign stuck on the mirror seemed at odds with a shower which emitted a rather voluminous amount of water that got nice and hot. Housekeeping comes by daily. Admissions gave me some information about the hospital, patients' rights, meal services, plus lists of local restaurants and hotels. While out there I made some friends who were staying in one of the hospital's hotel-like corner suites, if you feel like living it up. I shudder to think how much it cost, though. Once I got settled in, I went to sleep.

Wednesday, December 11

I met with Dr. Ousterhout in the morning, where he cheerfully answered all my questions for about an hour. I asked him about what to expect and what I should plan for immediately after surgery, and what I should and should not do in the upcoming few weeks. I was given a pain prescription and an antibiotic prescription, which I later filled at a Walgreens a few blocks away instead of at the more expensive hospital pharmacy. I went back to admissions and filled out some forms and answered some questions. Next, I had a small amount of blood drawn (the most painless ever!), which they used for standard chemical analysis, type verification, etc. Then I returned to take care of some financial matters with Mira, paying off the rest of my balance due. Once that was done, I went to the Safeway down the street and loaded up on soft, easy-to-prepare foods and ready-to-eat snacks. I bought a plastic cup and bowl and borrowed some hospital silverware for the duration of my stay. All of the errands, etc. took the better part of the day, and I was glad to have the time to do everything without having to rush. That night I had dinner with a friend and went to bed around 11.

Thursday, December 12

I got up at 5:30 to report to Admissions at 6:00. There, yet another nice administrator had me sign forms. I checked out of my room so I wouldn't have to pay for both the hospital and guest rooms that night, but they let me keep the key. I turned over all my stuff to them, and they checked my valuables. They gave me a wristband and plastic bag for the sweats I'd worn downstairs, and I put on the robe and slippers they'd given me. A nurse came in and took my medical history, temp, pulse and blood pressure. Dr. Ousterhout came in and we reviewed what he was going to do. His plan was to cut in front of my hair transplants, do the advancement, and if he got it far enough forward, he would remove them, too. A pre-op scrub nurse took me to a ready room, where they put me on a gurney and gave me an intravenous tube and hooked me up with some monitors. They gave me a mild sedative which made me a little loopy. I was wheeled into a ready room where the anesthesiologist introduced himself while the nurse pumped something cool into me (anti-nausea and anti-inflammatory medicines). We chatted a bit, then he said I would feel a mild burning sensation moving up my arm, and when I woke up they'd be done. I was so happy and relaxed, and he and the nurse both gently pressed down on me with their hands. I found it most peaceful.

From this point on, things are a little spotty. I remember waking up in the recovery room and feeling incredibly nauseous, which I had been told may happen. I was able to communicate this to someone, and then I think I threw up and then remember little until I was in my hospital room. I woke up with a little plastic tub on my shoulder, and I was very groggy. A nice nurse named John came in and got me some ice water, but told me to drink it slowly. At some point another nurse gave me a shot in the butt to reduce nausea. I had two IV bags going. A nurse took some of my blankets away since I got too hot, and she commented I had very soft skin. As I said, it's weird what you remember. I slept another hour or two. At some point toward evening Dr. Ousterhout came in and told me again (since I didn't remember anything he told me right after surgery) that he was able to remove my old plugs. He introduced me to two other T*s-- one from Chicago, and her partner from Dallas who was having her second session of surgery with Dr. Ousterhout the following day. Both had already had work done by him, and both looked great. (Later, when my Chicago friend showed me her "before" picture, I was flabbergasted. Dr. Ousterhout had transformed her entire face from very burly and square-jawed to quite feminine.) I was pretty out of it, but we chatted a little. After that, I talked with a couple of friends and relatives on the phone and slept more.

Late that night, a Russian nurse came in and asked if I had gone to the bathroom. I hadn't really needed to, but she seemed all worried that it had been 12 hours, so I got up without assistance and wheeled my IV tubes into the bathroom. I saw myself in the mirror for the first time. I was wrapped in a giant turban bandage and had a dressing on my throat. I could tell my eyebrows were much higher, but the rest was pretty swollen or covered up. Later, the Russian nurse came back to change my IV bags. Her English was very bad, and she and I had a hard time communicating about the bathroom stuff, but she really scared me when she saw that my IV tube had filled with blood after I got up. She said it didn't look good, and after fiddling around with the tubes a while she admitted she didn't know how my kind of IV worked. Just about that time she did something that made the tube fill with air bubbles that started flowing back toward my arm. I asked if that was a problem, and she didn't know or couldn't explain. I got pretty concerned and told her to get someone to look at it right away. John came in and said to my great relief that it was no big deal, but the nurse had me pretty scared as I watched what I thought might be a big ole embolism headed for my brain. He apologized for the nurse and her language barrier. It was the only thing that bothered me during the entire stay.

John arranged for me to get a clear liquid meal, and he also got me a regular meal later. I felt fine eating both- the fruit juice was possibly the most satisfaction I've derived from a beverage this year. John found my glasses in my belongings, but I couldn't put them on because of the turban bandage, which also made it hard to hear. I slept all day and night, waking up only to get my pulse and temperature taken and to take some anti-swelling pills, and getting up only to go to the bathroom. In the early morning a nurse unplugged my IV but left the needle taped to my arm.

Friday, December 13

In the morning I had breakfast, and Dr. Ousterhout stopped in to remove my bandages. There was a little vanity mirror in my tray, so he showed me how I looked. I was absolutely amazed. He said he wasn't sure he'd ever seen a scalp stretch as well as mine had. I no longer have a widow's peak, and the hair was moved from almost 9.5 cm from brow to hairline down to about 5.5 centimeters in front and a bit more at the corners. That's about an inch and a half forward. This put my hairline within normal female range. My Chicago and Dallas friends stopped by to say hi, I ate breakfast, then took a shower. My hair was matted with betadyne and blood and was pretty icky, so Dr. Ousterhout told me to wash my hair but leave the shampoo in to break up all the gunk. They had drawn a couple of lines on my face during surgery which took a bit of work to get off. I did all this, being very careful. They had to cut some of my hair along the incision and elsewhere, so I was a bit surprised to find myself holding a couple of big clumps of hair in my hands as I showered, but it certainly wasn't enough that anyone would notice. Coincidentally, RuPaul was on Rikki Lake as I waited for the nurse to verify that I could be discharged to my guest room. They took out my IV needle and had me sign some release forms, and a nurse helped me carry my bags down to my room. I felt fine, so I set up my room and showered again, this time rinsing. I went down to Dr. Ousterhout's office- they were holding my computer there. They observed that I really didn't look like I'd had surgery, which was true. Beyond the sutures, the only sign was that the upper part of my face was lightly bruised, but it was very mild and even. Later the hospital brought a lunch to my room, which I wasn't expecting but ate anyway. I slept and did nothing the rest of the day.

Saturday, December 14

The swelling was pretty noticeable along my brow and my forehead, and my scalp was super-tight. I was numb from brow to crown and couldn't move my eyebrows at all. I had red-colored bruises at the outer corner of each eye. I went up to see my friends. My Dallas friend had surgery on the 13th and was in bed with leg-pressure things massaging her legs and cold packs on her eyes. We all chatted, then Dr. Ousterhout stopped in to visit. After that, my Chicago friend and I went to breakfast in the Castro. With hat, glasses, and turtleneck, no one could really tell I'd had anything done. Besides, in the Castro there are far more interesting sights than little puffy me. As we ran a couple of errands, I could actually feel my eyes starting to swell, and by the time I got back, the skin beneath my right eye was really puffy and starting to discolor. I was very tired, so I lay down for the rest of the day.

Sunday, December 15

I was told the swelling would peak today, and they were right. My right eye continued swelling, and both got more bruised, but never to what I'd call a dark bruise. Cold washcloths felt great on my eyes. By the end of this day, I was feeling pretty off my pace, mostly because I felt nauseous.

Monday, December 16

My Chicago friend had returned home the day before, leaving my Dallas friend and me to our own devices. She was up and about, so we had breakfast at the cafeteria (open Mon-Fri 7-2, plus vending machines), which had good choices and prices (although all I felt I could handle was milk and a dry bagel), and then we went down to the Castro to get a few things. My digestive system was in a turmoil since surgery, so I bought some things for that, and I got some ice cream and a couple of delightful greeting cards. I was feeling nauseous still, so I begged off an afternoon trip downtown and went back to rest. Nothing I took was helping with my nausea. Later that night we got some tasty Chinese food and walked around a bit until my friend's recently reconstructed knee started troubling her. I was feeling nauseous anyway, so I was ready to call it a day, too.

Tuesday, December 17

I hadn't felt like working much, but the nausea got bad enough today that I just lay around the whole time. I had been taking my pills in groups, but I started to suspect that only one of them was making me sick. I took them one at a time spread out and immediately realized that the generic Keflex (called Cephalexin) was causing the problem. I was almost out of them anyway, so I stopped taking them. Yes, that's very naughty of me, but I felt so much better the next day that it was worth risking infection.

Wednesday, December 18

In the middle of the night I had the same dream twice, stopped both times at the same point when I was snapped awake from trying to make some sort of facial expression which really hurt. This was my first day of feeling back to normal. I called to set up an appointment to get stitches and staples removed and spent the rest of the day watching TV, working a little, and getting my appetite back. I'll bet I lost 5 pounds just because I felt so sick. I said goodbye to my Dallas friend, who was leaving in the morning. I stayed up late watching bad TV.

Thursday, December 19

Slept well. I've had a hard time doing any work I brought with me, but today I'm finally getting around to writing part of this at least. Mira called to tell me they want to take the stitches out on Saturday 12/21. I checked with the airline to see if I could switch my ticket, but since it was purchased with frequent flier points, it costs less to stay until Monday 12/23 as I originally planned. No pain medication taken today. At worst, my pain was like a mild sinus headache. Noticed mild bruising and some soreness on the right side of my neck. As stuff drains after surgery, some people have a lot of bruising on their neck or even their chest. Little nodes or glands about two inches directly below each ear were a little swollen and tender, but it didn't seem like anything to worry about. Can move my eyebrows a bit with effort, but I don't want to push it.

Friday, December 20

Today I did a really good job of getting shampoo in my eyes. This has happened every day since surgery for two reasons: one, my brow used to protrude enough that water would run off my brow instead of trickling into my eyes, and two, my forehead is still a little numb, so I don't feel the lather sneaking up on my unsuspecting eyes. My advice: consider bringing some baby shampoo. I went down to say good-bye to Mira and everyone because I thought they'd be out on Monday, but they said they would be there. They were all very effusive in their compliments, which was one of the most validating feelings I've had this year. At this point, things look great. Bruising is virtually gone. The trachea is much smoother and still a bit swollen, so I'm hoping for a bit more improvement. It's not as different as I wish it were, but it's about what I was told to expect, given its overall prominence. It definitely looks better, though. Much of the feeling in my head has returned, especially on the sides and in the center of my forehead. Directly above my eyes and from my hairline to my crown are still numb and ever so slightly swollen. I have limited eyebrow movement, although they do have a graceful arch just above the rims of my eyes, about half a centimeter higher than before. I used to have three horizontal lines on my forehead and a slight vertical one between my brows. They're all gone now. These changes make me look (and feel) untroubled by life. My hair falls totally differently now, too. The longest hair in front barely reached my mouth before; now it curls under my chin. It falls to the sides nicely and frames my face in a very feminine manner. I could probably go without bangs and have no one notice the incision.

Saturday, December 21

Dr. Ousterhout took out the staples in about 3 minutes this morning. Everything looked fine. He told me the stapled area will have a slightly raised seam that will eventually go down. Since it's all back in my hair, it's completely unnoticeable. The area along the incision is a little itchy, as is the numb areas under the skin on my brows, but it's not too bad. I have a couple of slight dimples near the incision along my forehead that will smooth out over the next week or so. The incision at my hairline is already difficult to see and easily hidden with a little make-up. The trachea incision had one suture that stuck out of either end. He gently pulled it out and told me to rub the raised scar frequently as it heals, and in a month or two it will settle down to an invisible scar. It was made through a natural wrinkle in my skin anyway, so even though it's pretty noticeable at the moment, that will change soon. I had assumed the trachea scar would be like the hard-to-see hairline incision. It's pretty noticeable, and I'll certainly get asked about it, which I thought and hoped I'd be able to avoid. I haven't taken any pain medication for a couple of days. The only odd feeling is some slight sinus pressure, but I would not even classify it as uncomfortable.

Sunday, December 22

Still no need for pain medicine. Bad weather kept me inside. I wrote and then packed for my trip home Monday afternoon.

Mira asked me to come in for some "after" photos. I brought my own camera and will have plenty of my own photos for comparison. I gave everyone big hugs, then I checked out of the hospital and spent a simply lovely afternoon with two friends. We went to the Castro for brunch and later down to Baker Beach overlooking the Golden Gate. The surf was crashing in, my friends' pug was frolicking on the beach, and I felt really at ease as we walked around. It was my first time out en femme without a hat. Did I pass completely? No. I've got plenty to do before that happens. But it felt good to be addressed as a female (most of the time) without a hat on. My friends were kind enough to drive me to the airport, where a miserable flight could do nothing to lessen the happiness I felt that day.

Sunday, January 12

One month since my surgery date, and things look good. The raised scars behind my hairline have almost entirely receded. The hairline scar continues to heal nicely, and it can be concealed with a little makeup or by several hairstyles. The scar on my throat is still pretty noticeable, but the rubbing has lessened its prominence a lot.

I have remained calm about it, but I've had significant thinning of the hair between my hairline and crown-- not enough that others might notice, but I was noticing a lot of shedding as I was showering. I should point out that losing 50-100 hairs a day is normal, and now that my hair is longer, it creates an illusion that you're losing more that it seems with shorter hair. Nevertheless, I decided to take action which I should have taken long ago. I've compiled a list of tips that anyone concerned about thinning hair should practice:

  • Use Rogaine or generic Minoxidil (2%) on the area where hair is receding.
  • If you're on hormones, ask your endocrinologist about increasing your spironolactone to help stop the hormone-induced loss.
  • Wash hair with a mild shampoo frequently enough to keep the scalp clean, and use a conditioner or cream rinse. The sebum or oils that the scalp produces has high levels of the enzymes and hormones linked to hair loss.
  • Have a couple of brands made for your hair type, and switch every few days.
  • Shampoo gently, working it into your scalp's oily parts with your fingertips, not your nails.
  • Shampoo often enough to keep scalp clean, but take care not to dry it out. Your scalp will compensate by producing more sebum.
  • Be very careful with wet hair. It's much easier to pull out. Avoid styling it until it's dried a bit.
  • Pat hair dry with a towel- don't rub vigorously.
  • Avoid dryers and curling irons whenever possible.
  • Let hair dry naturally. The less you do to it when wet, the better.
  • Use a natural bristle brush or a wide-toothed comb.
  • If you hit a tangle, use your fingers to separate it, not your comb or brush.
  • If you feel you need to perm or dye your hair, have a professional stylist do it- they can choose the mildest treatment. Consider vegetable-based dyes. Use low pH shampoo. Better yet, don't treat your hair.
  • A number of factors can add to hair loss. I've tried to eliminate as many as possible.
  • Limited blood supply to scalp: Rogaine helps with this (it's a vasodilator), and it can't hurt to massage your scalp occasionally.
  • Hats or headbands that are too tight can rub against hair and cause it to get more oily that it would without a hat.
  • Ponytails and other hairstyles like tight braiding or hairweaves can pull a lot of hair out. Avoid them.
  • Diet can affect hair--be sure you're eating well. Consider a multivitamin. While you need a certain amount of fat and protein in your diet, some studies have made links between meat consumption and hair loss.
  • Stress can cause hair loss among other worse things, try to eliminate it.

Thursday, January 16

My 30th birthday. As I begin my 30's, I now have a feminine hairline and forehead, and I'm right on target for my plan to go full-time in summer of 1998. I couldn't be happier!

The T* friends I met during my San Francisco stay had both previously had jaw, chin, and nose work done by Dr. Ousterhout that looked great and totally changed the way they looked. The minute I have enough money to get my jaw and nose done, you can bet I'll be back in San Francisco. The work that I had done was barely within my means and used up several years' savings. I'll be paying off the remainder for at least a year, since I needed to do it about a year sooner than I had originally planned. I would do it again in a heartbeat, though-- it's easily the smartest decision I've made regarding my transition. It was worth EVERY SINGLE PENNY.

Some Heartfelt Gushing

Those of you who know me know that unalloyed praise of the following type does not pour forth readily from me. But I was deeply impressed by my experience with Dr. Ousterhout.

I believe that in every person's lifetime, you come into contact with just a handful of really extraordinary people. I count Douglas Ousterhout among my extraordinary acquaintances. He is a brilliant, humble, compassionate man who has mastered an immensely difficult craft: combining the exacting artistry of sculpting with the technical skill required of surgery. As a dentist as well as a plastic surgeon (talk about a lot of school!), he has unique insights into surgical methods to reshape your face. Add to this rare combination the fact that he has dedicated much of his career to serving our transgender community, and you start to get a sense of how wonderful he is. How fortunate we are to have his expertise available to us!

Not only has he mastered facial feminization, but he also treats you with a kindness and a genuine respect for what it's like to be transgender. He sees the feminine, the beautiful in your face and brings it forward. He's surrounded himself with the most competent, accommodating associates. His staff is, and I am not exaggerating, the nicest and most efficient group of people I have ever had the pleasure of working with. They all make you feel like you're part of a partnership working toward the same goal, and they take great pains to make sure your every need is met.

Dr. Ousterhout's skills have made the greatest difference in my appearance and have boosted my self-confidence exponentially. If you feel you'd like to feminize anything about your face, I honestly cannot recommend Dr. Ousterhout highly enough.