Surgeries are the name of the game in the life of a transgender person. Not every transgender person transitions medically but a lot of us do, and many amongst this group opt to undergo surgical intervention as well. Choosing to undergo surgery is a big decision, and it gets harder once you have had one or two surgeries and truly understand what they mean for your mind, and body.  I have had a few surgeries so far, and I just had another surgery, and so this topic has been on my mind, a lot lately.  

Surgeries are physically and mentally taxing. They are also expensive and require you to pause your regular life while you recover. Basically, they are a big commitment. When I had my first surgery, I didn't understand them very well, and I have learned a lot since then and I hope by documenting it, I can help others in the process

Picking a surgeon

Depending on where you live, and what surgery you are opting for, you'll sometimes be overwhelmed with the choice of surgeons. Other times, you may have to fly across the world to find a surgeon that's right for the job. My first surgery was a rhinoplasty, and at the time I was living in Medellin, Colombia. There are literally thousands of 'cosmetic' surgeons in Medellin, and it was tough to pick one out. They all showcase their best work on Instagram, and very few of them have online reviews on sites like Realself. Finally, I asked a friend for recommendations who asked someone in the healthcare business, and I found a surgeon that I liked. At the time, I only focused on checking their past results. I eventually realized, that quality of the post-op care is equally, if not more important. Here is what I'd ask a surgeon if I were to go through the process again

  • Are you happy with the consult? Do they offer suggestions on what you need, or do they try to sell you everything they offer? In my opinion, good surgeons will often tell you what is necessary, and what may be a nice to have but not required.
  • Do they have any resources or brochure on after care or recovery? Merely having a few pages on what to expect, and when to seek help puts you at ease a lot once you are done with your surgery. Managing post-op anxiety is a big part of the recovery, and having good quality information from your surgeon goes a long way in staying calm.
  • Do they offer you an emergency telephone number in case you have a medical emergency after the surgery?
  • What is their follow-up schedule like? Do they give you followup dates before the surgery or do you have to chase them later to get follow-up dates?
  • Where do they operate on you, and what kind of medical insurance do they offer in case there is a complication and you need hospitalization or other medical services.
  • Do they offer revisions in case you aren't happy with results assessed 12 months post the original surgery?
  • If you are going for an out of town surgeon, do they help you with transportation, and with an affiliated hotel? Having this help in a new city, when you are already under stress, is very helpful.

Paperwork, bloodwork, and other requirements for a surgery

You'll most likely be asked to provide lab test results ranging from coagulation, to an x-ray of your chest before your surgery. They'll expose any challenging situations that could come in the way of a successful surgery. It's good to get these done as far ahead as possible (most surgeons would accept results in last 1-3 months), so you have time to redo any tests that didn't turn out as expected. A common one is coagulation time. It is a marker of how quickly your blood would coagulate after making an incision. It's easy for the readings to be off if you are on medications or taking supplements like vitamins or fish oil, which thin your blood. Sometimes the surgeons will ask you to re-do the tests.

In the transgender world, we are also asked for referral letters from therapists to prove that we are mentally sane, and understand what we are going to do to ourselves. Millions of people undergo cosmetic surgeries and give birth to children, but they are never asked to prove that they have made a sound decision. Putting that aside, it helps to coordinate these referral letters early so you can get them on time. Some surgeons insist on getting original copies of letter which may have to be mailed to you internationally depending on where your letter comes from.

Preparing yourself for the surgery

As I mentioned above, surgeries are physically and emotionally taxing. Some more than the others but it still helps to be mentally, and physically prepared. Here is how I have prepared for them in the past

  • A daily meditation practice to help stay calm. This is especially useful in the weeks, and days leading up to the surgery. It's good to try and continue this practice after the surgery because you will lose some of your mobility, and that can be emotionally very taxing. This is especially true of gender confirmation surgery, where you may be bedridden for 2-3 weeks, and then have very limited mobility for a month or two after that.
  • Eating a balanced diet, and supplementing it with essential supplements like magnesium, omega3, and a few others.
  • Exercising regularly leading up to the surgery, but avoiding any injury. Post surgery, you can't exercise for 4 - 12 weeks, and so it helps to be in the best shape possible before you go under the knife.
  • Taking care of the logistics like flights, hotels, medical leave of absence well ahead of time. Logistics can cause some severe anxiety, and they often get more expensive, the closer you get to the final date. As an Indian, I had the extra step of sorting out a visa for some of my surgeries. It's best to take care of them early on to avoid mental stress close to your surgery.
  • The last one is a bit of a tricky one to balance: reading up on what to expect and being mentally prepared. It's tricky because often people post on the internet only when they had some challenges in their surgery, and so it's easy to build up a very negative model of what's to come. This is where the quality of information from your surgeon helps. It also helps to remember that your experience will depend on your general health at the time of the surgery, and the quality of support you are receiving from the surgeon, family, and friends. If you have any specific concerns, it's best to email your surgeon, and see what they have to say.

Social support before, during, and after a surgery

Surgeries are emotionally taxing. Everything from deciding to do them, figuring out the logistics of making them happen, and then recuperating from them can leave you emotionally spent. Having some emotional support in the whole process is great! This can come from parents, partners, friends, and even co-workers. I have been very fortunate to have this support in my surgeries from all of these people, and I know how much harder it would have been without it. If you are flying abroad for a surgery, and can afford to, it really helps to go with someone. If you can't, you may sometimes be able to find companionship in other patients of the same surgeon. However, this would require you to stay at one of the recommended accommodation of the surgeon. Forums like Reddit can also help you find people who are going to the same surgeon around the same time.

Finally, you can also find support in talking to your therapist over the phone or skype. Post-op depression is a real thing, and it can take you by surprise. Between anesthesia, painkillers, disrupted sleep and, exhaustion, it can creep up on you unsuspectingly.

Tips for a good recovery

Here is what I have found helpful in recovering from surgeries

  • Since antibiotics upset the diversity of healthy gut bacteria, it helps to consume food rich in probiotics (like yogurt, kombucha, kimchi) and/or take a good probiotic supplement.
  • I also tend to use some supplements like Bromelain (for swelling), Arnica (for bruising), Vitamin C, Magnesium and Omega 3 (for helping my body rebuild). Most of these have been shown to have a positive impact on recovery, and generally don't interfere with other medication. However, it's still best to check with your surgeon.
  • Drinking of plenty of water helps flush out the anesthesia, and other chemicals from your body.
  • I try to start walking as soon as I can after surgery. It helps with getting better faster and also lifts my mood. It also feels like a significant milestone to be able to go for my first walk after surgery.

Patience

I wanna end this post by reiterating the importance of patience in all of this. The body heals slowly, and much more so if you are not very young. There isn't much that can be done about it than to be kind and, loving to yourself. If you have never had significant swelling before, it's surprising how long it can take for it to go down. In case of facial surgeries, it can take up to 12 - 18 months for all the swelling to be gone. Thankfully, you don't have to wait that long to resume your life, but the wait can still be 4-8 weeks.

Cover image courtesy of Facialteam, with whom I underwent a forehead reconstruction surgery. I highly recommend them if you are considering facial feminization surgery (better called facial gender confirmation surgery). If you are interested, I have also written about my sex reassignment surgery with Dr. Chettawut of Bangkok.