Douglas K. Ousterhout - Facial Feminization Surgery: A Guide for the Transgendered Woman

Copyright 2009 by Douglas K. Ousterhout, M.D. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, or otherwise, without the prior written permission of the publisher. For information, write Addicus Books, Inc., P.O. Box 45327, Omaha, Nebraska 68145.

ISBN: 978-1-886039-93-3

Cover design by Paul Goldstein

Illustrations by Jeanne Koelling

This book is not intended to serve as a substitute for a physician. Nor is it the authors intent to give medical advice contrary to that of an attending physician.

Library of Congress Cataloging-in-Publication Data

Ousterhout, Douglas K.

Facial feminization surgery: a guide for the transgendered woman / Douglas K. Ousterhout.

p. cm.

An Addicus nonfiction book.

Includes index.

ISBN 978-1-886039-93-3 (alk. paper)

l. FaceSurgery. 2. Surgery, Plastic. 3. Male-to-female transsexuals. I. Title.

RD119.5.F33O96 2009

617.520592dc22

2008045787

Addicus Books, Inc.

P.O. Box 45327

Omaha, Nebraska 68145

www.AddicusBooks.com

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

To

Naomi and Ken

Nancy

Dean and Don Don, Susan, Oliver, Thomas, Lauren Marlene

Jessica, Michaela, Sarah

I owe a tremendous debt of gratitude to many people who have helped me during the course of my facial feminization career. I could not have accomplished the pioneering surgical work discussed in this book without individuals who encouraged, guided, and otherwise supported my efforts.

For starters, thank you to Heather Lamborn, Andrea James, Sally Sparks, Lynn Conway, and Diane Sutton. They have let other male-to-female individuals, like themselves, know about my work. Heather put my brochure on the Internet while Andrea, Sally, Lynn, and Diane have shared their stories on their own Web sites about working with me. Several others, Deirdre McCloskey, Donna Rose, and Li Sam, have mentioned me in their biographies. Additionally, I have met many people at various transgender meetings through the years who have taught me much about their community. I wish to acknowledge the organizers of IFGE, Southern Comfort, Colorado Gold Rush, Esprit, California Dreaming, Be All, First Event, and Fall Harvest for facilitating those relationships.

Similarly, I couldnt have developed the procedures described in this text without help from the curators at the University of the Pacific School of Dentistry, Atkinson Skull Collection. They allowed me to study more than one thousand skulls from their extensive collection and to use the photographs interspersed in this book. I thank them for their continued cooperation. In a similar professional vein, I could not have successfully shared my procedures with colleagues over the years without the artistic help of Jeanne Koelling, my medical illustrator. She has shown a wonderful ability to translate my face-changing surgeries into detailed illustrations, also exhibited throughout this book.

I also wish to recognize the many hospital professionals who have taken care of my patients through the years with great dignity, understanding, and respect. I work with the best anesthesiologists in the business. Special thanks go to my current MD-colleagues, Bill Halsey, Michael McGehee, Tamara Jurson, Michael Yanakakis, and Tom Emerick, and my former MD-colleagues, Nina DeVilmorin, Jeff White, and Bill Berger. In addition, I want to acknowledge the hospital floor nurses, under the direction of Michele Foster, who are nothing short of fantastic, as are the operating room nurses, supervised by Marian MacMillan. My special respect goes to Dentry Hebert, Gregg Allen, and Sancho Miranda.

I wish very much to thank those who let me use their photographs. Photographs are not an easy issue in a book. Quality, good enough for publication, pre- and post-operative photographs in all three views are not as easy to come by as one might think. All of the post-operative FFS pictures are at least one year post-operative. As the great majority of my patients are from outside California and a lot from outside the USA; getting desirable post-operative pictures is sometimes luck. Also, a lot of my patients wish to remain anonymous. I understand this completely. Therefore, even though I have operated on more than 1100 patients, you will see several of the patients used in more than one chapter. The real issue is the subject being presented.

Finally, my office is where it all begins for patients. I could do nothing without the help of Tatiana Girma, my receptionist and photographer, and Mira Coluccio, who has been with me since shortly after I treated my first transgender patient in 1983. Miras office management skills and suggestions have helped me run an increasingly better medical practice over the past twenty-five years. Thank you, Mira. Moreover, she conceived of Cocoon House, the private residence nearby where patients stay prior to and following surgery. Run by life partners Tricia DeCuypere and Mary Lou Hopkins, this caring, healing environment is now emulated elsewhere. You are both great.

I amand always will begrateful to all of the individuals mentioned above and to the many others whose contributions made this work possible. Space doesnt allow me to name every person but you have my heartfelt thanks.

Douglas K. Ousterhout, M.D.

I t was Michelangelo who said, I saw the angel in the marble and carved until I set him free. Thats how many of us feel about Dr. Ousterhout. He sees angels in faces, and he sets them free.

As a transgender person, it is impossible to explain the inconsolable anguish of looking into a mirror, day after day and year after year, and seeing an imposter there. How does one find the words to express the endless frustration of play-acting through an uncomfortable, unfulfilling life trapped inside a body that never fit? At the same time, what words can accurately convey the simple peace that comes with alignment of spirit, mind, and body? Most people never ask themselves those questions. For many of Dr. Os patients, we are consumed by them.

My name is Donna Rose, and I was a patient of Dr. Os in 1999. At that point in my life, I was forty years old and had been a long-time husband, dedicated father, successful businessman, muscular collegiate wrestler, and devoted son. Like many transgender people I recognized my gender dilemma from an early age and spent much of my life running and hiding from my true self. I struggled with the overwhelming feelings of shame, guilt, and fear that harboring a dark secret can cause. Like many of us, I resigned myself to the sad fact that a cruel cosmic mistake had been made and I was powerless to change it. That all changed the day I saw Dr. Os work.

I stumbled across the Web site of one of Dr. Os early patients during my ongoing search for proof that a happy, fulfilling life was even possible for people like me. I spent hours staring in disbelief at extraordinary before and after photos there. On one side of the page there were images of a balding, middle-aged man and on the other was an attractive, feminine woman. Gone were all the traces of the unmistakable masculine facial features that no amount of makeup and no type of flattering feminine hairstyle could hide. It was more than amazing. My life changed that day, and it has never been the same.