Financing transition: Plastic surgery

Plastic surgery can be expensive, even more than SRS, but it can make much more of a difference in your daily existence than genital work ever will. If passing is your goal, and your face or hairline is too masculine to allow you to pass, I would strongly urge you to consider facial surgery. Having a passable face will make a major difference in the quality of your life. It will improve every aspect, from walking down the street without getting clocked, to employment issues, and in social/intimate situations. In my case, I feel face surgery was easily the most important investment of my entire transition.

Additionally:

• This category requires the most explanation, since it's all very complicated.
• There are savings when several procedures are done at once. The estimates below reflect multi-procedure discounts.
• See explanatory notes for further details on estimates.

Presurgical costs

Consultations: Most doctors charge $100 to $200 just for a consultation. This cuts down on those just curious and also has the effect of making people choose after seeing a small number of surgeons. For this reason research before seeing a doctor is vital. Don't go unless you are seriously considering that surgeon (unless it's free). If your consultation will require travel, add that in, too.

X-rays: A few doctors require x-rays before a consultation.

Bony facial work

Trachea shave: This is probably the most common procedure, often done at the same time as SRS. If done separately, it can sometimes be done in the surgeon's office under a local for considerably less than doing it in an operating room.

Nose recontouring: Another common procedure, often done during SRS. It requires a general. I've met a large number of people who have had their noses worked on a second time after an unsatisfactory first try.

Jaw recontouring: Reducing the angle takes the sharp flared part off the corner back by your ear. Sometimes, more complicated procedures are performed, or they may use prosthetics or fill.

Chin recontouring: A genioplasty involves reshaping the chin by cutting and repositioning the bone in that area. There are other more complicated procedures to correct bite problems as well.

Forehead recontouring: This involves rounding the forehead to approximate a female shape, often by shaving bone from the brow of filling in flat areas to round them out.

Soft tissue facial work

Ear pinning: Some people don't like having their ears sticking out and get them surgically folded back a bit.

Collagen/botox injections: These procedures eliminate lines and wrinkles, but sometimes only temporarily.

Eyelids: Tightening skin on lids (blepharoplasty) or under eyes will make you look younger.

Cheek implants: Also called submalar implants, they make your face look less flat, which can enhance its feminine appearance. Like any implant, there is a danger of rejection.

Lip augmentation: One of several methods to plump up lips, often temporary.

Facelifts: A fairly common procedure to make you look younger. Some older patients who have bony work felt they needed this in order to get full results of the earlier surgery.

Hair transplants: Generally, these are not good for filling in large areas. I recommend speaking with a physician about a scalp reduction or advancement prior to transplants. Some people felt they needed transplants to cover surgical scars along the hairline.

Skin resurfacing: Some people to this to reduce electrolysis and acne damage.

Body modification

Breast augmentation: It's an option some choose, though it is not necessary. There are significant risks you should consider while deciding if it's right for you. Many get this done in conjunction with SRS. Again, this is best dealt with after going full-time and after seeing how much hormonal development you have.

Hip implants: This is rarely done, and you may need to go outside the US for the procedure. It's generally considered a bad idea by US surgeons.

Rib removal: This is somewhat unusual, with the intent of enhancing an hourglass shape. One of two of the floating ribs at the bottom of the rib cage are taken out. Some surgeons contend that the scars on your back, the need to protect internal organs, and the possibility for rib regrowth make this a problematic procedure.

Liposuction: Some people choose this over dieting, or to make their waists more feminine. This carries certain risks and potential bad cosmetic results that should be discussed with the surgeon.

Tummy tuck: This removes excess skin on the abdomen and tightens everything up.

Castration: Officially called orchiectomy, this involved removal of the testicles. It is inexpensive (as low as $500), and is sometimes done prior to or instead of full genital reassignment surgery. While it allows patients to lowers hormone doses, it should be done in consultation with your SRS surgeon to ensure that the orchiectomy does not cause complications or damage potential grafts for SRS.

Silicone injections: This is an illegal medical procedure where medical-grade silicone is injected directly into the body under the skin. It's an inexpensive procedure, often used by younger, poorer members of the community, especially female illusionists and sex workers. This is a potentially dangerous procedure which I cannot recommend. For more on the dangers of this procedure, please read: Dangerous curves ahead

Ancillary expenses

Operating room: There is a fee for the room, which is usually by the hour.

Anesthesia: There is a fee from this specialist, also usually by the hour.

Recovery room: After surgery, you stay in this room for an hour or three until they can move you to a regular hospital room.

Travel: Cost to get there and back.

Hospital: Many procedures require stays ranging from 1 night to two or more weeks.

Hotel/transportation: You will need to make arrangements for getting around in that town if traveling, and make plans for days before and after your hospital stay if needed.

Food: Before, during and after hospital stay.

Prescriptions: Usually filled prior to surgery, most frequently an antibiotic and a painkiller.

Recovery items: Many surgeries have incidentals that make recovery better, like ice packs, scarves, anti-nausea stuff.

Do not base your own budget on these examples!

• Example 1 is the minimum anyone has reported for the category-- best-case.
• Examples 2, 3 and 4 represent standard ranges, with Example 3 as my attempt to show the most typical.
• Example 5 is the maximum anyone has reported for the category-- worst-case.

• ^[1] Read all notes in purple for explanation of estimates.
• ^[2] Notes in red contain very important information that will significantly affect costs and budgeting.
• The "Your estimate" column will be filled in as part of Exercise 7.

• ^[1] Assumes no work needed or covered under insurance and done with SRS.
• ^[2] Assumes trachea shave only, done separately from SRS, done under a local in surgeon's office.
• ^[3] Assumes three common procedures, not covered by insurance and done simultaneously with SRS.
• ^[4] Assumes four common procedures, done in the US, not covered by insurance and done separately from SRS.
• ^[5] Assumes every possible procedure available by the most expensive surgeons, not covered by insurance and done in seven sessions:
  • ^[A] bony face work *
  • ^[B] first soft tissue work session *
  • ^[C] second soft tissue work session
  • ^[D] two or three hair transplant sessions
  • ^[E] skin resurfacing
  • ^[F] first body work session *
  • ^[G] second body work session)
  •     * indicates multiple-procedure discount
• ^[6] These amounts are examples and do not reflect standard prices. There are far too many variables in plastic surgery costs to assume your own costs would match:
  • Physician used-- the difference between the cheapest and most expensive surgeons can be five to ten times the cost. One surgeon might charge $5,000 for the same procedures that would cost $50,000 elsewhere. Some people save a great deal of money by getting surgery outside the US, with variable results.
  • Procedure used-- some surgeons employ more complex techniques than others.
  • Extent of your needs-- some noses cost more than others (even from the same surgeon) due to physiology, etc.
  • Number of procedures done at once-- generally, there is a discount for each procedure after the first, plus doing more at once reduces anesthesia and operating room costs.
  • Do not base a budget on these numbers. You must get specific prices from your own surgeon based on your own needs for a price anywhere near accurate.
• ^[7] Cost estimate based on average range from a 10/14/96 US News article.
• ^[8] You could spend much, much more than this if you really tried...