Sunday, February 24, 2013

My Million Baht Body -- or -- The Exclamation Point (Part 14)

So what did I have done in Phuket, and how much did it cost?

Until now I have written only in general terms, so let me  get specific for anyone who may be considering surgery through the Phuket International Aesthetic Center (PIAC) at the Phuket International Hospital (PIH).  (Note:  Dr. Sanguan Kunaporn has his own site in addition to the PIAC site at

Gender confirmation surgery (GCS) with Dr. Sanguan Kunaporn cost $11,000 USD.  I prepaid this fee directly to Dr. Sanguan's account both for OD and for myself.  There is an additional $2000 charge if an extra skin graft is required.  As it turned out, one of us did require the extra graft -- I won't disclose whether it was was me or OD -- this graft being taken from the top of the leg.  We paid the extra cost by credit card on the spot.

Breast augmentation (BA) with Dr. Sanguan was $4000 USD done in conjunction with GCS.  Both OD and I had been uncertain about BA before going to Phuket and made the decision only after we were in the hospital.  We paid for this also by credit card.  Of all the surgeries we underwent, it is BA that provides the nearest thing to instant gratification.  Prior to BA, I was not quite a 36B/38B.  After 250ml implants, I am a full C cup.

Then we come to facial feminization surgery (FFS).  OD, lucky girl, had no need for FFS of any kind, but yours truly knew she could benefit from some degree of FFS.  The question from the beginning was, how much?  The FFS surgeon at PIAC is Dr. Rushapol Sdawat, to whom I sent a series of photos some six months before surgery and from whom I received a number of recommendations.  After meeting me in person in Phuket and after looking at photos of my sisters, Dr. Rushapol modified his recommendations, in particular dropping his earlier recommendation for a chin implant.  The guiding principle was that I needed to come through FFS with it still being evident that my sisters and I are from the same family of Scotch-Irish heritage.  This is the final list of procedures that we agreed upon along with prices in Thai Baht --
  • Forehead lift -- 215,000
  • Lower face and neck lift -- 200,000
  • Lower blepharoplasty -- 28,000
  • Reduction rhinoplasty -- 150,000
Thus the total fee to Dr. Rushapol was 593,000 Thai Baht,  approximately $19,900 USD.  I was not the first person to learn on this journey that FFS is generally more expensive than GCS.  I had transferred more than this in advance to the PIAC account used by Dr. Rushapol, and PIAC was very professional about refunding the overpayment.  (Note that payments to Drs. Sanguan and Rushapol go to separate accounts.)

FFS was the greatest gamble in all the surgeries I underwent in that one does not truly see the results until two, three, or more months after surgery.  As I write, my face is still swollen, a work in progress to be evaluated come summer.  All I can say at present is that I see good movement in the right direction since the days immediately after my surgeries.  

I can also say that I felt myself in good hands with Dr. Rushapol, who was both professional and gentle at all times.  I will never forget how he stood by my bed in the intensive care unit and personally fed me my first post-surgery meal the way a mother would feed a child, mouthful by mouthful.  Bandaged and without sight, I could not feed myself.  Although Dr. Rushapol could have called for a nurse, he took the time to do this himself, speaking soothing words about the results of the surgery that he could see but that I could not.

I will write separately about the care and service at PIAC.  In fact, I will have quite a bit to say, most of it positive but with a view to giving others advance information based on our personal experiences.  I will also give some hindsight consideration to the question of whether I should have undertaken quite so much surgery in such a short period.

First Post-FFS Day with Makeup
At the moment, however, I am remembering my last day at the PIAC office when we went over the final financial accounting.  Kat, one of PIAC's coordinators for international patients, took me through the paperwork line by line.  When she got to the last page, she paused.  She looked up and said, a bit in awe, "You spent over a million Thai Baht!"  

For those who prefer USD, I spent in the vicinity of $35,000-37,000 USD for all surgical procedures.  As to total trip cost, add $3160 USD each for round-trip business class tickets from Bucharest to Phuket and $1925 USD for our two days at the Aspasia resort before our surgeries and another twelve days after our release from PIH.

I am now recovering slowly at home in Bucharest.  I had intended to return to work tomorrow, but instead, I was felled by a virus that must have found its way into my system during our nearly 24 hours of flights from Thailand back to Romania.  Two days ago I was running a temperature as high as 103F (39.4C), and only today do I feel I have rounded a bend as the fever has dropped and remained below 100F.  My return to work will be delayed a few days more.  I am beginning to learn what others have learned before me, that recovery from this amount of major surgery will require time and patience.  

No longer feverish, I think back on Kat in the PIAC office and look at myself in the mirror.  I like what I see even with much of my face still swollen.  I am now the proud possessor of a Million Baht Body.

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Follow these links for more of The Exclamation Point:
Previous entry -- Vodka without Beer?
Following entry -- My Own General Contractor

Sunday, February 17, 2013

Vodka without Beer? -- or -- The Exclamation Point (Part 13)

Although written to be mildly humorous, this entry describes a medical procedure that is the centerpiece of recovery for anyone who has undergone gender confirmation surgery (GCS).  Those not wishing to read about such personal medical procedures are advised to look elsewhere and catch up with this journal at another time.  Meanwhile, OD and I are rather busy, as you will discover below.

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I first heard the Russian expression водка без пива, это деньги на ветер (vodka without beer is throwing money to the wind) from my Petersburg friends Zh and V in 2005.  I'm sure the expression has been around forever, but like anyone who attempts to master a foreign language as an adult, I am continually picking up new expressions that were not in textbooks and dictionaries when I was a university student in the pre-Internet days of the 1970s.

One might debate the wisdom of the aforementioned Russian expression, but OD and I have our own variation that applies as one of the certainties of life for anyone walking our path:  GCS without dilation is throwing money to the wind.

For those who have walked this path already, I apologize for a digression into known territory where OD and I are still beginners.  For those who have no clue as to where I am leading, I will attempt to enlighten.

You see, what Dr. Sanguan has done for us is to create neo-vaginas.   Two weeks post-surgery, I look in the mirror and marvel at how normal I appear even this soon.   To our bodies, however, our neo-vaginas are wounds that should be closed up and healed over.  To prevent this, to adapt our bodies to the new normal, we must dilate.  For the first three months, we most do so three times per day, morning, noon, and night.  Dilation is, in fact, the centerpiece around which we must arrange our days.

Dr. Sanguan visits his patients the day after the second surgery in his 2-step GCS procedure.  He comes bearing gifts in the form of six plexiglass stents that bear a somewhat clinical resemblance to a particular part of the male anatomy.  Whereas a woman might see a man for the first time and wonder about the size of this anatomical feature hidden inside slacks or shorts, OD and I were left in no doubt about our new friends.  Lengths are clearly marked, ruler-fashion, in inches, and diameters are recorded to the nearest 1/16 of an inch.  Our reaction to Dr. Sanguan's gift would be familiar to any teenage girl, a combination of fear, anticipation, and an urge to exclaim, "You must be kidding; you want me to put that . . . in here?!"
Our Insatiable Gentlemen

The stents are marked clearly as Nos. 1 through 6, but OD and I decided to personify them with human names.  This being a bilingual pilgrimage to Thailand, we have, of course, chosen appropriately from both English and Russian.  

No. 1 is Lyolik – nice, gentle Lyolik.  He is small and shy and slow to take advantage of the situation.  He must be coaxed inside and coaxed further still to go the distance.

No. 2 is Johny Angel, who is nice and gentle but without the shyness of Lyolik.  Just think of OD and me as Shelley Fabares wannabes.

Johny is followed by Dimchik and then Good Neighbor Sam, that family man from 1960s suburbia who steps in to assist his neighbor in a time of need.  Vasya then marks a transition to a qualitatively and quantitatively different dimension.

Finally we come to No. 6.  Here OD and I come to a certain parting of the ways.  For OD, No. 6 comes from deep in Russian history with a name that inspires a certain degree of dread.  I, on the other hand, felt I needed to end on an American note.  I have chosen from U.S. political history a figure whose title implies the respect with which I approach No. 6.  With this mixture of dread and respect, OD and I hold our last gentleman inside for somewhere between five and ten minutes.

So that, dear readers, is how we spend much of our day while in recovery at the Aspasia Resort in Kata Beach, Phuket, Thailand.   Between preparation and cleanup, each daily session with our gentlemen friends takes on the order of 45 minutes.  We can already see that our days for the next three months will center around these thrice daily trysts.  Neither of us is looking forward to our first session after our return to Romania and Moldova.  For nearly 24 hours of travel time, we do not expect to be able to arrange even a furtive meeting.

Speaking of our return to Europe, we fly home from Phuket in two days.  If there has been a casualty in our journey to Thailand, it has been my writing.  Forgive me for my conceit of believing I would be able to write frequently, giving near daily updates on our status.   In this I was sadly mistaken.  Recovery from GCS, in my case combined with facial feminization surgery (FFS) and breast augmentation (BA), takes time, strength, and patience.  I will fill in the blanks retrospectively from my home in Bucharest.

Meanwhile, our six insatiable and implacable gentlemen are calling.  Our day is planned.  We are working hard to prevent our money from blowing away in the wind.

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Follow these links for more of The Exclamation Point:
Previous entry -- We Interrupt this Program
Following entry -- My Million Baht Body

Friday, February 8, 2013

We Interrupt this Program -- or -- The Exclamation Point (Part 12)

I wrote the previous web journal entry on Thursday, January 29; today is Friday, February 8.  Twelve days have passed.  The good news is that OD and I were released from the hospital yesterday and are now back at the Aspasia Resort where we stayed before reporting to the Phuket International Hospital for our surgeries.

I raised two questions in my previous post, so let me answer both of them.  The first concerned "a matter of depth."  The answer is five inches.  Sometimes I'm just under five and sometimes a tad over, but more or less, five inches is the number.  I will have more to write about dilation at a later time.

"I also will learn the answer tomorrow as to how painful facial feminization surgery (FFS) really is."  That was the second question I raised.  The fact that twelve days have elapsed since that post implies the answer.  It was the most difficult surgery with the most unforeseen consequences.  For most of the past two weeks I have been unable to see clearly due to the bandaging that kept my glasses too far away from my nose.  I was simply unable to write anything other than short notes on Facebook and in e-mails.  Beyond my blurred vision, my head frequently was pounding too much for me to stare at this netbook screen for more than a few minutes.  

The other unexpected consequence was a dropped left foot.  I awoke from the long surgery to find I had no feeling in my lower left leg and foot and was not able to lift the foot from the ankle.  Fortunately, both motion and feeling are returning.  I'd say that I have reached about the 40% point as of now.

It will take me weeks to recount the events of the past twelve days.  I scarcely know how to begin.  Since I need to begin somewhere, I will reprint below some of the notes that were posted to Facebook or sent in e-mails over this period.  I will even preserve the typographical errors.  Relating our feelings and what we learned about ourselves will take longer.  Please forgive the unexpected but entirely necessary interruption.

February 1, 2013 -- Facebook Posting

Hi eeveryone. I can't really write today, but I wanted you all to know that I am on the healing path. After FFS, I was kept overnight in the ICU in some degree of pain. OD was beside herself with worry, not knowing what had happened with me. Yesterday was much better as I was brought back to our room. I could only barely see out of one eye, however. Today I am also beginning to be able to open my left eye also for short periods, but writing her or anywhere is with great difficulty. OD, lucky girld, is now completely disconnected from everything and is taking a nice long shower all by herself. I hope to be there also in antoher one or two days.

February 1, 2013 -- Facebook Posting

Continued rapid improvement and healing today. I can keep both eyes open, watch films and documentaries, and even read a little bit. I'm afraid the blog, however, will have to wait. OD had her packing removed and is an entirely free woman of the ward. Tomorrow I will have my nose straightening, the last word for me in Phuket. That will be about a 4-hour procedure. I'm told the worst part of having one's nose worked on is the claustrophibic feeling of having to breath entirely through one's mouth for several days. So far the pain of everything has been less than I feared, but as PW has written, I don't think I will want to see the inside of a hospital again for some time to come :).

February 3, 2013 -- Facebook Posting

Just want everyone to know that I'm improving but not really able to read or write today. My eyes are still very swolen, making seeing very difficult. Right not, I'm typing pretty much in the blind. Forgive me, therefore, if I am not responding to notes and letters. I just can't read them quite yet. My facial surgeon says the swelling should be down tomorrow and that he will remove tubes and some of the bandages then. I'm in little pain. The worst so far, of all things, has been my left foot. I've lost all feeling in the top of the foot and am unable to lift it. The doctors, of course, say it's because I've been lying flat for so long. They say I should have feeling backin 1-3 weeks. I'm walking the hallway carefully, lifting my left foot carefully and holding onto the railing. As to how I look, does anyone know of Halloween party tonight? I would easily win first prize.

February 4, 2013 -- Facebook Posting

OD has just gone for her last surgery (BA). I am hoping the tubes and "grenades" will be removed from my head today, after which I will be able to sleep and place my glasses close enough to my eyes to actually be able to see. (Right now everything is blurry because the lenses of my glasses are so far away from my eyes.) Biggest concern is still that I am not able to feel the top of my left foot or raise my left foot from the ankle. Dr. Kunaporn says this is likely a pinching of the perineal nerve (?) and that feeling and motion will come back. The BUT is that it may take several weeks. Meanwhile I limp as well as I can.

Sorry if I've been sounding down. GCS and FFS are possible in quick succession, but it takes a great toll on the body. Fortunately, I am falling back on my good physical condition from decades of being a daily bicycle commuter. If I were not in good physical condition to begin with, this would be all that much harder. A week from now, I see OD and myself sitting on our balcony, looking out on the view, and having these post-surgical memories as just that, memories.

Good news is that we are both dilating and getting expected depth. I am at 5" to start and up to dilator No. 4. Not that this easy, mind you, but it is possible.

February 4, 2013 -- Facebook Posting

Much better news to report. First, OD is back from her BA and is resting comfortably. That's the last surgical procedure either of us goes for.

For me personally, better yet is that all my bandages and "grenades" have been removed. I had thought I looked like a Mack truck had run over me two days ago. I now realize I have just reached that exalted status of beauty today. Two days ago it must have been as though ten trucks had rolled over my face. I am all shades of black and blue and yellow and orange, and my eyes in particular look as though they are staring out from two purple abysses. But now I can place my glasses at the right distance from my eyes and can actually see normally. As scary as my face looks at the moment, I think I can see enough to understand how it will heal. My forehead has been contoured nicely, the hair line having moved forward noticeably. The eyes have been opened and evened as well. I imagine it will be 2-3 months before everything settles.

I also just had my first shower in days. You can imagine what it was like to wash all the congealed blood out of my hair. It might have been better to ask our marines to give me a buzz cut and start over, but after an hour and lots of help from one of the nurses, I don't look quite as terrifying as I might otherwise.

Not much change yet on my left foot, but they are taking it seriously. I had one physical therapy session in my room this morning and will have another in the PT department this afternoon.

Best of all, I might now start catching up on something approaching normal sleep. 

February 5, 2013 -- Facebook Posting

Just a quick update to say that the big toe on my left foot now has some motion. Now I need that motion to spread to the rest of the foot. I had two PT sessions today.

Biggest complaint of the day was last night's sleepless night. Between constipation first followed by an enema at midnight, I think you will get the picture. It's only 7:30pm now, but I'm going to bed in hopes of a few more hours sleep than yesterday.

February 6, 2013 -- Facebook Posting

Continued slow progress with my left foot today. After one PT session in the morning and another in the afternoon, I am able just barely to lift the foot from my ankle under my own power.

Only setback has been my face. The surgeon decided to rebandage much of it because he did not see the swelling as going down as quickly or as much as he would like. So once again, my glasses are perched at the end of my nose, making things like reading and writing difficult. Even navigating while walking is not easy. Yes, my vision without proper optical correction is that bad.

The plan is for us to be released to our hotel tomorrow. For me there will be daily taxi trips back to the hospital for PT, and both OD and I will have multiple check-ups with our surgeons.

February 7, 2013 -- Letter to my Sister

Hi I.,

Good news is that OD and I will be released back to our hotel today.  I don't know how much of FB you have been able to follow, but I did try to put something up there everyday.  Writing in the blog was pretty much impossible, as my face was so bandaged that I couldn't place my glasses close enough to my eyes to see in anything other than a blur.  Even the FB postings were difficult to write.  As I think you can see here, that is beginning to improve :).

I should have known better based on all my years helping with XXX's sister and aunts, but I have now proven independently for myself that there is no such thing as an easy surgery or an easy stay in the hospital.  This has been hard, very hard.  One evening I was reduced to tears, almost at the end of my physical and emotional stamina.  

Thankfully, the rational side of my mind turned out to have been correct in its pre-op assessment that I was strong, in good physical condition, and ready to take almost anything.  I did take it all, but it was the equivalent of surviving the most horrible of imaginable car wrecks, the type where you wonder how it was possible for the driver to walk away.  Doing both SRS and FFS together was overload, like inviting two independent trucking companies to drive their 18-wheelers over my body as many times as they would like, each driver paying little heed to the other.  Total time in surgeries for me was on the order of not quite 24 hours.  Just imagine -- as I should have tried to imagine -- how the body will react to being under general anesthesia for a full day.  It is good news that I have had only one bad side effect, namely a dropped left foot.  They say I should regain full use within a few weeks, but for now I will need to walk with great care.  

Please give my love to G, P, and everyone.  I am on the recuperation path now.  Despite the pain and complications, know that I am happy.


February 7, 2013 -- Facebook Posting

Release day!  This photo was taken just as OD and I were released from PIH. What the staff lacked in English, they made up for with smiles. OD is ready for the beach, but I think one look at me will explain why I haven't been able to write or do much of anything at all. Today, however, we both felt wonderful.

The other news of the day is that OD and I got to our hotel in the early evening and unpacked our suitcases for the first time since coming to Thailand. My foot continues its slow return. For the coming week I will be returning to the hospital each morning for physical therapy. It's a good thing I was in as good shape as I was to begin with. Even so, I can tell it will be weeks, months, or a half year before I am back to that level. In addition to physical therapy, I plan to walk as much as I can to get the muscles working. The rest of the time I hope we will be sitting on the balcony and enjoying the water view. With my vision no longer obstructed by quite so many bandages, I may even get back to writing the web journal.

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Follow these links for more of The Exclamation Point:
Previous entry -- A Matter of Depth
Following entry -- Vodka without Beer?