FFS Consultation with Dr. DiMaggio

[EmilyMI]

I received a bit ago my consultation with Dr. DiMaggio (shown below) - I have received others from different surgeons as well but Dr. DiMaggio is the one that I am probably going with.  I do have a few questions for those who went with him for their FFS



What type of recovery am I expecting? How was the post-op care? Was your pain management issues addressed? Was there extensive numbness to your face after the surgery for any lengthy amounts of time? What kind of prep work would I need to plan for before the procedure?





Quote:
The forehead contouring MUST be done with a reconstruction (popularly called type 3), because the projection of your forehead is very pronounced and a simple shaving of the frontal bone won't be sufficient. If any other surgeon tells you that you don't need a reconstruction, you can assume that this is because he or she doesn't know how to do it and not because you don't need it, unless your x-rays show that you belong to the rare minority that has undeveloped frontal sinuses. To read more about the difference between reconstruction and a mere shaving, please read the forehead page on our website: http://t-change.com/en/forehead-contouring.shtml
While the surface of the middle area will be cut out and placed back into a more posterior position, the orbital rims will be burred (shaved) on the front to make them thinner, and from bellow to lift the edge of the eye-sockets roof and make them more open. This opening up will give your eyes the look of the female eyes. This look, so appreciated by romantic poets, is not female because of anything in the eyes themselves (which are the same flesh balls in both males and females), but because of the shape, thickness and especially the projection of the bones that surround them, like the orbital rims and the glabella.
The incision used to work on the forehead bones and the forehead soft tissues (including a repositioning of the eyebrows) is the same, and will run along the hairline, which can be lowered up to 2cm. This won't be enough to give your hairline a female height and shape, so you might want to get some hair grafts in the future.

Your nose seems to have a good size and shape when seen from profile. One could feel tempted to tell you that your nose is fine from this point of view. However, It looks a bit too wide and blunt when seen from the front. It will need to be reduced a bit in order to fall into proportion with the rest of the facial features once everything gets reduced, especially after setting back your forehead. The forehead set back would make the nose look out of proportion if it's not operated. The proposed goal would be to make it a bit smaller overall, mainly thinner, and to give the tip more definition.

The chin is square and large when seen from the front, so a reduction of the chinbone is indicated in both height and width. While this reduction in size is needed to improve the front view, an augmentation of the chin projection and definition (or "pointiness") is recommended when seen from the profile. In order to get this, either of two options could be used: a graft taken from the excess chinbone that will be cut off from the bottom of it, or a tiny silicone implant
We recommend a tapering of the jaw too. The maleness and "squareness" of your jaw when seen from the front is not produced by square or thick rear corners (which you don't have). It rather comes from the sides, under the jowls (the part of the jaw bone that is adjacent to the chin). There is a ridge that goes along the bottom edge of the jaw (like a ledge on both sides) and makes also part of the chin. We propose to remove or reduce this ridge in order to taper your jaw and your chin together and get a pointier, more delicate lower face.

Another procedure that you will see in the quote is an upper lip lift, because your upper lip is too tall and results masculine. This procedure is meant to make the upper lip shorter and increase the lever of teeth exposition when the mouth is slightly open.

Your Adam's apple is not visible in any of the photos you sent, so I am not including any procedure for this feature in the quote.

Your cheekbones seem to have very good size and shape, so no procedures are indicated for them either.

You would probably benefit from a face and neck lift to bring out the changes obtained on chin and jaw bones. It would help the soft tissues stretch back over the bones and give more definition to their new, feminized shape. However, you would probably get a better yield from this lift in around 5 years from now, so I am not including it in the current quote. As the need for undergoing a facelift is difficult to evaluate well without touching your face, just with some photos, when the case is borderline like yours, your opinion counts a lot here. If you think that you need (or you want) a face and neck lift, let me know and I will send you a new quote that includes it. This is a surgery that you can get later on with a local surgeon too.

Medical package for full facial feminization surgery
•   Forehead reconstruction with setback of the anterior wall of the frontal sinuses and orbital rims reshaping.
•   Hairline correction – up to 2 cm advance or corners smoothing out (*)
•   Brow lift (to make them match the new forehead shape) (*)
•   Feminizing rhinoplasty (to make the nose smaller overall, mainly thinner, and to give the tip more definition)
•   Upper lip lift (to make it vertically shorter and get more exposition of the upper teeth) (*)
•   Jaw feminization (tapering of the ridges that run along the bottom edges of the jaw on both sides, to make them match the chin reduction)
•   Chin reduction in height and width, with bone graft or silicone implant to improve projection and definition
•   Medical fees and costs including general anesthesia and up to 2 nights hospitalization (Standard general anesthesia is included. Patients who need special or unusual anesthetic drugs might be charged for them)
•   Bedside interpreters in the hospital to better communicate with the nurses.
•   All medical appointments and checkups.
•   Pre surgical tests and x-rays
•   Standard post-op medication (Patients with special medicine needs might be charged for them)
•   Bilingual assistant + transportation for your arrival/departure and every medical event
•   Free cellphone for you to be in contact with us 24/7
TOTAL: USD 17,000

[Diane Elizabeth]

I also had a consult by e mail with Dr DiMaggio.  I was looking for a few simple changes and he listed that I needed more done than I wanted.  Made me wonder if he wasn't trying to get more out of me than I needed.  So I am more confused than before I started my search.

[angelfaced]

my quote from dimaggio was about 16k and included a chin reduction, which dr. bart said i only needed a forehead setback so he possibly is trying to upsell. at the same time , i hate my chin,even tho i pass, and dr. dimaggio is an artist and hes prolly trying to make your results the best he can. just fyi, the stuff with the (*) is optional like the lip lift, the brow lift and the hair. im prolly gonna go with dimaggio cuz i agree with his assessment, even tho i could get away with not getting certain things done. my advice would be to send pictures to a ton of ffs surgeons. that way you get a good range of opinions, then go with whoever you feel fits you best.

[EmilyMI]

my quote from dimaggio was about 16k and included a chin reduction, which dr. bart said i only needed a forehead setback so he possibly is trying to upsell. at the same time , i hate my chin,even tho i pass, and dr. dimaggio is an artist and hes prolly trying to make your results the best he can. just fyi, the stuff with the (*) is optional like the lip lift, the brow lift and the hair. im prolly gonna go with dimaggio cuz i agree with his assessment, even tho i could get away with not getting certain things done. my advice would be to send pictures to a ton of ffs surgeons. that way you get a good range of opinions, then go with whoever you feel fits you best.

I have consulted with other FFS doctors (Dr. Zukowski, Facial Team and FemiLife) and honestly I think that Dr. DiMaggio was the the most thorough.  I honestly think I need everything that was in my quote (and the recommendations).  Also his post-op care, from what I have heard, is second to no one so that also is another big plus for him.  I think I am 99.9% sure that Dr. DiMaggio is my FFS surgeon that I will choose, now is just trying to find out when I want to schedule this (hopefully early - mid next year) and find out how I will come out in my professional life. 

[mementomori]

i cant decide between him and dr bart

[angelfaced]

yeah ,my choice was betwen him and dr. bart as well. i think since dr. bart wants to leave my chin the way it is, im gonna be going with dr. dimaggio. his chin work is stellar and the difference between quotes was only like 2k and also the aftercare doesnt compare to dr. bart, who will boot you out of the hospital in like 24 hours i beleive, but it mgiht be 48 hours. but still, i doubt i will be able to take care of myself 2 days after surgery.

[mementomori]

yeah ,my choice was betwen him and dr. bart as well. i think since dr. bart wants to leave my chin the way it is, im gonna be going with dr. dimaggio. his chin work is stellar and the difference between quotes was only like 2k and also the aftercare doesnt compare to dr. bart, who will boot you out of the hospital in like 24 hours i beleive, but it mgiht be 48 hours. but still, i doubt i will be able to take care of myself 2 days after surgery.

dr supporns after care seems amazing , but he seemed quite conservative in his approach  , which is good for some but im worried ill be left still looking too androgynous and not feminine enough

[mementomori]

i wouldnt mind having my upper face done with dr di maggio and my lower face with dr supporn becuase i want an aggressive change with my upper face but not with my lower

[collettemichelle]

EmilyMI.
It would appear that your question concerning you got lost in the fray.You poor thing.
I haven't been for any FFS yet so unfortunately I can't be specific on recovery.
I am a nurse so my heart goes out to you and I hope for only the greatest things for you.I'm sure professionalism is what you will get and a good recovery.
Any way, sweet days ahead.
Hugs Collette
P.S. thank you for the post it was a great insight.I hadn't considered this surgeon yet.Now I will contact him.Did you just send photos?
Love

[lisakmoore]

I had my FFS surgery with Dr. Di Maggio in June this year.  Overall, it went pretty well, but my forehead scar did not heal properly, so it stretched out and will require a revision.  Regarding the other questions you mentioned:

1. The recovery was MUCH harder than I expected.  My surgery lasted 10hrs and after they woke me up I wanted to die.  Things got dramatically better after the first day though.  I would HIGHLY recommend bringing someone with you to comfort you (just soothing words and to hold your hand). 

2. Post-op care was okay.  After 24 hrs in the hospital they'll encourage you to leave (although you can stay another night if you want).  The hospital stay was mentally very difficult.  The wifi didn't work and my tv remote died, so I felt very trapped.  Also, they want you to have ice packs on your face, but it was very uncomfortable for me to be reclined, so the ice packs kept falling off my face.

3. In the hospital, they were constantly asking if I was in any pain, but it was never overly painful, just extremely uncomfortable.  Once out of the hospital, they will give you Toradol pain pills.  This took care of the pain adequately, but after taking them for over a week, they upset my stomach. 

4. After surgery, my scalp, chin, and nose were 100% numb.  My lips were partially numb.  Three months later, my chin is still partially numb, my nose is mostly okay, my lips are normal, and my scalp is still mostly numb.  From what I've heard, this is normal.

5. If you're going alone (which I don't recommend), stock up on food and supplies before your surgery.  For the first few days I was on a liquid only diet.  So I recommend bringing a can of protein shake mix and buying the instant soup mix.  Having straws is very handy during this time.  Also, be sure to purchase Kleenex.  After the first few days, it's soft food only (pasta is nice). 

[EmilyMI]

I had my FFS surgery with Dr. Di Maggio in June this year.  Overall, it went pretty well, but my forehead scar did not heal properly, so it stretched out and will require a revision.  Regarding the other questions you mentioned:

1. The recovery was MUCH harder than I expected.  My surgery lasted 10hrs and after they woke me up I wanted to die.  Things got dramatically better after the first day though.  I would HIGHLY recommend bringing someone with you to comfort you (just soothing words and to hold your hand). 

2. Post-op care was okay.  After 24 hrs in the hospital they'll encourage you to leave (although you can stay another night if you want).  The hospital stay was mentally very difficult.  The wifi didn't work and my tv remote died, so I felt very trapped.  Also, they want you to have ice packs on your face, but it was very uncomfortable for me to be reclined, so the ice packs kept falling off my face.

3. In the hospital, they were constantly asking if I was in any pain, but it was never overly painful, just extremely uncomfortable.  Once out of the hospital, they will give you Toradol pain pills.  This took care of the pain adequately, but after taking them for over a week, they upset my stomach. 

4. After surgery, my scalp, chin, and nose were 100% numb.  My lips were partially numb.  Three months later, my chin is still partially numb, my nose is mostly okay, my lips are normal, and my scalp is still mostly numb.  From what I've heard, this is normal.

5. If you're going alone (which I don't recommend), stock up on food and supplies before your surgery.  For the first few days I was on a liquid only diet.  So I recommend bringing a can of protein shake mix and buying the instant soup mix.  Having straws is very handy during this time.  Also, be sure to purchase Kleenex.  After the first few days, it's soft food only (pasta is nice).

Thanks for this information, this helps A LOT honestly.  I hope I can get someone to come with me but that is still up in the air? I just don't want someone to come with me JUST to care for me? especially since that person(s) never been to Argentina before so that would not be fair to them.  I knew about the numbness and yes from what I keep hearing that it is expected.  Makes sense since they are literally cutting nerves which need take time to heal and rebuild.  I hear that it can take awhile actually before full sensation comes back - depends on the person.  This does help though so I do appreciate the information on your experience!!

[EmilyMI]

EmilyMI.
It would appear that your question concerning you got lost in the fray.You poor thing.
I haven't been for any FFS yet so unfortunately I can't be specific on recovery.
I am a nurse so my heart goes out to you and I hope for only the greatest things for you.I'm sure professionalism is what you will get and a good recovery.
Any way, sweet days ahead.
Hugs Collette
P.S. thank you for the post it was a great insight.I hadn't considered this surgeon yet.Now I will contact him.Did you just send photos?
Love

I am studying to be Nurse myself so it is nice to see another sister out there in the same profession (or soon to be profession LOL)   But yes I did get my pictures sent to this Doctor - they cannot provide an accurate FFS estimate without know what you look like so the ones I sent were excellent quality (according to them).  The assistant there, Amanda is just so amazing in her communication and is more then happy to assist in whatever she can.  I keep hearing about her absolutely incredible customer care and so far I have not been disappointed in that area at all.  When were you hoping to have your FFS? I am HOPING to start mine early next year.  /Hugs

-Emily