Only rhinoplasty - is FFS still possible then without revision?

[anjaq]

Hi.
I dont think i will do FFS really, I am way too scared of it. But i dont want to exclude that I may eventually do some things. What i am considering now is to have a rhinoplasty done as I will probably have to go for a surgery anyways to clear out my sinuses that are full of unwanted growth and constantly infected. i found a plastic and medical surgeon who can do both in one run and has a lot of experience. Now what do you think can i tell him to watch out for in terms of the nose change. I want a more female nose obviously and I want it to be done in a way that does not need a revision later if I should decide to have any other surgeries done there. I read some times that rhinoplasty should be done in combination with forehead shaping always - is that true and can that be avoided? What do I need to tell the surgeon to do in order to get a more female looking nose? I was thinking for now mostly to remove the little bulge at the upper third of the nose and maybe make it curved a little bit instead and a bit less wide. Also correct the assymetry. What else are gender markers on my nose that should be changed? The surgeon of course is no FFS surgeon...
Here is a picture:
Thank you

[NCAmazon]

From the pic it looks to be a fairly nice size. I would say have the bridge slightly narrowed and the tip elevated.The nostrils should not be narrowed or it will looked too pinched. Def do forehead with nose, to keep them in proportion.

[anjaq]

From the pic it looks to be a fairly nice size. I would say have the bridge slightly narrowed and the tip elevated.The nostrils should not be narrowed or it will looked too pinched. Def do forehead with nose, to keep them in proportion.

thanks, I think size is an issue and guessing the "bridge" is the part that makes the little bump in the upper third (?), it is what I intend to have done. What does it mean to elevate the tip? I will ask the surgeon about this however.
However I dont really have the option with this surgeon to do forehead stuff and nose as he is only a nose surgeon - plus I am scared to hell about the heavy FFS procedures so they are not on the table for now really until I get the impression that I really need them.
But what do you mean to have forehead and nose in proportion? Is there anything I can do to avoid things getting out of proportion later? I am not even sure what kind of forehead work would be done if I ever request this for real, so I do not know what parts of forehead changes do affect these proportion and if I would be getting those.

Thank you

[Celia0428]

Looking at your profile, it gives the impression that the upper stretch of the nose is at the same plane as the forehead. Then you will probably need to set back this part of the nose anyway at the same time of any forehead setback that you decide to get in the future, no matter if you get the rhinoplasty done now or not. But if you get a pretty tip now, I don't think  you will need to change it at all. Just my opinion.

[anjaq]

I think I begin to see what the issue is that you all are talking about when it comes to my forehead. I was always looking at this bulge that people often have and then get removed, but it is more that the whole part is rather shifted to the front. Sigh - dammit, I was hoping that it would look rather ok already. I will ask for the rhinoplasty mostly about the bridge (narrowing and correcting the bump) I guess, I am not sure what could or should be done with the tip???

>"set back this part of the nose anyway at the same time of any forehead setback that you decide to get in the future, no matter if you get the rhinoplasty done now or not."<<
Ok, so you are seconding the opinion that basically if I do get a rhinoplasty now and do a FFS later it would be in a way not be the best idea to get that rhinoplasty now. It is of course two things - one is that it costs money - like an additional some thousand Euros probably to do a rhinoplasty now and if that would be part of a later FFS it would be additional money spent - plus there would be two nose surgeries with injury, healing, risks and all of that instead of one. That is what I wanted to avoid, I was hoping to at least save the rhinoplasty part in any possible future FFS if I do the rhinoplasty now. This seems to be unlikely judging from your comments. sigh

[Celia0428]

Sorry Anjaq. I didn't mean to make you feel frustrated.
I am not a surgeon and I was judging based on a few cropped photos, so take what I wrote with a grain of salt and consult with some FFS surgeons about this.
Most FFS surgeons operate the upper segment of the nose from above, using the same incision that is used to access the frontal bone, as this upper segment of the nose is not reachable through the nostrils with the usual rhinoplasty techniques. So in case you now get the bump removed off the bridge and the tip of your nose done in a way that matches the future forehead reset (which would require some kind of clairvoyance or futurology talents from the rhinoplasty surgeon but is not impossible), then you might not need to redo the rhinoplasty work when you undergo the forehead surgery. It might be possible for the forehead surgeon to reduce the top of the nose from above in a way that matches the rhinoplasty of bridge and tip that was previously done from below. If the rails of the transcontinental railroad matched in one spot coming in opposite ways from the west and east coasts, approaching your nose from above and below in a seamless way shouldn't be impossible, as long as all the parts are calculated to fit into the right proportion. You won't have all the chances on your side, though.
The best thing to do, I think, is consulting with the FFS surgeon of your preference.

[anjaq]

Sorry Anjaq. I didn't mean to make you feel frustrated.
I am not a surgeon and I was judging based on a few cropped photos, so take what I wrote with a grain of salt and consult with some FFS surgeons about this.

Not your fault. I am getting frustrated anyways nowadays at 15 years working on my face.
Tell me what difference you see (also in respect of bones and bossing) here:

So in case you now get the bump removed off the bridge and the tip of your nose done in a way that matches the future forehead reset (which would require some kind of clairvoyance or futurology talents

No that is not what I want - if I was sure already to do a forehead work and thus know how it would change, I would let the same guy do the nose. The thing is however that I probably will not do it and still want to do the nose, but kind of was wondering if there are some things I can to so that it matches even IF I should get FFS later. It seems that there is no such way and one can have either rhinoplasty OR FFS that includes rhinoplasty. Well unless they can do that sort of matching you mentioned and compared it to railroads matching.

The best thing to do, I think, is consulting with the FFS surgeon of your preference.

The thing is I do not have one yet - and may not have. Because I think the chances are not that great that I would actually take that risk. And of course all of them I am ure will tell me to do both in one run with them and not get a rhino beforehand. Plus they will manage to sell me a FSS probably 😉

[Celia0428]

Tell me what difference you see (also in respect of bones and bossing) here:

What differences do I see? Not sure what your point is with this game, but I'll try to play it as well as I can 🙂 First of all, I must say that the crop is so tight that no feature is shown complete in the pictures and if I can't see the features to begin with I can hardly notice the differences between them. But let's make an attempt 
1. The skin is pinker in the bottom pic
2. The skin is softer in the bottom pic, like before and after hormones
3. The eyebrows are plucked
4. The eyebrows are lifted (can't tell if this was done with surgery, by pulling them up with the fingers, by making a "surprise" gesture, or just with photoshop). The one on the right side of the face seems to be overly high to my taste. In the absence of better points of reference I am using the freckles on the eyelid to calculate the height.
5. The double eyelids have been tighten up so they don't hang so much (can't tell if this was done through a dedicated surgery/digital retouch or is a consequence of lifting up the eyebrows)

These are the differences that I can spot

[anjaq]

Yeah, see, the game in the image is that the lower one is me about 13 years ago, the upper one is me now. This is making me mad as everyone I show this to says that basically it looks like these are pre/post pictures of HRT and/or FFS. So basically in these 13 years I had a reversal of these. My present theory and not an ill founded one at athat, is that I have just gotten a really bad and ineffective HRT which caused my face to reverse some of the feminization I had originally or even masculinized it to a degree. In the upper picture I actually do try to pull up the eyebrows a bit, but its not effective. In the upper picture it looks a bit like I need FFS which the lower (older) picture does not seem to show. This is what really annoys me - hwo dit it happen that 15 years into transition and HRT the face develops in a way that would benefit from FFS now, when that long time HRT should have stopped any such virilization...

But its unrelated to the nose thingy. I will go tomorrow to the surgeon and show him the explanations on the VFFS website as well as Dr Barts homepage and ask him about gender differences in the nose and about what could be done with my nose and  if there is a chance to combine this with the functional surgery... its just a consultation and after that I will need to decide - rhinoplasty now and no FFS in the future or both at the same time sometime in the future...

[Nicolette]

anjaq, this is normal ageing. This is not reversal of feminisation or ineffective HRT. I'm a similar age to you, but I've had a brow lift to counter what you're experiencing. No FFS required and cis-women go through the same process.

[anjaq]

I dunno - there is most definitely more bones now above my eyes than it used to be. The "openness" of my eyes declined. How can bones grow with just regular female aging? It is IMO a sign of a partially male type aging to develop more bones above the eyes. Some women have that too in the menopause I guess, but it still is virilization (and these women can also develop a bit of a beard - I dont want eather of it - esp not with not even 40)

[Nicolette]

Yes, the openness of your eyes has become less because skin sags with age. The skin on your forehead has become less elastic and has sagged causing the skin and brows to drop. It happens with cis-women all the time.

Now, bone is different matter. But you don't need bone growth to cause what I see in the photos. Ask any surgeon. Bone growth after a certain age is very unlikely. Do you feel more bone?

Wait, you've had SRS. Bone growth very unlikely.

[anjaq]

I think I feel the bone. Also the chin and jaw seems to have changed a bit in that time. A friend of mine who looks a lot into the biochemical side of HRT has told me that I probably got not enough Estradiol and definitely not enough Progesterone and too much Estron. This may cause some masculinization similar to what men get if they get older (the difference between a 23 year old transitioning and a 40 year old). i also got some hair loss above the temples that was not there before http://i.imgur.com/4dO2vuA.jpg 🔗 . I am changing that now and hope things get better, but still, I think this did not exactly go well over that time since I am post op. There are other symptoms as well but they are many and less unique though, like obesity, lack of drive to do anything, tiredness, ...
Anyways - a brow lift sounds like a good idea but I am not sure what this would entail. It it is a low risk procedure I might consider it...

[Nicolette]

The sagging around the brows may cause skin to bunch up and make your brow protrude more. A brow lift is a relatively low risk procedure. I've had two. One 17 years ago and one last year. I looked a bit grumpy before then.  I presume your E was in a good range over the last decade?

Oh yes, my brother said that the last brow lift made me go from looking German to Scandinavian. 

[anjaq]

My E2 was ok, but not great and I did have no Progesterone at all and too much Estron. So that was not that great. I also experienced a bunch of other effects like weight gain and migraines - google Estrogen dominance and you find some of the effects.

Anyways back on topic, I had the appointment today with the rhinoplasty specialist and basically he tried his best to talk me out of it. He said that my nose is quite delicate and in respect to my face quite small already, that I have a delicate tip and that basically making it much smaller would rather emphasize anything else in the face that is a bit bigger. He also looked at eyes and their distance and said that this is perceived ok. And finally he said the no one can do a perfect nose and there will always be some things we dont like about it. He also looked at the inside and said it looks better than 90% of his patients. So in the end he basically said that of course if I want to, I can do rhinoplasty, but his opinion is that it is not needed and maybe would not reach a result I would think it does. He took photos and put them into a program to simulate changes - saying that about th eonly thing he would change is the width of the bridge and he simulated that - taking away more on one side than on the other because I have some assymetry. I like that picture, but in fact it is not that much of a big change so I am not sure it is worth it. I will consider it again , but he said I should first loose my obesity and then reconsider as this is affecting my face a lot more at the moment. Yeah - so that is the result so far - I did not even have time to ask him about how it would do with FFS 😉

[Meshi]

I think you are overthinking all of this.  Your nose is already very feminine.  If you want or feel the need. Yes take care of that little bump and you could lessen the width of the nostrils a bit.  Dr Toby Meltzer is very good with this and not so expensive as some in Beverly Hills.  If you want to deal with the forehead then i would also use Dr O and also him for the nose.  It all depends on how much you want to do, but your face is good to go regardless. 

[anjaq]

Hi, Michelle

I think you are overthinking all of this.  Your nose is already very feminine.  If you want or feel the need. Yes take care of that little bump

Thats wht the surgeon said more or less...

If you want to deal with the forehead then i would also use Dr O and also him for the nose.

Right now I am not in for FFS. too scared an not sure if the improvements are worth the risk. It would probably be partly cosmetical or for my own self image and not all about "passing".

It all depends on how much you want to do, but your face is good to go regardless. 

Well, I am not sure I showed you full face photos but thank you for the confidence 😉

[Stephe]

I just wanted to add: I was thinking I needed a lot of facial surgery. But due to several factors, all I had done was my nose and I now have zero interest in having any more work done. Having my nose done + 2 years of HRT have feminized my face to well within what "normal" female should look like.  I feel some MTF over stress about brow bossing etc. If you look around at women in public, there is a wide range of characteristics. You might likely find, like I did, that changing your nose will be enough to make you happy with your appearance.

BTW the doctor I used was not on "the list" of FFS doctors but any decent plastic surgeon should understand the difference in male and female noses.

[Yasmine]

The surgeon of course is no FFS surgeon...
Here is a picture:
Thank you

Why no FFS surgeon anjaq?

[anjaq]

Why no FFS surgeon anjaq?

Well mostly because there are good Rhinoplasty surgeons in my vicinity that I could use, in part because I fear a bit that a FFS surgeon would tend to "sell" me more surgeries and I somehow got the impression that FFS surgeons charge more for the same surgeries because they have the label "FFS" on them.

For the moment this is off the table and into the drawer again. The Rhinoplasty surgeon here said I dont need Rhinoplasty, it would not make me look much mor feminine, he could not do much that would not look odd then in relation to the rest of the face. He could remove a little bump and assymetry but that would be a minute change and he would only do that if I really want to. So I guess I might consider this, but overll I got the impression that a full rhinoplasty may only make sense in the context of a FFS which I do not plan as of now. I may get a second opinion on that though.