Before people read the whole report I just want to say that Alexandra has been incredibly helpful, insightful and I 100% recommend her services. She is awesome and her work speaks for herself.
Hello Antonia.
Please remember that these virtuals are not and could not be 100% accurate but I hope they will give you a good idea of the possibilities and take you a long way towards planning how best to proceed.
Also remember that just like a surgeon, I am fallible and although I take quite an obsessive amount of care over virtuals, I will inevitably make a mistake every so often.
Working from photographs is not the same as seeing the person in real life. Camera lenses can affect the facial proportions to some extent and the lighting in a photograph can also affect how a face looks. So, a face or feature that looks masculine in a photo might not look quite as masculine in real life or might not be quite as important if the person has a very feminine presence about them.
Facial surgery is not an exact science and while I can control the changes I make in Photoshop completely, a surgeon may not be able to control things with quite so much precision in real life.
The eye takes a little while to tune-in to facial changes so you may be disappointed at first glance. It is best to spend a few days getting used to the pictures before you make any decisions and it is important to imagine the face in a more feminine context with a little make-up and female hairstyle.
I have created 4 different versions of your pictures (a) to (d) adding extra procedures for each version. Here is a list of changes in each version:
(a) Shows hairline corner correction, brow bossing removal, hormonal effects and beard removal.
(b) Includes rhinoplasty.
(c) Includes chin reduction and rounding.
(d) Includes a lip lift.
Hairline height:
The height of your hairline in the middle is a little lower than average for a woman. I don't think this is a problem for you but I recommend that you do not bring it any further forwards. Many surgeons do not realise that a low hairline is masculine and routinely lower hairlines for transwomen. If you have forehead surgery with the incision over the top of the head (this hides the scar under your hair) it would have the effect of raising your hairline slightly. This is not a problem for you - a slight raise would be technically a touch more feminine. I have simulated the effect.
Hairline shape:
Your hairline has corners that give it the masculine "M" shape. I have filled in the corners to give it a more rounded and feminine shape and this can be achieved with hair transplants. Some surgeons try to fix the corners with a scalp advance but it is questionable whether this works. Hair transplants look more natural than a scalp advance and you don't end up with a scar along the hairline.
Forehead:
You have quite strong brow bossing both in the centre above your nose and above your eyes. I have removed this to bring your forehead into normal female ranges. I generally recommend that people find a surgeon who can do a forehead reconstruction which sets the bone itself back a little. The other method, where the bone is only ground down, can be very limited as many people have quite thin bone here.
Eyebrow height:
Your eyebrows sit in a medium, or possibly slightly higher than medium position and I do not think you need a brow lift. They are likely to lift a little with forehead surgery and I have simulated that but I do not think you need any additional lift.
Eyebrow shape:
Your eyebrows are very nicely shaped. I don't recommend any changes.
Eyes:
I don't see any problems with your eyes or the soft tissues around them.
Nose:
Your nose is nicely symmetrical but it is a touch large overall. I have lowered the bridge to reduce the overall size and I have also reduced the tip very slightly to balance with the smaller overall size. The base of your nose has a very feminine upwards angle, as seen from the side, so you don't need to increase that.
Nostrils:
The width and height of your nostrils is fine. You do not need to make any adjustments.
Cheek bones:
I don't think you have any cheekbone problems but it is difficult to tell for sure before the hormones have had their effect (see below).
Apple of the cheeks:
The apple of your cheeks (the soft part) is a bit hollow. This area will become fuller and rounder on hormones and I have simulated this for you. It is impossible to predict exactly how the hormones will affect you (everyone's different) but I've given you an idea of the kind of change you can expect. I suspect that the hormonal effect is all you will need here and that you will not need to consider cheek implants. Feel free to send me some pictures when you have been on hormones for a year or so and I will give you a free opinion on it.
Upper lip to nose distance:
The distance between your top lip and the base of your nose is about right so technically you do not need a lip lift. However, it looks like you might not show much of your upper teeth when your mouth is open. Try looking in the mirror and counting to ten to see how much of your upper teeth you show. If you don't show the teeth then a lip lift might be useful. It might still be useful even if you do show your teeth.
I have simulated a lip lift on you and it does look nice. However, one thing to bear in mind is that a lip lift leaves a small scar at the bas of the nose and because of the upwards angle of the base of your nose, the scar could be more visible on you than it would be for some people.
The lip to nose distance is one of the most difficult areas to judge from pictures as you can probably tell from what I have written. To sum up, I would say that a lip lift is probably not essential for you but it might look quite nice and have a feminising effect anyway as long as the scar is not too visible.
Lip fullness:
Your lips are full and feminine and have a very nice shape. I don't think you need to consider any filling.
Chin height and shape:
Your chin is just a little taller than average and has a slightly square shape. I have rounded it and I have reduced the height slightly. It is difficult to say whether the change is worth the trauma and risks of surgery - the effect looks relatively subtle to me.
Chin projection:
Your chin projection is good so you do not need to move it forwards or backwards.
Jaw:
Your jaw is within normal female ranges at the back but I think chin surgery would have to reach some of the way into the mid-jaw area. Hormones tend to narrow the jaw a little - they don't alter the bones but they do reduce muscle mass and if this affects the chewing muscles it can effectively narrow the jaw a little at the back. I have accounted for this in the pictures but it doesn't look like your chewing muscles are particularly big so I suspect the effect will be quite subtle.
Adam's apple:
I don't see an adam's apple problem in these pictures.
Hormones:
I have simulated hormonal effects for you - mainly filling the cheeks but they add layer of fat that rounds off your features and they make the skin texture itself softer and more feminine. These changes can be very powerful, especially when combined with beard removal.
Beard:
I have reduced your beard shadow for you and this can be achieved with electrolysis and/or laser. People have mixed results with laser but there are many different types. I had great success with a system called "Lightsheer Diode". It was extremely painful but very effective.
Priorities:
Surgically, by far your biggest priority is the brow bossing so if you only have one procedure done - that is the one to do. The nose and hairline corners would probably come next. The other surgeries are probably more optional. However, the non surgical changes from hormones and beard removal will make a huge difference so don't underestimate them.
You have a very attractive face and I think you will retain this through FFS.
A good way to view your pictures is to lay the before and after shots side by side and keep looking from one to the other or placing one print on top of the other and quickly flicking between them. However, if you have a way to overlay them on your computer and click between them, that is ideal. For example: if you have "Photoshop" or "Photoshop Elements" you can load up a before and after picture at the same time and then by holding down "Ctrl" and pressing "F6" you can flick between the two. This often works for other photo software too. Alternatively, if you have "Word" or "Open Office Writer" you can open a new document, click on "insert", choose "picture from file" browse to your before shot and insert it. Without making any adjustments open another new document and do the same thing again but this time with the after shot. You should have 2 tabs at the bottom of the screen – one for each document. If you click on one and then the other you should see the picture change from before to after.
I have improved the photographic qualities of your pictures (contrast, focus, colour balance etc.) so I am sending you copies of the before shots with the same improvements to make them easier to compare with the after shots.
The pictures are yours so feel free to share them and the assessment with any support groups you are member of if you want some second opinions. Do take prints to your consultations with surgeons or email them in advance - most surgeons welcome them.
Please email me to confirm that the pictures have arrived. If you have any questions about your pictures and your assessment please feel free to email me.
Let me know if you want any surgeon recommendations.
You can find out more about facial gender and FFS by reading through my website.
The changes described in this assessment and illustrated in the pictures represent my opinion as an artist. You and/or your surgeon/s may disagree with my opinions. I cannot guarantee that my opinion is good or that the pictures are accurate so if you act according to my opinion, you do so at your own risk.
Thank you very much for entrusting me with your virtual FFS - I very much hope the pictures are helpful.
Good luck and best wishes,
Alexandra.
