Which FFS procedure helps with passing the most?

[antonia]

Exactly, I feel like many operators just don't get it, passing over an area at half strength twice is not the same as full strength once, you have to boil the hair root and totally kill all the follicle cells and heating a follicle up twice is not the same as boiling it once.

Whenever I see the topic of hair removal, I feel compelled to put my 2 cents in about laser. I was contacted by my endocrinologist, last year, because he was surprised with my hair removal results. The hospital, that is his employer, does perform hair removal for transgender patients but he had not seen similar results. He wanted to be able to give some advice to his other transgender patients since reduction of facial hair is one of the side effects of hormone therapy that patients usually desire.

[misty2]

Exactly, I feel like many operators just don't get it, passing over an area at half strength twice is not the same as full strength once, you have to boil the hair root and totally kill all the follicle cells and heating a follicle up twice is not the same as boiling it once.

Antonia, Great analogy! - Danielle

[Paula1]

Thank you Paula, you have certainly added a wealth of experience as well. Thank you.

You are welcome Danielle ... 

I do not know when you started your transition, but it is like a mountain sometimes, particularly for us who grew up before the internet.


I started in 1988 - a long time ago but also seems like yesterday

From a distance it looked like a mountain. But, a mountain that I could climb. Then, as I got closer the mountain kept getting bigger. When I got to its base it turned scary. But, I started climbing anyhow. After climbing for a few months, steadily, exhausted, I turned to look down. It was so extraordinary how far below the ground seemed. Then I looked up. I realized that I had only climbed a 1/10 of the way. And I was already exhausted! I didn't realize that I literally still had years to climb!

It is a long journey indeed. But what a trip eh? If I had to start again I would, despite all the problems with transition which in my case were virtually all caused by poor surgery.

As I look up, now, I can finally see the summit. But, I'm still not there! I think I still have at least 2 more years of climbing.

Me too

Kind Regards, Danielle

My very best wishes to you and I am sure both of us will keep strong despite any problems that we have had. We girls sure need to be as tough as cookies.

Hugs

Paula

[Jannicke]

Hello Danielle,

It was very interesting to read your story. Thanks a lot for sharing.

Having reaped what benefits I can from HRT I've finally decided to embark upon a journey through FFS that hopefully will result in a facial apperance more to my liking.
I decided intially that moving forward in steps, like you did, would suit my needs best.
Most important to me was beeing able to assess the progress and adjust the next  step according to that, and-like you did too-hoping to have reaced a satisfactory result before all the planned steps is completed. 
First step is the forehead and I have shortlisted Di Maggio, Dr Ousterhout and Bart vd Veen. I addition I will have to take a closer look on Facial Team.
At first I wanted to include Rhinoplasty in the first step, but your approach makes me want to reconsider. Who did you shortlist here, and where did you carry out the surgery?
Second(or third) step is lower part of the face and I haven't really started my ressearch here as I still haven't decided what I need to do.
Also interesting to read about your experiences with hair-removal by laser as I made use of the same approach. I had 4 treatments on the body and and a bit over 10 on the face-leaving me happy with the results. They were all carried out some 12-13 years ago.

Take care.

[Sybil]

I posted this in another thread, but I thought it would be useful here as well:

If passing to the general public is the concern, the human face is replete with signatures of sexual dimorphism. Their importance, in my opinion, is as follows:

Very strong indicators:
- brow bone prominence
- lower chin projection, chin length, square vs. rounded chin shape (viewed from the front)
- angle and depth of the nose
- vertical ratio of facial thirds; from the hairline to the eyebrows, from the eyes to the lower nose, lower nose to chin
- upper eyelid exposure (covered / not covered by brow bone and its soft tissues)

Strong indicators:
- anterior cheek bone projection
- upper and lower lip ratio, upper lip curl
- hairline shape
- overall nose size
- jaw width

Mild indicators:
- cheek fullness
- angle of jaw line
- lip fullness
- length of the philtrum (the area between the upper lip and bottom of nose)
- lateral cheekbone projection

Very mild indicators:
- canthal tilt (the angle between the fleshy inner and outer bits of the eye)
- cheekbone height

There are indeed women who carry a lot of masculine facial traits and men who, likewise, carry many feminine traits. The reason that humans maintain a strong ability to tell one another apart is because these differences are often measured in millimeters and depend on how they relate to the rest of the face. For example, a woman with a strong brow bone is often either older or has considerable upper eyelid show. She is also likely to inhabit many other female-range features (like a sweeping nose angle and shallow upper nasal depth). A man with a petite, dainty nose likely still has strong nasal depth, modest upper eyelid show, and a facial ratio that favors the middle and lower thirds. He could also have masculine lower chin projection. The list goes on.

Whether or not a trans woman "needs" FFS to pass depends on how all of her facial features relate to one another. Even one well-established masculine feature can throw off the rest, especially if it is a feature that is strongly associated with sexual dimorphism.

As an aside, facial thirds cannot be manipulated by medicine that is practiced by the vast majority of surgeons (and certainly not any FFS surgeons, that I'm aware of). The techniques currently available to move these bits are fairly risky, often produce ample scarring, and are almost entirely reserved for people disfigured by genetic abnormalities. However, someone with masculine thirds (especially a very long midface) can still easily pass as long as their remaining features are feminine, hence there are few people that skilled FFS cannot help.

I also want to add that getting forehead work done without a rhinoplasty can be tricky business. These two parts of the face are very closely integrated with one another. However, I suppose it would be possible to get a forehead reconstruction done and adjust the bridge of the nose accordingly, leaving the rest of the features alone for a future surgeon. I think the result could potentially be very odd in the interim, though.

I also want to add to my list that the philtrum can be a very strong indicator if it is exceptionally long and has prominent anterior projection (i.e. lack of lip curl).

I hope this helps you. Best of luck on your FFS journey.

[misty2]

Hello Danielle,

It was very interesting to read your story. Thanks a lot for sharing.

Having reaped what benefits I can from HRT I've finally decided to embark upon a journey through FFS that hopefully will result in a facial apperance more to my liking.
I decided intially that moving forward in steps, like you did, would suit my needs best.
Most important to me was beeing able to assess the progress and adjust the next  step according to that, and-like you did too-hoping to have reaced a satisfactory result before all the planned steps is completed. 
First step is the forehead and I have shortlisted Di Maggio, Dr Ousterhout and Bart vd Veen. I addition I will have to take a closer look on Facial Team.
At first I wanted to include Rhinoplasty in the first step, but your approach makes me want to reconsider. Who did you shortlist here, and where did you carry out the surgery?
Second(or third) step is lower part of the face and I haven't really started my ressearch here as I still haven't decided what I need to do.
Also interesting to read about your experiences with hair-removal by laser as I made use of the same approach. I had 4 treatments on the body and and a bit over 10 on the face-leaving me happy with the results. They were all carried out some 12-13 years ago.

Take care.

Hi Jannicke,

Thank you so much for writing. Do you have any photos... particularly profile, posted anywhere? - Danielle 

[misty2]

I posted this in another thread, but I thought it would be useful here as well:I also want to add that getting forehead work done without a rhinoplasty can be tricky business. These two parts of the face are very closely integrated with one another. However, I suppose it would be possible to get a forehead reconstruction done and adjust the bridge of the nose accordingly, leaving the rest of the features alone for a future surgeon. I think the result could potentially be very odd in the interim, though.

I also want to add to my list that the philtrum can be a very strong indicator if it is exceptionally long and has prominent anterior projection (i.e. lack of lip curl).

I hope this helps you. Best of luck on your FFS journey.

What a great post, thank you. One think I might add to the "strong" category  is upper tooth show. Almost all women have upper tooth show when the mouth is in repose, but open. Kind Regards, Danielle

[Paula1]

Hi Danielle,

Could not agree with you more about the teeth.

After my Zukowski upper lip lift, he then put fat in the top lip that negated the effect of the lift so that I really need another one. This I will be discussing with the Facial Team when they are in London next month.

A friend of mine in the USA who hated her fat filled top lip had him try to remove the fat by cutting it out in April 2013 but she is still very unhappy with it's appearance. She is currently looking elsewhere to get more removed. 

In fact another friend of mine who was having revisions done by him insisted that he did not top up the fat in her top lip but he went ahead anyway and she was furious.

All this fat does is make the top lip longer (also fatter) and is another marker ( like the similar short nose and over raised eyebrows ) that you are a 'Z' girl which I really dislike and as a result don't often like mixing with some of my 'Z' friends in public because we look like relatives.

When I look at my Pre FFS fotos. I used to have a longer nose without the slight piggy look it has now and my top lip also looked shorter than it does now because of my natural born aesthetics !!!! An Upper Lip Lift with no fat and a far better rhinoplasty would have been desirable.

I am so upset that I am going to have to spend more money to improve my appearance. Whether my nose can be improved is going to be a real challenge and maybe I will just have to live with it. It's sad that I wake up each morning regretting my Zukowski FFS and having to go thru that major forehead revision last October here in the UK was indeed quite hard to say the very least.

If my nose can't be altered, then another upper lip lift and, if possible, fat removal will make the whole area look better.

But at least my forehead has been sorted so I am getting there which is awesome ...  so I must remain positive.

   

What a great post, thank you. One think I might add to the "strong" category  is upper tooth show. Almost all women have upper tooth show when the mouth is in repose, but open. Kind Regards, Danielle

[Jannicke]

Hello again Danielle,

I don't seem to be allowed yet to include photos in my profile.
Weather you wish to answer my questions or not it's entirely up to you. I',m here just looking for information and, occassionally, to give some information to whoever might be interested.

[Sybil]

What a great post, thank you. One think I might add to the "strong" category  is upper tooth show. Almost all women have upper tooth show when the mouth is in repose, but open. Kind Regards, Danielle

Thank you, I appreciate that. I do agree that upper tooth show could be added to the "strong" category, though it is age dependent. Upper tooth show is a very strong indicator of age (in men, too), and older women begin to lose their tooth exposure as life continues on. I really should add this to any future iterations of the list.

It is also considered a masculine trait to have considerable lower tooth show -- mind you, unlike with women, this is not exclusive to also having upper tooth show. I think this is important to keep in mind when smiling (and possibly even speaking), as either gender seems a bit conditioned to use different facial muscles to express a smile and exaggerate this effect. That is to say, men use mid/lower facial muscles for an even-toothed exposure, while women use upper facial muscles for greater upper tooth exposure and lower tooth concealment.

For anyone wondering how FFS would expose your upper teeth, it is a side effect of a lip lift. A lip lift removes a section of the philtrum in order to shorten the philtrum's length, create a lip curl, and roll out the upper lip so that it is more prominent. The shorter philtrum length and heightened, centrally angled vermillion border create more tooth exposure.

[Obfuskatie]

This was my ranking of forehead surgeons two years ago:

1.       DiMaggio
2.       Facial Team
3.       Ousterhout
4.       Suporn
5.       Bart
6.       Spiegel

...

Time: I have spent a lot more time: swollen, bruised, debilitated and traveling. I am tired of it. It would've been nice to have one surgery (if it had only been one surgery) and just be done with it. It would be nice to be able to get onto the next phase of my life. If people ask me what I've been doing with my life recently: the answer I tell them is working on my stand-up comedy. But, in reality the biggest part of my life is been working on transition, my divorce, (which my wife blames on me having surgery) and healing.

...

Before I did my FFS, I made sure to read Dr. Ousterhout's book, which is available on ebook-form on Amazon.  Unfortunately, Dr. O doesn't perform surgeries anymore, he is now consulting with and assisting Dr. Jordan Deschamps-Braly in San Francisco in a joint practice for their FFS patients.  I ended up choosing them for my FFS, and am quite happy with the results so far, although I'm barely a month and a half into my recovery.  Also, doing all my procedures at once really kicked my butt, and it has been a really hard recovery so far.  Price-wise, I spent nearly 50k total, including hospital fees, anesthesiologist, and a room for a week at a hotel near my doctor's office.  The procedures i had done were; trache shave, a small amount of fat removal from my neck, chin, nose, forehead contouring, and a scalp advancement.

I'd say the most important procedure to do first is the one you feel most insecure about.  Forehead/Nose, Scalp Advancement, Lips, Chin, Jaw Contouring, whatever you like least about your face, do that procedure first.

Just know that paying for the anesthesiologist and hospital visit each procedure, will cost a lot.

[misty2]

Before I did my FFS, I made sure to read Dr. Ousterhout's book, which is available on ebook-form on Amazon.  Unfortunately, Dr. O doesn't perform surgeries anymore, he is now consulting with and assisting Dr. Jordan Deschamps-Braly in San Francisco in a joint practice for their FFS patients.  I ended up choosing them for my FFS, and am quite happy with the results so far, although I'm barely a month and a half into my recovery.  Also, doing all my procedures at once really kicked my butt, and it has been a really hard recovery so far.  Price-wise, I spent nearly 50k total, including hospital fees, anesthesiologist, and a room for a week at a hotel near my doctor's office.  The procedures i had done were; trache shave, a small amount of fat removal from my neck, chin, nose, forehead contouring, and a scalp advancement.

I'd say the most important procedure to do first is the one you feel most insecure about.  Forehead/Nose, Scalp Advancement, Lips, Chin, Jaw Contouring, whatever you like least about your face, do that procedure first.

Just know that paying for the anesthesiologist and hospital visit each procedure, will cost a lot.

I think you are correct about everything you have written here. And, post op or not, your avatar is beautiful. - Kind Regards, Danielle

[misty2]

Hello again Danielle,

I don't seem to be allowed yet to include photos in my profile.
Weather you wish to answer my questions or not it's entirely up to you. I',m here just looking for information and, occassionally, to give some information to whoever might be interested.

Hi Jannicke,

I only wanted to see a photo to see if a FFS surgeon could do your nose. I trust FFS surgeons more with less complicated noses. For my nose I went to a surgeon in Minnesota. I do not mind sharing his name, if you really want it, just ask again. However, I think the surgeon you chose depends a great deal on your "before" nose. Look at many before and after photos and look for your nose (if possible) in the "before"... then do you like the "after" versions? Hopefully there are some surgeon comments along with the before and after of your nose. Those will give a great idea what the patient requested... such as, "I do not want much change, keep it similar to my existing nose. just take out the hump" or simply, "make me beautiful!" the patient requests are an important factor. Finally, visit a lot of rhinoplasty surgeons. I am sure there are at least 10 within 100 miles of you. Visit all ten! You will learn something every time. This seemed like your only question, if not please follow up with more details.

Kind Regards, Danielle

[Obfuskatie]

I think you are correct about everything you have written here. And, post op or not, your avatar is beautiful. - Kind Regards, Danielle

Aww, thank you Danielle!

And to the OP: be careful about getting your nose done by a doctor unfamiliar with FFS.  Make sure you clearly inform them you want to make your face look more feminine and bring examples of what you'd like, then listen to their input to see what they think would be the best course of action. They are the expert opinion you need most of all.  And if you feel like they are merely trying to sell you any new nose, get out of there and find a Rhinoplasty surgeon who cares more about patient satisfaction than money.


Sent from my iPad using Tapatalk

[misty2]

Aww, thank you Danielle!

And to the OP: be careful about getting your nose done by a doctor unfamiliar with FFS.  Make sure you clearly inform them you want to make your face look more feminine and bring examples of what you'd like, then listen to their input to see what they think would be the best course of action. They are the expert opinion you need most of all.  And if you feel like they are merely trying to sell you any new nose, get out of there and find a Rhinoplasty surgeon who cares more about patient satisfaction than money.


Sent from my iPad using Tapatalk

Absolutely, make it clear you want a feminine nose. It is important to know about "Nasolabial Angle" & "angle of rotation" (106 degrees is a good target, but results are individual.) Supra-tip break. (I like it, but also an individual choice.) Alar show... and so many other terms. Visiting a good rhino website, (this is a good basic site... but there are many: http://www.drhilinski.com/rhinoplasty-tutorial/nasal-analysis-in-rhinoplasty/)

Visiting a surgeon, then back to an instructional website, then back to a surgeon. Then visit a different surgeon... Learning the terms and how to describe in Doctor terms what you want is critical. Communication is difficult and important.

The first few times visiting I was nervous and hardly remembered anything. Another reason to visit many doctors and be patient before being a patient. (sorry, had to make that corny joke.)

Kind Regards, Danielle