Cardenas revision

[jgirl76]

I had full facial feminization surgery with Dr. Cardenas last May 2014 (1 year post op photos BELOW) -  I plan to travel back to Guadalajara this June for a post surgery follow-up and revision surgery consultation.

I had:

Forehead contouring type I
Rhinoplasty
Jaw/Chin contouring
Trach shave
Fat infiltration to the lips
Chin lipo

Cost =  Approximately 16,000  (at the time)

I was one of the first patients to have surgery in the new Innovare hospital. The facilities were great and the hospital staff were very attentive and the care I received was superb. I ended up staying an extra night, I didn't want to leave!

My thoughts about the surgery? Overall it was an improvement but not the level of feminization that I was hoping for.

Forehead -

The type I procedure did improve my profile although there is still residual brow bossing. It wasn't readily apparent shortly after surgery when my forehead was still swollen, but once the swelling receded the bossing reappeared.  One generally wouldn't notice it in pictures with bright lighting that tends to smooth/blurs everything out, but in other light it is readily noticeable. I will include photos showing this. I also have temporal hollowing which I think could have been addressed, perhaps with some fat grafting?

Eyebrows -

My eyebrows have a nice arch but I would prefer them to appear more "straight across" my forehead like in most genetic females. I think this could have been achieved if we had done a type III procedure? Too much frontal sinus bone in the way? I'm not sure.

Nose:  I have a very roman nose typical of my family heritage (Italian/Eastern European) and I did request that we go conservative on the rhinoplasty. My nose is improved but it could be more narrow (the tip could also be refined) and I would like to take a little more of the hump/projection out.  At the end of the day I DO NOT fault Dr. Cardenas as I had requested that he take a conservative approach to this area of my face, although I think we could afford to do a little more.

Chin/Jaw -

My chin was GREATLY improved, it is definitely more v-shaped than before, although none of the jaw flaring in the masseter area was reduced.  The result is a lower face that although refined, still appears rather boxy and square.   I will probably always have a stronger jaw than most women (which I expect) but I think it could be a "bit" softer - Some people feel a square jaw is very "modelesque" but I'm not a model... and as I begin to age (on approach to 40) I think it looks too masculine and won't necessarily carry over well through the rest of my life? I don't want to "chop it all away" but I do think we could afford to soften it a bit more.

Trachea - 

Beautiful job! Dr. Cardenas was able to remove it all without any damage to my vocal chords - My voice is one of my best assets so this was a HUGE concern for me. I do have a little scar but perhaps a little Fraxel laser will help it? For now I just cover it with some makeup and nobody notices.

Lips (fat infiltration) -

The fat grafting didn't last, not sure I would do this again. We did this procedure in lieu of an upper lip lift, although in hindsight I think shortening the distance between my nose and upper lip would have been a good thing. Potential scarring and loss of feeling scared me away initially, but I'm open to re-visiting the idea of this prodcedure.

Chin lipo -

I think the results were good, although naturally some fat has redeposited here... I probably just need to call it a day and put my fork down  

Cheeks -

We didn't do anything to my cheeks but I wonder if some fat infiltration to the cheeks would have been nice. I would also consider implants but they scare me a little. Perhaps my fear of them is unwarranted?

So overall my surgery was an improvement but I would like to a achieve a more v-shaped/round face (not as square) refine my nose and get rid of the residual brow bossing with the type III procedure. I was open to doing the type III procedure from the beginning but Dr. C decided it was unnecessary at the time of surgery, although I don't feel that was the right decision.

With that said I do feel that I've been able to communicate my concerns to to Dr. Cardenas without any risk of judgement. I feel Dr. Cardenas to be a kind and caring surgeon who is open and willing to discuss my results and my concerns and I look forward to speaking with him soon face-to-face.

I will keep everyone posted.

[jgirl76]

More one year post op photos, one can see the residual brow bossing on the right side, jaw flaring, nose projection (too much projection).   

[jgirl76]

PRE Operative photos (sent to Dr. Cardenas)

[kittenpower]

I agree with your evaluation, but I would like to say that you are really pretty, you look very female, and he did do a really good job on your chin; it's perfect. 

[jgirl76]

Thank you, Kitten. I appreciate your acknowledging my concerns while at the same time pointing out the positive. Appreciate the feedback!

[ArielAce]

I tend to agree overall with your assessment. I am seeing Cardenas on July 1 and insisting on type 3. It seems to me that type 3 nearly always gives a better result. I think you did get good results overall, but I can see why you'd want a revision for the forehead. It seems to me you could definitely get a better result there.

As far as your eyebrows, I just wanted to mention, many cis females do have very arched eyebrows, probably equally as many do as the straight across. I do not think yours look unnatural. It really is a matter of personal preference and if you prefer them straight then you should make them straight.

I think you look really quite beautiful and model like with your hair down. I hope you get the result you are looking for on your second visit. <3

[jgirl76]

Great, Ariel! Please let everyone know how it goes for you! And as always appreciate before and after photos showing  profile. There is still some contention as to "how skilled" Dr. Cardenas is with type III.

I've not yet decided that I will actuall go to Dr. Cardenas for the revision surgery. That will depend in part on my meeting with him, what he has to say and if he can readily accept that mistakes that were made, and more importantly that he can fix these issues with confidence. I also don't expect to be charged for any subsequent procedures that are required to deliver the results that I should have gotten when I laid down my money last year. I would pay for anesthesia and the hospital of course, but nothing beyond that.

We'll see....

[lovelessheart]

Great, Ariel! Please let everyone know how it goes for you! And as always appreciate before and after photos showing  profile. There is still some contention as to "how skilled" Dr. Cardenas is with type III.

I've not yet decided that I will actuall go to Dr. Cardenas for the revision surgery. That will depend in part on my meeting with him, what he has to say and if he can readily accept that mistakes that were made, and more importantly that he can fix these issues with confidence. I also don't expect to be charged for any subsequent procedures that are required to deliver the results that I should have gotten when I laid down my money last year. I would pay for anesthesia and the hospital of course, but nothing beyond that.

We'll see....

Hey i understand what you mean! I went to dr carsenas in june last year... He did do a good job on my forehead it is an improvement, but i feel like he could have smoothed it out a little better. Also..my nose is okay.. I would prefer the radex to be lower than it is and also my nostrils are different shapes. I want to go back for jaw or chin shaving.. But im afraid he wont be agressive enough. I dont have time to play russian roulette with my money.

[jgirl76]

Perhaps instead of paying for a plane ticket back to Guadalajara I should fly to Buenos Aires instead and consult with Rossi and DiMaggio. 

I paid Dr. Cardenas already and there is a "part of me" that doesn't want to pay for another full FFS...  My hope is that Dr. C would correct what is wrong, but the MORE I think about.... the MORE I'm unsure that he has the right level of skill for the job. I do think he is a good surgeon for some girls, and that he is a kind and good man, as aformentioned, but that doesn't necessarily equate to good results. The MORE I think about it, I will only get ONE MORE shot at this... I need someone to do it right, and I'm not 100% confident in his ability so I should just call a spade a spade and resolve to going elsewhere...

[shedevilcanada]

just for your info Jgirl, Dr Mdm will do consultation in NyC this september

[ArielAce]

Great, Ariel! Please let everyone know how it goes for you! And as always appreciate before and after photos showing  profile. There is still some contention as to "how skilled" Dr. Cardenas is with type III.

I've not yet decided that I will actuall go to Dr. Cardenas for the revision surgery. That will depend in part on my meeting with him, what he has to say and if he can readily accept that mistakes that were made, and more importantly that he can fix these issues with confidence. I also don't expect to be charged for any subsequent procedures that are required to deliver the results that I should have gotten when I laid down my money last year. I would pay for anesthesia and the hospital of course, but nothing beyond that.

We'll see....

I will definitely be posting detailed before/after photos and I hope that may help with your decision. My surgery is a month away. I realize there is not a lot of type 3s out there (the only one I've seen is Roni) so hopefully it will be helpful to people.

All this talk about him makes me a bit nervous but seeing as I've already paid the deposit, this is happening one way or another. I just hope for the best!

[jgirl76]

I'm sure because you are having type III you will be better off than I was. Do not get me wrong, I don't think Dr. Cardenas is not a good surgeon, HE IS, when he does the right procedures. Roni did get EXCELLENT results from him, and my results weren't "terrible" they just weren't optimal. For me because I only have one more shot at this, my confidence is blown because he didn't do the right thing the 1st time, however, that isn't to say he won't do the right thing by you. I have trust you'll be in good hands

[Jennygirl]

I see what you mean about the residual brow bossing as well. Seems like he might have even been a bit conservative with the Type I approach, but I know it also varies greatly by patient how much they are able to take off. My forehead is completely flat after Type I with Dr. Mayer in Beverly Hills. And yeah, Roni looks fan-freaking-tastic.

I second getting a consult from DiMaggio. I've seen some incredible Type III results from him!

Goes without saying that you already look fantastic, but also I don't think what you want to do would be seen as "going too far". Best of luck to you with your choice of surgeon and following procedure(s)!

[RubyAliza]

Hi Jgirl,

     I almost went to Cardenas too; actually it was your thread initially that convinced me to go to Dr. Rossi instead. I most likely won't be able to afford a revision, much less want that kind of pain again, so I'm going to someone who can do it right the first time (hopefully). Dimaggio is great too, more expensive. Either way, you can't go wrong.

    I just don't understand why he would not do a Type III. He was just plain wrong. I think you're beautiful, but you needed a type III like 95% of the trans women out there.

Hi Jennygirl - you are certainly one of those lucky 5% cause you're forehead looks incredible with only the type 1.

[Jennygirl]

Hi Jennygirl - you are certainly one of those lucky 5% cause you're forehead looks incredible with only the type 1.

Thank you Ruby! It's important to have realistic expectations with any procedure, and I did. I still have a bit of overhang at the orbitals and over the nose, but the forehead is indeed flat across the front which is what mattered to me. With Jgirl, I see what she is talking about. The "bossing" bumps towards the middle on either side of her nose along the brow are still somewhat prevalent- as if Cardenas took a very mild approach to it (or perhaps the frontal sinus bone there was very thin).

And FWIW, Ousterhout told me I would most definitely need Type III/IV and that I should never trust a doctor who just wanted to do a Type I based on my measurements. He was probably technically right about it for being perfectly within female spec from his research- because my forehead does slightly protrude forward more than average for a female... but whatever- looks in range to me. I'm floored with my overall result from Type I and I'm glad I stuck with the conservative approach.

Thank you again for the kind words

[RubyAliza]

just being on honest Jennygirl. Dr. Mayer did an incredible job.  I recently read Dr. Ousterhout's book and remember when talked about the female measurement ranges and all that. He's a bit of a perfectionist I would say, but on balance, I would never mistake you for anything other than a cute girl.


And I think Cardenas did a pretty good job with your chin and nose, jgirl. He was conservative like you asked him to be, but you look like a model already - I love that last picture of you looking down. Those eyebrows are gorgeous Anyhow check out my thread for Dr. Rossi's work or Charlotte 15's thread for Dr. Dimaggio's work. But I"m optimistic that Dr. Cardenas will do the revision with only the operating room and anesthesia fees. It's the least he could do for his reputation, which is incredibly important for these people.

For the hollowed temporals, I'm thinking if the fat graft on the lips didn't work, maybe your body won't accept the grafts up there too. Not sure if you need it at all. But there is actually a better technique that Dr. Ousterhout developed with solid implants for that anyways. There are a lot of techniques he developed that few other surgeons use unfortunately. Check out the book I mentioned about on FFS - he even has a technique where he uses dermal grafts from the extra skin from the forehead for a permanent lip fillers. He was a genius - too bad he was crazy expensive and is now retired.

[jgirl76]

just for your info Jgirl, Dr Mdm will do consultation in NyC this september

Thanks for the information... I want to consult with both MDM and Rossi so I'll fly to Buenos... and make small vacay out of it probably  

[jgirl76]

Hi Jgirl,

     I almost went to Cardenas too; actually it was your thread initially that convinced me to go to Dr. Rossi instead. I most likely won't be able to afford a revision, much less want that kind of pain again, so I'm going to someone who can do it right the first time (hopefully). Dimaggio is great too, more expensive. Either way, you can't go wrong.

    I just don't understand why he would not do a Type III. He was just plain wrong. I think you're beautiful, but you needed a type III like 95% of the trans women out there.

Hi Jennygirl - you are certainly one of those lucky 5% cause you're forehead looks incredible with only the type 1.

Thanks so much for the compliment. Yup! I needed type III... FOR SURE. I'm glad I could help you make your decision. I know Dr Cardenas has done type III for others, but I still think his skill in that area is in question. Without a doubt the Argentinian surgeons do so many of them that they really are the subject matter experts.

[jgirl76]

just being on honest Jennygirl. Dr. Mayer did an incredible job.  I recently read Dr. Ousterhout's book and remember when talked about the female measurement ranges and all that. He's a bit of a perfectionist I would say, but on balance, I would never mistake you for anything other than a cute girl.


And I think Cardenas did a pretty good job with your chin and nose, jgirl. He was conservative like you asked him to be, but you look like a model already - I love that last picture of you looking down. Those eyebrows are gorgeous Anyhow check out my thread for Dr. Rossi's work or Charlotte 15's thread for Dr. Dimaggio's work. But I"m optimistic that Dr. Cardenas will do the revision with only the operating room and anesthesia fees. It's the least he could do for his reputation, which is incredibly important for these people.

For the hollowed temporals, I'm thinking if the fat graft on the lips didn't work, maybe your body won't accept the grafts up there too. Not sure if you need it at all. But there is actually a better technique that Dr. Ousterhout developed with solid implants for that anyways. There are a lot of techniques he developed that few other surgeons use unfortunately. Check out the book I mentioned about on FFS - he even has a technique where he uses dermal grafts from the extra skin from the forehead for a permanent lip fillers. He was a genius - too bad he was crazy expensive and is now retired.

I could never afford Dr. O... it just wasn't ever going to be feasible, and as you pointed out he is retired now so... even if I could afford it... it's not an options   I agree the fat grafts may not be long lasting, but perhaps in that area (temples) they would last longer? I'd be willing to try it...  Also I'm sure Cardenas would be open to doing the surgery at no charge BUT I need to be confident he would do it the right way, not just use some bone cement to smooth things etc. At the end of the day I need someone who I can trust will do the type III and do it WELL. So there ya go!

[Jennygirl]

I could never afford Dr. O... it just wasn't ever going to be feasible, and as you pointed out he is retired now so... even if I could afford it... it's not an options   I agree the fat grafts may not be long lasting, but perhaps in that area (temples) they would last longer? I'd be willing to try it...  Also I'm sure Cardenas would be open to doing the surgery at no charge BUT I need to be confident he would do it the right way, not just use some bone cement to smooth things etc. At the end of the day I need someone who I can trust will do the type III and do it WELL. So there ya go!

Yes I know exactly what you mean. The one I have seen over and over give good results is DiMaggio. If I thought I needed type III, I most likely would have gone with him based on the recommendation of other members here alone. Some really dramatic and beautiful results.