Best US FFS Doctors?

[myfairlady49]

On Facial Team's website it says that both of the surgeons completed fellowships sin craniofacial surgery but I am not sure what that means, and how skilled they are compared to someone who went immediately into a craniofacial surgery residency through a med school track.  It seems both of them went through maxillo-facial tracks with more dental focus and then got a fellowship in craniofacial surgery later on.  I suppose the question I am interested in is the strength of these "fellowships" that the various surgeons participated in.  Looking at Deschamps-Braly, he went through the general surgery tract, then got a fellowship in craniofacial surgery and then some other experience through further fellowships.  So clearly the fellowship level is where you specialize your skills as a craniofacial surgeon, but I wonder about the strength of these programs, like say the fellowship the Facial Team guys participated in vs. the fellowship Deschamps-Braly participated in.  I suppose Facial Team has their results to back up their skills.  It is just interesting how medical professionals from various, sometimes seemingly unrelated tracks, end up doing Facial Feminization Surgery.

I don't like how the surgeons just put on their websites "completed X fellowship" and don't even tell you how many years the program was, how many surgeries they performed during that time and other information like that.  Guess I could always ask in the consultations :p.

The confusion is confusing !      And brings up the whole range of issues about medical tourism.

Based on their web sites, the two Facial Team "head surgeons" are both dentists with further training in maxillo-facial surgery.  A lot of people trained that way spend their whole careers doing root canals and wisdom teeth extractions.  Some of the dentist - max-fac program guys have added the term 'craniofacial' to their pedigrees, but that is mostly just vanity at play. 

From discussions with a plastic surgeon friend it appears there  are only a half a dozen craniofacial fellowships available in the U.S.  Those programs are all full one year programs at medical schools that have high patient volumes for children and trauma patients needing craniofacial repairs. 

Each of those programs have pre-requisites that include a full M.D. degree (not a DDS) training program and then a subsequent full 5+ year surgical residency at an accredited plastic surgery program. 

Stated another way,  a person trained the way the two facial team surgeons are trained would normally not even be eligible to apply to get into one of the recognized craniofacial fellowship programs in the U.S.

There is a good reason for that.  "Real" craniofacial surgery often involves some massive 8-12 hours surgeries in which the skull of patients (many of them very young children) are completely opened up (brain fully exposed) and sometimes the cranium is removed and re-worked and then put back on the children.  Dentists and max/fac trained people simply do not have the broad surgical training and experience required to be qualified to do those complex surgeries on those types of patients.

Unfortunately, none of this is nearly as transparent as it should be.  One has to dig deep into the details to separate the important aspects of the training and experience from the vanity / marketing hype.

[RubyAliza]

Dr. Deschamps-Braly/Dr.Ousterhout are the best in the US, as some other patients on this thread testified to. Together they are the most highly trained FFS doctors in the US. Dr. Harrison Lee, Dr. Speigel, they're real good too.  They are all very expensive but maybe it makes sense to have patience and save for an extra year or two. Seriously, this is your face!

And honestly, I think that one should be skeptical of medical tourism too, like myfairlady49. If something goes wrong, you'll end up paying more in the end and have to suffer. Be very, very skeptical especially for FSS. The problem though is that we trans people quite honestly don't have all that much money. It is cheaper to go to Facial Team even with all travel expenses for example. However quite honestly, Facial Team does excellent Type-3 forehead contouring. And they also do hair transplants in the same procedure  if they are doing a behind the hairline incision (coronal). That's a great idea that many other surgeons aren't doing. The hairline stays low, no visible scar, and they use the perfectly good hair follicles of the hair strip instead of just throwing them out.

To be fair myfairlady49 I woudn't fault Facial Team for lack of perfect credentials. They are quite good even if they don't have the absolute highest credentials. The results and testimonials are very good. But we can learn something from you as well, to be highly skeptical of any surgeon, US or overseas.

- Ruby

[Lagertha]

I think words "better" or "best" should be taken with care, and rather used with added meaning behind it. It would be fair to say that Facial team doctors are "better" in upper face osteotomies than dr. Zukowski (I suspect you are probably referring to him). But it is to be understand that dr. Zukowski is really good plastic surgeon, who specializes on soft-tissue work, and is in that regard far superior to Facial team doctors (result prove my point). While one patient in her 20s might need only subtle bone work (not too aggressive), Facial team might be ideal... But someone in their 50s might need something completely different to achieve desired feminizing effect, primarily focused on soft-tissue, and less on seeking aesthetically ideal underlying bone-structure.

In my opinion there isn't anyone who could (or should) be proclaimed best. A surgeon who was the best choice for me, for what I needed and wanted for my face, might not be the best surgeon for someone else with different needs and different goals than mine. 

[RubyAliza]

I changed my reply to correct that. I absolutely agree with you! Different surgeons for different face types. Dr. Zukowski is a great plastic surgeon for soft tissue work, especially fat transfers. And he has a free revision policy to back up his work. I wanted to go to him for fat transfers and other rejuvenation procedures after my main FFS with Dr. Rossi. I turned in all the paperwork, corresponded with Cole, but got nothing back. Don't know why that happened But he's great, just doesn't do type 3 contouring though which for me was absolutely necessary.

[Paula1]

Yes Dr Z has done some great soft tissue work on many of my friends who have gone to him but I am still suffering problems as a result of his work on me in Feb 2004.

See https://www.susans.org/forums/index.php/topic,180029.msg1772273.html#msg1772273

Which proves every surgeon can have a bad day.

I also wish that I had never had the fat transfer to my top lift because it has negated the effect of the upper lip lift by making the area longer once again.

Also I think it looks very unnatural on an older patient such as myself and I know of one patient that has been back to him to have some of it cut out as she is so unhappy with it's appearance.

[shoko]

Jessie Ann you look fabulous, thanks for sharing!  So you were only a few months into HRT when you did it?

I'm looking forward to my consultation with Dr. Lee, but worried he might be pretty expensive.  I just sent a consultation request to Facial Team, it seems a good place with consistent results..

[SamSparks]

The confusion is confusing !      And brings up the whole range of issues about medical tourism.

Based on their web sites, the two Facial Team "head surgeons" are both dentists with further training in maxillo-facial surgery.  A lot of people trained that way spend their whole careers doing root canals and wisdom teeth extractions.  Some of the dentist - max-fac program guys have added the term 'craniofacial' to their pedigrees, but that is mostly just vanity at play. 

From discussions with a plastic surgeon friend it appears there  are only a half a dozen craniofacial fellowships available in the U.S.  Those programs are all full one year programs at medical schools that have high patient volumes for children and trauma patients needing craniofacial repairs. 

Each of those programs have pre-requisites that include a full M.D. degree (not a DDS) training program and then a subsequent full 5+ year surgical residency at an accredited plastic surgery program. 

Stated another way,  a person trained the way the two facial team surgeons are trained would normally not even be eligible to apply to get into one of the recognized craniofacial fellowship programs in the U.S.

There is a good reason for that.  "Real" craniofacial surgery often involves some massive 8-12 hours surgeries in which the skull of patients (many of them very young children) are completely opened up (brain fully exposed) and sometimes the cranium is removed and re-worked and then put back on the children.  Dentists and max/fac trained people simply do not have the broad surgical training and experience required to be qualified to do those complex surgeries on those types of patients.

Unfortunately, none of this is nearly as transparent as it should be.  One has to dig deep into the details to separate the important aspects of the training and experience from the vanity / marketing hype.

I think you may have misread or misunderstood the listed qualifications of Facial Team.   Here is what it says about Dr. Capitan: "Dr. Capitán then focused his specialization in Orthognathic and Craneofacial Surgery, completing fellowship at the Institute of Maxillofacial Surgery and Implantology of Clinica Teknon in Barcelona , as well as in the Unit of Craneofacial Surgery and Dento-facial Deformities at the Morriston University Hospital of Wales (U.K.).". 

I think what you are getting hung up on is that these guys started in dental school and with a maxillo-facial surgical background, which yes is a dental school background.  You are right that many oral surgeons do simpler surgeries and don't do more advance craniofacial surgeries.  But with that said if you go through dental school (in the US) and go into Oral Surgery you can further get a dual medical degree and get into more advanced surgical fellowship.  Like you can't discount a surgeon just because he started with the dental school tract.  Med school students don't know much more about about surgery than dental school students, they specialize in all of that after the primary school in residencies so it really depends on what you do AFTER the primary education.

Maybe I should not imply that you are a wrong, cause you are right.  I guess my point was just that you don't need to be the most advanced craniosurgeon to do type 3, just advanced enough, obviously its not open brain surgery.  But of course I would want to be in the hands of the highest trained professional ha.    I really wish Deschamps had more results, as I'm sure he will in the next decade, but I don't want to wait to see how he turns out lol.  I think in the end results are more important to hypothetical training.  Aesthetic vision is a unique thing afterall.  But I mean, Deschamps is clearly an overall an EXTREMELY well trained surgeon.  But hes a young guy lol.

For example, Dr. O, who was by most accounts a good surgeon, started out in the dental school track. 

But ya like Capitan's fellowships definitely sound more geared towards oral and dentition work just by the name descriptions.  I don't know.  Deschamps fellowship maybe more advanced, its like impossible to know unless you are in the know about these programs which I am not.  Deschamps fellowship definitely sounds more specialized to cranio reconstructive surgeries than the ones from facial team which seem more oral and dental focused.  Its probably more advanced, or at the very least more competitive. But idk results are results of course.

[SamSparks]

I think words "better" or "best" should be taken with care, and rather used with added meaning behind it. It would be fair to say that Facial team doctors are "better" in upper face osteotomies than dr. Zukowski (I suspect you are probably referring to him). But it is to be understand that dr. Zukowski is really good plastic surgeon, who specializes on soft-tissue work, and is in that regard far superior to Facial team doctors (result prove my point). While one patient in her 20s might need only subtle bone work (not too aggressive), Facial team might be ideal... But someone in their 50s might need something completely different to achieve desired feminizing effect, primarily focused on soft-tissue, and less on seeking aesthetically ideal underlying bone-structure.

In my opinion there isn't anyone who could (or should) be proclaimed best. A surgeon who was the best choice for me, for what I needed and wanted for my face, might not be the best surgeon for someone else with different needs and different goals than mine.

I wouldn't really call z like a soft tissue specialist.  I mean he was a plastic surgeon who specialized in burring, endoscopy, thats what he has spent the most time doing.  There are probably lots of plastic surgeons who have his level of skill or higher in soft tissue work but he just (smartly) decided to cater to FFS patients.  I think more doctors will in the future, we are an overlooked market.

[Lagertha]

I guess my point was just that you don't need to be the most advanced craniosurgeon to do type 3, just advanced enough...

True... Until something goes really really wrong, and you are left with two young surgeons, who don't have the most advanced training nor knowledge nor experience in more advanced craniofacial surgery and general surgery. Just an example of why it might make some sense to go with a little more expert surgeon, like dr. Di Maggio, or dr. Van der Dussen, or dr. Ousterhout.

[Jessie Ann]

Jessie Ann you look fabulous, thanks for sharing!  So you were only a few months into HRT when you did it?

I'm looking forward to my consultation with Dr. Lee, but worried he might be pretty expensive.  I just sent a consultation request to Facial Team, it seems a good place with consistent results..

Ahhh thank you Shoko.

I started HRT at the beginning of March and did my trech shave and nose work in April.  I did my hairline, forehead, brow bone and breast augmentation at the very end of August so it was at the 6 month of HRT mark.

Depending on what your having done Dr. Lee is not too bad price wise.  I was a patient before it became known that he was the FFS surgeon for Caitlyn, so maybe that helped.  I went to him originally because he took my insurance and that covered most of my nose work.   The other thing that I liked was he was local for me so there was no traveling involved.  I was lucky that I really didn't have to have extensive work done to complete the look I wanted.  He never tried to sell me on getting my jaw, chin or cheeks done.  He did recommend upper blepharoplasty which I wasn't going to do until my therapist told me that it didn't make sense not to do it since it wasn't that much more and I was already going to be under.  So the day before surgery I added that to my list and then he also did the lower blepharoplasty at no additional charge.   

It has been almost 3 months now and I am getting the feeling back in my scalp and my features have settled and softened.  People who I have know and worked closely with for over 20 years do not recognize me.  To me it was worth every penny I paid to feminize myself in such a dramatic yet non-surgical appearing way. 

[SamSparks]

True... Until something goes really really wrong, and you are left with two young surgeons, who don't have the most advanced training nor knowledge nor experience in more advanced craniofacial surgery and general surgery. Just an example of why it might make some sense to go with a little more expert surgeon, like dr. Di Maggio, or dr. Van der Dussen, or dr. Ousterhout.

Well good point but you know looking at Van der Dussen he probably started in the dental track too lol.  I mean he has a DMD and his specialty is oral-maxillofacial surgery.  So he probably has the same level of training as the facial team guys, just with many many more years experience.  DiMaggio though certainly is a guy who went through general surgery and looks like he was a "true" "advanced" cranio surgeon.  But I mean they are technically all performing the same procedure, so it does come down to "if something goes wrong"... maybe... I mean its all the same procedure you know?  So even if their training is more advanced... if they are doing the same thing then results are what matter.  Definitely a step above the guys who can't even do that type of procedure though.  I mean it gets weird when you try to analyze the training and who is "best" or most capable because many of these guys came through different backgrounds.  Like Spiegel isn't an offical "craniofacial surgeon" either, his website states his speciality was Otolaryngology, head and neck surgery, which is I could be wrong, more focused on soft tissue surgery involving the head and neck.  Yet he does ffs forehead reconstructive surgery as well.  Fairly well.  So its just a procedure.  If you can do it and do it well then you can do it and do it well.  Dr. Lee has the same official background as spiegel (otolaryngology) but he doesn't do type 3, probably cause he doesn't want to take the time and effort to learn how at this point in his career.

I don't really have a point to make, just sharing information I found on these guys websites.

[myfairlady49]

   . . . 

Maybe I should not imply that you are a wrong, cause you are right.  I guess my point was just that you don't need to be the most advanced craniosurgeon to do type 3, just advanced enough, obviously its not open brain surgery. 

"Not open brain surgery . . . "   

      At least not until you run into a cephalocele or some related complication.   Then it is brain surgery.

        Definition: Cephalocoele refers to the outward herniation of central nervous system contents through a defect in the cranium.

Quote from Dr. O's FFS book on the subject:

"The other procedures are even more complex, necessitating the experience of someone trained in craniofacial surgery to do them successfully. These are not the kinds of techniques one learns as a plastic surgeon or ear, nose, and throat resident. No matter how good these specialists are in their respective disciplines, their training is not sufficient to handle either the procedure or the types of events that might be seen or occur with it.

I mentioned earlier about the patient who surprised me with a small encephalocele. I was able to handle it without a neurosurgeon's help, as I handle other such untoward events. I also noted that in approximately 70 percent of my secondary forehead surgeries, the patient has required a cranial bone graft. Again, this is not routine, especially for someone who is not trained in craniofacial surgery. Finally, I discussed the significant disease in the frontal sinus that I have found in more than 10 percent of my Type III patients. Neither the patients nor I knew about these conditions prior to surgery. Two of those cases may have been life threatening. Again, because I had seen it before and knew what to do, I was prepared.

As you can gather from these examples (and I have many more), all of these situations must be handled on the spot, not left to another time or another specialist. Treatment requires experience over many years. I strongly believe that only someone trained in craniofacial surgery is ready to perform these forehead feminization approaches and is able to deal with the ensuing issues." (copied from my kindle download.)


Ultimately, even good and skilled people with the limited training (not even as thorough as the Spiegle / Lee type ENT training referenced by Dr. O, above)  which is evidenced by the Facial Team web site - -  do not appear to be adequately trained to deal with the types of unexpected but not all that unusual issues that Dr. O describes above. 

Ask yourself this question (serious question):  Do you really want your surgeon,  who happens to encounter one of those types of problems during YOUR surgery  to have to scrub out of the operating room and go down the hall (if they are even in a real fully staffed hospital, which they often are not) and ask around to see if someone can find a neurosurgeon to come in on an emergency basis and deal with the "oops" problem ?   

[SamSparks]

"Not open brain surgery . . . "   

      At least not until you run into a cephalocele or some related complication.   Then it is brain surgery.

        Definition: Cephalocoele refers to the outward herniation of central nervous system contents through a defect in the cranium.

Quote from Dr. O's FFS book on the subject:

"The other procedures are even more complex, necessitating the experience of someone trained in craniofacial surgery to do them successfully. These are not the kinds of techniques one learns as a plastic surgeon or ear, nose, and throat resident. No matter how good these specialists are in their respective disciplines, their training is not sufficient to handle either the procedure or the types of events that might be seen or occur with it.

I mentioned earlier about the patient who surprised me with a small encephalocele. I was able to handle it without a neurosurgeon's help, as I handle other such untoward events. I also noted that in approximately 70 percent of my secondary forehead surgeries, the patient has required a cranial bone graft. Again, this is not routine, especially for someone who is not trained in craniofacial surgery. Finally, I discussed the significant disease in the frontal sinus that I have found in more than 10 percent of my Type III patients. Neither the patients nor I knew about these conditions prior to surgery. Two of those cases may have been life threatening. Again, because I had seen it before and knew what to do, I was prepared.

As you can gather from these examples (and I have many more), all of these situations must be handled on the spot, not left to another time or another specialist. Treatment requires experience over many years. I strongly believe that only someone trained in craniofacial surgery is ready to perform these forehead feminization approaches and is able to deal with the ensuing issues." (copied from my kindle download.)


Ultimately, even good and skilled people with the limited training (not even as thorough as the Spiegle / Lee type ENT training referenced by Dr. O, above)  which is evidenced by the Facial Team web site - -  do not appear to be adequately trained to deal with the types of unexpected but not all that unusual issues that Dr. O describes above. 

Ask yourself this question (serious question):  Do you really want your surgeon,  who happens to encounter one of those types of problems during YOUR surgery  to have to scrub out of the operating room and go down the hall (if they are even in a real fully staffed hospital, which they often are not) and ask around to see if someone can find a neurosurgeon to come in on an emergency basis and deal with the "oops" problem ?

That is a good excerpt.  And I agree with you fully.  You want the highest trained professional to do the job.  Thats why I wish Deschamps had actual results I could analyze because his training is on par with Dr. O, though I question if his training in Europe was performing actual surgeries or just observing...  All surgeons have their flaws though.  Dr. O was good with bone work, not as skilled in soft tissue manipulation which led to complaints from patients and revisions.  Because humans can't learn and become experts in everything.  I still haven't heard of any complications like that from Facial Team patients.  And as I mentioned before its hard to know what they learned in their fellowships, perhaps they did spend time on more craniofacial focused cases during their fellowship.  I agree though that its a possibility they would be out of their depth should a major complication happen involving the sinus opening into the skull cavity.

Could I ask who you had your surgery with?  I have not had any surgery.

[Lagertha]

Thats why I wish Deschamps had actual results I could analyze...

You can have a consultation... I'm shure they would be more than willing to show you more results that you could handle. Keep in mind that even those surgeons who post results online, can't use their best results, because patients live stealth. If lucky they can use a few of their better results, and most other are about average. My jaw dropped when I was showcased about 20+ best results of my surgeon during consultation. And none of that results was or will ever be found online.

[SamSparks]

You can have a consultation... I'm shure they would be more than willing to show you more results that you could handle. Keep in mind that even those surgeons who post results online, can't use their best results, because patients live stealth. If lucky they can use a few of their better results, and most other are about average. My jaw dropped when I was showcased about 20+ best results of my surgeon during consultation. And none of that results was or will ever be found online.

Ya I need to, its just a hassle getting it set up.  Did you mention who your surgeon was?  Lol sorry I just don't understand the point of the culture here where everyone is like "my surgeon" and doesn't say the name like its some secret.

[myfairlady49]

That is a good excerpt.  And I agree with you fully.  You want the highest trained professional to do the job.  Thats why I wish Deschamps had actual results I could analyze because his training is on par with Dr. O, though I question if his training in Europe was performing actual surgeries or just observing...  All surgeons have their flaws though.  Dr. O was good with bone work, not as skilled in soft tissue manipulation which led to complaints from patients and revisions.  Because humans can't learn and become experts in everything.  I still haven't heard of any complications like that from Facial Team patients.  And as I mentioned before its hard to know what they learned in their fellowships, perhaps they did spend time on more craniofacial focused cases during their fellowship.  I agree though that its a possibility they would be out of their depth should a major complication happen involving the sinus opening into the skull cavity.

He shows lots of  B/A pictures during his presentations at the TG conferences.  I have seen some of that, and it is pretty impressive.  And Lagertha is right, you can see and ask questions about those during a consultation.  I assume the reason he does not post up galleries, is just simply a respect for patient privacy.     From the posts on yelp, he does lots of other surgeries, including some very complex double jaw surgeries and extensive face lifts with fat grafting.  He doesn't post up galleries of the other surgeries he does, either.  He is different from most of the surgeons in that respect.

As far as his ability to do exceptional soft tissue manipulation, check out this yelp post:

http://www.yelp.com/biz/jordan-deschamps-braly-md-san-francisco?hrid=EcBP83BGtJg-toBvn4IHfg&utm_campaign=www_review_share_popup&utm_medium=copy_link&utm_source=(direct)

That report documents what appears to be some rather complex and exotic soft tissue work correcting a devastating adult onset facial syndrome.  That soft tissue surgery changed that lady's life and, from what she writes,  apparently it also saved her career. 

The routine soft tissue stuff involved in FFS surgery appears to be almost trivial compared to the skill and training required to do that sort of successful restoration work.

[ErinS]

He shows lots of  B/A pictures during his presentations at the TG conferences.  I have seen some of that, and it is pretty impressive.  And Lagertha is right, you can see and ask questions about those during a consultation.  I assume the reason he does not post up galleries, is just simply a respect for patient privacy.     From the posts on yelp, he does lots of other surgeries, including some very complex double jaw surgeries and extensive face lifts with fat grafting.  He doesn't post up galleries of the other surgeries he does, either.  He is different from most of the surgeons in that respect.

As far as his ability to do exceptional soft tissue manipulation, check out this yelp post:

http://www.yelp.com/biz/jordan-deschamps-braly-md-san-francisco?hrid=EcBP83BGtJg-toBvn4IHfg&utm_campaign=www_review_share_popup&utm_medium=copy_link&utm_source=(direct)

That report documents what appears to be some rather complex and exotic soft tissue work correcting a devastating adult onset facial syndrome.  That soft tissue surgery changed that lady's life and, from what she writes,  apparently it also saved her career. 

The routine soft tissue stuff involved in FFS surgery appears to be almost trivial compared to the skill and training required to do that sort of successful restoration work.

His stitchwork on my friend's lip lift wasn't so hot; she has a noticable scar, and they basically blew her off when she complained about it. She was especially pissed because mine(from Mayer) is invisible. He did do a great job on her jaw though, and his bone work is apparently excellent.

I had a consult with him, and he and his team are incredibly thorough and detailed in it. Just understand he's a serious upseller and very pushy, and he'll do his best to get you to let him basically rebuild your face. For example my adams apple is completely invisible and barely a nub by feel, yet he still wanted to shave it lol. However if you do actually need a lot of work he's a good choice, and overall probably better than O ever was.

Honestly I don't think any one doctor is the best for every face, and if you're looking for more subtle he's probably not it. My face wasn't all that bad and I wanted only a mild amount of work with a heavy emphasis on aesthetics, so Mayer was a great choice for me.

[Paula1]

Our community have a much wider surgeon choice now, which is really good.

When I was researching FFS in 2003 the leading players were Suporn in Thailand,  Ousterhaut in the USA, Van der Dussen in Belgium , Musgrove in the UK and new kid on the block Zukowski.

Back in those days and up to two years ago, Yahoo group FFS Support was the place to be but now the group has been effectively destroyed  by Yahoo's new 'Neo' format, so thank heavens for Susan's Place.   

During my research, all the established surgeons had their good and poor results and Zukowski had yet to have problems that we knew about. I was one of his first UK patients and we all know about my story.

If our surgeon of choice is not capable or unwilling to correct the problem, then we have to find someone else.

What I am saying is that anything can go wrong and sadly we have to deal with it, often at our own expense.

Who said 'transitioning' was easy. Nobody I think.

[myfairlady49]

His stitchwork on my friend's lip lift wasn't so hot; she has a noticable scar, and they basically blew her off when she complained about it. She was especially pissed because mine(from Mayer) is invisible. He did do a great job on her jaw though, and his bone work is apparently excellent.

I had a consult with him, and he and his team are incredibly thorough and detailed in it. Just understand he's a serious upseller and very pushy, and he'll do his best to get you to let him basically rebuild your face. For example my adams apple is completely invisible and barely a nub by feel, yet he still wanted to shave it lol. However if you do actually need a lot of work he's a good choice, and overall probably better than O ever was.

Honestly I don't think any one doctor is the best for every face, and if you're looking for more subtle he's probably not it. My face wasn't all that bad and I wanted only a mild amount of work with a heavy emphasis on aesthetics, so Mayer was a great choice for me.

Sorry your friend is unhappy with the scar with the lip lift.  From my personal experience, scar tissue formation is hugely dependent on the individual.  As a child, every time I had a cut that required stitches,  it always left an ugly scar, with keloid red tissue.  I was told that generally the keloid formation would not normally happen on the facial tissue.  However,  I later had an accident and it required stitches on my face. Good surgeon.  Tiny internal stitches.  In an area where there was no tension on the incision.  It still ended up with an ugly scar that was obvious for five years or more and only after about 10 years did it mostly resolve.   Had another friend who went through a windshield in a car accident.  Nose and forehead "peeled". Facial scarring was almost invisible at the end of a year.      Different patients - -  different scaring potential. 

Ultimately,  scar tissue is highly dependent upon both the skill of the surgeon,  and the biology of the patient.  Again, it is unfortunate that your friend ended up as you describe.

As to the observation about "upselling" for a wide range of FFS procedures - -  consider the alternative?
If you look around at the messages posted in this group - - there is a very clear pattern.   That pattern is that there are many times more girls who express regrets for not having had additional procedures done during their first FFS surgery while they were already under anesthesia,  as there are complaints that they had "too many" or unnecessary procedures.    It always costs a  LOT more to have additional procedures later - - than it would if they had been incorporated into the first surgery.

The surgeon really is absolutely obligated to offer the patient all of the procedures that the surgeon's judgment suggests will be useful to get the desired result.  But ultimately,  it always remains the patient's responsibility to select a less complete effort,  if that is what they really want. 

As Dr O pointed out in his FFS book,  the % of girls that do not require a type III is very small.  He stated that only about 9% of the patients can get good forehead results with only the use of bone burring. So if you did not need a type III,  then you were one of the lucky ones !   

From the yelp reviews being posted up by Deschamps-Braly's patients, the results appear to be consistently pretty outstanding. 

[BellaSwan]

Just because a doctor recommends things another doctor doesn't, it doesn't mean he's overselling. He might just be better at his job.

Edit: Unless it's cheek implants. Be wary of those.