6 years into transition, finally considering FFS

[Debra]

So As the title points out, it's been 6 years since I transitioned and after BA, GCS, Tracheal shave, and even FUT Hair transplants to round out my hairline, I feel pretty good about where I'm at. I'm at 2 jobs since my 'transition on the job' employment and people either don't know about my past or they just don't say anything. I'm also re-married to a great supportive guy and we're in a good position financially.

Throughout all of that, the forehead still bugs me a LOT. My brow ridge is pretty prominent , mostly from the side but also with bad lighting, it causes the 'shadows in the eyes' look. The nose is kind of secondary and makes sense to take care of with the forehead.

So I'm starting out researching and I want to stay in the US.

So far, I'm consulting with 5 doctors:

1. Mardrossian
2. Harrison Lee
3. Toby Mayer
4. Spiegel
5. Deschamps-Braly


So I think I'm going for a full forehead scalp advance, reconstruction, and brow lift and then rhinoplasty...slated for Early 2017. Gives me time to consult, research, and save for it.



So far I had a skype consult with Mardrossian and felt pretty good about it. He addressed my concerns of swelling similar to someone else on the forums that swelling in the forehead isnt too bad because the skin is thin and stretched. Wondering if that is the majority concensus or not though.....whether forehead/eye swelling is usually only for a few days, week, etc.

I was also at first wary of doing a scalp advance because I thought it mean tdoing more FUT hair transplants and after doing it once, I don't want to do it again....apparently I had the wrong idea and it's really just pulling the whole hairline/scalp forward. For those that have done it, does that initial stretch hurt/cause headaches for days/weeks after?

Both Mardrossian and Mayer have mentioned chin implants but I just don't want to go there. I want minimal recovery time and really only the problem areas that bother me.

Planning on keeping this thread up to date as I go along.

[Lagertha]

Well, If you're looking for forehead reconstruction and actual removal of masculine brow ridge (instead of just smoothing), you can easily cross dr. Mayer off your list, because he doesn't perform forehead reconstruction. I don't know if dr. Lee does it now, but I know he didn't do forehead reconstruction in the past, and he had to have his colleague dr. Gary Alter in surgery room who would perform type 3 reconstruction on his patients.

Swelling around eyes is hardcore for a week.. but it reduces in next week or two. There is no noticeable swelling in forehead. All the swelling goes down and it stays in your lower face regardless if you had any lower face work or not. How much and how long it stay it's depends from person to person, and how much work and care you actually put in, like using ice packs and doing facial massage. Generally it starts to get better after a week. Some people look presentable after third week... some other clearly look like they had facial surgery even after 2 months. We all react and heal differently.

Scalp advance doesnt hurt or cause headaches... whole area behind forehead incision (on top of scalp) will be temporarily numb, so you wouldnt even feel much. You might feel some tension... 

If two surgeons you consulted already suggested chin implant, you must have somewhat receding chin. It's not feminine trait as some people might think it is in comparison with strong male forward projected chin. Receding chin is not aesthetic, and it mostly affects facial balance. Ideal feminine chin is at 2% receding angle (male is 0%). Chin implant is least invasive procedure, and it can also have a narrowing effect on your chin (besides improving projection), without performing any invasive osteotomy. It is inserted through small inside-mouth incision.
Personally, I would advise against chin implants, and suggest you to go for more invasive sliding genioplasty, if you decide to resolve receding chin problem.

You cant expect or wish for minimal recovery if you plan on having rather invasive facial surgery. Its not like you will have only rhinoplasty, or only upper blepharoplasty. Recovery takes its time on not just your face but whole body. As you mentioned you have good job, and you're in good position financially, you probably won't have a problem with taking 6-7 weeks off, and have more than enough time to recover. Having additional chin implant or sliding genioplasty won't really in any way effect your recovery time.

[BellaSwan]

The only US doctor I would let do my forehead is Dr Deschamps-Braly as he trained under Dr O, the only FFS surgeon in the US who in my opinion produces desirable forehead results. I find the others' forehead work substandard considering what *I* would hope to achieve from the surgery. If you just want a flatter forehead, of the ones you've mentioned, I'd probably go to Spiegel because his work is what I'm most familiar with. If money was no object, Deschamps-Braly would be my pick without hesitation. I'm sure others disagree, but this is just my opinion.

[BellaSwan]

It's also worth noting, that if you desire the nasal radix to be lowered, Dr O is the only doctor I've seen do this dramatically.

[Paula1]

With the strong $US and weaker Euro, many US girls are now travelling to Europe for surgery.

The prices are a lot cheaper to start with and results that I have seen over here in Europe are just as good or even better than various US surgeon's post-op patients I have seen while in the USA including myself and I am a 'Z' girl.

Still you have plenty of time to make your final choice and I wish you all the best.

Hugs

Paula ( from the UK )

[Debra]

Well, If you're looking for forehead reconstruction and actual removal of masculine brow ridge (instead of just smoothing), you can easily cross dr. Mayer off your list, because he doesn't perform forehead reconstruction. I don't know if dr. Lee does it now, but I know he didn't do forehead reconstruction in the past, and he had to have his colleague dr. Gary Alter in surgery room who would perform type 3 reconstruction on his patients.

Yeah I have heard that about some of these surgeons. I figured I'd at least consult with a few of them though.

Swelling around eyes is hardcore for a week.. but it reduces in next week or two. There is no noticeable swelling in forehead. All the swelling goes down and it stays in your lower face regardless if you had any lower face work or not. How much and how long it stay it's depends from person to person, and how much work and care you actually put in, like using ice packs and doing facial massage. Generally it starts to get better after a week. Some people look presentable after third week... some other clearly look like they had facial surgery even after 2 months. We all react and heal differently.

Yeah basically hoping to take 3ish weeks off of work.

Scalp advance doesnt hurt or cause headaches... whole area behind forehead incision (on top of scalp) will be temporarily numb, so you wouldnt even feel much. You might feel some tension... 

Thanks for the info!

If two surgeons you consulted already suggested chin implant, you must have somewhat receding chin. It's not feminine trait as some people might think it is in comparison with strong male forward projected chin. Receding chin is not aesthetic, and it mostly affects facial balance. Ideal feminine chin is at 2% receding angle (male is 0%). Chin implant is least invasive procedure, and it can also have a narrowing effect on your chin (besides improving projection), without performing any invasive osteotomy. It is inserted through small inside-mouth incision.
Personally, I would advise against chin implants, and suggest you to go for more invasive sliding genioplasty, if you decide to resolve receding chin problem.

Interesting. Yes I know my chin is pretty small and caused a huge overbite when I was a kid....which I got fixed back then but at this point, it's just another thing I'd need to recover from....and my chin doesn't bother me.

[Debra]

The only US doctor I would let do my forehead is Dr Deschamps-Braly as he trained under Dr O, the only FFS surgeon in the US who in my opinion produces desirable forehead results. I find the others' forehead work substandard considering what *I* would hope to achieve from the surgery. If you just want a flatter forehead, of the ones you've mentioned, I'd probably go to Spiegel because his work is what I'm most familiar with. If money was no object, Deschamps-Braly would be my pick without hesitation. I'm sure others disagree, but this is just my opinion.

I do hear lots of good things about him and a lot of reference to Dr O as well. He'll be the last one I consult with because I'll probably fly to san fran to consult.

[Debra]

With the strong $US and weaker Euro, many US girls are now travelling to Europe for surgery.

The prices are a lot cheaper to start with and results that I have seen over here in Europe are just as good or even better than various US surgeon's post-op patients I have seen while in the USA including myself and I am a 'Z' girl.

Still you have plenty of time to make your final choice and I wish you all the best.

Hugs

Paula ( from the UK )

Thanks! Yeah just rather stay in the US. I'll pay for it, I know....but that's ok.

[deeiche]

So As the title points out, it's been 6 years since I transitioned and after BA, GCS, Tracheal shave, and even FUT Hair transplants to round out my hairline, I feel pretty good about where I'm at. I'm at 2 jobs since my 'transition on the job' employment and people either don't know about my past or they just don't say anything. I'm also re-married to a great supportive guy and we're in a good position financially.

Congratulations, sounds like life is good.

Throughout all of that, the forehead still bugs me a LOT. My brow ridge is pretty prominent , mostly from the side but also with bad lighting, it causes the 'shadows in the eyes' look. The nose is kind of secondary and makes sense to take care of with the forehead.

I completely relate to "shadows in the eyes" look.  Just to let you know you could still have under eye darkening post FFS, it can be hereditary.  I still have some even after a large reduction in my forehead.  Also you could still have some eye "hooding" depends on the location of frontal sinus posterior wall.  In my case it was right above my eye.  Dr Mardirossian told me that was probably the case based upon the photos I provided.  Only X-rays can give you that insight prior to surgery.

So I'm starting out researching and I want to stay in the US.

So far, I'm consulting with 5 doctors:

1. Mardrossian
2. Harrison Lee
3. Toby Mayer
4. Spiegel
5. Deschamps-Braly


So I think I'm going for a full forehead scalp advance, reconstruction, and brow lift and then rhinoplasty...slated for Early 2017. Gives me time to consult, research, and save for it.



So far I had a skype consult with Mardrossian and felt pretty good about it. He addressed my concerns of swelling similar to someone else on the forums that swelling in the forehead isnit too bad because the skin is thin and stretched. Wondering if that is the majority consensus or not though.....whether forehead/eye swelling is usually only for a few days, week, etc.

Forehead swelling is marginal, cheek swelling and lower face was greater.  Cheek swelling was still subsiding 5 weeks after surgery, but my list of procedures was about as extensive as you can get.

I was also at first wary of doing a scalp advance because I thought it meant doing more FUT hair transplants and after doing it once, I don't want to do it again....apparently I had the wrong idea and it's really just pulling the whole hairline/scalp forward. For those that have done it, does that initial stretch hurt/cause headaches for days/weeks after?

No headaches after surgery, I was out an about walking about the city less than 7 days post-op.  I know what headaches are too, I've had chronic sinus and migraine headaches for over 40 years.  I think I've had one sinus headache since surgery and that is most likely related to nose swelling related to rhinoplasty.  It can take at least 6 months for nose swelling to subside.

Both Mardrossian and Mayer have mentioned chin implants but I just don't want to go there. I want minimal recovery time and really only the problem areas that bother me.

That should help a lot, anything done to the chin will cause numbness in your lower lip and chin area.

Planning on keeping this thread up to date as I go along.

[BellaSwan]

Your chin might not bother you now, but it might after you get your forehead done. The more feminine something is, the more masculine the rest looks. I wouldn't go for a chin implant. They are unnecessary. If Dr Deschamps-Braly does what Dr O does, he can give you a very aesthetic chin without any need for an implant

[BellaSwan]

Lol no need to get prissy. He does the genioplasty, lengthens the chin, fixates the elongated chin into position with plates and screws and fills the empty space between the chin and the rest of the jaw with some sort of paste. In time, bone will grow there again.

[BellaSwan]

I don't agree that any decent plastic surgeon can do it. I don't think they'd risk implants if they could. I understand what you mean that if you come from a place of severe under development, they can both be used. I'm sure if the under development is severe enough, an implant is warranted. All surgeries have limitations, including the sliding genioplasty. However, in the case of a MtF that would mean the jaw would have to be within female standards already, because implants add mass, and most decent chin implants wrap around the jaw a little, so you really have to start from a very petite point. I have no issues with implants in and of themselves (I think Angelina Jolie's facial implants are perfection, for example), but I wouldn't get one personally. That being said, I guess I should allow room for the unlikey, but very possible, event that some of us might need a chin implant

[Lagertha]

Actually it's a part of training in regular Aesthetic, Reconstructive & Plastic Surgery programs.

In severe cases, they would only use sliding genioplasty. In less severe cases, with needed projection improvement in just lower frontal part of chin, it would be prefered to use an implant. Whether to use implant with lateral support or frontal-only "button" implant, depends on case to case. The lateral support part, on C shape implants is very thin (unless those implants more masculine effect), so it doesnt really add more than mm or so to the jawline.

[BellaSwan]

Forgive me, I meant to say do it *well*. Is it really part of regular training? I've encountered many plastic surgeons who don't offer the procedure. I suppose it's because they can't do it well. And I've seen enough before and afters from many plastic surgeons to know that many who do offer can't do it well either.

No, but it's adding width to already masculine features. If you're female, those extra mm probably won't do too much, even if you have your entire facial structure enhanced (like Angelina), but in MtF transsexuals it's just not the same. Conversely, if you already have a very defined bone structure (like Gigi Gorgeous) you may be inclined to keep your square jaw because you think it's "modelizing" but in transwomen I find it just makes us look like.. transwomen. Obviously, everyone can feel free to disagree, but that is my opinion.

[Lagertha]

Yes practically all are trained in doing this. It's not exactly anything special or anyhow advanced. One just needs enough training and experience. Not cutting any nerves is the only really complicated aspect of it. I wouldn't go to a plastic surgeon who havent done it enough times. I wouldn't be scared about them ->-bleeped-<-ing up the shape, or not doing it "well" as you put it.. I would be affraid for messed up nerve and worst case scenario permanent numbness.

It's not really part of common "offerings" or advertising procedures... they much more often offer and promote chin implants. it's much easier money for them. That doesnt mean that they don't do sliding genioplasty and do it well.

If one has masculine and wide jaw, it can be reduced. reducing it for another mm or so, isnt really a problem, if thats the case for implant. 

[myfairlady49]

Yes practically all are trained in doing this. It's not exactly anything special or anyhow advanced. One just needs enough training and experience. Not cutting any nerves is the only really complicated aspect of it. I wouldn't go to a plastic surgeon who havent done it enough times. I wouldn't be scared about them ->-bleeped-<-ing up the shape, or not doing it "well" as you put it.. I would be affraid for messed up nerve and worst case scenario permanent numbness.

It's not really part of common "offerings" or advertising procedures... they much more often offer and promote chin implants. it's much easier money for them. That doesnt mean that they don't do sliding genioplasty and do it well.

If one has masculine and wide jaw, it can be reduced. reducing it for another mm or so, isnt really a problem, if thats the case for implant. 

Lagertha,

I think BellaSwan has this about right.   Most of the very best soft tissue plastic surgeons will not do any bone work other than what is required for nose jobs.  If they have to do bone work - -   they refer it out to another plastic surgeon who is also further specially trained in jaw surgery or craniofacial work.   Are their exceptions?  Yes. 

Some plastic surgeons offer implants because they are not comfortable doing heavy duty bone work - -  and offering implants as  a "solution" keeps the patient from going to see  another surgeon.

You really want to see a surgeon who is trained in both plastic surgery and then also specially trained in jaw/orthognathic surgery.   If implants are the right way to get the desired result - -  they can tell you that.  If bone surgery is the better way,  they can tell you that, too.

With implants,  you can get an implant infection years down the road. Just as a result of an unrelated  common tooth or other systemic infection.  They can erode bone or tissue.   But,  sometimes they are still the right choice.

[Lagertha]

You really want to see a surgeon who is trained in both plastic surgery and then also specially trained in jaw/orthognathic surgery.

I had consultation few months ago with a local plastic surgeon about something else, but I also asked him few things about sliding genioplasty, because I'm not completely happy with chin implant (like the visual side, dont like the feel, and if I sleep on my face, it can cause some discomfort). He said he is pretty much doing it on a regular basis, even more often than implants. 

[myfairlady49]

I had consultation few months ago with a local plastic surgeon about something else, but I also asked him few things about sliding genioplasty, because I'm not completely happy with chin implant (like the visual side, dont like the feel, and if I sleep on my face, it can cause some discomfort). He said he is pretty much doing it on a regular basis, even more often than implants.

As I mentioned,  there are undoubtedly exceptions, and it appears you found one. 

But I just did a mental count,  and I know or am aware of the details related to five  board certified plastic surgeons that completed standard programs.  None of those five do any bone work, except for rhinoplasties.  One of those is a really  well known plastic surgeon.  The others have well regarded practices in the geographic areas where they work. 

[Debra]

Congratulations, sounds like life is good.I completely relate to "shadows in the eyes" look.  Just to let you know you could still have under eye darkening post FFS, it can be hereditary.  I still have some even after a large reduction in my forehead.  Also you could still have some eye "hooding" depends on the location of frontal sinus posterior wall.  In my case it was right above my eye.  Dr Mardirossian told me that was probably the case based upon the photos I provided.  Only X-rays can give you that insight prior to surgery.

Good to know, thanks. Yes life is pretty good.

Forehead swelling is marginal, cheek swelling and lower face was greater.  Cheek swelling was still subsiding 5 weeks after surgery, but my list of procedures was about as extensive as you can get.No headaches after surgery, I was out an about walking about the city less than 7 days post-op.  I know what headaches are too, I've had chronic sinus and migraine headaches for over 40 years.  I think I've had one sinus headache since surgery and that is most likely related to nose swelling related to rhinoplasty.  It can take at least 6 months for nose swelling to subside.That should help a lot, anything done to the chin will cause numbness in your lower lip and chin area.

All great info, thank you! =) How bad was the nose swelling? Dr. Mardrossian made it seem like it would swell some but not be any bigger than your previous nose or something (because the final result was smaller).

[Debra]

Your chin might not bother you now, but it might after you get your forehead done. The more feminine something is, the more masculine the rest looks. I wouldn't go for a chin implant. They are unnecessary. If Dr Deschamps-Braly does what Dr O does, he can give you a very aesthetic chin without any need for an implant

That's true, I'm hoping it's not the case. Since it's an underdeveloped chin, I've never felt like it outs me in any way.