Certification matters : What certifications?

[StartingOver]

Regarding the 90% quote.  Are you sure it's not 90% of the patients who came to Dr O needed Type III?  I would find that more accurate.  MtF who don't need FFS don't see surgeons for evaluation.

This is pretty much what I wanted to say.  90% who went to Dr. Ousterhout needed it done.  Which omits the underlying fact that they're going to Dr. Ousterhout because they have prominent brows in the first place (and if they didn't, they wouldn't be consulting with an FFS surgeon), so obviously they'll be more likely to need it.  Those with less prominent brows would not be seeking out a surgeon capable of that procedure in the first place.

To illustrate this point somewhat differently, it would be like me claiming that "90% of people are ill", when my data comes from my family doctor describing the typical patients he sees (i.e. ill people).  It can't be extrapolated to the entire population, and it doesn't take very much logical reasoning to figure out why; ill people go to see doctors, while the vast majority of well people don't stroll into the doctor's office.

Yet somewhere along the line, the 90% has become generalized and used out of context, resulting in the thoroughly stupid idea that 90% of MtF girls "need" the procedure done.  And of course few FFS surgeons (except, notably, Zukowski) challenge this misconception because it drives lots of lucrative business their way.  Free marketing, etc.

[JaniceNL]

If someone doesn't need a type 3 should they still get it? can a further setback look more aesthetically pleasing?

I have been told I only need shaving but I am still conflicted wether to go with that or not...

[Lagertha]

If someone doesn't need a type 3 should they still get it? can a further setback look more aesthetically pleasing?

I have been told I only need shaving but I am still conflicted wether to go with that or not...

Depends on what you want. If you will be happy with subpar result then go with type1. I would say if you are paying thousands and thousands and you are going under anesthesia and through hardcore recovery, might as well do it right not just halfway right. 

[StartingOver]

If someone doesn't need a type 3 should they still get it? can a further setback look more aesthetically pleasing?

NO!

When it comes to FFS, more is not better!  Erase the obvious male traits, tweak a few things that you want tweaked if you absolutely must, but stop there.  Too much FFS, like all plastic surgery, is just ugly and certainly not more feminine than subtle FFS.

The face is a delicate balance.  Mess with it at your peril.

Depends on what you want. If you will be happy with subpar result then go with type1. I would say if you are paying thousands and thousands and you are going under anesthesia and through hardcore recovery, might as well do it right not just halfway right. 

THIS IS LITERALLY THE WORST ADVICE EVER!!!!!

Where are you guys getting these ridiculous ideas about FFS from?  Type 1 forehead work is not subpar by definition; it's a valid FFS technique that's appropriate for many patients who don't need type 3 work.  If that's all Janice needs, then that's all Janice should get and nothing more.  Using your reasoning, Janice should also add in lip work, cheek implants, jaw bone and chin work, hairline changes, brow lifts, eyelid surgery, breast augmentation, liposuction, etc.  After all, she's under anesthesia and might as well throw in everything including the kitchen sink to "do it right"...

[deeiche]

I too want to say Type I procedure is not less of a procedure if that is all someone needs. 

The Type definitions ( I, II, III and IV ) were created by Dr O, to define forehead feminization procedures.  They are ALL legitimate procedures for specific cases.

Dr O's book "Facial Feminization Surgery: A Guide for the Transgendered Woman" is a very good read for someone considering FFS.  I own a copy, it cost $40 on Amazon.  Considering the $29k I spent on all my face procedures / lodging / travel it was a minor cost.

[BellaSwan]

Fine, 90% of people who need FFS need a type 3. It not a coincidence that all the doctors who competently perform type 3 have the same statistics, whereas the ones who don't perform it at all claim it's invasive and unnecessary. I have seen the results from the doctors who don't do type 3, and these women have been cheated. What a waste of money. I don't care if you find it offensive - I'd rather no others waste their money in the future by calling it like it I see it. The only type 1s I've seen that were satisfactory were from a Dr O's book. Even if I were a type 1 and shaving is all that I would need, I would go to Suporn to have the forehead "setback" technique that he developed. That's s matter of aesthetic. The ffs surgeons who don't do type 3 - that's not a matter of aesthetic, but lack of competence and training. I guess it's better they don't attempt it then. Type 1 foreheads exist, but on the results page of thesE ffs surgeons that only do type 1 contouring, I have yet to see a type 1 forehead.

[radialan]

Someone posted the following earlier, but I can't find it anymore in this thread.  In any case, my reply is below the quote and addresses this.

97% (not 90%) can have more or less significantly better forehead result with forehead reconstruction than with shaving technique. And if forehead reconstruction is done right, it is far more safe than having thin shaved down frontal sinus wall. With shaving technique the surgeon burrs down the strongest outside surface of bone, and what is left is very thin and far more fragile bone.. Accidents can happen.

I'm not aware of any peer-reviewed studies that have determined the actual ratio of patients that need Type III, so I won't wade through the mine field of percentages.  I'll just say that many patients seeking feminization of the forehead are Type III candidates.

Forehead Bone Contouring (bone shaving method) is also an appropriate option for many FFS patients.  From a risk standpoint, it is not true that the patient is at greater risk than if she had the Type III procedure.  A competent surgeon who specializes in FFS will not leave the the bone covering the sinus as thin as a piece of paper.  This would indeed put the patient at greater risk of an accident-related fracture.  Instead, the bone is shaved down to a point that still permits it to retain most of its protective qualities.  We know of no forehead bone contouring patients who have suffered subsequent fractures attributed to this.

Type III reconstruction involves removing a section of bone covering the frontal sinus.  This section of bone is also shaved and contoured before placing it in the new setback position.  If the bone were not shaved, it would still retain some of its undesirable contours, albeit a little farther back.  Like forehead bone contouring, the section of bone is not made to be so thin that it would result in a significant risk of fractures down the road.  Both Type III reconstruction and conventional contouring involve shaving of the bone that covers the sinus and both result in a similar bone thickness.  The main difference is that Type III involves removing the bone and setting it farther back on the frontal sinus.   

[Lagertha]

We know of no forehead bone contouring patients who have suffered subsequent fractures attributed to this.

Actually we do. Since 2007, that I have been following FFS field, I remember 4 patients that shared their pictures of collapsed frontal sinus wall (not a pretty sight). There has also been quite nicely documented series of photos shared by a surgeon, presenting how to resolve this kind of problem. After a year or so this surgeon, sadly for us now, decided to remove this pictures. I guess we will never know the approximate numbers of all such cases... but we could kindly ask a surgeon from Boston and a surgeon from Buenos Aires how many of this "collapse after type1" cases they had to fix.

[myfairlady49]

I too want to say Type I procedure is not less of a procedure if that is all someone needs. 

The Type definitions ( I, II, III and IV ) were created by Dr O, to define forehead feminization procedures.  They are ALL legitimate procedures for specific cases.

Dr O's book "Facial Feminization Surgery: A Guide for the Transgendered Woman" is a very good read for someone considering FFS.  I own a copy, it cost $40 on Amazon.  Considering the $29k I spent on all my face procedures / lodging / travel it was a minor cost.

The kindle version is still less expensive!   But rather than guess at what was written,  here is a copy/paste from my Kindle copy:

> " A Type III approach tackles the frontal sinus, which appears in 95 percent of all people, and the masculine projection of the forehead, which, in nearly every male, extends well beyond any female projection. (See Figure 4-7a.) The great majority, some 82 percent, of my forehead feminizations are Type III operations. I've performed it in more than 750 MTF patients and many other non-transsexuals as well." <

That statistic does not appear to be an artifact of patient self selection, as was suggested in another post.  I think that the source for that statistic came from the extensive male/female / ethnic skeletal study that Dr. O says he did from a local skeletal collection in San Francisco, prior to developing the Type I, II, III, IV procedures.  That is an observation that is also consistent with my somewhat limited reading from some other skeletal anthropology/forensic books & articles.   

[Paula1]

This is a very informative post and helps me understand more about forehead procedures ...  You would have thought that I would know everything about them now but I still don't and back in 2004 , I was very uneducated about it all. In those days I just thought " Well the surgeon seems to know what he is doing, so I will be fine "

Someone posted the following earlier, but I can't find it anymore in this thread.  In any case, my reply is below the quote and addresses this.

I'm not aware of any peer-reviewed studies that have determined the actual ratio of patients that need Type III, so I won't wade through the mine field of percentages.  I'll just say that many patients seeking feminization of the forehead are Type III candidates.

Forehead Bone Contouring (bone shaving method) is also an appropriate option for many FFS patients.  From a risk standpoint, it is not true that the patient is at greater risk than if she had the Type III procedure.  A competent surgeon who specializes in FFS will not leave the the bone covering the sinus as thin as a piece of paper.  This would indeed put the patient at greater risk of an accident-related fracture.  Instead, the bone is shaved down to a point that still permits it to retain most of its protective qualities.  We know of no forehead bone contouring patients who have suffered subsequent fractures attributed to this.

That's good to know as my forehead was burred down and occasionaly I still partake in extreme sports !! .. 

Type III reconstruction involves removing a section of bone covering the frontal sinus.  This section of bone is also shaved and contoured before placing it in the new setback position.  If the bone were not shaved, it would still retain some of its undesirable contours, albeit a little farther back.  Like forehead bone contouring, the section of bone is not made to be so thin that it would result in a significant risk of fractures down the road.  Both Type III reconstruction and conventional contouring involve shaving of the bone that covers the sinus and both result in a similar bone thickness.  The main difference is that Type III involves removing the bone and setting it farther back on the frontal sinus.

Unfortunately my left frontal sinus was penetrated during my burring surgery and ever since has caused me problems. This is explained more fully in my post " Thank God for the UK's NHS " thread

See: https://www.susans.org/forums/index.php/topic,180029.msg1784396.html#msg1784396

and now the forehead is going to be reconstructed for the very first time by Facial Team in April 2016. So  I was a Type III all along despite Dr Z saying at the time that there was no need for X-Rays and he said that he knows when to stop burring as the colour of the bone changes ... It has worked for many of his patients but not me sadly ...   

[deeiche]

someone asked me in a message if I could share Dr Ousterhout's description of Type I.  Below is a quote from his book.

In his book, "Facial Feminization Surgery, A Guide for the Transgendered Woman", Douglas K. Ousterhout, MD says
   "Type I
      Individuals who undergo a Type I procedure usually don't have as severe an issue with their foreheads as other MTF patients.  (See Figure 4-4) Only 9 percent of my MTF forehead patients, eighty-five individuals, have needed this type of forehead correction.  It is designed for those who had no frontal sinuses (fifty-three of the eighty-five) or had a very small frontal sinus and/or a very thick anterior frontal sinus wall (thirty-two of the eighty-five).  A Type I approach consists of burring away the excess forehead bone and developing a desired female contour without entering the frontal sinus, if it exists.  (See Figures 4-3a,4-3b.)  Although it is the easiest of my four forehead approaches, it must be accomplished in such a way that the bone is not burred down so thin that the underlying frontal sinus, if there is one, is vulnerable to trauma to injury."  (39-40).

[Debra]

NO!

When it comes to FFS, more is not better!  Erase the obvious male traits, tweak a few things that you want tweaked if you absolutely must, but stop there.  Too much FFS, like all plastic surgery, is just ugly and certainly not more feminine than subtle FFS.

The face is a delicate balance.  Mess with it at your peril.

For me personally, I agree with this. I just want what's needed to get fixed and get a few things tweaked (FFS)....worried about doing too much because any little thing could potentially have issues.

I also feel like as trans women, we get roped into a lot of surgeries and it might cause some of us to fall into an endless loop of never being satisfied with who we are and how we look and can potentially lead into a plastic surgery addiction.

I've had 4 different areas worked on on 3 different surgery dates over the last 6 years since I transitioned and I've considered/researched a few other areas as well (and not just for transition-related).

At some point I really just want to be 'done' and I feel like I have to learn to be satisfied with what I have.

[deeiche]

SNIP
At some point I really just want to be 'done' and I feel like I have to learn to be satisfied with what I have.

You and me both, I thought I was done 30 years ago after 4 years of one surgery per year.  If FFS had been readily available 30 years ago I'm sure I would have had FFS too.  I'm still looking at non face surgery in the next couple years, to replace 33 year old breast implants.