Help me choose a FFS doctor for an Asian face!

[shoko]

First of all you are all amazing and I love this forum!  It's really been a great help in planning my transition.  Right now, I really want to get my FFS lined up for early spring.  I'm pretty sure I need:

1. Scalp advancement, hairline
2. Hair transplant
3. Brow
4. Jaw
5. Tracheal shave
6. Nose revision
7. Cheeks
8. Eyelids
9. Fat transfer

What is this Type III forehead thing and would I need it?  I'm now 38, but want to look younger, too.

I really don't know where to start, but I have consultations with Dr. Harrison Lee, Facial Team, Dr. Toby Mayer, Dr. Zukowski, maybe Deschamps Braly.  Of these, who would be the best, or is there someone else I don't know about who would be good for my face?  I hope to have insurance cover it but mine isn't so good (Blue Shield HSA PPO in CA).







Example dressed up


Someone once said I resembled her (Park Bom), I wonder if I could look like this!

[Dena]

As you aren't on HRT or haven't been for very long, I would delay the FFS. Your after picture looks pretty good and I am not sure you would need at worst one or two things out of the list if that. I would like to see you on HRT for a year or two before you alter your face as I think that HRT may make a noticeable difference.

[shoko]

As you aren't on HRT or haven't been for very long, I would delay the FFS. Your after picture looks pretty good and I am not sure you would need at worst one or two things out of the list if that. I would like to see you on HRT for a year or two before you alter your face as I think that HRT may make a noticeable difference.

Thanks, I've debated this long and hard but am determined to do FFS ASAP since HRT won't change bone structure or my nose/Adam's apple.  So as long as it's not too drastic I think it will be okay

[Lagertha]

Its perfectly fine to have FFS before even starting hormones. It makes no difference because bone structure wont change... but some procedures like fat transfer to cheeks or lips should be avoided, because hormones can have some effects on that, and its better to not do that until after 2-3 years on hormones.


You can read about different forehead techniques here: http://www.virtualffs.co.uk/Forehead.html
Whole site is very informative and very well written.

[shoko]

Its perfectly fine to have FFS before even starting hormones. It makes no difference because bone structure wont change... but some procedures like fat transfer to cheeks or lips should be avoided, because hormones can have some effects on that, and its better to not do that until after 2-3 years on hormones.


You can read about different forehead techniques here: http://www.virtualffs.co.uk/Forehead.html
Whole site is very informative and very well written.

Do you think a little fat transfer would hurt?  I mean it wouldn't stop the natural redistribution, right?  Or would it just appear uneven?

Thanks so much for that link, it was very helpful!

[Lagertha]

Its hard to predict the soft tissue changes, it depends on age, genetics, and mainly how your body reacts to hormones, etc... Your cheeks will become fuller after enough time on hormones, but we dont know how much fuller and how soon.

Transfered fat is more likely to accumulate better when you inject it into tissue with enough fat already present, and it is less likely to get reabsorbed and less likely to cause unevenness, which may or may not require additional fat transfer to smooth the uneven areas. More fat already present means more predictable result.. but having small fix later isnt really a big deal, because smaller fat transfer can be done in office environment under local anesthesia and sedation, which means its also not that expensive.

[Laura_7]

Your hair should be long enough for clipin extensions already.

You might try some exensions, I'd prefer real hair... then you might do what the people in your pictures do... they cover their brows with bangs. This can already make for a huge effect.

I personally would simply give it a bit more time... or try one process like a rhinoplasty.

HRT can make a huge difference in appearance and in aura in some people...


hugs

[Lagertha]

... or try something simple like a rhinoplasty.

Facial surgery is far more serious deal than some might think. Botox injection might count as "something simple", rhinoplasty definitely isnt, and noone should have rhinoplasty or any surgical procedure just to try it. Every facial surgery, but especially FFS, needs to be well assessed, planned to every and last detail by both surgeon and a patient, otherwise its a disaster waiting to happen, and same things need to be surgically altered twice or more. Almost all patients who had rhinoplasty done before, need to have it done again when they have FFS which includes forehead work.

[Laura_7]

Facial surgery is far more serious deal than some might think. Botox injection might count as "something simple", rhinoplasty definitely isnt, and noone should have rhinoplasty or any surgical procedure just to try it. Every facial surgery, but especially FFS, needs to be well assessed, planned to every and last detail by both surgeon and a patient, otherwise its a disaster waiting to happen, and same things need to be surgically altered twice or more. Almost all patients who had rhinoplasty done before, need to have it done again when they have FFS which includes forehead work.

Excuse the language. It was not meant a s try but to say its not as intricate as other processes.
And this one correction might already have a huge influence.

Often people are shown results from a software making an estmate of a correction.


hugs

[Lagertha]

Rhinoplasty is always done to allign nose with other facial features, primarily forehead. When you change forehead you need to reallign nose again to "fit" with the new forehead. Having nose done once is a good idea. Doing it right for the second or third time is a lot more tricky (because of scar tissue, cartilage issues, etc..). If one even only considers having FFS, they should never have rhinoplasty done first. Always wait.. because its always forehead first, and nose last. Multiple revision are generally a bad idea, even if its only rhinoplasty.

[edenbijoux]

Dr Bart van de ven in Belgium has operated on Asian faces and has had excellent results. He's my number one choice for ffs!

Sent from my SM-N910F using Tapatalk

[shoko]

Thank you for the suggestions, and I think hair extensions is a great idea I have to look into that.  Is Dr. Bart van de Ven expensive?  I did hear about him recently, too.

I had a consult with Facial Team, I really liked it the doc was super nice and detailed.  I also like their approach, but he did say they don't do too many Asians.  Should that be a concern?

I also just saw Dr. Toby Mayer in Beverly Hills. He said he never needs to remove the brow bone or use any hardware, just shaving.  He also said I didn't need jaw contouring because it might make the face unbalanced (top larger than bottom) but I would benefit from a chin implant.  He also does voice modification through an external cut.  He also advances the scalp via a front hairline incision vs. mid scalp like Facial Team.

Should I try to see Dr. Deschamps Braly, too?  It would be a trip though

[Lagertha]

Thank you for the suggestions, and I think hair extensions is a great idea I have to look into that.  Is Dr. Bart van de Ven expensive?  I did hear about him recently, too.

I had a consult with Facial Team, I really liked it the doc was super nice and detailed.  I also like their approach, but he did say they don't do too many Asians.  Should that be a concern?

I also just saw Dr. Toby Mayer in Beverly Hills. He said he never needs to remove the brow bone or use any hardware, just shaving.  He also said I didn't need jaw contouring because it might make the face unbalanced (top larger than bottom) but I would benefit from a chin implant.  He also does voice modification through an external cut.  He also advances the scalp via a front hairline incision vs. mid scalp like Facial Team.

Should I try to see Dr. Deschamps Braly, too?  It would be a trip though

dr. Bart van de Ven is one of least expensive FFS surgeons. And EUR-USD exchange rate is quite favourable for US citizens having surgery in EU. If you have that option, I would suggest you focus on everything else before price and cost of travel.

I personally dont believe that you should be concerned about their or anyone else's experience, or lack of it, with Asian patients. It doesnt really matter that much, because FFS is primarily about bone structure. Approach of every surgery is very individual, and ALL facial characteristics are different and individual, regardless of which racial background a patient is.

dr. Mayer said he never needed to use any technique other than shaving, because he doesnt have necessary training and skills to perform forehead reconstruction. What he told you is pure patient manipulation. If you look at his online gallery, you can clearly see that many (most) of his patients actually NEEDED forehead reconstruction not just shaving, and that their results in upper face area should be much better.

Your lower face isnt too bad. You definitely dont need aggressive chin or jaw reduction. But some lateral reduction for little more V-shape might be good idea. Your chin is little receding... not a lot. It doesnt look problematic. I dont think you need an implant.
He uses CTA voice modification technique.. there is generally better technique in use today with more predictable results, called glottoplasty, and it can be done endoscopically.. so there is no neck incision> and no scar.

Facial team incision isnt benefitial for scalp advance. mid-scalp (coronal) incision actually moves hairline further back (3-5mm). That means that for any hairline advance or improvement in corners hairtransplant must be additionally used. They offer immediate hair transplant option, but its generally better to do it at least 6 months after surgery. And you can find a lot more affordable price for hair transplant compared to what they offer.

Dr. Deschamps Braly and his elderly assistant dr. Ousterhout are the most expensive FFS option out there. Maybe Dr. Deschamps Braly also does skype consultations ?

[shoko]

dr. Bart van de Ven is one of least expensive FFS surgeons. And EUR-USD exchange rate is quite favourable for US citizens having surgery in EU. If you have that option, I would suggest you focus on everything else before price and cost of travel.

I personally dont believe that you should be concerned about their or anyone else's experience, or lack of it, with Asian patients. It doesnt really matter that much, because FFS is primarily about bone structure. Approach of every surgery is very individual, and ALL facial characteristics are different and individual, regardless of which racial background a patient is.

dr. Mayer said he never needed to use any technique other than shaving, because he doesnt have necessary training and skills to perform forehead reconstruction. What he told you is pure patient manipulation. If you look at his online gallery, you can clearly see that many (most) of his patients actually NEEDED forehead reconstruction not just shaving, and that their results in upper face area should be much better.

Your lower face isnt too bad. You definitely dont need aggressive chin or jaw reduction. But some lateral reduction for little more V-shape might be good idea. Your chin is little receding... not a lot. It doesnt look problematic. I dont think you need an implant.
He uses CTA voice modification technique.. there is generally better technique in use today with more predictable results, called glottoplasty, and it can be done endoscopically.. so there is no neck incision> and no scar.

Facial team incision isnt benefitial for scalp advance. mid-scalp (coronal) incision actually moves hairline further back (3-5mm). That means that for any hairline advance or improvement in corners hairtransplant must be additionally used. They offer immediate hair transplant option, but its generally better to do it at least 6 months after surgery. And you can find a lot more affordable price for hair transplant compared to what they offer.

Dr. Deschamps Braly and his elderly assistant dr. Ousterhout are the most expensive FFS option out there. Maybe Dr. Deschamps Braly also does skype consultations ?

I did get the feeling Dr. Mayer was a bit out of date.

If Deschamps Braly is that expensive, I think I'll pass.  I'm not sure paying more will guarantee the best result, and the staff said he had only 2 years experience in FFS?!  In any case he does require a $250 fee and in person is best if I'm going to pay that and need x-rays (by phone is an option, too).

So I guess it's between Facial Team and Dr. Bart van de Ven.  I looked on his website and consultations seem to only be in person and in select cities only?  I can't find an email link.  It would seem there is a long wait for him?  Are his prices comparable to Facial Team?

[Lagertha]

None of FFS surgeons have a long wait list... most wanted is dr. Di Maggio and he is usually booked around 5-6 months in advance. And there is always an option for earlier date when somebody postpones/cancels their surgery...

More money doesnt guarantee better result. Better skills and better more appropriate training (craniofacial especially) and experience usually does. Dr. Deschamps Braly really hasnt worked in FFS field for long, but he is a craniofacial surgeon and at least as of now works together with pioneer of facial feminization, with 1000+ FFS surgeries, and 40+ years of experience.

Facial team is more expensive than dr. Bart... about 1/3 more expensive. If you think about europe... dare I suggest you look into services of dr. Norman van der Dussen, a lot more experienced surgeon and craniofacial surgeon.

[shoko]

None of FFS surgeons have a long wait list... most wanted is dr. Di Maggio and he is usually booked around 5-6 months in advance. And there is always an option for earlier date when somebody postpones/cancels their surgery...

More money doesnt guarantee better result. Better skills and better more appropriate training (craniofacial especially) and experience usually does. Dr. Deschamps Braly really hasnt worked in FFS field for long, but he is a craniofacial surgeon and at least as of now works together with pioneer of facial feminization, with 1000+ FFS surgeries, and 40+ years of experience.

Facial team is more expensive than dr. Bart... about 1/3 more expensive. If you think about europe... dare I suggest you look into services of dr. Norman van der Dussen, a lot more experienced surgeon and craniofacial surgeon.

I see, I'll look into him also.  Thanks a lot for the insights!

[myfairlady49]

 
   . .  .  .

Facial team is more expensive than dr. Bart... about 1/3 more expensive. If you think about europe... dare I suggest you look into services of dr. Norman van der Dussen, a lot more experienced surgeon and craniofacial surgeon.

I don't think I understand the Facial Team approach  (ok, ...  "business model " ?   "Operating paradigm ? " - -  maybe this is better in a new thread ?)

Why get 4 for 5 surgeons to do what one properly trained surgeon can do in the same surgery?    The amount of "coordination" in terms of communicating the details of the patient's wishes and contraindications,  allergies,  and medical history is multiplied by  400 or 500 % and the risk of a screw-up / mis-communication is multiplied.  There is a lot of wasted overlap in the time of the different surgeons all having to attempt to get on the same page.     

Let's face it - - the most common request around the message boards is for the surgeon to have an artistic / aesthetic appreciation of what the patient needs in order to make them look like the female behind the male face.

But the Mona Lisa was painted by ONE artist- - Leonardo.  Not a team of painters.    The Moon Light Sonata was written by ONE composer,  not a team of musicians.     

Can you imagine what the Mona Lisa painting might look like if it were painted by five different artists ?

Maybe there is some technical merit and economic efficiency in that practice model - - but I doubt the rational for that is obvious to most outside observers. 

[shoko]

i see what you mean.  working in the OR, i know other surgeons often walk in and finish what the other started, or begin working on another part (for example, breast augmentations with each side done by a different doctor).  is this bad?  i don't know, it depends on the results.  patients of course will never know.

i thought facial team was just two doctors, maybe 3?  they seem to have good results and reviews, are experienced, and have an organized system from preop to postop.  that is what attracts me to them.  they are also not too old like some others, who may be more stuck in their ways and less flexible.  i don't know.  i wish they were cheaper in any case.

i had one rhinoplasty done in 2012 in south korea.  i had done my research, he had great reviews, i thought i had settled on the best for me.  i hate my nose.  and only one doctor did it.  this stuff is so subjective which is why it's so frustrating!

[Paula1]

Well having one surgeon doing my forehead and nose certainly did not work out for me ... 

My surgery lasted nearly 10 hours and maybe he was exhausted because the day before he operated on another Brit friend of mine for a similar time.

I prefer having one or two craniofacial surgeons and a soft tissue/rhinoplasty surgeon working on me.

Less stress for them and also more heads are better than one in my opinion.

[Lagertha]

None of facial team surgeons is craniofacial surgeon. Lets be honest here, dr. Capitan and dr. Simon have dental surgery background and specialization in oral & maxillofacial surgery