Order for rhinoplasty vrs. brow reduction if any

[HappyMoni]

Hello! I am looking at FFS this summer. My intention is to do a rhinoplasty in June with a surgeon who specializes doing noses. I then would like to do brow boss reduction with upper lid surgery a month or so later(with a different surgeon). Anyone see a problem with the order of how this would be done?
Also I have been on HRT for eight months and suddenly the boobs stopped hurting about a week ago. Am I done growing? Starting to worry. I had just increased Estradiol to max. amount but reduced Spiro by half because T. was so low. Anyone with similar issue of boobs taking a break? (Never thought I would wish for pain.)

Thanks!
Moni

[Ashley3]

Hello! I am looking at FFS this summer. My intention is to do a rhinoplasty in June with a surgeon who specializes doing noses. I then would like to do brow boss reduction with upper lid surgery a month or so later(with a different surgeon). Anyone see a problem with the order of how this would be done? ...

I seriously recommend you consider getting several consultations with FFS surgeons you'd like to consider for forehead contouring/bossing reduction and explain your goals to them, and that you're planning to get the rhinoplasty performed separately, possibly before the forehead work. This will let them explain to you any issues they may see, such as how far post a rhino you should be before your surgery day for the forehead or other work. There's a reason why I mention this...

I believe it may be inadvisable. I know at least one FFS surgeon who wanted me to be at least 4 or more months post a rhinoplasty before forehead reconstruction via maxillofacial reconstruction. Other surgeons may want to see 6 months or even a year, I don't know. That's not it...

At least one other well-known FFS surgeon mentioned to me that doing any feminization forehead reduction work via maxillofacial reconstruction typically necessarily involves what is technically a revision rhinoplasty to the extent the existing patient's nose needs to blend into and work harmoniously with the new forehead shape/contour/size. To what extent such a revision manipulates the existing nose as part of a so-called "revision" is unclear to me, but what the surgeon mentioned made sense to me. They weren't saying a "revision rhino" would be on the estimate, just that he, as an FFS surgeon, technical does what someone might call a revision rhino as part of completing harmonious forehead reduction work... he was referring to making it all come together, I believe. The top of the nose is connected to the portion of the brow/forehead which is being reduced, so it all must come together in a way that looks natural and feminine. I don't claim to be an expert, just passing on my vague/limited recollection as a way of saying you might want to really seek clarifications and info about this sort of thing, timing, downtime, recovery, risks from the experts.

As part of finding a definitive answer, you might want to clarify if forehead reconstruction is not as dependent on knowing final nose size/shape as would be the opposite, knowing facial proportions to give you the best nose. Your FFS or rhinoplasty surgeons should be able to help you arrive at a good answer.

Another person who can likely offer excellent info on all of these nuances...  A consult with http://www.virtualffs.co.uk/ would likely give you excellent suggestions/information about what you're asking. (Note, I have no association other than being a happy customer of theirs.) Some answers may already be on the web site, you might want to look.

You might consider separating your FFS and hormone questions across separate posts. I don't have an answer to that portion of your post and can only recommend checking with your doctor.

[Paula1]

Great reply Kao3.

My nose has been done twice (so far)

In 1990 pre FFS

In 2004 during FFS with Dr Z

And now it's been revised again by Facial Team in April.

So I need to ask if they will be modifying the top bony part in addition to the soft tissue/cartilage during the complex forehead reconstruction.

One more thing to remember when I see Dr Bellinga who is performing the complex rhinoplasty alongside Dr's Capitan & Simon.

[oneoftwo]

Great reply Kao3.

My nose has been done twice (so far)

In 1990 pre FFS

In 2004 during FFS with Dr Z

And now it's been revised again by Facial Team in April.

So I need to ask if they will be modifying the top bony part in addition to the soft tissue/cartilage during the complex forehead reconstruction.

One more thing to remember when I see Dr Bellinga who is performing the complex rhinoplasty alongside Dr's Capitan & Simon.

Is it really a good idea to have three surgeons to do a single nose surgery ?  If only one person can have their hands on the scalpel at one time - -  does it really make any sense to have three surgeons involved in trying to do one nose?   Hard to understand any way that two out of the three of them will not just be standing around !  Is that an efficient way to do surgery?

[Ashley3]

Thanks Paula!

...
And now it's been revised again by Facial Team in April.

So I need to ask if they will be modifying the top bony part in addition to the soft tissue/cartilage during the complex forehead reconstruction.

One more thing to remember when I see Dr Bellinga who is performing the complex rhinoplasty alongside Dr's Capitan & Simon.

I didn't know there was a 3rd surgeon who handles the rhinoplasty for them... I bet he's very good.

I see Virtual FFS touches upon the "Nose and Forehead at the same time" topic briefly... http://www.virtualffs.co.uk/Nose.html.

I think any forehead work without a formal rhinoplasty, where the nose area needs to be touched as part of doing that forehead work correctly as part of the same surgical session, is generally acceptable/common, sort of implicit to the whole process.

I'm actually not sure what details go on with the nose as part of a forehead procedure (that does not include a formal rhinoplasty), but I've never felt it's worth worrying about too much... top FFS surgeons doing excellent forehead work are in the driver's seat, so I figure they'll do it right regardless of whether or not they need to adjust the nose.

When it comes to doing two separate procedures, where a whole official separate rhinoplasty procedure is involved at a date/time which is different than when a forehead procedure is performed, when different non-coordinating surgeons are involved across the procedures, I think the main issues are twofold:

• Recovery/healing: Doing two or more surgeries, any surgeries of any kind, within close proximity time-wise, especially when different surgeons are involved, and
• Aesthetic or other compatibility issues: Doing two such surgeries, regardless of proximity in time, which affect bone/cartilage/tissue within the same area, if not the same area, in a manner where two or more unrelated surgeons may have different or uncoordinated goals (i.e., a rhino done prior which simply isn't as compatible with subsequent forehead work given an FFS surgeon's desired approach... things like this).

Those two general items are largely typical anomalies relating to multiple procedures with various doctors... after consulting and looking into this stuff, perhaps getting a surgery or two, I picked that up...  two procedures done near the same area by different non-coordinating surgeons usually have to be spread apart time-wise (to the satisfaction of at least the second surgeon), and both procedures should be aesthetically compatible.

You know all this but I'm clarifying my prior post.

If it helps to know, I got a rhinoplasty alone with the idea I might want later forehead work as HappyMoni is seeking. I knew going into that rhinoplasty I may need some sort of rhino revision at that forehead work time (TBD). Getting a rhino like that was a choice I consciously made in order to move forward since I was unsure about forehead work, wanted to see how well a rhinoplasty alone worked for me.

From the FFS consultations I've had, I've not had surgeons require any nose work explicitly, so it's either not required in my case, or they build it into the their forehead contouring pricing. Given I know the surgeon produces great results, I personally didn't need to know the details... it's one surgeon/team, one day of surgery, I have faith they'll do it right, they do all the time.

That's totally different than two different unrelated doctors one month apart with difficult procedures such as rhino and forehead. Totally different story there because it's not a single package so to speak, and we're talking about nearby procedures where each truly requires relatively undisturbed recovery.

If my case were like HappyMoni's, where I wanted to get a rhinoplasty from one surgeon, and immediately (or as soon as possible) get FFS foreheard work from yet another surgeon, I'd consult with both to get their input. I'd also consult with Virtual FFS (and Yahoo FFS, where Virtual FFS sometimes responds to user's posts).

Those research steps with at least the surgeons should help me better understand the timeline and ordering that will be most agreeable if not required by the surgeons involved (and hopefully produce the best result).

Community and non-surgeon input can be good because you might hear cautionary info which will be golden to know about, but in terms of knowing what will work best surgically and aesthetically for multiple procedures within a close period of time, I'd definitely want to ask the surgeons.

[Paula1]

Hi,

Sorry did not make myself 100% clear.

My complex rhinoplasty revision is being done by Dr Bellinga who works with Facial Team and also has his own private practice in Madrid.

See his website:  http://rinoestetica.com/

and his FT link: http://facialteam.eu/facial-feminization-surgery/dr-raul-jimenez-bellinga/

and my complex forehead revision surgery is being done by Dr Capitan & Dr Simon.

See: http://facialteam.eu/facial-feminization-surgery/

Paula

Is it really a good idea to have three surgeons to do a single nose surgery ?  If only one person can have their hands on the scalpel at one time - -  does it really make any sense to have three surgeons involved in trying to do one nose?   Hard to understand any way that two out of the three of them will not just be standing around !  Is that an efficient way to do surgery?

[Laura_7]

Boobs grow in spurts. Its possible they pick up again in a few days.

It might also be possible spiro is a bit low ... you might see how you feel the next days...

you might think about adding bioidentical progesterone, many say it helped with breast development, and with a more rounded and fuller form vs a cone shaped one.

Just talk about it with your doc.


hugs

[Paula1]

Hiya,

Thanks Paula!

You are welcome

I didn't know there was a 3rd surgeon who handles the rhinoplasty for them... I bet he's very good.

He is excellent and also does their soft tissue work like facelifts/neck lifts etc.

I see Virtual FFS touches upon the "Nose and Forehead at the same time" topic briefly... http://www.virtualffs.co.uk/Nose.html.

Indeed and more great information from you below....

I think any forehead work without a formal rhinoplasty, where the nose area needs to be touched as part of doing that forehead work correctly as part of the same surgical session, is generally acceptable/common, sort of implicit to the whole process.

I'm actually not sure what details go on with the nose as part of a forehead procedure (that does not include a formal rhinoplasty), but I've never felt it's worth worrying about too much... top FFS surgeons doing excellent forehead work are in the driver's seat, so I figure they'll do it right regardless of whether or not they need to adjust the nose.

When it comes to doing two separate procedures, where a whole official separate rhinoplasty procedure is involved at a date/time which is different than when a forehead procedure is performed, when different non-coordinating surgeons are involved across the procedures, I think the main issues are twofold:

• Recovery/healing: Doing two or more surgeries, any surgeries of any kind, within close proximity time-wise, especially when different surgeons are involved, and
• Aesthetic or other compatibility issues: Doing two such surgeries, regardless of proximity in time, which affect bone/cartilage/tissue within the same area, if not the same area, in a manner where two or more unrelated surgeons may have different or uncoordinated goals (i.e., a rhino done prior which simply isn't as compatible with subsequent forehead work given an FFS surgeon's desired approach... things like this).

Those two general items are largely typical anomalies relating to multiple procedures with various doctors... after consulting and looking into this stuff, perhaps getting a surgery or two, I picked that up...  two procedures done near the same area by different non-coordinating surgeons usually have to be spread apart time-wise (to the satisfaction of at least the second surgeon), and both procedures should be aesthetically compatible.

You know all this but I'm clarifying my prior post.

If it helps to know, I got a rhinoplasty alone with the idea I might want later forehead work as HappyMoni is seeking. I knew going into that rhinoplasty I may need some sort of rhino revision at that forehead work time (TBD). Getting a rhino like that was a choice I consciously made in order to move forward since I was unsure about forehead work, wanted to see how well a rhinoplasty alone worked for me.

From the FFS consultations I've had, I've not had surgeons require any nose work explicitly, so it's either not required in my case, or they build it into the their forehead contouring pricing. Given I know the surgeon produces great results, I personally didn't need to know the details... it's one surgeon/team, one day of surgery, I have faith they'll do it right, they do all the time.

That's totally different than two different unrelated doctors one month apart with difficult procedures such as rhino and forehead. Totally different story there because it's not a single package so to speak, and we're talking about nearby procedures where each truly requires relatively undisturbed recovery.

If my case were like HappyMoni's, where I wanted to get a rhinoplasty from one surgeon, and immediately (or as soon as possible) get FFS foreheard work from yet another surgeon, I'd consult with both to get their input. I'd also consult with Virtual FFS (and Yahoo FFS, where Virtual FFS sometimes responds to user's posts).

Those research steps with at least the surgeons should help me better understand the timeline and ordering that will be most agreeable if not required by the surgeons involved (and hopefully produce the best result).

Community and non-surgeon input can be good because you might hear cautionary info which will be golden to know about, but in terms of knowing what will work best surgically and aesthetically for multiple procedures within a close period of time, I'd definitely want to ask the surgeons.

Take care

Hugs

Paula

[HappyMoni]

Thank you for responding. I found a surgeon, not one who specializes in FFS, but someone who really walked me through what he could do on the nose. I connected with him, feeling he was very competent. At the time I was not serious about brow reduction. I thought I would just do a face lift. Now, I want to do both. My brow is not real prominent. My nose is too wide to be feminine and he would adjust bone and cartlige to give it a slight bow or curve. The problem is he does not do brow redux. The FFS doctor could do both but I question how much time could be devoted to the nose with other procedures being done. Would she hurry through it? I wonder. My job is my time constraint. I must do this over the summer or wait a year which I couldn't stand. I know I need to call the surgeon Monday to see how things coordinate. Unfortunately, to get on his schedule I had to do nonrefundable deposit. I was too worried about time frame I guess. Maybe the right call is the FFS surgeon. I don't know. The virtualFFS site is great and I had pics done, but she is an artist not a surgeon I believe. I feel like a mess trying to coordinate full time, coming out at work and the surgery all in a short time period. I guess I will start by talking to nose surgeon. (Going overseas for this surgery is not an option for me.) I do worry about the two surgeries looking well together. Don't know what comes first the chicken or the egg. The nose or brow. Thanks. Guess I am a bit overwhelmed right now. Hope this post makes some sense.  Moni

[mmmmm]

If you would only want to do slight change to forehead, for example which can be achieved with type 1 shaving technique, it wouldn't really matter which one you do first, because forehead and your lower forehead projection wouldn't change much. But if you are planning to do forehead reconstruction aka type3 approach, then its essential to do forehead first, and nose second to allign it with the new forehead, either during the same surgery or months later with other surgeon.

[Ashley3]

Thank you for responding. I found a surgeon, not one who specializes in FFS, but someone who really walked me through what he could do on the nose. I connected with him, feeling he was very competent.
...

Finding a separate rhinoplasty surgeon and doing your nose separately from other FFS work is not unheard of. I read on Yahoo FFS of someone else going to a top nose surgeon to do the rhinoplasty, and going elsewhere for forehead and other boney FFS work. You can search old messages on Yahoo FFS and see some of those older threads. (Note, with old info, keep in mind it's, well, old... it can be useful but let your instincts temper it as you also gather current info, perhaps from surgeons or forums like this.)

While you often find top FFS surgeons doing both forehead/rhinoplasty, I believe rhinoplasty is a truly complex area just as maxillofacial work on the forehead. It's not that each requires a completely different skillset. It's really about one doctor working strongly in one area, another doctor strongly in another area, each bringing special finesse to those areas, usually based on many years of training and experience. True, some surgeons cannot do the maxillofacial work, but even if they could, it doesn't mean they're going to be superb with MTF FFS.  Likewise, I don't believe all top maxillofacial surgeons performing excellent FFS necessarily produce the best rhinoplasties (often, I like what I see, but great rhinoplasty surgeons consistently do great noses and really know that area).

All that said, I've seen some one-stop-shop FFS teams that do everything and it typically looks phenomenal.

I've heard this time and again from others, and I believe it for myself, in the end, I think the way shop this stuff is to do as much research as you can, including a few good consults with top surgeons, and eventually arrive at a decision which often involves both the information you've gathered, and a gut feeling, all while considering several very good options.

...
Now, I want to do both. My brow is not real prominent. My nose is too wide to be feminine and he would adjust bone and cartlige to give it a slight bow or curve. The problem is he does not do brow redux. The FFS doctor could do both but I question how much time could be devoted to the nose with other procedures being done. Would she hurry through it? I wonder.
...

So it sounds like you are 100% certain you want to do your nose, and, after having been uncertain about the brow, you are now 100% certain you want to do the brow. It sounds like you have a strong gut feeling to go to a nose specialist for the rhino, yet you want maxillofacial reconstruction for FFS forehead contouring and brow reduction from a separate surgeon/team that specializes in FFS.

Personally, I consider forehead reconstruction the more specialized since far fewer surgeons do it, and even fewer do it for purposes of MTF FFS. The nature of the surgery also seems more involved and therefore "serious." Not to say that a rhino is easy street, but relatively speaking, my gut informs me that forehead reconstruction is the more specialized of the two, really requiring it to be shopped carefully/thoroughly.

With this in mind, I'd suggest you check with your FFS surgeon who will do the forehead contouring and brow reduction to discuss any issues revolving around getting the rhinoplasty separately from another surgeon. It's not bad that you're going to consult with the rhino surgeon... I'm just saying do both then. I mean, the FFS surgeon will likely have dealt with someone who wants a rhino either after or before forehead work. Why not ask your FFS surgeon to find out what he or she thinks?

...
My job is my time constraint. I must do this over the summer or wait a year which I couldn't stand. I know I need to call the surgeon Monday to see how things coordinate. Unfortunately, to get on his schedule I had to do nonrefundable deposit. I was too worried about time frame I guess. Maybe the right call is the FFS surgeon. I don't know. The virtualFFS site is great and I had pics done, but she is an artist not a surgeon I believe. I feel like a mess trying to coordinate full time, coming out at work and the surgery all in a short time period. I guess I will start by talking to nose surgeon. (Going overseas for this surgery is not an option for me.) I do worry about the two surgeries looking well together. Don't know what comes first the chicken or the egg. The nose or brow. Thanks. ...

If I had to guess, I would say you are probably right, that you at the very least need the FFS forehead reduction surgeon to inform you of the parameters that are best for his or her work on you in connection with a prior or subsequent rhinoplasty by another surgeon.

Essentially you want to go to two different doctors for relatively important/involved procedures which affect the aesthetics of your face. You really need to consult with both, let them know your thoughts, and hear what they have to say. You want to find out what limitations each places on your scheduling and recovery goals, and stuff like that.

Note... for myself, I got a rhinoplasty alone last year. I personally didn't worry too much about what my FFS surgeon would require because I didn't have it planned near that surgery... I had no set definitive plans for forehead work, and my main goal was to get a rhinoplasty alone to see how it would do alone, in harmony with my remaining untouched facial features...

Your case sounds different because you're seeking to get both by different surgeons on different dates, but you're really trying to get it all done as a unit of work that is, in the end, harmonious as if performed by the same surgeon...

I think this distinction is important for me to make because you might hear of others getting a standalone rhino and wonder why you can't just go do that... well, you probably could, but wisdom tells me you really are trying to do both together just with different surgeons, so you are best consulting with both surgeons to ensure you maximize outcome.

If I had to guess, and this is only a guess, for a situation where someone wants to get both procedures, rhino and forehead contouring/reduction, by two different surgeons across two different yet nearby dates, I bet, weighing all things, getting the forehead work first is better because then the nose can be done to act in harmony with that forehead work. The other way around seems less perfect because the rhino surgeon will be seeing your more masculine forehead and working off that. Assuming my guess is correct, you would then need to clarify the distance in time between procedures required by both surgeons. I bet it's no less than a min of 4 months, likely 6 or more depending on the surgeon. A rhinoplasty has visible healing changes through that first year post-OP. I can't speak on forehead but I bet it has parameters requiring good space in time between it and other nose/forehead boney work. I'm guessing here though... ask your surgeons.

Obviously, you don't have to have a gap in time between both procedures if they're done at the same time, but that requires you can get both done during that same surgical session. As you can see, Paula is getting both procedures by different doctors all at the same time, so she has a rhinoplasty specialist but without any need to coordinate gaps between separate procedures. Because all her doctors are part of the same team, they coordinate together as part of the same team working on her during the same surgical session, all on the same day. All done at once, all healing at once. No need to mix and match different practices and procedures.

I believe it's accurate to say, if someone wants the luxury of going to separate surgeons for differing facial procedures, the patient must likely incur gaps in time between those procedures (compared to getting them done as part of the same surgical session). While this is assumptive for me to say, it seems highly likely given what I've generally heard from surgeons, that they want you to be a certain amount of time post-OP from a prior procedure before working on you in the same area. So this sort of approach, if being done, not for incremental reasons (i.e., try a rhino to see if that's enough), but rather to do many separate procedures as part of a larger unit of work, the result is that the patient must afford doing that larger unit of work (separate procedures) across more time than would be required going to a single team on one day or some such. 

You mention "... Maybe the right call is the FFS surgeon. I don't know. ..." Do you mean in connection with who to consult with first? I assume you mean that. That you have a consult with your rhino surgeon coming up, and you are wondering if it should be with your FFS surgeon instead. Assuming that's true, I'm wondering, why not just consult with both? I would personally work to do no less. It should be easy to achieve that, and you'll get input from them both which should help you understand what is doable given both your constraints as well as their limitations, concerns, or anything else your doctors mention.

... Guess I am a bit overwhelmed right now. Hope this post makes some sense.  Moni

I don't have enough fingers and toes combined to count the number of times in the last several years I've been overwhelmed with surgical information and considerations.     I've come to realize it's part of what happens when you're taking in a firehose amount of information from various sources. It sounds like you're being wise and patient, and that you're working to carefully plan. I would just take things step by step.

By the way, if you learn something about how best to coordinate schedule the two surgeries, it would be really great to hear what you find out. Either way, good luck with your upcoming consultations!