Best FFS Place?

[Miss Clara]

I think DiMaggio is a fine FFS surgeon.  He was my second choice after Facial Team.  I mentioned his filling the frontal sinus cavity as the main reason for not selecting him, but there were other reasons.  One is that my communications with his office pointed to a potential language barrier problem.  One's patient coordinator should have good English language skills.  There was a lot of back and forth e-mails to clear up confusing statements.  Second, it became clear that Dr. DiMaggio is very meticulous in his work, but also quite slow.  I don't remember the hours I would have been on the operating table, but it was a couple of hours longer than what the other surgeon's customarily take for the same work. Seven hours under general anesthesia is about as long as I wanted to risk.  Finally, the flight to Buenos Aires was by far the longest and most expensive for the two of us which pretty much cancelled out the savings on the price he quoted for the FSS.

[anjaq]

Ah - ok, I did not read that, apparently.

I also noticed the language issue - it took me 3 emails to clarify what procedures he really recommends and why, after I sent the photos. Also he had surgeries on the list that I clearly do not need, so he offered a trach shave and cheek implants as an option, even though those are my best feminine features - of course it was not in the list of strong recommendations but he had in in the list anyways - I suspect it was sort of a standard list. I would not want to rule him out from that , though. I know someone who was there and the result is great, but I also know that he takes long time - some had 2 days of 8 hour surgery each with him, which seems a bit too much, event hough they had a lot of things done.

One major difference about Facialteam is the coronal incision for the forehead work. It seems to me no one else does that and there is a debate about if this is a better or worse approach. This is sort of a deciding factor when going for Facialteam or not, in my opinion. I saw some post op pictures and met some patients from facialteam and hairline keeps being an issue for many, as the coronal incision raises the hairline even more and does not change it at all. So when going for that option, I think hair transplants are basically a requirement, which adds a significant amount to the price they charge for the surgery, evening out their otherwise lower prices. I am not totally decided about this yet, but as I see it, this is THE unique feature of FT - if one wants the coronal incision, one should probably choose FT as they do this all the time and are most experienced in it, if one does want a hairline incision, one should not choose FT as the rarely do it but rahter some of the others who do it routinely.

[deeiche]

Lots of FFS surgeons do coronal incisions, however only FT does immediate hair transplants using FU harvested from strip of skin during coronal incision.

Ah - ok, I did not read that, apparently.

SNIP
One major difference about Facialteam is the coronal incision for the forehead work. It seems to me no one else does that and there is a debate about if this is a better or worse approach. This is sort of a deciding factor when going for Facialteam or not, in my opinion.
SNIP

[AnonyMs]

I've been looking at FFS recently, and I've noticed that they have very few complaints about them. The only one I found is from Shoko here. Even when you ignore all the testimonials published by Facial Team there's still a lot of positive reviews. It seems like a very good record.

All that marketing does put me off, but I'm interested in spite of it.

The one "negative" I hear about them is that they are very conservative in what they will do. Along the lines of if you don't need it they won't do it, and they know best. Better than the surgeons who push you do do everything so they get paid more but I'd worry that its not enough.

[Ellement_of_Freedom]

What are the pros/cons of a coronal incision vs forehead?

Does it prevent your hair from growing where the incision is made..?

I guess one big pro is the scar is hidden. What else?

[anjaq]

Well, at least those surgeons on top of my list - di Maggio, Spiegel, DesChamps, Suporn and slo the ones I have now basically cut off the list van de Veen and Zuchowski all seem to use hairline incisons... The main reason of course being that the hairline can then be modelled in the same step as forehead reconstruction. Which of the well known surgeons do use a coronal incision?

All that marketing does put me off, but I'm interested in spite of it.

The one "negative" I hear about them is that they are very conservative in what they will do. Along the lines of if you don't need it they won't do it, and they know best. Better than the surgeons who push you do do everything so they get paid more but I'd worry that its not enough.

Well, the Marketing is something a lot of the surgeons do. FT travel a lot and show up at a lot of conventions to sell their FFS, van de Veen travels a bit and does consultations wher eI also had the impression he was mostly trying to sell. DesChamps has a more "viral marketing" tactics in that he does not give email adress or makes online consultations, but spreads a bit the aura of being exclusive, di Maggio had sort of a flatrate marketing offer with one cheap price for all the procedures in the standard list, Zuchowski seems to be almost like a car salesman I was told by someone who had FFS with him - his webiste is also a bit of an agressive marketing... its all a big business to provide surgeries for us who so desparately want this.

FT seem to be a bit conservative in their suggestions compared to others - but its always a matter of how much one self wants to achieve. They told me I do not need anything at all if my goal is to be "passable". But they still said that I do have some slightly or moderately masculine features that they could change for me if I want this - its all optional though. So they will do it if I ask for it, others pressed more to do all of these things. Since the prioritization of the procedures and the list of procedures was the same in all surgeons and VFFS as well, I assume they judged it the same way, they just left it more to my own judgement, what I feel that I need and want and also they told me which parts are less risky. Also they had the simulation photos so I could see which of the changes I see more important. I actually liked that approach.
What I am not sure is, if they are also "too conservative" in their surgeries? Do they change the face less strongly than others would do?

What are the pros/cons of a coronal incision vs forehead?

Does it prevent your hair from growing where the incision is made..?

I guess one big pro is the scar is hidden. What else?

So far I had the impression of the folloging:
coronal incision pro:
scar is hidden, less nerve damage as the main nerves are more to the front of the head, hair can be harvested to correct hairline by transplant (FT only?)
con:
no hairline rehaping with incision - need transplants, possible bald spots at the incision (needs transplants), hairline moves back a little, making the transplants almost non optional
hairline incision pro:
hairline remodelling at the same time as forehead surgery, hairline advance is possible
con:
possibly more nerve damage, visible scar at the hairline (needs transplants), strong limitation in amount of hairline advance (may need additional transplants)

[AnonyMs]

Well, the Marketing is something a lot of the surgeons do.

I don't like it because it makes it difficult to work out if they are popular because they are good surgeons or good at marketing.

I don't know much about FFS but I spent a lot of time researching SRS, and for that I like Suporn partly because he's one of the most highly regarded SRS surgeons and does no marketing. There's other SRS surgeons that do a lot of marketing and I don't like their work at all. Its a lot of work trying to sort though it all. I'm not confident about Suporn for FFS because I can find so few reviews of his work, and that increases the risk.

[anjaq]

What bugs me a lot is that next to direct marketing by FFS surgeons, which is to be expected of course, although it too does not help, nowadays a lot is done with "social marketing", so there are a lot of former patients around, or people who claim to be former patients or claim to have done a lot of research into FFS surgeons, who will promote a particular surgeon online - there are apparently few independent groups where everything can be discussed - the Yahoo group died, so here in the forum one can read, but its still a bit restriced as it is public, so its not a good idea to talk too negatively about a surgeon - and also even though I read a lot here, I find it very hard to decide on a surgeon, as the opinions differ widely and are often repeating the opinions of one surgeon or another.

[R R H]

Yes absolutely. There's a combination of:

- Imposters who work for the clinics either directly or indirectly as agents earning a commission

- People with an axe to grind

- The threat of legal action hanging like a sword of Damocles

- and finally genuine people who wish to share their experiences

It does make it very hard to sift out what is valuable insight and what isn't. I probably differ from you slightly Anjaq in that I am interested in personal experiences as long as I know the person is bona fide. In some ways I'm more impressed by that kind of thing than before and after images which clinics post up. It's too easy to manipulate those these days.

[anjaq]

Well what I really would like to read is experiences of people who had the surgery and talk about it a year later when its all settled and one can for sure say that some complpication is gone instead of not mentioning a complication in the belief it surly is not an issue eventually. And I like real pre and post images that are not modified or tained too much with makeup. The ones at the surgeons presentations or website are of course somewhat cherrypicked and often I see that post op pictures are done with a different makeup than pre op (often pre op no makeup is used).
So I get the impression it is next to impossible to get an objective opinion and one has to accept some sort of diffuse feeling of many people speaking well of a surgeon, the surgeon giving an impression to be honest and professional in a consultation and not hearing too many bad stories by chance and then make a choice from that base, which is not objective and can be menipulated, but there is nothing else to use as a base for a decision.

[JS UK]

I'm going to be in BA this week for a hair transplant with Dr Szyferman and was thinking it would be worthwhile having a chat with Dr Dimaggio re having a rhinoplasty on a future visit.

Can anyone give me rough indication of the possible cost prior to me speaking with him?

Thanks.

J

[Amy Rachel]

Great info here! Just to share a couple of very minor things.

* A transition friend had full FFS with Suporn and she had a truly gorgeous result. I don't know what type forehead she had. As I recall, he did the hairline scalp advancement technique.

* I had rhino and lip shortening with Dr. Suporn. In post-op recovery, I could see my lip was different but I could not see the incisions. Only some months later when I got a bit too much sun one day could I see the tiny incisions that curved up into my nostrils. He truly works skin like nobody's business!

* I was fortunate to have Dr. O for the full meal deal. Retired now, he was the facial bone master and anyone who attended gender conventions back when he was still practicing probably saw one of his presentations. He also did free consults — and honored his quoted prices even years later. I was passing and living "stealth" before but he changed my life. Now I don't see any hint of "him" in the mirror anymore.

Dr. O did scalp advancement technique. I did have numbness but feeling is mostly back now and still getting better years later. And when I had the numbness, it bothered me for a couple of days and then my proprioception seemed to grow accustomed to it. I can't comment on the other hairline techniques. I can say that I do not need plugs or transplants to cover any scar. (I suppose if I shaved my head there'd be something visible.)

Hope this helps.

[Ellement_of_Freedom]

Great info here! Just to share a couple of very minor things.

* A transition friend had full FFS with Suporn and she had a truly gorgeous result. I don't know what type forehead she had. As I recall, he did the hairline scalp advancement technique.

* I had rhino and lip shortening with Dr. Suporn. In post-op recovery, I could see my lip was different but I could not see the incisions. Only some months later when I got a bit too much sun one day could I see the tiny incisions that curved up into my nostrils. He truly works skin like nobody's business!

I wonder why we hardly ever hear of his FFS results these days.. why do so many choose to go elsewhere?

[Amy Rachel]

I wonder why we hardly ever hear of his FFS results these days.. why do so many choose to go elsewhere?

Perhaps because there are more options now. Perhaps because his SRS procedure itself can take 9 hours, which makes FFS a difficult choice for an oh-by-the-way add-on procedure. Perhaps because he's not the bargain he was decades ago. My sense is that in general the SRS surgeons are soft tissue surgeons. The best FFS surgeons master bone and cartilage work. Not many do both well, affordably, and in the same anesthesia session.

[AnonyMs]

I wonder why we hardly ever hear of his FFS results these days.. why do so many choose to go elsewhere?

I wonder that myself. I'd definitely choose him for SRS, but not at all confident about FFS. The lack of reports increase the risk for me, and I really don't like taking risks.

[anjaq]

A friend of mine had partial FFS with him. She says it was great. But I guess his main focus is on SRS. I doubt it is advised to combine both in one surgery, but he seems to be an option for both procedures individually - I read very little about people going there for FFS alone though, I have not heard any negative reports about this.

[Ellement_of_Freedom]

I wonder that myself. I'd definitely choose him for SRS, but not at all confident about FFS. The lack of reports increase the risk for me, and I really don't like taking risks.

I'm in the exact same boat!

[Sophia Sage]

For me, facial surgery was more about erasing the old features that made me dysphoric in the mirror than anything else.  No one can tell you what you "need" -- not when it comes to dysphoria.  If something makes you dysphoric, well, there's your answer.

So I do recommend that if your face makes you dysphoric, even if you're passing, just get the whole thing done.  Because it's just so transformative.  It really does help to bring the "real" you forward.  And get it as radically feminine as your bones will allow, while still acknowledging that, given the overall configuration of your face, some aesthetics may "work" better than others. 

Here's something that isn't often talked about: our bones can limit the work available, particularly the jaw, because of how the facial nerve passes through it.  That entry point pretty much sets what contouring can be accomplished. Which can still be a lot, but not always as much as we'd like.  Likewise, some foreheads are very thin, and a shave isn't going to work -- it has to be removed and either broken up and rearranged, or replaced with filler.  None of this can be determined without X-rays.

Back when I transitioned, all I'd ever heard about was Dr O.  It was only when I met a few Meltzer patients in my local community that I even knew he was also doing facial work.  His early results were... not very impressive.  His later results, though... one girl, pretty young, was completely unclockable in her result.  I really liked and preferred his rhinoplasties and how naturally he'd get the nose to join the forehead.  Whereas Dr O's typical aesthetic was a kind of ski-slope that I found a bit too flat.  I do think I lucked out in going to Meltzer, as I got a great result even though it's not his forté.  But then, I was able to clearly articulate and delineate my exact aesthetic preferences, and he was able to match them -- it really does help when communication isn't an issue, and when you have your own well-researched opinion of what you really want.

I don't have any opinions on the current slate of surgeons -- it all looks very exciting, I'm seeing so many good results, all over the world.  Make sure you're going to a place with great aftercare, as recovery can be quite grueling.  More importantly, though, do your research.  Study your face, and figure out everything that isn't working for you on an emotional level, and figure out what it will take to correct.  Consider everything.  Go to your consultations knowing what it is that you want, and then it's a matter of seeing if they can deliver the goods, rather than being passive and being presented with emotionally uninformed recommendations that might not fully address your underlying issues.

And if you're young, understand that your youth helps to pass, and that while it's ultimately fleeting, you can always go back for FFS further down the road, when you've actually got, you know, money. 

[anjaq]

And get it as radically feminine as your bones will allow, while still acknowledging that, given the overall configuration of your face, some aesthetics may "work" better than others. 

I am not so sure about this. Getting too much done seems to be awkward and some trans women who had FFS look a bit odd because if that, because either too much was changed and it just shows - or because the FFS can after all just change some of the facial features and it is not complete. Some features are not changeable with FFS and if you feminize those parts that can be changed to the max, but have other parts unchanged, it is a weird puzzle. I especially see this if people have a rather large and long head and get the usual things forehead, nose, chin, jaw done but the shape of the face overall is still a bit masculine - then there is a face with very delicate features that is shaped more like that of a woman who would have a bit less feminine features. There seems to be various priorities with different surgeons but of couorse in the end if the patient goes there and tells them to do the face as much feminine as they can, they would probably try to do so...
Why do you suggest this - do you think there is a bigger benefit of doing more radical work?

(Personally I am still undecided on how much I would want to change - its such a hard balance between looking like "me", looking natural, being as feminine as possible, risks of damage fro surgery,...)

Go to your consultations knowing what it is that you want, and then it's a matter of seeing if they can deliver the goods, rather than being passive and being presented with emotionally uninformed recommendations that might not fully address your underlying issues.

This is not always so easy to say. If you have some part that causes dysphoria - like your big jaw or the brow bossing, its easy. Sometimes the dysphoria is more diffuse in origin and maybe it also comes and goes - its sometimes sadly not so easy to pin it down.

And if you're young, understand that your youth helps to pass, and that while it's ultimately fleeting, you can always go back for FFS further down the road, when you've actually got, you know, money.

This is of course true, but I think if you have the means and you have some dysphoria over it, but think you can after all get away with it, because you pass well enough - it makes sense to think about the future and maybe its better to get it done then rather now than later and enjoy the benefits of it a few years earlier - if it is coming anyways. This for me is a big thought now. I transitioned at age 25 and passed well after 2 years or so. It started to get less good over the years and now at age 41 it still works ok, but I am still feeling dysphoric about it ins ome ways and I fear that at age 50 or 60 it will probably rather get worse, so I consider doing a FFS rather now than in 10 year - basically I tell mysefll now or never - I would hate to have to do FFS at age 55 and then curse myself over not doing it at age 41, getting rid of dysphoria much earlier.

[deeiche]

SNIP
Here's something that isn't often talked about: our bones can limit the work available, particularly the jaw, SNIP

Not just the jaw, frontal sinus anterior bone location also limits how much setback can occur.  This occurred with me, my eyes are still setback some.  However it is genetic, my sister and mother both have deep set eyes.