Dr. Z.?

[Wynternight]

I'm seeing a lot here about Cardenas, Rossi, and DiMaggio but not much on Zukowski. Any Dr. Z. alumni that can give me some info on him? I hear he's one of the best so what is he like? How is his aftercare? How about his pricing?

[EmilyMK03]

I had a rhinoplasty with Dr. Zukowski.  I had a huge, wide nose, with a very large bump on my nasal bridge.  My nose looked hideous.  Now, 6 months after my surgery, my nose looks wonderful.  Everyone who knew me from before my surgery (all of my friends, both trans and cis, and my own immediate family) tell me the result is nothing short of amazing.  I am extremely happy with the result.  I am planning to go back to him soon for some additional FFS.

Before I had my rhinoplasty, I spoke with, in person, three other trans women who had many FFS procedures done by Dr. Z within the last few years.  They were all happy with their results.  One of them is a medical doctor.  She had nothing but good things to say about Dr. Z.  Given her myriad of options to travel worldwide and afford any surgeon, the fact that she chose Dr. Z made quite an impression on me. 

The staff at Dr. Z's office are all super friendly.  They'll instantly remember every person who walks in the door by name and greet you with a smile.  They're genuinely good people.

Dr. Z himself is a bit of a personality.  Some describe his personality as that of a car salesman.    He's also quite direct and to the point, but I like that about him.  He also genuinely cares about his patients.  I have heard that some FFS surgeons don't visit their patients after surgery.  Dr. Z will visit you at your nearby hotel, if you are recovering there.  And he will personally see you for every single follow up visit, spending as much time as you need to answer as many questions as you like.  Since I live just 40 min away from his surgical center and office, I've been back for many follow-up visits to check on my recovery, even though everything's been going fine.  And he always takes time to see me and examine me himself.  There's no additional cost for all of these aftercare visits either.

As for pricing, I'm pretty sure Dr. Z has some of the most reasonable pricing compared to other FFS surgeons in the US, especially given his years of experience.  You can get quotes from other surgeons and compare, but I'm sure that everyone will tell you that his prices are really quite low for how much you get.  It certainly was the case for me.

That's not to say that everyone who has had surgery from Dr. Z is happy, but I've found that that's the case with every surgeon.  There always seems to be a few cases for every FFS surgeon where the patient is unhappy.  Whether that's due to the surgeon, the patient, or a miscommunication in expectations between the two, it's difficult to say.

[Maybebaby56]

I had a consultation with Dr. Zukowski last week.  He was very detailed in what he would do and why. Much more so than the other two doctors I went to.  Also, he has a great eye.  He spotted the fact my left orbital bone is slightly higher than the right.  I never noticed that asymmetry. It's very subtle, but I could see it after he pointed it out. He also said I probably broke my nose as a child, because I have a deviated septum which I had no clue about, but makes so much sense as I have always had nasal congestion problems, and indeed, it is easier for me to breath out of one nostril than the other.  How can I have not noticed that in 50-some years??  He picked up on it in less than 60 seconds. He had a lot of impressive before-and-after pics, as well. About two-thirds of his practice is with transgenders, so everything is very trans-friendly.

Yes, he is not shy about selling himself, but I took an instant liking to him.  Plus, he is ex-Navy, and he gave me a $1500 discount for being a Navy civilian  

His prices do seem reasonable.  I am getting everything from forehead to neck (brow reduction/scalp advance, blepharoplasty, rhinoplasty, upper lip reduction, chin contouring, trachea shave, plus face/neck lift, and fat transfers for $35K.  In comparison, Dr. Lee in Beverly Hills quoted me $58K for about the same work.

I booked my surgery today for September 15th, another plus: no long wait times.

~Terri 

[Maria77]

I had surgery with Dr. Z about two years ago.   I am pleased with my results and his prices are very fair.  He didn't try to push extra procedures, as I didn't really need forehead work and he said so.  After my surgery, he visited us in the hotel and petted our cats.  So he is a pretty down to earth guy.  My husband also quite liked him.   His staff is easy to work with-Cole is especially sweet.

[anjaq]

I totally can imagine him being a bit of a "car salesman" personality. I read his webiste http://www.mlzukowski.co.uk/index.php/procedures/face/pure-endoscopic-biplaner-brow-lift and it sounds a bit like he is saying he is the best surgeon doing forehead FFS and basically all others are using grandpas techniques and just are not good enough to do it better and actually are spreading lies about his technique being inferior instead of superior.

This actually put me off a bit. Of course it may be true, but if not - almost all other surgeons including Dr O agree that forehead FFS usually requires a type 3 reconstruction and advise against burring of the bone instead. With 5% exceptions in those who have a situation that allows such an approach. Also the endoscopic approach versus open approach debate is tough - most say that they can preserve the nerves and tissue much better when they revome it from the bone in one piece rather than creating canals for endoscopic procedures. He says the opposite, that basically the majority of FFS patients from other surgeons suffer severe nerve loss and problems with sinus and nose later on.

This is of interest to me, but I do not know how to find this out - every surgeon claims his technique is better at avoiding nerve damage but also admits that some nerve damage occurs and apparently often they claim that using a different technique causes much more damage... How would one decide this.

Basically I have the impression about FFS recently that you pick a surgeon that seems to be in the top 10 list and that you like and then just hope for the best, because there is apparently no way of really finding out what is going on really and what the risks really are - and after the surgery, you learn to deal with the damage that everyone seems to get to some degree but never talks about it.  Its a bit of a toss of dice... this leads me to postpone the decision to do FFS for now actually - too much misinformation and unhealthy competition.

What I read though is that with Dr Z there may be more swelling in forehead surgery but the scars will be smaller because of the endoscopic approach. I guess because he does no type 3 forehead reconstruction, one has to see if one has a strongly masculine center forehead (above the nose), in that case it may be a problem if not enough can be changed with burring.

[Debra]

I have a gf who had full face done by him many years back and is happy with her results. I've heard both good and bad about him around online but he didn't end up being in my top 6 US surgeons to interview.

[Wynternight]

Thank you all for the good info. I'm down to Dr. Rossi (who I can pay in cash) who says he'll decide on reconstruction or shaving based on my xray but the cost is the same regardless, or Deschamp-Braly who I may be able to get covered by insurance. If I can get insurance to cover the procedure than I'll likely go to Deschamp but, setting aside costs, they both seem to be very qualified at what they do and have many happy clients.

[anjaq]

Deschamp ist the surgeon who is successor of Dr O, right? I saw he does not even provide email contact on the website, only phone connection and consultations are only face to face and no photo consultations. Apparently he also is quite expensive?

[Wynternight]

Deschamp ist the surgeon who is successor of Dr O, right? I saw he does not even provide email contact on the website, only phone connection and consultations are only face to face and no photo consultations. Apparently he also is quite expensive?

I dinnae know about his pricing but you're spot on with the rest. He prefers to see you in person with an xray taken an hour before the appt. so he can get a good idea on what to do. He prefers phone discourse to email for privacy and confidentiality and does not want photos. He believes a hands-on consult is the absolute best way to assess what work needs to be done. He will work with me to get pre-certified through insurance so I'm going to be working on that and we shall see what happens.

[Debra]

Deschamp ist the surgeon who is successor of Dr O, right? I saw he does not even provide email contact on the website, only phone connection and consultations are only face to face and no photo consultations. Apparently he also is quite expensive?

Yep that's right. I consulted with him in person in June and decided to go to him in November for FFS. He has great results! He just won't show them on the website....which is great as a prospective client, frankly.

He is rather expensive though....on par with Dr. Speigel

[Danielle11746]

Dr. Z did my chin and Adam's apple back in 2004, his bed side manner and aftercare are wonderful.  My chin was slightly uneven, I had follow up apts and a fat transfer to even it out at no extra charge.  I think the surgery was 6500 if I remember correctly.

[Wynternight]

I have a phone consult with him next Wednesday so I'll update with how that goes.

[SamSparks]

I totally can imagine him being a bit of a "car salesman" personality. I read his webiste http://www.mlzukowski.co.uk/index.php/procedures/face/pure-endoscopic-biplaner-brow-lift and it sounds a bit like he is saying he is the best surgeon doing forehead FFS and basically all others are using grandpas techniques and just are not good enough to do it better and actually are spreading lies about his technique being inferior instead of superior.

This actually put me off a bit. Of course it may be true, but if not - almost all other surgeons including Dr O agree that forehead FFS usually requires a type 3 reconstruction and advise against burring of the bone instead. With 5% exceptions in those who have a situation that allows such an approach. Also the endoscopic approach versus open approach debate is tough - most say that they can preserve the nerves and tissue much better when they revome it from the bone in one piece rather than creating canals for endoscopic procedures. He says the opposite, that basically the majority of FFS patients from other surgeons suffer severe nerve loss and problems with sinus and nose later on.

This is of interest to me, but I do not know how to find this out - every surgeon claims his technique is better at avoiding nerve damage but also admits that some nerve damage occurs and apparently often they claim that using a different technique causes much more damage... How would one decide this.

Basically I have the impression about FFS recently that you pick a surgeon that seems to be in the top 10 list and that you like and then just hope for the best, because there is apparently no way of really finding out what is going on really and what the risks really are - and after the surgery, you learn to deal with the damage that everyone seems to get to some degree but never talks about it.  Its a bit of a toss of dice... this leads me to postpone the decision to do FFS for now actually - too much misinformation and unhealthy competition.

What I read though is that with Dr Z there may be more swelling in forehead surgery but the scars will be smaller because of the endoscopic approach. I guess because he does no type 3 forehead reconstruction, one has to see if one has a strongly masculine center forehead (above the nose), in that case it may be a problem if not enough can be changed with burring.

Hint:  Its not true. 

[Maybebaby56]

Hint:  Its not true.

Which part? I am very interested, as I am scheduled to have FFS with Dr. Zukowski in September.

~Terri

[Wynternight]

Which part? I am very interested, as I am scheduled to have FFS with Dr. Zukowski in September.

~Terri

Please, do elaborate.

[clawdeenwolf]

I'm not sure I'd go to him for type 3 forehead work.

[anjaq]

Well - I said this before - if a surgeon does not recommend a procedure but you feel that it would be better or needed, the better way is to choose a different surgeon for that. I would not choose facialteam for hairline incisions and scalp advance, because they recommend crown incisions for 99% of the patients. I would probably also not really want to go for a open forehead reconstruction with type 3 forehead surgery with Dr Z who states on his website that his is a procedure that is not needed and risky. So even he would do a open type 3 forehead reconstruction or facialteal would do a hairline incision and scalp advance, it is basically going against their convictions and experience and I would rather have someone do such procedures who is confident that it is the best choice rather than doing it basically only because the patient insisted on it.

I do not know many Dr Z patients and none personally yet. I have contact on facebook with one patient who had surgery with him this summer and she is very happy about it though. The forehead reconstruction methods of his versus others seems to be a highly controversial topic though with each "side" claiming to be right and the other to be inferior in his technique - its impossible to decide this by logic, apparently. One can only trust and hope to get a good outcome.

In the end, all the surgeons have many good outcomes and always a couple of bad ones - how many of each is hard to really count

[likealolita]

Dr. Zukowski doesn't do type III forehead reconstructions, they just do type II (shave-and-fill), which, in certain cases, could still be "good enough" to produce a satisfactory result, but in other cases, likely won't be enough to sufficiently remove all brow bossing.

[SamSparks]

Which part? I am very interested, as I am scheduled to have FFS with Dr. Zukowski in September.

~Terri

When I said its not true I meant this.  I just don't believe his angle on burring the forehead vs. doing the removal and reshaping of part of the frontal sinus.  I don't think either is more or less safe.  Its entirely down to the surgeon performing the procedure, ie his skill.  A surgeon that is not as skilled can make a mess for the patient in either scenario.  Reconstruction requires more skill than burring.  Neither heals any better.  Reconstruction has maybe a higher chance of infection due to the nature of the procedure, thats about it.  Just think of the procedure.  One is grinding a burr on top of the sinus.  The other is taking out the front wall of the sinus (it has a back wall, behind that is the brain tissues), and then.... burring it (sometimes breaking it into a few pieces and wiring the pieces back together in a different shape). 

One procedure isn't safer than another, one just simply requires more skill and experience.

[Maybebaby56]

When I said its not true I meant this.  I just don't believe his angle on burring the forehead vs. doing the removal and reshaping of part of the frontal sinus.

Oh.  I was hoping you might have something more than just an opinion.

Its entirely down to the surgeon performing the procedure, ie his skill.  A surgeon that is not as skilled can make a mess for the patient in either scenario. 

That sounds reasonable.

Reconstruction requires more skill than burring. 

And you know this because you have performed both surgeries?

Neither heals any better.

Source, please.

Just think of the procedure.  One is grinding a burr on top of the sinus.  The other is taking out the front wall of the sinus (it has a back wall, behind that is the brain tissues), and then.... burring it (sometimes breaking it into a few pieces and wiring the pieces back together in a different shape).  One procedure isn't safer than another, one just simply requires more skill and experience.

That sounds like completely unsupported conjecture to me. I can "think about the procedure" all I want, but I am not a craniofacial surgeon. I don't think you are either.

Thank you for your input, Sam, but this does not clarify anything for me.

~Terri