Truthful difference, between the two main techniques for brow bossing surgery?

[Hanouf]

As I have mentioned in my two earlier posts, I am a 57 year old post op of more than 10 years, looking to have facial feminization surgery and much less possibly massive revision surgery to repair the damage from past seriously batched jobs. Given, my age the revision surgery does not look likely. But, for career reasons, I must be in the ball park of passing, or I can say with confidence my career at 57 years of age is over.

Enough of the background information on me and now to the pressing question: I have now consulted two of the most popular doctors in Bangkok.  The first is well known for removing the anterior sinus wall and reshaping it in the brow bossing process.  This is the process that this doctor has suggested be done on me.

The second doctor I consulted does not remove the anterior sinus wall to reshape. He just grinds down the required skull bone with the sinus wall in place. He claims that there is less risk involved in his process than the former process. But, I am concerned that the results will be a major compromise. 

These two doctors or their clinics are among the top three most popular in Thailand, and they all do a very good job in selling their surgical technique, so I am seeking a more objective and straight forward  opinion regarding these two brow bossing procedures.  Is the first technique really more risky? Does the second brow bossing technique really deliver the same results as the first? My career is really at stake based on the results, but on the other hand, given my age, I do want to minimize risk.

[deeiche]

As I have mentioned in my two earlier posts, I am a 57 year old post op of more than 10 years, looking to have facial feminization surgery and much less possibly massive revision surgery to repair the damage from past seriously batched jobs. Given, my age the revision surgery does not look likely. But, for career reasons, I must be in the ball park of passing, or I can say with confidence my career at 57 years of age is over.

Enough of the background information on me and now to the pressing question: I have now consulted two of the most popular doctors in Bangkok.  The first is well known for removing the anterior sinus wall and reshaping it in the brow bossing process.  This is the process that this doctor has suggested be done on me.

The second doctor I consulted does not remove the anterior sinus wall to reshape. He just grinds down the required skull bone with the sinus wall in place. He claims that there is less risk involved in his process than the former process. But, I am concerned that the results will be a major compromise. 

These two doctors or their clinics are among the top three most popular in Thailand, and they all do a very good job in selling their surgical technique, so I am seeking a more objective and straight forward  opinion regarding these two brow bossing procedures.  Is the first technique really more risky? Does the second brow bossing technique really deliver the same results as the first? My career is really at stake based on the results, but on the other hand, given my age, I do want to minimize risk.

It really depends on your frontal sinus and the thickness of your bone.  In some cases the second technique has resulted in perforations of the outer bone because it was shaved down to far.  If you have a QUALIFIED craniofacial surgeon the first method is not any riskier than the other method, and may have less risk depending on wall thickness.

Take a look at the Xrays I posted in my surgery thread to see before and after Type III surgery.

[Paula1]

I can only tell you about the following surgeon's techniques that I investigated.

These are the differences between Dr Di Maggio and Facial Team's ( Dr Capitan & Dr Simon) forehead surgery.

Dr di Maggio often partly or completely fills the sinus cavity with bone chips. If he fills it completely, he will also block the entrance to the sinus (this is called sinus obliteration). He also removes the mucous lining of the sinus.

Facial Team take a different approach. They keep the mucous lining and they don't fill the sinus at all - they set the frontal bone back but retain the sinus and its function. It's one of the reasons I personally chose them for my forehead surgery rather than Dr di Maggio. Other people prefer the di Maggio approach so I am not necessarily saying one is better than the other, it's just that the Facial Team approach is closer to my philosophy.

Dr di Maggio says that he removes the lining to prevent infection. Interestingly, Facial Team retain the lining for the same reason. I don't know of any Facial Team patients with sinus complications.

See Facial Team's video  http://facialteam.eu/#499-procedures-techniques-ffs-in-3d-videos

[Paula1]

Forgot to mention but I had burring done in the USA in 2004 and it was pretty well a disaster.

I was told that I did not need CT Scans done prior to surgery which, of course, was crazy. The surgeon said that when the bone changes colour then that is when to stop burring the bone. Well he went a little bit too far and my left frontal sinus was breached and I had a blow hole in the soft tissue after two days which subsequently was filled in with some sort of synthetic paste some months later. But I was still left with a lot of brow bossing as this method of surgery for me at least was not the correct one.

See my thread on the matter and now twelve years later my forehead is properly feminised for the very first time.

https://www.susans.org/forums/index.php/topic,199847.0.html

I have never been happier ....  and getting on with life at over 70 and have just sent up a new business as I need the money to live and more importantly I like to work and the challenge of it all.

[deeiche]

SNIP

Dr di Maggio often partly or completely fills the sinus cavity with bone chips. If he fills it completely, he will also block the entrance to the sinus (this is called sinus obliteration). He also removes the mucous lining of the sinus.

SNIP

How recent is your info on this?  When I was investigating surgeons last year I understood MdM had stopped doing sinus obliteration because of complications.  Of course the best way to get this information is directly asking the Surgeon/Surgeon's office.

[oneoftwo]

As I have mentioned in my two earlier posts, I am a 57 year old post op of more than 10 years, looking to have facial feminization surgery and much less possibly massive revision surgery to repair the damage from past seriously batched jobs. Given, my age the revision surgery does not look likely. But, for career reasons, I must be in the ball park of passing, or I can say with confidence my career at 57 years of age is over.

Enough of the background information on me and now to the pressing question: I have now consulted two of the most popular doctors in Bangkok.  The first is well known for removing the anterior sinus wall and reshaping it in the brow bossing process.  This is the process that this doctor has suggested be done on me.

The second doctor I consulted does not remove the anterior sinus wall to reshape. He just grinds down the required skull bone with the sinus wall in place. He claims that there is less risk involved in his process than the former process. But, I am concerned that the results will be a major compromise. 

These two doctors or their clinics are among the top three most popular in Thailand, and they all do a very good job in selling their surgical technique, so I am seeking a more objective and straight forward  opinion regarding these two brow bossing procedures.  Is the first technique really more risky? Does the second brow bossing technique really deliver the same results as the first? My career is really at stake based on the results, but on the other hand, given my age, I do want to minimize risk.

Do yourself a serious favor - -   and download a Kindle copy of  Dr. Ousterhout's book on Facial Feminization Surgery.

He is the person who invented and perfected BOTH types of forehead surgery ( and more). 

Dr. Ousterhout has a chapter in which he discusses the forehead surgery methods you are concerned about  - -   and he describes the surgical training required for a surgeon to be able to perform those surgeries safely and competently. 

Probably not a great idea to accept any contrary point of view without some overwhelming good reason to do so.

Based on the significant number of "bad outcomes" related in messages here on Susan's over the last few years - -  a number of people have ignored the information in that book and have ended up with bad results and multiple "re-do" surgeries.

[Paula1]

Hiya,

Just woken up at 2.00am and where do I migrate to.

Susan's Place, naturally .... 

This information was from Jan/Feb 2015 when I was researching but as you say, best to contact him direct.

Hugs

Paula

How recent is your info on this?  When I was investigating surgeons last year I understood MdM had stopped doing sinus obliteration because of complications.  Of course the best way to get this information is directly asking the Surgeon/Surgeon's office.

[R R H]

Do yourself a serious favor - -   and download a Kindle copy of  Dr. Ousterhout's book on Facial Feminization Surgery.

He is the person who invented and perfected BOTH types of forehead surgery ( and more). 

Dr. Ousterhout has a chapter in which he discusses the forehead surgery methods you are concerned about  - -   and he describes the surgical training required for a surgeon to be able to perform those surgeries safely and competently. 

Probably not a great idea to accept any contrary point of view without some overwhelming good reason to do so.

Based on the significant number of "bad outcomes" related in messages here on Susan's over the last few years - -  a number of people have ignored the information in that book and have ended up with bad results and multiple "re-do" surgeries.

Except that there is considerable criticism of Dr. Ousterhout which cannot be simply dismissed as disgruntled ex patients.

There's a widespread tendency for cult worship amongst us MtFs, whether that's with FFS or GRS.

No surgeon is above scrutiny, especially one who invents a theory and then makes a wodge of cash out of it.