Zukowski - Rhinoplasty and brow bossing removal?

[icy]

Sophia Sage,

So I wanted to kindly ask you again. There is no problem doing procedures piece by piece? I want to ultimately do my forehead with doctor Deschamps however with rhinoplasty thats 28K.

So I'm wondering if I could féminise my nose first as much as possible and do my ear pinning surgery. So then I can gather money to do my forehead and jaw/chin operations.

I understand it's better to do forehead with nose however would it be a problem if I do my nose first and follow up with a revision in 1.5-2 years when money is sufficient.

I could consider Cardenas, DiMaggio, and facial team. However I feel confident to do it in USA. Maybe I'm paranoid however I hope I can do my nose with doctor Z or Deschamps first and come back a year and a half later to revise my nose to make ultimately thinner and smaller with forehead work with a cranio surgeon

Thank you

The prominence of a forehead has nothing to do with the thickness of the bone.  Very thin bone can still bow outwards to a great degree. 

It's a very good reason to actually consult with doctors in person and see a number of results; they always have more in the office than are published online.  More importantly, they can serve as a reference point for explaining what we want, because doctors tend to use technical language that we haven't mastered.

When I consulted with Meltzer, I explained this very aspect of the nose, how I thought it should be, and he said that would be no problem -- and looking at results, it was very easy to point to a nose and say, "like this, not like that."  Dr O, on the other hand, was kind of firm in his own sense of aesthethics, and said that's just how it had to be; I never really got a technical explanation from him as to why. 

I ended up going with Meltzer, and was very happy with my nose.

[kittenpower]

Just to chime in a little; if you have your nose done like you are wanting without the forehead, the surgeon may not remove any bone (osteotomy)that sits at the top of the bridge of your nose between your eyes, so that may deepen the radix which would make any existing brow bossing look a lot more prominent.

[jentay1367]

Hi Icy....I don't pass so my goal is to do just that.  So my intention will be to ask him what and how much. That will give me a basis to go from and some kind of reference point. I intend on getting a quote from FT as well. Braly is out....too expensive. So first, I want opinions from a professional.  Without that, I have no way to know where I'm at or what I need. It's simply too hard to be objective about yourself.

[icy]

Thank you!

Interesting! The forehead surgery info is a bit confusing. As I look at my forehead it isn't bad or dominantly masculine. Since doctor Z maybe cheaper and well reputed. I'm considering to do these procedures with him and after 1.5 year to go to another surgeon or go to doctor Deschamps.

So with doctor Z I will ask him to do my ears, nose and perhaps possibly forehead burring and recontouring all at once.

To be honest I don't know the difference with forehead burring and contouring compared to forehead reconstruction type 3

I wish someone can explain to me like I'm 5 and show some images. I also want to know if I do the forehead burring and recontouring and say 1.5-2 years later I consider forehead type 3 reconstruction, would this interfere with the results as I have done the former first?

I'm sorry to be annoying

I wouldn't be informed if It wasn't for this amazing community.

Thank you

Just to chime in a little; if you have your nose done like you are wanting without the forehead, the surgeon may not remove any bone (osteotomy)that sits at the top of the bridge of your nose between your eyes, so that may deepen the radix which would make any existing brow bossing look a lot more prominent.

[Ypsf09]

Forehead type 3 reconstruction:

https://www.youtube.com/watch?v=oXSnTil9HFA&feature=youtu.be

Forehead burring/contouring: in this video they use implant, some surgeon use fat/bone paste or nothing.

https://www.youtube.com/watch?v=JMy_hvYhWg8&feature=youtu.be

[Sophia Sage]

So I wanted to kindly ask you again. There is no problem doing procedures piece by piece? I want to ultimately do my forehead with doctor Deschamps however with rhinoplasty thats 28K.

So I'm wondering if I could féminise my nose first as much as possible and do my ear pinning surgery. So then I can gather money to do my forehead and jaw/chin operations.

As I said before, it's possible to do things piecemeal in the fashion you suggest, but I don't think it's wise. First, the more you split up your work into separate sessions, the more expensive it's going to be.  Every time you go in, there's an additional charge for the operating room, anesthesia, and so forth, in addition to the doctor's fees for his work.  If you're looking to gather your money, then, it will ultimately take longer for you if you cut into those savings to do some lesser work ahead of time.

Second, you only want to do your nose once, if at all possible.  Most of the nose isn't bone, it is cartilage, and it can only take so much work before it degrades.  Because the nose connects contiguously to the forehead, it usually needs work when you get your forehead done.  But they won't be able to do as much if it's already been worked on; this can limit the results available to you.  So it really is for the best to have any nose work done at the same time. Now, does this mean you can't get a good result doing the nose first, with a subsequent revision when you have your forehead done?  No, but it does mean there's more risk of getting a sub-par result (or worse).

Don't limit yourself to Deschamps-Braly when it comes to your forehead.  Until you see a lot of results, you won't know which surgeon's aesthetic is most closely aligned with yours.  With Deschamps-Braly, those results aren't posted online, you have to see him in person and have a proper consultation. 

Given that cost is an issue for you, I wouldn't rule out getting work done overseas if you have a Type III forehead. In fact, I'd strongly recommend it.

In brief, a Type III forehead has thin bone, regardless of how far it "sticks out," and so to change the shape it must be removed, then either reshaped (by breaking it down and putting it back together) or replaced using a prosthetic.  It's then put back.  There is no theoretical limit to what can be done, other than the shape of the skull and how the forehead fits into place.

Type I foreheads have thick bone, again regardless of what the visible shape is.  When the bone is thick, it can be shaved down without being removed.  The limiting factor is the thickness of the bone -- if you want to set your forehead and brow ridge back by say 5mm, and the bone is 7mm thick, then this is feasible. 

Forehead type 3 reconstruction:

youtube.com/watch?v=oXSnTil9HFA

Forehead burring/contouring: in this video they use implant, some surgeon use fat/bone paste or nothing.

youtube.com/watch?v=JMy_hvYhWg8

Fixed this for you.

[jentay1367]

It appears Zukowski has no need for nor desire for you to bring Xrays or other imaging types to his consults. The following is an interesting note from Zukowski's site. I went looking for answers regarding Xrays and need at consults since I got no feedback from a previous post here and ran into this info:

From M. Zukowski's site:

In over 22 years of doing endoscopic forehead lifts, I have never had to convert to a open procedure.  In over 18 years of working with the gender community, I have never requested a patient to get a x-ray to determine sinus thickness. The anatomy is predictable and with experience and the 20x magnification capabilities of endoscopy, you can determine bone thickness. Besides, most sinus x-rays that patients show me are deliberately over penetrated to make the bone seem thinner than it is

So there it is. You either are willing to have Type I work where he feels skull Xrays to be unhelpful, or you go to someone else for Type III and have the open technique performed where it would seem to me that an Xray would be redundant as their going in anyway. But obviously, some surgeons feel that if they can get away with Type I, it's the better choice.

The following is more insight to his perspective on the different techniques:

Endoscopic minimal scar surgery has revolutionized the way that all surgeries have been performed since the mid 1990s. People that badmouth this technique simply cant do it. The endoscope is a lighted fiberoptic camera system that magnifies the operative site 20 times and displays the image on a high definition screen.  The endoscopic biplaner variant browlift is an advanced 21st century technique that replaces open browlifts and takes into account the use of the endoscope which is a tool that helps a surgeon work in a more closed or distant space. Endoscopic techniques avoid some of the built in complications of open techniques, such as permanent hair loss, longer scars, cut sensory nerves with resultant permanent numbness to the six inches of scalp behind the scar, or cutting and invading into the sinus with the risk of permanent sinus dysfunction in the form of sinus headaches and runny, drippy noses. Of great concern to you, the patient, should be the fact that open techniques are fraught with complications that are independent of how good or how bad your surgeon is. They're built into the technique.