Hi Sisters,
I had Skype consultation with Dr Barry Eppley today and was more than impressed by his evaluation of the current status of my forehead and his direct and no beating around the bush attitude.
At the start of my Ffs journey, I was a bit naive/confused in what exactly makes a forehead feminine and how could that be achieved for me. Due to this, I decided to go to the best in business, Dr Deschamps and totally trusted his skills and aesthetic. While Initially I was super happy with my forehead results, as time went on and swelling went down I started to notice some wierdness and started feeling something is not right. This made me start analyzing foreheads of women across different ethnicities and comparing them with mine. I started carefully studying postop forehead feminization results of other trans women and felt even though there was good amount of improvement made, it was still not quite there.
Here's the observations I have made:
1. Male vs female forehead
A typical male forehead has a prominent browbone, a visible browbone break into the upper/middle forehead. Central forehead region that is often flat and even slopes backward to some degree. This is exactly opposite of female foreheads who have a rounder, smoother and a more vertically oriented forehead with minimal to no browbone. As far as genetic females with brow bossing, it is still aesthetically acceptable since there is no break between the browridge and the vertical forehead bone above it and the eye socket configuration, eyeball position/tilt, eye size and the distance between them is feminine. The sides of the brow-ridge/forehead are more tapered towards temple unlike in males in which the sides can be more boxy/square shaped. This is what makes a female forehead relatively fuller in the central region and overall rounder 3 dimensionally while also making the eyes pop out more( relative to men's deepset eyes). So for a optimal forehead feminization, combined 1) flatenning of the inner half of the browbone( mostly type 3 reconstruction) 2) aggresive reduction of the tail of the brow bone 3) increasing the convexity and the vertical slope of the forehead, would be required.
2. My forehead feminization:
While my surgeon did aggressively setback the browridge region over the frontal sinus with type 3 reconstruction, the tail of the Browbone was not as significantly reduced. This caused the sides of the forehead to be more prominent than the central region which is opposite in a female forehead. The sides of the forehead are not as tapered into temporal region giving my forehead a broad and flat look overall with the tail of the browbone slightly sticking out. Finally, while having a coronal incision was good for giving me a slight brow lift and increasing the forehead height in the centre, it was not so good for the temporal/sides of the forehead. But I don't regret having it done through the coronal incision way.
Dr Eppley evaluation was totally in line with my observations. He also made suggestions on how the flow of the forehead into the rest of the skull needs to be enhanced/feminized which is extremely important to me as well. Something conventional FFS surgeons don't address that carefully or if at all. If you ever wonder why a lot of times postop Ffs trans women don't still really look like cis women despite having a feminine forehead, part of it is this reason. Also Dr Eppley offers simulations of the prospective results before choosing/performing the procedure.
I had consultation with Dr Adrian Hsieh(Taiwan) and his assessment was very similar, but don't want to travel that far just for forehead work.
Reading Dr Z's forehead feminization approach from his website helped a lot too in understanding things. I think if he did type 3 reconstruction(which is extremely important for optimal forehead feminization) in addition to everything else that he currently does, he could produce some really excellent results. Because he doesn't setback the frontal sinus region aggressively, he relies on aggressive reduction of the tail of the browbone and sometimes on upper/mid forehead augmentation to create a rounder feminine forehead 3 dimensionally. However the eyes still are hooded and not as open.
From what I have seen from Dr MDM, he seems to be the best if not number1 surgeon when it comes to forehead feminization as he seems to address all of the issues to create a rounder feminine forehead with eyes as open as possible.
So for me, I am about to make the decision sometime next week between Dr MDM and Dr Eppley.
Anyway, as always I am opening up about every stage of my transition to help others as much as possible by sharing the knowledge acquired from my research and maybe saving other Ffs candidates from having to require revisions by being very well informed the first time.
