Giving credit where credit is due: Dr. Tessier the precursor to FFS

[seldom]

I found out something from Dr. Leis.  It seems like Dr. O and Dr. Leis trained under a Doctor in Paris during the early 70's that pretty much created facial reconstructive surgery which was later used by Dr. O to form the basis for FFS.  His name was Dr. Tessier.  Most of the techniques that O uses were based on Tessier's procedures.  The thing is Tessier did not train that many doctors.   Leis however ended up working with O for a period  of time with the nineties and later Bowers (Leis does both FFS and SRS).   Pretty much all of O's innovations for FFS are in fact based in Tessier's work on deformed and severly injured faces.    O learned how to do the reconstructive methods he used to create FFS from Tessier during the early seventies.  Its very surprising that his name does not get brought up so much, then again...its not something one is to find out unless they are told about it. 

[Keira]

People are so focused on O as god, that they forget that most reconstructive surgeon can do what he does EASILY. Any surgeon who can reconstruct a smashed GG face to looking good, which is way harder because the blood supply and nerves are heavily damaged which complicates recovery, is able to do a good job on us.

If the technique is that old, then its been desiminated to all surgeons for quite a while, regardless of the fact they trained or not with Tessier.

[Natasha]

Isn't Dr. O too old to be playing with scalpels?

[seldom]

Isn't Dr. O too old to be playing with scalpels?

Some of us think he should retire.  He is very old.  He probably is going to retire in the next couple of years anyway.

As Keira stated, its not like when O started where he was the only one doing reconstructive surgeries on trans people.  Now its quite the opposite, many reconstructive surgeons you probably never heard can and will do the surgery.    Tessier's methods have become common practice, its not like when O started when a small handful of surgeons worldwide knew them.  It still is a very specialized area, do not get me wrong, but not as much as it once was.  O's cult thinks he is unique in what he does...he has not been unique for awhile.  He is not the only one who knows how to do boney surgeries.  Effectively when you are going to him these days you are going to somebody who spends to long in surgeries, charges for things that are considered part of other doctors procedures (for example he charges the scalp advance and forehead work seperately), and generally speaking he really should retire.  In addition to that he is overpriced to begin with.  There is no real reason somebody should go to see Doctor O these days when there are younger doctors out there who are in their prime performing these surgeries.

Just in case anybody was wondering, Surgery is something where there is such a thing as too old.  Dr. O definitely falls into that category.

[MeghanAndrews]

Hey, nice, I'll let you know how my consult with him goes in January, lol. I've spent the better part of four months now researching different doctors, talking to people who got surgeries with different doctors and looking at before/after pics. Once I discount the completely subjective comments (sometimes bordering on "cultish") and focus on results, I feel comfortable with deciding between two or three doctors. Dr. O will be expensive, definitely. He is definitely old. He probably operates too long. But, to me, the results of his work are undeniable and THAT is why I'm getting a consultation with him.

One thing about me, as if you couldn't tell by now, I do a lot of research on something before I choose a path. FFS is definitely one of those things. Everyone's entitled to their opinions and ideas, but I like to just get rid of all the subjectivity and focus on results. What will I get for what I pay? Is it worth the $ to me? It's an extremely personal decision, but I'll feel comfortable with the doctor I choose in the end.

And no matter who I choose, I won't be a Dr. O cult person, a "Z girl" or one of Spiegel's girls or whatever. I'm just me looking to get FFS and live my life.

[Keira]

But Megan, what does the "result are undeniable" mean if someone is doing the EXACT SAME THING.
Z and Spiegiel don't do the exact same thing as O, so your comparing apples and orange there.

The technique of doing type III will get you essentially the same result no matter who does it.
There are esthetic standards for that area that are well established, its not guesswork!
They are applied to GG's having reconstructive work, and now applied to TS.

All I see about O is he's got more testimonials since more people went to him and he's been doing it longer and his partisans are insanely vocal and quasi cultish, which biases their own experience immensely.

Trying to find testimonials from more low key surgeons will be harder because they'll be less of them and those that exist will less vocal.

In marketing, there's the first to market thing that exist, where the first there is given a huge future advantage no matter if their product is exact the same as the next 20 to come.

All the other techniques, jaw or chin and especially nose are routinely done on GG's. Jaw is done a lot in the asian community and chin reductions are done on GG's, for far less money and often better results.

O's nose are nothing to write home about!! I'd take my nose from Brassard, an incredibly meticulous surgeon (the nose needs that), than one from O.

[MeghanAndrews]

I should have added to my comment about Dr. O's results being "undeniable" something to the effect of looking at pictures of the before and afters from different angles and knowing how much bony work I need to have done, I'm thinking that Dr. O's techniques will work better on me. I do understand that Dr. O does the bone stuff where the Z and S do soft tissue work. Trust me, I so wish that I only needed soft tissue work or needed less than what I do need done. I feel good about my size and figure and everything else with transition, but my face has a very masculine bone structure with the exception of high cheekbones. Come in chat some time and I'll show you a picture, I just dont like posting it here in the forums

Keira, I am definitely 100%, not a technical person by nature. I'm looking at my FFS like I've got one chance to get this right, I want to go with someone who has experience with TS FFS heavy bone work, you know? Like, I can understand that there are other surgeons that do the same work and even better work than Dr. O, but I don't want to save some $ and take a chance that this doctor who typically operates on jaws in the asian community will do a great job on me. I'm pretty scared about the whole thing, rightfully so I believe.

I also do not like the noses that I've seenfrom Dr. O and I also want to try to find a way to do the hairline incision a little further back in the hairline rather than basically in front of it. I mean, I know it has to be pulled forward, but sheesh, to do the incision RIGHT on the hairline is so invasive, you know? I plan on going to Brassard for SRS when that day comes and I want to talk to him about doing my nose as well. I have heard nothing but good things about him and his staff.

I'm going to need trachea, jaw, chin, upper lip, heavy brow work, hairline and that's probably it (like that's not enough). I have so much brow bossing they are going to need a chainsaw and some bolt cutters to get that to gg proportions, lol.

Part of the reason that I don't post a lot on the forums like this is because, honestly, I'm kind of lost in a discussion like this. I guess in the end, although I do a lot of research and stuff, I still depend on people like you and some of the others in the forums and some of my real life friends who have a heavy research and empirical backgrounds to help keep me grounded and thinking about things. I appreciate that about you

[shanetastic]

I have so much brow bossing they are going to need a chainsaw and some bolt cutters to get that to gg proportions, lol.

Thanks for the laugh, Meghan

[Keira]

Another thing I disagree with is O's wanting the hairline much lower than what I find esthetically good.
The standard of esthetics is 1/3 (chin to base of nose), 1/3 (base of nose to just above eye-eye line (glabela) and (1/3 forehead). All models without exception have these proportions. That's a lot more forehead than O says is "normal" in women. My own hairline almost respects that 1/3 proportions (1/8 inch higher than that), but is 1/2-3/4 inch higher than my juvenile hairline which was rather low.

The problem Megan is that if your doing your forehead with O and he resets the nose back this much, he'll insist on doing his crappy nose. The nose needs much more detail than the rest of the bony work he does and its obvious that this is not his background and he doesn't have the skills for it (at least its obvious to me). If you want to know the opinion on his rhinoplasty, ask for advice on the online rhinoplasty forums.

Also, I feel he overcorrrects the jaw line. In esthetics, a wider jaw in women
is seen as better than the almost total destruction of it that he does.
He does a simple cut of the angle instead of doing a volume cut.
There was a korean site that illustrated the difference it makes.
A wider jaw reacts better to aging because it drapes the skin. Also,
with age, there is a natural bone loss. If you start with less, than lose more,
well the result may not be too good.

I also feel the chin is to small and pointed, which again while female is not
the most esthetic chin result, a slightly more open angle gives a rounder base to the face, which
makes the face oval (the ideal).

Well, lets just say I don't agree at all with his esthetics and never will.
I hate his esthetics with a passion.

[seldom]

The thing is Speigel...does NOT do primarily soft tissue work, most of the work is bone work (you are right about Dr. Z however...he does primarily soft tissue work).  Speigel is primarily known for his type III forehead reconstructions, which I have seen, and are very good.  Many O fanatics think type III surgeries are ONLY done by O, even though I can name half a dozen doctors who do them.  It seems like you think with regards to this forehead technique O is it as well...he's not.

Then there are people like Dr. Leis, who has pretty much identical training as O, knows ALL of his surgical methods, yet will not go the same route as O.  Why?  Leis believes O goes a bit to far, recommends things when not needed, and  significantly overcharges for surgery.  Leis is a reconstructive surgeon and does bone work.


Thats the thing I have seen breakdowns for O's surgeries and breakdowns for both Leis and Speigel.  I have seen IDENTICAL procedures with O often coming out to two to five times as much because of extra charges he tacts on.  I can go line by line on some bills and cross out things that are on O's bill, such as scalp advance ($3000) with any forehead work and tell you things that are included in a procedures price for another doctor. The thing is even Speigel is overpriced in some regards.   

I will tell you the proceedures too that some people consider unique, but are far from it...Sliding Genioplasty (the jaw surgery) and Type III forehead reconstruction.  Both things that any good maxiofacial surgeon knows how to do. 

Meghan, as much research as you did with O.  Looking at the select few before and after pictures online is not research, especially since O devotees are much more likely it seems to post them in public and he has been around for awhile.  The fact is as Keira said you really have to research it from a different angle.  These are medical procedures.  If a doctor knows them, they know them. 

She is also right in the fact that O is by in large a marketer.  He developed a cult like following.  But anybody worth their salt in research skills and methodology would not go to him.  I do research professionally.  It did not take me long to figure out there is alot of problems with O.  The thing is when you present the evidence to many O devotees, they really start acting like a cult, so to say they are cultish is dead on.  He is not the only one doing boney surgeries, not even close, and he really has issues with everything from time taken (the more time taken in surgery the worse BTW) to pricing.

When it gets down to it.  Dr. O is just somebody who markets himself well.   Thats really it.  This is a man who has made a fortune selling himself to trans people at conferences, and presenting himself as unique, when in reality this has not been the case for years. 

Just in case you are wondering.  I am probably going to see Leis.  Why?  He knows how to do bone reconstructive methods such as type III surgery when necessary, but he also does not overcharge for his surgeries, rather he charges the market rate for reconstructive surgeries rather then an over inflated cost that the big three like to hit trans people with.  The thing is I am largely going to him because of proximity, a couple hours on the train...its not like a several hour plane ride or a trip to Boston. He also has built up a good reputation of recommending only whats necessary, rather then overselling significant surgical procedures like O.  I can tell you the price difference is also tens of thousands of dollars (and this is comparing apples to apples, I asked strictly for prices on proceedures).  Thats the thing.  I am a researcher.  I did my work, I tracked down multiple doctors, some you probably never heard of, I asked what procedures they do and if they work with trans patients.   Before an after pictures do not mean much to me personally, because as Keira suggested a particular procedure is going to have a particular result.   I ended up with somebody who does specialize with trans surgeries, but one who is not particularly fond of the marketing or pricing practices of the big three and just views his work as a reconstructive surgeon. The fact is the more reconstructive doctors state they do FFS as part of their practice, the more reasonable the costs will be and reflect what women pay for these proceedures outside of the trans world. 

The dedication though to the big 3 may break down over time, and the cult of O will not mean much with his impending retirement.    I can tell you the focus on Z and O is not very strong anymore on the eastern seaboard anymore.  While many people do go to Speigel, the fact is there are now a number of reconstructive surgeons people look into.  Speigel ends up being a popular choice, but he does not have the same cult mentality O does.  People just go to him because he works more on trans patients, but he is pricey for everybody. 

Keira...with regards to the hairline...I agree.  O pushes it WAY to low.  I was kind of creeped out when I first saw it.