Dr. Zukowski phone consult, feeling blah from it

[josie76]

So I spoke with Dr. Zukowski this morning. First I was left believing he really does know facial tissues and don't doubt his skills for FFS. However, I was left feeling like he was pushing for the maximum of all surgical options. I feel that my age, nearly 42, was definitely a determining factor in what he was suggesting to me should be done.

His thoughts, from what I remember: Upper face, arches and outer edges of eyes, other grinding across the forehead to smooth everything, hairline pulled forward, something about cutting the muscles above the center of the eyes like above the glabella maybe because it causes age lines. Nose and septum work of course. Chin grinding to narrow, shorten length and forward projection. Trimming muscles up under the jaw to define it. Sounded something like a inside necklift. He talked about grinding my jawline and angle and a tracheal shave. He had me tilt my head way back and feel for my tracheal bump. Fat grafts into the upper cheeks and upper lip. Fat removal from the cheeks to prevent future aging. looking at $40k for him to work on me.

My thoughts:
I have supraorbital arches yes. They come next to each other at the glabella but do not form a complete ridge. There is a bit of flare at the outer eye rims also. Yes I'd like those all taken down. I can live with my forehead but if I am going anywhere I'd like it taken down there. There are cis women with bigger brow ridges than me. I could live with it as is if I had to and be OK.
Nose and septum need worked on definitely.
Chin needs narrowed some with shirtening and forward projection reduced. I'd be sure happy about that. A neck lift would be nice but I could stand to loose weight as well. That would reduce my familiar turkey neck everyone in my family has.

What I'm not keen on, extra fat grafting into my cheeks or wherever. The tracheal shave need not be done. Plus if I end up budgeting it all right maybe I'll look into Dr. Thomas' Feminizing Larnynoplasty procedure for my voice in which case its better not to have had someone cutting on that.
My jaw, he talked about cutting down the jaw and jaw angle and reducing the masciter muscles. My jawbone has no flare at the corner and the angle is around 120 degrees not the common masculine 90 degree angle. I don't see any need to reduce my mandible bone.

All that leaves me scratching my head. For one I don't think I can budget $40k for FFS. Second I want to remove the extra stuff Testosterone did to me, I don't feel the need to be a perfect 10 as it were. I don't need to look different, just not masculine. I just got the impression he likes to do everything he thinks of and seemed resistant to just more basic level of things.


My jaw angle


My chin is forward, I also have an underbite that makes it worse.


At an angle you can see how that arch pushes out and see the lip at the edge of my outer eye rim. From front or side I don't feel too much dysphoria issues from the arches and eye sockets, but from that angle I do.

[Becca Kay]

you decide what procedures you want.  Dr Z, like every other FFS specialist is going to suggest the procedures that THEY think will produce the best overall result. 

But if you have a few areas YOU want worked on and not others that's OK too.  You can decide. 

It's ultimately about what YOU want and feel comfortable with.  You can always get more work done later too.  It doesn't need to be done all at once.

[josie76]

Someone else told me to work it out with his office staff. Just when I asked him he was like well you can do it upper and lower parts. Kinda ND of impkied there wasn't an option to do less procedures. I'll wait and see what his letter says. He said it could be a week or so because several office people are out right now.

[Allison S]

I was recommended all the same bone work as you and lowering hairline. But then I was told I really only need my nose done... My quote was a bit over 40k too..
I haven't met Dr. Zukowski so I don't know much, but the surgeon I did meet seemed to just be working from experience.
The biggest factor for me is cost and now trying to get insurance to cover at least my nose and brow ridge.
I know in another post you mentioned seeking out a particular surgeon that has experience in a speciality... Well, that's how I feel about my forehead and nose. I'm very choosy which I feel is delaying me..
Sorry I know this doesn't help but seems we're in similar situations

Sent from my VS501 using Tapatalk

[josie76]

I was recommended all the same bone work as you and lowering hairline. But then I was told I really only need my nose done... My quote was a bit over 40k too..
I haven't met Dr. Zukowski so I don't know much, but the surgeon I did meet seemed to just be working from experience.
The biggest factor for me is cost and now trying to get insurance to cover at least my nose and brow ridge.
I know in another post you mentioned seeking out a particular surgeon that has experience in a speciality... Well, that's how I feel about my forehead and nose. I'm very choosy which I feel is delaying me..
Sorry I know this doesn't help but seems we're in similar situations

Sent from my VS501 using Tapatalk

One girl messaged me and said "don't let him cookie-cutter you" and to have done the things I want.

[Sarah1979]

Would you mind me asking Josie, what are your criteria for choosing a FFS surgeon, I think after HRT and a bunch of electrolysis, this needs to be my next step in transition.

[josie76]

Would you mind me asking Josie, what are your criteria for choosing a FFS surgeon, I think after HRT and a bunch of electrolysis, this needs to be my next step in transition.

Hi Sarah, I suppose just finding someone with good surgical background and experience with major face reconstruction. That's really what we are going to them for.

I like Dr Z's approach to forehead work of doing it laproscopic. The idea that he doesn't cut all of those major nerves is a plus to me. Also I don't think I need to have my sinus bone cut out to get the smooth forehead shape. If I had a large brow ridge then I'd bee looking at others.
Aside from the forehead work I think I would be comfortable with a more local maxifacial surgeon. I contacted one office in St Louis and the doctor emailed back with me himself. The plus with him is I have that underbite, and he can set my lower jaw back to correctly align my teeth. He does a lot of nose work for mainly women along with the dental related work. He also is the main doctor the large children's hospital has for cleft pallet repairs. My brother-in-law had his upper jaw cut and reset years ago by the older doctor in the same practice due to teeth alignment issues. Anyway this doctor said he could do the chin and jaw set back along with rhinoplasty and septoplasty no problem. He also told me right up front that he has not had surgical practice on forgead reconstruction so he would not be the guy for that part.

I'm going to see what Dr. Z's office sends me in the letter and maybe work with the office person on a package of what I really want without the bonus work. Just because I'm over 40 doesn't mean I NEED work for age issues after all.😁

[Danni98]

I had a consult with Dr. Z about 10 days ago. He said my forehead, cheeks and eyes were fine. I don't think I really need a trach shave, but after thinking about it when I lose weight again it will show a lot more. For me he recommended a Rhinoplasty, which I wanted. Jaw and chin work, which I also wanted. Fat grafting to lips, a hairline advancement and brow lift, and buccal cheek fat excision to correct jowling, what ever that is. For a grand total of $37,500, he gave me a bit of a discount because we got to talking about about something important to us both. Hope I turn out well as I booked a surgery date with Cole about 20 minutes ago. He seems like a competent guy, I like him and I don't think he tried to sell me too many extras.

[josie76]

The cheek or buccal fat makes jowling on older women. The fat and skin hangs down past the jawbone kind of deal. IDK though since I had no cheek fat until I started HRT. I'm alright with how my skin is for being nearly 42. Way better than it looked before HRT that's for certain. I've gone back and pulled my neck as tight around my Adams apple as far as I can and even with my head tilted all the way back it doesn't look worse than women's do if they have a bump. Honestly even with a neck lift I don't think the trachea is at all a problem for me. Also in the last year plus I have gained height of the trachea with what voice modulation I can do. The muscles are slowly moving it higher in my throat.

I should have money sometime soon from a work injury settlement but I have plans to get GCS and anything else done in one series of surgeries and then just go on living life more comfortable with myself. Honestly GCS would give me more comfortable right now. Generally I seem to pass with in casual encounters with people in the community. I just see the maleness left in my face. It's a tough call though because my nose and chin would do wonders but also my brow would be a big difference alone.

[Sonja]

What I'm not keen on, extra fat grafting into my cheeks or wherever. The tracheal shave need not be done. Plus if I end up budgeting it all right maybe I'll look into Dr. Thomas' Feminizing Larnynoplasty procedure for my voice in which case its better not to have had someone cutting on that.
My jaw, he talked about cutting down the jaw and jaw angle and reducing the masciter muscles. My jawbone has no flare at the corner and the angle is around 120 degrees not the common masculine 90 degree angle. I don't see any need to reduce my mandible bone.

All that leaves me scratching my head. For one I don't think I can budget $40k for FFS. Second I want to remove the extra stuff Testosterone did to me, I don't feel the need to be a perfect 10 as it were. I don't need to look different, just not masculine. I just got the impression he likes to do everything he thinks of and seemed resistant to just more basic level of things.

@josie76 - Josie I read and looked at your photos and totally agree with you - Your jaw profile does not need changing IMO - however if the chin were reduced might the jaw need to be done to some degree simply to match the reduced chin? - I would ask that question if you're planning on chin work.
Taking fat from the lower cheek/jowel area and plumping the higher area sounds like a good idea to me but this could be done later once you've evaluated the outcome - unless there is a cost saving to signing up in one go.....Also I imagine with any kind neck or facelift that leaving the lower buccal fat would reduce the effective look of the face/neck lift - so there's that to consider also.
The one thing I am sure of is the jaw bone - looks feminine to me!

Just some thoughts,

Sonja.

[josie76]

@Sonja

Hi Sonja. In all my reading jaw work means cutting and shaping the mandible angle. That is the bony point that forms at the back corner of the jawbone. Testosterone usually makes it grow longer and flare out. Then the muscles are thicker as they have more bone to pull on when chewing. So Dr Z talked about working on that but I barely have a nub of bone and it is directly verticle there with no flare out. Just seemed like he was going through the regular list and not customized list for me.

I've seen other illustrations where the chin height is reduced with shaving the sides of the mandible back from the chin. Since I do have some mandible width past the teeth line, there should be bone to cut there. Part of that also narrow the point of the chin and the front can be cut off to reduce the forward projection. However, if I got my teeth aligned that would set my chin back by like 2mm alone. This is not something Dr Z does so a local maxiofacial or cranialfacial surgeon would need to do the procedures.

The buccal fat is more of a middle age beauty treatment. Yes I can see it if you can do it all at once but when the total price needs to come in a certain range it is not that mportant. I know also that narrowing the chin or just setting my jaw back will make the cheekbones appear more feminine.

Yeh this is a complicated decision. I definitely need to take my time.

[Allison S]

Hi Josie, I have a question... If you're not going with a ffs surgeon, do you still try to have insurance cover ffs as medical necessity? Or would it just be out of pocket?

Sent from my VS501 using Tapatalk

[reborn]

my opinion is that you need an aggressive type 3 forehead, orbital rims nose and hairline lowering for feminization. Your chin surgery would be only functional. I don't see how your mandible angle would change anything. If you are paying out of the pocket save your money and go to one of the Argentinean doctors. They are amazing with foreheads and I think that rossi is better with noses. If your insurance is paying you have many doctors available in the US that do type 3 forehead works.

[josie76]

Hi Josie, I have a question... If you're not going with a ffs surgeon, do you still try to have insurance cover ffs as medical necessity? Or would it just be out of pocket?

Sent from my VS501 using Tapatalk

My insurance is out of MS so zero coverage for anything. It's a COBRA policy so I'm stuck with it for now. If insurance would cover it I'd maybe look elsewhere anyway 

my opinion is that you need an aggressive type 3 forehead, orbital rims nose and hairline lowering for feminization. Your chin surgery would be only functional. I don't see how your mandible angle would change anything. If you are paying out of the pocket save your money and go to one of the Argentinean doctors. They are amazing with foreheads and I think that rossi is better with noses. If your insurance is paying you have many doctors available in the US that do type 3 forehead works.

Hi reborn, I appreciate the input. I'm not sure that I need type 3. Mainly because I can feel the line down between my supraorbital arches down to my nose. I think this would mean my sinus cavity is not very tall so type 1 ought to work. It seems like until or unless I see a doctor who does CT scans I may not know for sure.

[reborn]

Judging by the picture I think that you need to set your forehead back about 1 cm, and that is possible with type 3 forehead work only. Only my opinion though. Can't you change insurance in order to get the FFS covered?

[josie76]

Judging by the picture I think that you need to set your forehead back about 1 cm, and that is possible with type 3 forehead work only. Only my opinion though. Can't you change insurance in order to get the FFS covered?

Changing my insurance might be a possibility with open enrollment comming up for ACA policies. I will look into it for certain. However I get cut rate BCBS of MS for basic stuff under my COBRA policy for another 6-7 months. I'll have to see what insurance premiums through the state marketplace I can qualify for. I am not working right now and still on work comp total temporary disability. This limits my income to 2/3 what I used to earn.

[Miss Clara]

Josie, I'll pass along something that I think is essential before making any decision on major facial feminization surgery.  Get an independent, professional virtual FFS analysis and photo simulation.  It will help you to make a decision better than any of us here can.  I had Alexandra Hamer do a virtual before my surgery, and it was well worth the price (from $75 to $375 for the written evaluation and up to 4 simulation photos).  Her evaluation will be about as impartial and objective as you could hope to receive, and the photos will give you a pretty good idea about what can be achieved given her recommendation.  The final result won't be exactly like the simulation, of course, because there are anatomical considerations that only the surgeon can assess and work with at the time of surgery.  Still, the VFFS is incredibly encouraging to see.  It erased all my doubts about proceeding with FFS.  BTW, I ended up going to Facial Team in Marbella, Spain.  At the time the cost was less than anyone state side, and their surgical team is top drawer. Like you, Dr. Z wanted to do way more than was really needed.  I do think Dr. Z is a gifted surgeon, but he has pretty strong opinions about what should be done.  Having a VFFS will strengthen your case for doing possibly less based on the independent evaluation, your own criteria, and, of course, your budget.  Good luck.

[AutumnLeaves]

Hi Sarah, I suppose just finding someone with good surgical background and experience with major face reconstruction. That's really what we are going to them for.

I like Dr Z's approach to forehead work of doing it laproscopic. The idea that he doesn't cut all of those major nerves is a plus to me. Also I don't think I need to have my sinus bone cut out to get the smooth forehead shape. If I had a large brow ridge then I'd bee looking at others.
Aside from the forehead work I think I would be comfortable with a more local maxifacial surgeon. I contacted one office in St Louis and the doctor emailed back with me himself. The plus with him is I have that underbite, and he can set my lower jaw back to correctly align my teeth. He does a lot of nose work for mainly women along with the dental related work. He also is the main doctor the large children's hospital has for cleft pallet repairs. My brother-in-law had his upper jaw cut and reset years ago by the older doctor in the same practice due to teeth alignment issues. Anyway this doctor said he could do the chin and jaw set back along with rhinoplasty and septoplasty no problem. He also told me right up front that he has not had surgical practice on forgead reconstruction so he would not be the guy for that part.

I'm going to see what Dr. Z's office sends me in the letter and maybe work with the office person on a package of what I really want without the bonus work. Just because I'm over 40 doesn't mean I NEED work for age issues after all.😁

This brought up a point I was going to: for the jaw/underbite issue I would DEFINITELY choose a surgeon who's a craniofacial/maxillofacial specialist as well as an FFS surgeon. While I would not recommend having a regular plastic surgeon just grind down your jaw, I would also not recommend letting a surgeon without FFS experience do your rhinoplasty. Personally I would look at both Dr. Harrison Lee and Dr. Deschamps Braly, both of whom appear to have a ton of additional training in maxillofacial procedures. It seems likely they could both do the jaw setback while at the same time feminizing your jaw/chin area and the rest of your face as well. If nothing else you could have the lower face/jaw done with one of them, and then have the upper face work done endoscopically with Dr. Zukowski or somebody else.  FFS is a big expense and you really only have one chance to get it right, so I wouldn't trust your complex jaw issues to anybody other than a super specialist.

[josie76]

I still have not received the letter with actual quote from Dr. Zukowski's office. He did say they were shorthanded in the front office recently.

I have sent photos to Dr. Parit Patel who is also in Chicago. He is board certified and both a maxiofacial and cranialfacial trained surgeon. From what I saw about him, he went to med school in Chicago but after surgical fellowship he was in NY for 5 years before moving back to Chicago. He is advertising FFS specifically also. I'll see what this brings.

[Danni98]

Have you checked your email? I to was waiting for that letter but it was emailed to me.