Deciphering my CBCT scans

[mistyjensen]

Hi,

Despite not being a medical professional, I'm trying to understand my CBCT scans to find out which is the best approach to feminize my forehead given the divergent opinions I've received from surgeons, who perform FFS.  I know that most of the members here aren't medical professionals and surgeons.

Please find enclosed a screenshot of my CBCT scans: 



I also embedded in this thread an image of my head in the front:



Does the scan of head from the saggital position show that I have a thick brow bone where the frontal sinus should exist? Maybe I have a small frontal sinus or none at all?

One of the surgeons, who I had a consultation with, couldn't access all of my scans, though I did show him select images of the scans. I don't think it would be worthwhile for me to send him the above screenshot as it's highly unlikely that he will perform my FFS revision. I don't want to waste his time in other words.  I don't think I have a prominent brow. I was a tad surprised that the surgeon recommended Type 3 forehead contouring for me upon seeing me and taking measurements of my face. I vaguely recall that he said my brow bone projection is 6 mm and that the upper ideal range for a woman is 5 mm.

Other surgeons I consulted with didn't recommend forehead reduction.  My insurance is moving forward with one of those surgeons to perform my revision, although that surgeon doesn't usually perform Type 3 forehead contouring. I sense that he tries to avoid performing Type 3 forehead contouring, if not necessary. The surgeon did  gree with me that I could benefit from orbital rim reduction. If and when after my insurance and the surgeon reach an agreement on performing my FFS revision, I will send his office my CBCT scans.

[josie76]

Hi mistyjensen,
In my completely unprofessional, non-learned opinion, yes you have a frontal sinus cavity showing but it looks like it may be disconnected from the nasal cavity or perhaps the passages are clogged. It look full of what is not air as usual.

Its too bad the scan is cut off so low on your head because we cannot see how your forehead is shaped the rest of the way. Really only models have totally flat sinus areas. Most cis women have some bit of raise to the frontal sinus and slight supraorbital arch. I can't tell by that position of the 3D rendering if you have any thickening of the outer orbital rim or not.

[mistyjensen]

Hi mistyjensen,
In my completely unprofessional, non-learned opinion, yes you have a frontal sinus cavity showing but it looks like it may be disconnected from the nasal cavity or perhaps the passages are clogged. It look full of what is not air as usual.

Its too bad the scan is cut off so low on your head because we cannot see how your forehead is shaped the rest of the way. Really only models have totally flat sinus areas. Most cis women have some bit of raise to the frontal sinus and slight supraorbital arch. I can't tell by that position of the 3D rendering if you have any thickening of the outer orbital rim or not.

Hi Josie,

Thank you for your feedback!

[reborn]

It is difficult to tell based on those scans and without actual pictures, but i think that you need very aggressive chin/jaw work done and type 3 forehead work.

[mistyjensen]

Hi,

Some of my photos:

[reborn]

your forehead is in the female range I believe

[josie76]

I agree with reborn about your forehead. Doesn't seem like you should do much of anything there with your sinuses.

You have a pretty large pointed gonidal angle protrusion and quite a bit of outward flare there so jaw work would be a plus. If you were going to have anything done with your chin I would think they would either slide the bone forward or use an implant there.

[mistyjensen]

Hi,

I had jaw reduction surgery before the scans got made. But I still have a lot more jawbone left. Therefore, I will have further jaw reduction. I'm a tad concerned that further jaw reduction would make my face look more vertical. I don't want my face to look more vertical. In the hands of the surgeon, who will perform my FFS revision, I should be okay.  Also, I will have a rhinoplasty revision and sliding genioplasty to reduce my facial verticality, which conveys lingering masculinity.

[josie76]

Hi,

I had jaw reduction surgery before the scans got made. But I still have a lot more jawbone left. Therefore, I will have further jaw reduction. I'm a tad concerned that further jaw reduction would make my face look more vertical. I don't want my face to look more vertical. In the hands of the surgeon, who will perform my FFS revision, I should be okay.  Also, I will have a rhinoplasty revision and sliding genioplasty to reduce my facial verticality, which conveys lingering masculinity.

I don't see anything masculine like overall in your pictures. Generally testosterone makes the point at the gonidal angle grow long and flare out. Usually doctors cut that point away most of the way to reduce the edge and it makes the jaw appear more V instead of square at the rear of the jaw. Separate from chin shape. Your chin sets back well behind your lower lip. What one doctor said was the "ideal" look was for the chin to appear 1-2mm behind the lower lip. I am guessing the genioplasty is sliding forward.

You do look quite feminine.