Also need advise about FFS! pictures included

[sweetstars]

I understand and support the whole "Doctors Without Borders" thing
where the baby receives surgery to correct a cleft lip or similar face deformity
to ease the poor things future interactions with society. I hope that you are not
suggesting that someone blessed with a less than socially acceptable appearance
is not worthy of social interaction. A world basing it's determination, of whether
or not someone is worthy of social interaction, on the individual's looks,
would be very sad one to live in........too late, I suppose.

In reality looks determine social interaction, anybody who thinks confidence is really all that matters is living in a fantasy world.  It is a very much an older transitioner thing to think it is the sole thing that really plays a part.  FFS is not about beauty, its about normalcy.  And I am sorry you have this delusional opinion where it doesn't matter...looks matter quite a bit.  Confidence only goes so far, its the difference between if people treat you as female, or if people treat you as trans. Most younger transitioners know the difference, alot of older transitioners don't, alot of older transitioners buy into the confidence BS, when the reality is people don't see them as women, they see them as trans.  Initial impressions matter a great deal...right now, I will be honest, get FFS. 

[Myself]

In reality looks determine social interaction, anybody who thinks confidence is really all that matters is living in a fantasy world.  It is a very much an older transitioner thing to think it is the sole thing that really plays a part.  FFS is not about beauty, its about normalcy.  And I am sorry you have this delusional opinion where it doesn't matter...looks matter quite a bit.  Confidence only goes so far, its the difference between if people treat you as female, or if people treat you as trans. Most younger transitioners know the difference, alot of older transitioners don't, alot of older transitioners buy into the confidence BS, when the reality is people don't see them as women, they see them as trans.  Initial impressions matter a great deal...right now, I will be honest, get FFS.

I wonder if you said "get ffs" to me or toheatherrose ^^
I find it funny that I am feeling I want to say thank you for telling me to get ffs instead of the "I don't think you need anything" while reality seems to treat differently than that sentence ^^

[sweetstars]

I wonder if you said "get ffs" to me or toheatherrose ^^
I find it funny that I am feeling I want to say thank you for telling me to get ffs instead of the "I don't think you need anything" while reality seems to treat differently than that sentence ^^

It was directed at you.  If you are like most younger transitioners I imagine integration is very important.  The good news is you may not need as much work as is being suggested.  I would start with a rhino and forehead work.  The jaw and chin is frequently disputable, I have only met a few where its a necessity.  As my doctor said...the nose is at the center of the face.

Sorry for the brutal honesty, I have come long ago to the conclusion many older transitioners live in a fantasy land where first impressions don't matter.  Don't buy it, even for a second.  Confidence only goes so far, and if you are generally wanting to get to a point where most people consider you female and not trans, FFS is recommended. 

[Mischa]

some may disagree but I this you should wait as long as you can for FFS. don't rush good thing because they come in good time. When I started transition I weighed 220 lbs. I had just gotten out of the military and I looked like your typical pumped up muscle head. after about four years on HRT the shape of my face changed dramaticly. People say it doesnt happen, it did here.
Just do the basics for now i.e. brow trim and facial hair removal. You look great and should be proud!

Opps just noticed your brows in your avatar, they look great! and as far as brow bossing go. Look at other women. not the Idealized ones either, real women and you see that yours don't look half as bad.

[Suzy]

In reality looks determine social interaction, anybody who thinks confidence is really all that matters is living in a fantasy world.  It is a very much an older transitioner thing to think it is the sole thing that really plays a part.  FFS is not about beauty, its about normalcy.  And I am sorry you have this delusional opinion where it doesn't matter...looks matter quite a bit.  Confidence only goes so far, its the difference between if people treat you as female, or if people treat you as trans. Most younger transitioners know the difference, alot of older transitioners don't, alot of older transitioners buy into the confidence BS, when the reality is people don't see them as women, they see them as trans.  Initial impressions matter a great deal...right now, I will be honest, get FFS.

I have never heard anyone espousing that confidence is all that matters.  But I have seen some passable girls without it.  They are no longer passable.  That is a shame. 

Do looks matter?  Of course!  Does confidence matter?  Yep to that too.

How would you define older?  Usually when I see comments like this it is from a young upstart who thinks she looks too hot and passes completely.  Look, before you go saying things that sound elitist and offend some of our "older tranistioners" here please think about how you say things.  It is not about brutal honesty.  It is about being offensive in how you say things.  Even if what you say is true, I am afraid you say it in such a way that you will likely not be heard.   I, for one, would like to be able to hear what you are really saying.

This from one of those ancient girls.  Oops, please excuse me.  I dropped my cane.  If you can help me pick it up I will hobble my way out to my FFS.

Kristi

[heatherrose]

You, FFS? Not freakin' hardly! Don't make me trip you.
You know how brittle your old bones are.

[Suzy]

You, FFS? Not freakin' hardly! Don't make me trip you.
You know how brittle your old bones are.

Eh?
Speak up, will you?  The hearing is the second thing to go!

Kristi

[heatherrose]

I SAID, "YOU SHOULD UP YOUR CALCIUM INTAKE."

[Alyssa M.]

Holy crap, people, why are you suggesting she get brow bossing?!!!

Look at this picture again and show me where the eyebrow ridge is -- I just don't see one:



Your forehead shape (and I just mean the SHAPE of the BONE) is very feminine. PLEASE, don't do anything about it! If there is anything masculine about your forehead, it has to do with your hairline and eyebrow (as in, the hair, not the bone). Get your eyebrows waxed, play with your haircut, and consider doing something like an eyebrow lift or scalp advance or whatever -- but NOT anything that involves bone contouring.

You could do something with your chin, but you don't need very much. It's a little bit prominent from the front view, but you probably don't want to take too much off.

The areas where surgury could do a lot are in your nose and lips. You might want a more upturned nose and pouty, rather than hooded, upper lip (if that makes sense). Also, you seem to have a little bit of an Adam's apple. It's hard to tell how much, but you might want a traecheal chave.

The things in the earlier pictures that are most obviously masculine are the beard shadow and the large, low, and unkempt eyebrows.

You can look pretty darned good without doing a thing (at least surgically), and you could look fantastic with some work -- but leave the brow bone alone!

[Myself]

I have consulted two people by sending them photos, photos is not like examining the real thing but it give an idea:
One of them was Dr Douglas and the other was Alex from VirtualFFS, who also edited a photo.

Dr Douglas saw the photos posted on this site, Alex saw newer photos.

Here are their reviews, starting with VirtualFFS:

Hairline:
I think the height of your hairline is fine. Women have slightly higher hairlines than men - not enough surgeons realise that. One problem with moving your hairline forwards is that a shorter forehead can make the middle third of the face seem taller - in your case it could emphasise the distance between the nose and top lip. You could move it forwards a little without it detracting much but I don't think you will gain anything other than a scar along the hairline. I have moved it forwards in the fourth set of pictures (d). If you have forehead work and also decide to move the hairline forwards then you could have a scalp advance as both procedures can use the same incision. However, I personally tend to recommend hair transplants to correct hairline problems as they are less invasive and the end result looks very natural. It would probably take at least 2 sessions of "micro follicular grafts" and the first session would be done a few months after any forehead work. You can also have a combination where you have a scalp advance to cover most of the distance but then have transplants to hide any scarring and give a more natural hairline.
Forehead:
You have moderate brow bossing in the centre above your nose but less above your eyes. I have removed the bossing to bring your forehead into normal female ranges. Your forehead is quite smooth with no clear step between the bossing and the rest of the forehead so it already looks reasonably feminine. You do have a step where the bossing meets the nose though and the bossing overshadows your eyes.
Eyebrows:
Your eyebrows are nicely shaped and sit in medium position neither high nor low. I personally do not think you need a brow lift but you could lift them a little depending on your personal preference. I have simulated this in the third version of the picture (c).
Eyes:
I don't see any notable problems with your eyes or the soft tissues around them. You have large eyes in proportion to your face - this is very feminine and a great asset. It is not something you can get from surgery - you have to be born with it.

Nose:
Your nose is already female. You could maybe make a small aesthetic improvement by narrowing the bridge a little, lowering the columella a little (the bit between the nostrils) and removing the slight hump to the lower half of the bridge that you can see from the side. I have simulated these changes in the second version of the picture (b) but they would show more clearly in a profile shot.
Cheeks:
You have full and rounded feminine cheeks. I do not recommend any changes. Hormones will probably enhance them further but as your hormone history is a bit disjointed, I can't really make a guess about how much.
Lips:
Your lips are full, feminine and beautiful. It does look like the distance between your mouth and your nose is a little longer than average, making the nose to lip distance a touch longer than average. As you say, there is a procedure (the Le Fort procedure) that can change the position and height of the upper jaw but I feel that is way too invasive a procedure for you. We all have particular things that give our faces character and I think this is one of yours - your upper jaw does not really masculinise your face or detract from your attractiveness. This area of your face is all about the lips and they are so good on you that I think you should leave the area just as it is and accept the slightly taller than average upper jaw as part of the personality of your face.
Chin:
Your chin is quite tall and slightly square. I have rounded off the corners and shortened it. This is probably the most feminising procedure for you.
Jaw:
Your jaw is within normal female ranges - I do not recommend any adjustments.
Adam's apple:
I don't see an adam's apple problem in these pictures.
Overall:
This is already a feminine face with good skin, large eyes and excellent mouth. The key masculinities are the forehead and chin. Everything else is optional.

And now for Dr Douglas:

Thank you very much for your recent email with the little bit of information about yourself and the photographs. They will all be helpful in giving you what I think will be beneficial to you in feminization of your face. Please appreciate that what follows is an estimate based on photographs alone and will remain so until such time that I have had the opportunity to see you in person, can make measurements directly on your face, and have reviewed the appropriate radiographs. I would want you to obtain these radiographs in San Francisco for I know that they will be completed appropriately for my purposes. I have had extensive experience at estimating surgery from photographs alone and I am usually very accurate. If, however, there is an area of question, I will tend to over estimate rather than the reverse so that if I am wrong it will possibly become less expensive. No promises. I will work from the top down and then summarize this at the end.

Before I begin, I should tell you that I am giving you what I feel would be the best and ideal situation for feminization. What you decide to do is of course totally up to you and we will work with you in that spirit.

SCALP/FOREHEAD:   You have a long forehead and I think you need to have your hairline brought forward into a more female position. A scalp advancement is indicated

Your forehead is masculine and it probably is what I call in my classification system a type III. A type III is not better nor worse than a type I or II, it is just for different anatomical situation. The surgical access, black and blueness, pain, and time of healing are basically the same in all of the procedures. In the forehead procedure the entire brow forehead area will be feminized.  I will also be completing a brow lift.

CHEEKS:      Your cheeks are nice and they are only going to look better after the surrounding areas are feminized. Cheek augmentation is not necessary. 

NOSE:      While you have a nice nose it is a masculine nose and it will need to be feminized. A feminizing rhinoplasty is certainly indicated.

UPPER LIP:      Your upper lip is somewhat long but yet you show a very adequate amount of upper teeth when you open your mouth and before you smile. An upper lip reduction is not indicated. 

CHIN:      Your chin is vertically high, it is  broad and it is retruded. All of these can be corrected at one time in a procedure we call a feminizing sliding genioplasty.

JAW:      Your lower jaw is bowed outward along the sides and the angles are quite full. I do think a jaw tapering angle reduction will help to further feminize your face

THYROID:      I do not see any evidence that you have a prominent "Adam's apple". Therefore I do not think a tracheal shave is indicated.

Therefore, it is my feeling that those procedures that you will benefit from most of all in feminization of your face are a scalp advancement, forehead III, open rhinoplasty, chin feminization and jaw tapering. All of these procedures can be completed at one time and would be completed under general anesthesia in an operation taking approximately 9 hours. You would be in the hospital two nights following the surgery. We would want you to stay in San Francisco for at least another seven days before returning home. You probably will want at least another two weeks before returning to your usual activities particularly if it involves being in front of other people.

I think we can deliver an excellent result. My qualifications, education, and our record speak for themselves. We have completed over 1000 facial feminizations. Our concern for your feminization, well being, and progress is our trademark. We respect your desires and are proud of and stand by our work.

If you want to combine your final evaluation with your scheduled surgery you could do this by arriving in San Francisco at least two days before your planned surgery. On the first day you would obtain the appropriate radiographs, we would meet, measurements would be completed on your face, we would discuss the issues in detail, the radiographs would be reviewed, and surgery would be finalized. The next day, the day prior to surgery, you and I would have appropriate amount of time to talk about all aspects of your surgery, answering all of your questions and hopefully more.

The majority of our out of town patients will spend those two days before and the seven days after hospitalization at the Cocoon guesthouse. This has worked out very nicely for our patients. If you are not familiar with this you may want to look at lynnconway.com.

Mira, my Business Manager, whom I assume you have already been in touch with, will enclose with this letter an estimate of the costs of the surgery. This will include my fees, the anesthesiologist's charges, the hospital operating room expenses and the cost of the guesthouse. It obviously does not include the cost of getting to and from San Francisco, the cost of getting to and from our office while in San Francisco, the cost of your out of hospital medications nor the cost of the radiographs. The radiographs will cost $155.00 USD.

I hope the above is helpful. Obviously if you have any further questions we will be very happy to answer them. You will find Mira to be extremely knowledgeable and helpful about the things that we do.

My very best.

Sincerely yours,
Douglas K. Ousterhout, MD

[heatherrose]

The doctor will be able to make a payment on his Porche,
if he can convince you that you need one of his procedures.

[sarahb]

Dr. O's assesment is pretty spot on. The only thing I would consider unneeded in his assesment is the jaw work. I have a more prominant jaw than you and didn't have it done and it looks fine. Once the other procedures are done the jaw will not be an issue at all. If yours was more square/prominant than I'd say do it, but your jaw is not prominant at all.

I'd love to see the pictures from virtual FFS if you wouldn't mind posting them :-)

~Sarah

[sweetstars]

Dr. O is right about the nose and forehead, problem is he does the same nose job for everybody, and its one of the biggest complaints.  The jaw is also right. 

I will also say there are cheaper (and better) options out there.  Dr. O is getting older, his proceedures are taking much longer than they should  (5-7 hour proceedures are now 10+ hours...and the longer you are under the more risks there are).  His proceedures are no longer as "unique" as they once were boney surgeries are now very common. 

[Myself]

Dr. O is right about the nose and forehead, problem is he does the same nose job for everybody, and its one of the biggest complaints.  The jaw is also right. 

I will also say there are cheaper (and better) options out there.  Dr. O is getting older, his proceedures are taking much longer than they should  (5-7 hour proceedures are now 10+ hours...and the longer you are under the more risks there are).  His proceedures are no longer as "unique" as they once were boney surgeries are now very common.

Do ou mean the Jaw needs work or doesn't? You didn't mention the chin! 😮

[sweetstars]

Do ou mean the Jaw needs work or doesn't? You didn't mention the chin! :O

Sorry, meant the chin.  😛

[Myself]

So I went to the surgeon.

He said chin, "MAYBE" nose and forehead not at all O_o

I honestly went a bit confused because the forehead was pretty much one of the things I was completely sure of, being at home and looking I still think I want the forehead.

He was like, "do you want a forehead like your mother? yours is prettier.. considering the amount of prominence, I don't think we need to operate there""

[heatherrose]

...being at home and looking I still think I want the forehead.

Sweety, that is the whole thing in a nutshell. As you
stare at yourself in the mirror and pick yourself apart,
it is what you want not necessarily, what you need.

[Alyssa M.]

I wouldn't even put it that way. Most people I have seen who have had FFS (not in person, just videos, pictures, etc.) have looked perfectly presentable beforehand; FFS just made them look better.

So, sure, based on what I've seen before, I would believe that FFS could make you look better, so maybe it's worth it for you. But I agree with the surgeon: leave the forehead alone! You don't "need" to change the shape of your forehead simply because there's no room for improvement. (For elaboration, you can read my previous comment in this thread.)

[Myself]

I wouldn't even put it that way. Most people I have seen who have had FFS (not in person, just videos, pictures, etc.) have looked perfectly presentable beforehand; FFS just made them look better.

So, sure, based on what I've seen before, I would believe that FFS could make you look better, so maybe it's worth it for you. But I agree with the surgeon: leave the forehead alone! You don't "need" to change the shape of your forehead simply because there's no room for improvement. (For elaboration, you can read my previous comment in this thread.)

I am not sure, I already knew the chin is ok and just needs a little work, same with the nose.
But the forehead, I the way it closes overshadows my eyes, even if not as much as most people, is just too much, in the mirror, in pictures.

I can also clearly see the nose-forehead bump, because the forehead doesn't merge with the nose, the nose slides down and then *bump* forehead*.

I feel it's kinda showing badly in profile photo, maybe like young boys.

My feeling is that it is just a bit too much.

I sitll don't get how you thought I have an adam's apple though O_o

[Alyssa M.]

I know exactly what you mean about the shadowed eyes. It's probably the thing I'm most self-conscious about. But everybody's has that to some extent, and to the extent I see it in your photos, I just thought it would be more effective just to do an eyebrow life. As for the nose merging with the forehead, that's definitely something that doesn't happen with most guys, but a lot of women don't have that either; I'd say roughly half, after glancing through the results of a Google image search for "woman's face in profile," and it's not really correlated with beauty or femininity. Comparing with your photo, I'll admit that it's slightly more abrupt in your case than many of the photos from Google, but it's still perfectly feminine in my opinion.

As for the adams apple -- well, they just don't always show up. Everybody adult, whether man or woman, has one to some extent (i.e., a laryngeal prominence), it's just a matter of how prominent, and that tends to depend a lot on the photo (because they sort of move around), so it's more a matter of not wanting to rule it out based on just one photo. Also, I was probably focusing on the photo I refered to, which makes it more prominent than any of the other ones you posted, so I need not have worried.

Anyway, I'm sorry for going on so much. I'm kind of obsessing over this issue these days, trying to figure it out for myself, and I really don't have it down yet (obviously). So thank you for this thread. 🙂