Susan's Place Transgender Resources

Howdy y'all.

Yesterday I had an FFS consultation with Dr. Jonathon Sykes from UC Davis. If anyone had any experiences with him, I'd love to hear what that was like.

Here's what we discussed:
1 Correct and contour minor asymmetry in the face by using filler--which is fine and a standard procedure as I understand it.
2 Plans on using Botox as a regular treatment to the Maceter Muscles (these are the jaw muscles slightly forward from your ears and clench when you bite down). My contention with this is... well botox is expensive and doesn't last indefinitely. Not sure at all if I want to go this route.
3 Using FILLER for the forehead - instead of doing a drill contouring. He also mentioned that if I were to opt for contouring that he would do hair advancement at the same time.
Having a slight brow protrusion, I felt like Filler is a great option but I wonder if anyone else has had a treatment like this instead of opting for forehead contouring and if you had any reference photos (i.e.: before/after photos).
4 Jaw contouring
5 Chin Augmentation (slight) so as to make my jaw appear balanced with the contouring and to make the chin pointy and more heart shaped. I was surprised that this would be an augmentation and not a contouring.
6 Rhinoplasty - slight upturning of the nose and a contouring of the "bridge" so as to create a gentle slope.

He mentioned that 4,5, & 6 were the biggest things he would like to do and that I could get away with not doing forehead at all. But of course, it's one of the things that make me feel dysphoric.

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fimg.photobucket.com%2Falbums%2Fv180%2Fzer0zOd%2FFFSConsult-Full.jpg&hash=78792baa0315da2e11a0a40c0d5436c12fe65290) (http://smg.photobucket.com/user/zer0zOd/media/FFSConsult-Full.jpg.html)

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Anyway. I'm putting myself out there, feel free to add your thoughts or anything that could be useful. Thanks <3

Using fillers for forehead is generally a bad idea. In rare cases with very sloped foreheads, augmentation with forehead implants are done to improve the projection of middle and upper forehead thirds. This is often performed by Korean and Thai surgeons. Your forehead is typical masculine shape of forehead with prominent brow bossing, which is only properly resolved with forehead "type3" reconstruction. Any fillers used above brow ridge would slighltly smooth the appearance, but wouldnt really add much in terms of feminization, as forehead ridge would remain just as prominent and projected. With proper reconstruction the brow bossing would be removed, and FFS surgeons usually more or less successfully shave the orbital ridges, which would in fact have even greater feminizing effect than forehead remodeling. Nose is usually adjusted to allign with the new forehead, which wouldnt be necessary in your case as your nose is already low at radix, but some lowering of middle bridge area (into slightly sloped shape) would work well with remodeled forehead. Upper lip lift, (shorter nasolabial distance) would be very benefitial. There is slight asymmetry in your chin which can be improved with chin osteotomy. I have no idea what this surgeon has in their mind when they recommended chin augmentation. Your chin already has enough projection. Adding any projection would make your chin look more masculine from profile. If anything proper remodeling with shaving and osteotomies will feminize your chin, aiming for reducing asymmetry and achieving more feminine pointy shape. Jaw could be reduced at mandibular angle, and slighlty along whole jawline.
I recommend you contact some reputable FFS surgeons, send them pics, and ask for their evaluation and recommendations.   

I agree with Pastry, i think you should contact some other FFS doctors. Its important to find a surgeon who has the same vision as you, and as you say the forehead is one of the things making you feel dysphoric you should defintly get it fixed properly :)

I have seen some results of botox injected in the masseter muscle, and in most cases it`s not that effective (unless you have serious TMJ) I would think some jaw reconturing would be more beneficial and is a permanent solution.

The thing with fillers are the need for refills, wich in the longrun is costly and a bit bothersome. I used to have my lips augmented with restylane, but the cost and repetitive nature of it was to much.

You have beautiful eyes and very feminine and full lips :) I hope you find a doctor who can help you correct the feautures you have dysphoria for .

Victoria

You are already pretty and that is 1/2 the battle.   I agree with everyone else.  You want to take away and reduce size rather than make features larger.  Thinning and shaping your eyebrows would be a big help in the short run. The chin implant is unecessary unless you are going for that really pointy chin look.

I agree with everything that pastry, Maria77 and Victoria have said ...  :)

I despair at what some of these surgeons suggest !!!! ... >:(

Thank you all for the feedback.

Filler as this doctor's mainstay did alarm me to some degree... and you're right he doesn't  have a lot of experience in the FFS role as much as just facial touch-ups to cis-gendered females. So this is a much different ball game, and I recognize and thank you all for your concern.

To clarify the chin augmentation - he did say that he wanted only a very small prosthetic to be put in to create better balance. I'm not sure what he meant exactly because he didn't have any examples to show me at the time of the consultation. Which again, was rather alarming. I wouldn't care to be the first of these surgeries.

I will say that I have a consultation with Dr. Harrison Lee (the doctor who did Caitlyn Jenner's ffs), Dr. Satterwhite in northern california, and looking at booking a consultation with Dr. Zukowski.

Ultimately this research is really daunting and I have to make the right decision the first time.

I'll keep y'all updated. Thanks <3

Audree

Small "button" chin implant is indeed used to create more pointy chin AND to improve frontal projection of the chin, which is why it wouldnt work in your case. I have small and thin chin implant used in this matter, and in my case it worked because I had slightly receding chin. Regardless, if I were to choose again, I would choose to have sliding genioplasty instead.

Take your time and do as much research as possible. In the end it will be your decision and your choice of surgeon which will determine the look of your face. Happy FFS shopping! :)

Because of the prices now being charged in the US and also here in the UK for surgery, many US girls go to Dr Di Maggio in Argentina or come to Europe.

Burring to the forehead is a limited procedure ( I had it done originally ),  many patients tend to have a dolphin shaped forehead afterwards as I did and now that I have had full reconstruction, the difference in femininity is incredible. My whole forehead is now much flatter and the transition to my nose is also now totally feminine. My orbital rims have been opened up as well and my eyes are far less sunken. 

Good luck in your research.

Hugs

Paula

On Monday I had my consultation with doctor Harrison Lee. He was very well practiced and the pictures of his patients are quite remarkable... You won't be able to see them unless you were in the office as I don't think he posts online.

That being said, for forehead type 3, rhinoplasty, chin and jaw we are looking at 27k plus 5k for operating room expenses.

I asked him what he thought about Dr Sykes reliance on fillers and he disagreed entirely that these were necessary at all and even said if I wanted them he would do it free with the option of botox included! This makes me feel like the last consultation with Dr Sykes was a crock.

He of course advocated the use of x rays and that was certainly reassuring. Very nice guy and seemed to offer the right answers re: the chin implant, as with what pastry said about it, Dr Lee mentioned it's only necessary for people with receding chins.

Well. I definitely think Dr. Lee is a viable option. For 32 total that's sounding a little pricey to me, but what do y'all think? I will be looking into Dr. Braly DesChampes next as I hear he's very good... The only downside is that a consultation with him is $250! And a ticket to San Francisco.

Audree

I also liked Dr. Lee. He seemed confident (although expensive) and friendly.

Let me know how it goes with Deschamps-Braly.

I plan on seeing him as well for a consult in June.

You could send pictures to few more surgeons and ask for their evaluation and opinion. Some also do skype consultations. (I suggest you get proper photos done at photographic studio, it makes a LOT of difference.. $10 or $20 well spent)

Dr. Lee is on the higher side of price range. Dr. Spiegels prices are about somewhat similar. Dr. Deschamps Braly is more expensive. Facial team and Dr. Di Maggio have more reasonable prices, for same procedures that dr. Lee quoted you $32k, you look at around $20k with Facial team or Dr. Di Maggio. Dr. Van der Dussen has similar prices as well. Dr. Suporn and dr. Chettawut are slightly more expensive. These are all very good surgeons, even though I dont like to make any specific recommendations, you wouldnt make any mistake by consulting with any of them.