Community Conversation => Transitioning => Facial feminization surgery => Topic started by: iamthatiam8 on December 19, 2017, 03:34:36 AM Return to Full Version
Title: Virtual ffs assesment
Post by: iamthatiam8 on December 19, 2017, 03:34:36 AM
Post by: iamthatiam8 on December 19, 2017, 03:34:36 AM
Hi guys just got my assessment from alexandra at virtualff.com. I'm so glad she came to the same conclusion that i had except for my forehead i did not know how important it is to feminisation. Al i need is some mula.
Please remember that this assessment is not and could not be 100% accurate. This is a starting point designed to help you get to know your face and its feminisation possibilities, and to help you set your priorities for FFS. Your final result will depend on the procedures you choose, your individual anatomy, how you heal, and the abilities and techniques of your surgeon.
Also remember that just like a surgeon, I am fallible and although I take quite an obsessive amount of care over assessments, I will inevitably make a mistake every so often.
Working from photographs is not the same as seeing the person in real life. Camera lenses can affect the facial proportions to some extent and the lighting in a photograph can also affect how a face looks. So, a face or feature that looks masculine in a photo might not look quite as masculine in real life or might not be quite as important if the person has a very feminine presence about them.
Hairline height:
The height of your hairline in the middle is fine. If you have forehead surgery with the incision over the top of the head (this hides the scar under your hair) it would have the effect of raising your hairline slightly but not enough to be a problem for you. Many surgeons do not realise that a low hairline is masculine and routinely lower hairlines for trans women. This also typically leaves a visible scar all along the hairline.
Hairline shape:
Masculine hairlines tend to have corners that give them an "M" shape if they are deep corners, or a square shape if they are not so deep. Feminine hairlines tend to be rounded with either mild corners or no corners.
Your hairline has a typical female shape - it is rounded and there are no corners to give it the masculine square or "M" shape. You don't need to make any changes and I do not see any room for improvement.
Forehead:
The forehead is by far the most important area in facial gender. The male forehead usually has a bony ridge running across it at about eyebrow level called brow bossing, It also tends to have vertical ridges either side of the forehead ("temporal ridges") and often has a bump on either side of the upper forehead ("frontal eminences"). The female forehead is smoother and flatter with less pronounced ridges and bumps, and it usually has either no bossing, or very little bossing.
You have moderately strong brow bossing both in the centre above your nose and above your eyes. Removing this will be the single most feminising procedure for you. You can also open out your orbits to give you a more open, feminine expression. This is done by removing a little bone from the underside of the orbital rim.
You also have mild temporal ridges and frontal eminences. These can be smoothed down as part of the forehead feminisation.
I generally recommend that people find a surgeon who can do a forehead reconstruction which sets the bone over the frontal sinus back. The other method, where the bone is only ground down, can be very limited as most people have quite thin bone here. According to one study, the thinnest part is, on average only between 2.6 and 2.9 mm thick. It is difficult to know how thick a patient's sinus wall is in advance, even if you take an xray.
It is easy to get confused about forehead surgery and the various options, so I recommend that you have a read through my web page on the forehead:
http://www.virtualffs.co.uk/Forehead.html
Eyebrow height:
Your eyebrows already sit in a high position. They will lift a little with forehead surgery but the lift that comes with brow bossing removal tends to be reasonably subtle - it helps to emphasise a more open, feminine expression without lifting them so high that it looks unnatural.
Eyebrow shape:
Your eyebrows are very nicely shaped. I don't recommend any changes.
Eyes:
I don't see any problems with your eyes or the soft tissues around them. You have fairly large eyes in proportion to your face - this is feminine and a good asset.
Nose profile view:
From the side, your nose is very feminine - the size is good and the base has a strongly feminine upwards angle. You might be able to make it slightly more feminine by making it smaller, but it would be very optional and not worth the surgical risks in my opinion.
Nose frontal view:
From the front your nose is bent slightly to your right, but the degree of asymmetry is completely normal (everyone is asymmetrical) and you don't need to worry about it. A surgeon could attempt to straighten it but it is not always possible to straighten it completely in real life.
Nostrils:
The width and height of your nostrils is fine. You do not need to make any adjustments.
Cheeks:
You have reasonably full and rounded cheeks with good cheekbones. I do not recommend any changes.
Naso-labial folds:
These are the creases that come down from the corners of your nose and they tend to get a little deeper as we age. They are gender-neutral and have no masculinising effect.
Yours are completely normal and you don't need to worry about them. I only mention them because some surgeons recommend filling them, even in cases where they are not at all deep or are barely visible. All that would do is make your surgery more expensive.
Upper lip to nose distance:
The distance between the top lip and the nose tends to be shorter in women, and they also tend to show some of their upper teeth when their mouth is open and relaxed.
Your lip to nose distance is relatively long and you don't show any upper teeth when your mouth is open as far as I can see from the open-mouth shot you sent me. You can have a lip lift to correct this. This procedure is both feminising and rejuvenating but it does leave a small scar at the base of the nose so you need to balance the potential improvement against the scar.
Lip fullness:
Your bottom lip is a lot fuller than the top one. This is not a fault - this is just part of the character of your face. You could fill the top lip a little to make them more balanced but it would be optional. One thing to keep in mind is that lip filling has the effect of lowering the top lip so that would undo some of the effect of the lip lift.
If you do decide to fill it, I recommend non-permanent fillers at first so that you can see the effect. If you like it, you could consider a fat transfer which can become permanent after a few sessions. I also recommend that you take a fairly subtle approach because over filled lips do not look good.
Chin height and shape:
Your chin is a little taller and wider than average for a woman. You could make it a little smaller and narrower, but in my opinion, it would be optional and the overall effect on your femininity would probably be quite subtle.
Chin projection:
Your chin projection is good so you do not need to move it forwards or backwards.
Jaw:
Your jaw is is just a little heavier than average and you could reduce it. The effect would be a subtle feminisation and in my opinion, it would probably be optional for you.
Chin and jaw surgery incisions:
Some surgeons work on the jaw and chin by making external incisions. This is completely unnecessary and leaves very visible scars. The best place to make the incisions is inside the mouth - this means that the scars will be invisible.
Adam's apple:
You have a strong adam's apple and I don't think you will be able to hide it completely. However you can expect a big improvement with a tracheal shave. I understand your fears about your voice. If it is done properly, there should be no danger.
There are two ways of approaching the adam's apple when you do a tracheal shave. The old-fashioned method involves putting the incision right on the adam's apple. There are 2 problems with this - firstly it leaves the scar in a very noticeable position, and secondly. you can get adhesions where the scar tissue sticks to the adam's apple. That means that the skin can be tugged in an unnatural way when your adam's apple moves, such as when you are talking or singing.
The more modern method involves putting the incision under the chin and then tunnelling down towards the adam's apple. This means that the scar is in a much less noticeable place, and you avoid the adhesion problem. I strongly recommend that you find a surgeon who uses the under-chin approach.
Rejuvenation:
You don't have any signs of ageing that I can see, so you don't need to consider rejuvenation procedures.
Priorities:
Androgyny is a difficult thing to aim for surgically. I generally recommend that people do androgyny with styling rather than surgery. You have 2 relatively strong masculinities - your forehead and your adam's apple, so they would be the most important features to change if you want to feminise your face. Next comes the lip lift. This would help feminise but it does leave a scar so you need to think carefully about it. The chin and jaw changes would feminise, but they would be relatively subtle I think.
Overall, your face is feminine and pretty and I think it would feminise very well. Usually this is a good thing, but it it might be more difficult for you to retain physical androgyny in your face if you have FFS. Essentially, a physically androgynous face is what you already have, so FFS might make it more difficult for you to look androgynous rather than female.
The assessment is yours so feel free to share it with any support groups you are member of if you want some second opinions.
Please email me to confirm that the assessment has arrived. If you have any questions about it, please feel free to email me.
You can find out more about facial gender and FFS by reading through my website.
The changes described in this assessment represent my opinion as an artist. You and/or your surgeon/s may disagree with my opinions. I cannot guarantee that my opinion is good or that the assessment is accurate so if you act according to my opinion, you do so at your own risk.
Thank you very much for entrusting me with your FFS assessment - I very much hope it is helpful.
Good luck and best wishes,
Alexandra.
Please remember that this assessment is not and could not be 100% accurate. This is a starting point designed to help you get to know your face and its feminisation possibilities, and to help you set your priorities for FFS. Your final result will depend on the procedures you choose, your individual anatomy, how you heal, and the abilities and techniques of your surgeon.
Also remember that just like a surgeon, I am fallible and although I take quite an obsessive amount of care over assessments, I will inevitably make a mistake every so often.
Working from photographs is not the same as seeing the person in real life. Camera lenses can affect the facial proportions to some extent and the lighting in a photograph can also affect how a face looks. So, a face or feature that looks masculine in a photo might not look quite as masculine in real life or might not be quite as important if the person has a very feminine presence about them.
Hairline height:
The height of your hairline in the middle is fine. If you have forehead surgery with the incision over the top of the head (this hides the scar under your hair) it would have the effect of raising your hairline slightly but not enough to be a problem for you. Many surgeons do not realise that a low hairline is masculine and routinely lower hairlines for trans women. This also typically leaves a visible scar all along the hairline.
Hairline shape:
Masculine hairlines tend to have corners that give them an "M" shape if they are deep corners, or a square shape if they are not so deep. Feminine hairlines tend to be rounded with either mild corners or no corners.
Your hairline has a typical female shape - it is rounded and there are no corners to give it the masculine square or "M" shape. You don't need to make any changes and I do not see any room for improvement.
Forehead:
The forehead is by far the most important area in facial gender. The male forehead usually has a bony ridge running across it at about eyebrow level called brow bossing, It also tends to have vertical ridges either side of the forehead ("temporal ridges") and often has a bump on either side of the upper forehead ("frontal eminences"). The female forehead is smoother and flatter with less pronounced ridges and bumps, and it usually has either no bossing, or very little bossing.
You have moderately strong brow bossing both in the centre above your nose and above your eyes. Removing this will be the single most feminising procedure for you. You can also open out your orbits to give you a more open, feminine expression. This is done by removing a little bone from the underside of the orbital rim.
You also have mild temporal ridges and frontal eminences. These can be smoothed down as part of the forehead feminisation.
I generally recommend that people find a surgeon who can do a forehead reconstruction which sets the bone over the frontal sinus back. The other method, where the bone is only ground down, can be very limited as most people have quite thin bone here. According to one study, the thinnest part is, on average only between 2.6 and 2.9 mm thick. It is difficult to know how thick a patient's sinus wall is in advance, even if you take an xray.
It is easy to get confused about forehead surgery and the various options, so I recommend that you have a read through my web page on the forehead:
http://www.virtualffs.co.uk/Forehead.html
Eyebrow height:
Your eyebrows already sit in a high position. They will lift a little with forehead surgery but the lift that comes with brow bossing removal tends to be reasonably subtle - it helps to emphasise a more open, feminine expression without lifting them so high that it looks unnatural.
Eyebrow shape:
Your eyebrows are very nicely shaped. I don't recommend any changes.
Eyes:
I don't see any problems with your eyes or the soft tissues around them. You have fairly large eyes in proportion to your face - this is feminine and a good asset.
Nose profile view:
From the side, your nose is very feminine - the size is good and the base has a strongly feminine upwards angle. You might be able to make it slightly more feminine by making it smaller, but it would be very optional and not worth the surgical risks in my opinion.
Nose frontal view:
From the front your nose is bent slightly to your right, but the degree of asymmetry is completely normal (everyone is asymmetrical) and you don't need to worry about it. A surgeon could attempt to straighten it but it is not always possible to straighten it completely in real life.
Nostrils:
The width and height of your nostrils is fine. You do not need to make any adjustments.
Cheeks:
You have reasonably full and rounded cheeks with good cheekbones. I do not recommend any changes.
Naso-labial folds:
These are the creases that come down from the corners of your nose and they tend to get a little deeper as we age. They are gender-neutral and have no masculinising effect.
Yours are completely normal and you don't need to worry about them. I only mention them because some surgeons recommend filling them, even in cases where they are not at all deep or are barely visible. All that would do is make your surgery more expensive.
Upper lip to nose distance:
The distance between the top lip and the nose tends to be shorter in women, and they also tend to show some of their upper teeth when their mouth is open and relaxed.
Your lip to nose distance is relatively long and you don't show any upper teeth when your mouth is open as far as I can see from the open-mouth shot you sent me. You can have a lip lift to correct this. This procedure is both feminising and rejuvenating but it does leave a small scar at the base of the nose so you need to balance the potential improvement against the scar.
Lip fullness:
Your bottom lip is a lot fuller than the top one. This is not a fault - this is just part of the character of your face. You could fill the top lip a little to make them more balanced but it would be optional. One thing to keep in mind is that lip filling has the effect of lowering the top lip so that would undo some of the effect of the lip lift.
If you do decide to fill it, I recommend non-permanent fillers at first so that you can see the effect. If you like it, you could consider a fat transfer which can become permanent after a few sessions. I also recommend that you take a fairly subtle approach because over filled lips do not look good.
Chin height and shape:
Your chin is a little taller and wider than average for a woman. You could make it a little smaller and narrower, but in my opinion, it would be optional and the overall effect on your femininity would probably be quite subtle.
Chin projection:
Your chin projection is good so you do not need to move it forwards or backwards.
Jaw:
Your jaw is is just a little heavier than average and you could reduce it. The effect would be a subtle feminisation and in my opinion, it would probably be optional for you.
Chin and jaw surgery incisions:
Some surgeons work on the jaw and chin by making external incisions. This is completely unnecessary and leaves very visible scars. The best place to make the incisions is inside the mouth - this means that the scars will be invisible.
Adam's apple:
You have a strong adam's apple and I don't think you will be able to hide it completely. However you can expect a big improvement with a tracheal shave. I understand your fears about your voice. If it is done properly, there should be no danger.
There are two ways of approaching the adam's apple when you do a tracheal shave. The old-fashioned method involves putting the incision right on the adam's apple. There are 2 problems with this - firstly it leaves the scar in a very noticeable position, and secondly. you can get adhesions where the scar tissue sticks to the adam's apple. That means that the skin can be tugged in an unnatural way when your adam's apple moves, such as when you are talking or singing.
The more modern method involves putting the incision under the chin and then tunnelling down towards the adam's apple. This means that the scar is in a much less noticeable place, and you avoid the adhesion problem. I strongly recommend that you find a surgeon who uses the under-chin approach.
Rejuvenation:
You don't have any signs of ageing that I can see, so you don't need to consider rejuvenation procedures.
Priorities:
Androgyny is a difficult thing to aim for surgically. I generally recommend that people do androgyny with styling rather than surgery. You have 2 relatively strong masculinities - your forehead and your adam's apple, so they would be the most important features to change if you want to feminise your face. Next comes the lip lift. This would help feminise but it does leave a scar so you need to think carefully about it. The chin and jaw changes would feminise, but they would be relatively subtle I think.
Overall, your face is feminine and pretty and I think it would feminise very well. Usually this is a good thing, but it it might be more difficult for you to retain physical androgyny in your face if you have FFS. Essentially, a physically androgynous face is what you already have, so FFS might make it more difficult for you to look androgynous rather than female.
The assessment is yours so feel free to share it with any support groups you are member of if you want some second opinions.
Please email me to confirm that the assessment has arrived. If you have any questions about it, please feel free to email me.
You can find out more about facial gender and FFS by reading through my website.
The changes described in this assessment represent my opinion as an artist. You and/or your surgeon/s may disagree with my opinions. I cannot guarantee that my opinion is good or that the assessment is accurate so if you act according to my opinion, you do so at your own risk.
Thank you very much for entrusting me with your FFS assessment - I very much hope it is helpful.
Good luck and best wishes,
Alexandra.