Susan's Place Transgender Resources

Hi, I am a cis-gendered female who has always had a very prominent brow.  A few years ago, I decided that I wanted to have my face more feminine so I had a type 1 forehead shaving by Dr. Z.  I honestly think he did a really good job, as my forehead is much smaller than it was and much smoother.  I have no brow bossing anymore.  However, the one thing I still wish looked better was the middle of the forehead and specifically the radix/nasion/glabella region.  My forehead slope isn't as steep as I'd like it.  It's perfectly smooth, but slopes down in kind of an outward angle.  The radix or place where the nose usually dips in for most people doesn't dip in on me, but just continues to slope down outwardly.  I had an x-ray done and have a pretty big frontal sinus, which is now only covered by a thin layer of bone (which is to be expected after my past surgery).  However, I wondered which FFS surgeon did the best job taking in the radix/nasion/glabella region so the lower part of my forehead had a steeper slope and the radix dipped in?  I have looked at a ton of FFS surgeons online, but can't figure out who would be best to go with.  Money isn't a factor for me, as long as it is done correctly.

-Deschamps-Braly is supposed to be the best, but there are no before and after pictures, so it's hard to see his work.  The only negative thing I have heard about him was that he doesn't take down the orbital rims.  However, Dr. Z already took them down nicely, so I wouldn't need that done.
-Di Maggio's work looks good, but it looks like he doesn't really take down the radix/nasion/glabella region down all that much, even though he sets the lower forehead back by a large amount.
-Bart Van De Ven has a patient on his site named Hannah who I think has the perfect forehead.  If I could pick out my forehead, hers is the one I'd want.  He also discusses setting back the nasion region on his site.  However, there are other patients on his site that seem to have after photos already similar to my forehead, which worries me.  I have also heard some bad stories from former patients of his which makes me worry.
-Rossi's work looks really good in terms of setting back the radix/nasion/glabella region in around 70% of the patients on his site.  However, I've seen scans of his forehead work from the inside and it looks like he isn't the safest in terms of covering up the sinus fully.  It also looks like some of the foreheads he operates on has slight bumps afterwards.
-Facial Team's work looks pretty good and I've heard no safety concerns regarding them.  However, of all 100 before and after pictures they show on their site, I can only find a handful where the radix is taken down at all, which concerns me.

There are other surgeons I've looked at as well, but none of them seemed to be able to set back the radix/nasion/glabella region as much as I'd like.  I was wondering all your thoughts on who would be my best bet to contact.  Thank you.

You seem to have escaped us for quite a while so welcome to Susan's Place. As you have already had FFS, I am not sure a revision would be in your best interest. As money isn't a problem, I would suggest that you visit multiple surgeons and have an evaluation by each one. That way you will be able to learn what is possible with your facial structure  and if the results you desire can be achieved.

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Thank you for your response.  Well, I only had a type 1 shaving procedure, so I didn't see why having a reconstruction would be a problem, especially since I have a large sinus.  And when I say money isn't a problem, I only mean it in terms of going to the best surgeon.  With my work schedule, I don't have the flexibility of going to numerous consultations all over the world though, unless they would be online consultations.  That's why I just wondered other's opinions.

Dr. Toby Meltzer did mine; I would recommend him to a friend or family member without hesitation; definitely an A+ result!😊

Hell Sination,

It would be helpful if you could show some photos, because I am unsure how forehead surgery alone would address your issues, based on your description. It sounds to me like you need rhinoplasty or combination forehead contouring and rhinoplasty to achieve the results you want. The nasal radix/nasion areas are addressed during a rhinoplasty.

Quote from: IsabellaSwan on February 12, 2018, 12:18:39 PM
Hell Sination,

It would be helpful if you could show some photos, because I am unsure how forehead surgery alone would address your issues, based on your description. It sounds to me like you need rhinoplasty or combination forehead contouring and rhinoplasty to achieve the results you want. The nasal radix/nasion areas are addressed during a rhinoplasty.

Yeah, my radix issue was corrected during my rhinoplasty; Dr Meltzer removed the bone where the nasal bridge and forehead meet.

He seems to have done a very good job, because you look unmistakably female and - even from the front - the radix appears to dip. Your nose looks very Angelina Jolie (definitely a compliment). I have a rather high nasal bridge, but my nose was a disaster before my surgeries, so bad that I didn't even realize how bad the rest of my face was until I had it fixed.

Quote from: IsabellaSwan on February 12, 2018, 01:28:28 PM
He seems to have done a very good job, because you look unmistakably female and - even from the front - the radix appears to dip. Your nose looks very Angelina Jolie (definitely a compliment). I have a rather high nasal bridge, but my nose was a disaster before my surgeries, so bad that I didn't even realize how bad the rest of my face was until I had it fixed.

Thanks for the compliment😊

Thank you both for your responses.  Yeah, I had a rhinoplasty with Dr. Z, but I think I would probably need a revision on that as well in order to acheived the look I wanted.  Attached is a picture of what I look like now https://ibb.co/jt8qVn (https://ibb.co/jt8qVn) and a second picture with a blue line drawn on where I'd like my forehead/nose to be. https://ibb.co/ihyw37 (https://ibb.co/ihyw37)  Also, here is a picture of my sinuses so you can see how much room there is to work with. https://ibb.co/ctUiGS (https://ibb.co/ctUiGS)

Hi, Sination

Is the blue line exaggerated, or is it actually quite close to what you would actually like to see?

It does look from the radiograph that your doctor did burr the bone as much as he could. What remains over the sinus seems quite thin, so it's possible some doctors may feel uncomfortable doing a revision.

The forum rules prohibit comments regarding what may or may not be possible—but if I may, I would suggest discussing your wishes vs. what can be done with more than one surgeon and confirming what they've done in similar cases. It may also be prudent to not ask for too great a change. (^ ^)

Thanks for your response.  Well, the blue line would be ideal, but if it wasn't taken down by quite that much, I wouldn't really mind.  Maybe this is a stupid question, but why would thin bone over the sinus make it uncomfortable for some doctors to do a revision (if the revision was a type 3)?

Something to keep in mind: if you take down the nasal radix a lot, your nasal projection will appear proportionally much larger than it does now, and fixing tip projection is rather difficult.

Yeah, that's true.  Perhaps I drew the line to take off a little too much.  It's really hard getting it perfect with my paint program, lol.  I just wish my sinus was set a little further back so my forehead was a little flatter and my nose radix/nasion came in slightly instead of how it looks now with a continuous outward slope. 

The line you drew on the images has a problem in that it would leave a hump on your nose. Ideally from the tip of the nose to just below your brow the nose should curve slightly inward in order to appear attractive. A straight line would be acceptable if the material isn't there. I had a serious hump on my nose before the doctor worked on it and the slight inward curve really made a difference in the appearance of my nose.

I actually disagree. Perfectly straight noses are more appealing, in my opinion. I had mine changed from a curve to a straight line, after ignoring surgeon recommendations during my first rhinoplasty and insisting he make it curved instead of straight.

Straight nose curved nose? I'm lost. Isn't a curved nose with a hump on it? I don't think the tip should be curved up or pushed down. It should align just about even where it's hanging.

When I went for just a rhinoplasty as a "guy" the surgeon wanted to do way too much just on my nose... then he mentioned making the space between my upper lip and nose larger! What?! Sorry but that's not even attractive for a man!!

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Hi, sination

Quote from: sination on February 13, 2018, 08:58:38 AM
Maybe this is a stupid question, but why would thin bone over the sinus make it uncomfortable for some doctors to do a revision (if the revision was a type 3)?

When the bone covering the sinus is cut and set back the detached part and/or the peripheral area is generally shaped to smooth the transition, and any remaining irregularities are further smoothed out using either a paste made with the bone dust resulting from the burring or with synthetic filler. Since the outer layer of bone is generally harder/tougher than the inner part, depending on what's left after the first procedure some surgeons may be worried that additional shaping may end in less strength than they'd like. Using more filler may work, but e.g. a surgeon who doesn't like synthetic paste may feel reluctant to do so.

Anyway, this really is something that only the surgeons themselves can say with confidence. Revisions are usually a bit more involved than the first round since there is less material to work with, so discussing all the details involved in person helps the doctor visualize what needs and can be done.

Thank you all for your responses thus far.  I'm learning new things.  Ah okay.  That makes sense.  Do you know which surgeons use synthetic paste and therefore would be more likely to possibly revise my forehead?  I'm assuming synthetic paste is the same thing as "bone cement".  I gave another shot at altering my forehead with the line.  Do you think this would be more in line with what should be done? https://ibb.co/f1ST1S (https://ibb.co/f1ST1S)

Quote from: sination on February 13, 2018, 10:56:00 PMDo you know which surgeons use synthetic paste and therefore would be more likely to possibly revise my forehead?  I'm assuming synthetic paste is the same thing as "bone cement".  I gave another shot at altering my forehead with the line.  Do you think this would be more in line with what should be done? https://ibb.co/f1ST1S (https://ibb.co/f1ST1S)

sination,

Yes, I did mostly mean bone cement. I'm afraid I don't remember who uses it. When I researched the subject I just wanted to find out who is willing to not use it, because my immune system is rather vehement about not accepting anything foreign. Perhaps someone else may be able to provide more relevant information.

As for the revised line, I can upload a very rough rendering of what it might look like in profile if that's OK with you—just let me know.

If you don't mind my asking, who did you go to for FFS?  And thank you, that would be great.  Use this picture instead though.https://ibb.co/fdjG6S (https://ibb.co/fdjG6S)  I think I drew it a little better.  And when you take off everything, you can take off the line too.  I think it should be about right that way.

Hi sination

Here it is.
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.hostpic.org%2Fimages%2F1802151752040099.jpg&hash=29b9db1cf2b71953e883061660eb727449ba405e)

I made no attempt to do anything but to follow the inside edge of the line. One of my friends has a very similar silhouette, but says she feels it's "too cliff-like." I guess grass does always tend to look greener across the fence... (^ ^)

As for my own situation, I haven't yet had facial feminization surgery. (I need financial leeway, since it won't be covered by insurance.) When I do, I'll probably go to Facial Team, or a Japanese doctor who doesn't even use titanium plates. As I mentioned, my body seems to reject just about anything foreign.

Thank you.  That picture looks weird, lol, but I actually like the forehead.  That does show me that I would need the nose made smaller as well though in order to look in proportion.  I tried altering it myself again.  Maybe you could use the program again to see what it would look like with the nose taken down as well like I did in this picture.  I just covered up everything I wanted off.  https://ibb.co/cEwfGS (https://ibb.co/cEwfGS)

I thought Facial Team used titanium?  I could be wrong though but I thought they used the standard metal hardware.

Quote from: sination on February 15, 2018, 08:14:22 AM
Maybe you could use the program again to see what it would look like with the nose taken down as well like I did in this picture.

Do you mean something like this?

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.hostpic.org%2Fimages%2F1802152215420102.jpg&hash=b02b8bac9fd17047c8b52362299240db9125747e)

When you change the size of the nose many variables come into play, including nostril shape—so I didn't try anything too elaborate. A precise and realistic simulation would take more Photoshop skills than I have.

Quote from: sination on February 15, 2018, 08:14:22 AM
I thought Facial Team used titanium?  I could be wrong though but I thought they used the standard metal hardware.

Yes, I understand that they do, which is why I'm considering the doctor in Japan. However, if they are able and willing to do the procedure without any hardware... Anyway, I'll ask them when the time comes.

Exactly, that looks much better.  Thank you for letting me see what it looks like.  I wonder how many surgeons do FFS type 3 procedures.  I thought there were only a handful in the world, but apparently there are more than I know about.  I didn't even know there was a Japanese surgeon.