Hi Everyone,
I'm looking to get FFS this May/June (so in a matter of a couple months) and I've narrowed down my options to Dr. Zukowski and Dr. DiMaggio. Both of these doctors have different styles and techniques, but I feel like their results are the best for my budget. Both doctors have recommended the same list of procedures:
Brow Reduction
Rhinoplasty
Cheek Implants (listed as "optional" by both docs)
Upper Lip Lift
Jaw/Chin Reduction
Tracheal Shave (I had to request this with Dr. DiMaggio)
For reference, here are photographs of my face currently (pre-op): http://imgur.com/a/KfCaS (http://imgur.com/a/KfCaS)
Aside from the cheek implants, I agree with everything that needs to be done. My concern is the forehead and nose. Dr. Z only grinds/burrs and I'm worried this won't provide enough reduction in my brow. Dr Z. has confidently stated it would be more than enough reduction, but Dr. DiMaggio has stated confidently that reconstruction is the only way to get acceptable results (and that anyone saying otherwise is unable to do the procedure properly). Personally, I do not like the Dr. O "ski-slope" type forehead/nose, and I've seen several Dr. DiMaggio results that were similar to this (as seen in the profile here: http://www.t-change.com/img/Partial_Facial_Feminization_Surgery_11a.jpg (http://www.t-change.com/img/Partial_Facial_Feminization_Surgery_11a.jpg)). When looking at the profile, I think a slight amount of brow curvature/indentation (where the forehead curves down-and-in to meet the nose) looks good. So if anyone has had experience with Dr. Z, are you satisfied with the amount of forehead reduction and the shape?
My other concern between the doctors is the nose. I'm concerned about the noses I've seen in some of Dr. Z's results. I also saw some negative results when looking at the Yahoo FFS-Support site (where the nose required revision by Dr. Z and even then still looked unsatisfactory). I understand all doctors have bad cases, but from an overall standpoint, is Dr. Z a good option when it comes to nose work?
I greatly appreciate any input anyone is able to provide... I feel like I'm going crazy researching this all day long! Thanks!!!
Lisa
Another difference to take into consideration is the "type" of Plastic Surgeon that Dr Z and Dr DiMaggio are. What do I mean by that? Dr Z is a Plastic/Reconstructive Surgeon and Dr DiMaggio is a CranioFacial Plastic Surgeon. A CranioFacial Surgeon (what Dr O is), works on the bone structures of the face and forehead, where as a Reconstructive Surgeon will work mainly on the soft tissues.
There is a big difference when it comes to the Forehead for instance, instead of only burring or grinding down the Brow Bossing, a Cranofacial Surgeon would remove the Frontal Sinus Bone and recontour or reconstruct it depending upon the Forehead Type (I II III IV), to feminize the forehead.
You might want to checkout Dr O's book, Facial Feminization Surgery: A Guide for the Transgendered Woman, Douglas K. Ousterhout, MD, DDS, Addicus Books, Inc., 2009. In his book, Dr O describes the principles concerning Facial Feminization and the procedures involved.
I saw your pictures and I think both doctors are right about the procedures. You have a flat face and to become beautiful you need the cheek implants. It will not ad to the feminizing process but I believe it is important sign of beauty. When it comes to the cheeks I would go for small implants. Make sure they don't overdo them. Who ever you choose you will not make a mistake, I believe they are both good doctors. Perhaps you can have your cheeks done by Dr Mayer in LA, he makes very good and natural results when it comes to facial implants.
When it comes to your frontal bone judging by the x ray that can be fixed with burring only, but you will have only thin bone remaining on the anterior wall of the sinus. There is always a possibility that the sinus will accidentally be opened during the procedure and you need an experienced doctor who will be able to do a prompt reconstruction at the same time. Good luck with your FFS.
I never thought I'd say this, but just like Swan I agree that you may want to go for small cheek implants.
As far as which Dr, you have to go with the one you feel most comfortable with. You are welcome to dig through my thread here on susan's (https://www.susans.org/forums/index.php/topic,111192.0.html) or our website (http://www.dragonflydreamsfarm.com/Dragonfly_Dreams_Farm/FFSSummary.html) for my results from Dr Z.
Good luck with who ever you choose and I hope you healing is quick and the results better than you expected.
I know dr z , injects fat into the temples to lift up the male depression of the bone there , do other doctors reconstruct this bit ? I want someone who will give me agressive work to my nose , but I think my limit is 25,000 for the surgery unless I get a higher paying job and can save more before next year when I want to do this , my priorities is I need a doctor who can do medphore cheek implants and allaplasty ( nostril reshape ) and aggressive nose work , I was considering eithet dr Z , chettawut , or maggio or dr bart
Someone told me something about a former clinic magio had went down and a lot of girls payed for their FFS and ended up not being able to get it , does anyone know if he made up for it in his own clinic doing those patients who had already paid . I love his results but would like to know if I can trust him
SandraJane
Thank you for the feedback. I've actually read Dr. O's book and it was very helpful. When looking at burring/grinding vs reconstruction, I actually have concerns with both. With grinding (Dr. Z), I'm unsure if enough material could be feasibly removed. However, with reconstruction (Dr. DiMaggio), I'm afraid I'll end up with a completely flat forehead and sloped nose. Also the riskier complications with reconstruction scare me. Although all this talk of painful massaging with Dr. Z has me equally freaked out now.
I sent Dr. DiMaggio a series of Photoshop manipulations I made to my forehead to get his opinion on what is possible (http://i.imgur.com/xriQQ.jpg (http://i.imgur.com/xriQQ.jpg)). Personally, I think somewhere between #2 and #3 looks the best. However, I think #4 and #5 is more common with Dr. DiMaggio. I prefer to have an indentation at the end of the forehead because it matches my sisters' faces.
Swan
It's funny to hear someone finally recommending cheek implants. ALL of the feedback I've received on the Yahoo FFS-Support group has been against the them strongly. Dr. DiMaggio gave a very pragmatic explanation for suggestion the cheek implants which I liked. He stated that it appeared I use to have an under-bite that was corrected with orthodontics and not surgery, so this made my cheeks appear more sunken. He reasoned that implants would help the cheeks stand out given the strong lower projection. I did in fact have a strong under-bite as a kid and had braces twice... pretty impressive he could determine all that based on just my current photos and my x-rays. I'm wondering if it would make sense to hold off on cheek implants to see how things turn out first though. And then if I still want them, I could go to any surgeon in a year.
Jeneva
Haha, thanks for another vote on the cheek implants; I must say I'm surprised. Thanks for the link to your thread, I've been following it. Congrats on the progress!
Raneth
Thank you so much for posting your before/after photos! Are you happy with your nose now? Did you discuss the type of nose you wanted with Dr. Z beforehand, or did he just do what he felt would look best? I think your brow looks good (this is more the result I would like). Regarding the cheek implants, why are you unsure? Do you feel like the fat injections would have been enough alone or something else? Thanks!
Mementomori
I asked Dr. DiMaggio about the depressions at the temples and here is the response I received from Amanda:
"Apparently the hollowness of your temples is partially produced by the contrast between that area and the protrusion of the orbital rims and the crests of the frontal bone. These crests are the vertical boundaries between the frontal bone and the temporal fossae (the hollowing on each temple area). Some surgeons like to fill out the temples with fat or other materials, but this is usually because they don't reset the brow bossing properly. We don't recommend this approach. It could end up resembling a motorcycle helmet. The right approach would be grinding down the vertical crests and the orbital rims protrusion, levelling them to the current hollow level, instead of filling out the hollowness. Once the forehead protrusion and the orbital rims get reduced, the hollowing will stop looking like such, or at least the contrast will be much lower. I mean, the idea of making a continuous smooth concave outline for the forehead/temples area is the same, but instead of bringing the deep areas outwards we propose to "push" the protruding areas backwards. Your sisters have some degree of hollowness on the temples although smoother than yours, so you might expect to get something similar after the crests of your frontal bone, your brow bossing and your orbital rims get reduced."
Regarding issues with Dr. DiMaggio in the past, I had heard he use to work with a company that did the arrangements for foreign patients, but the company was unreliable. So he he opted to bring Amanda (who handles all the patient arrangements) directly into his clinic. I could be totally off, but that's what I briefly heard.
Thanks so much for that reply lisamoore , actually from the description. You just posted dr maggio is looking very favourable , I heard someone else online recently say he quoted them 18 K for everything , so his prices seem reasonable too
Ill just have to research the thing that went bust more to make ease my concerns about that
Thank You Lisa, glad you read his book, and I'm getting ready to read it a second time too! What other Surgeons did you check out? Did you checkout Jeffery Weinzwieg of Chicago, or Berry Eppley of Indianapolis? Both are Craniofacial Surgeons that do FFS.
All this information has been really helpfull does anyone have any info on dr chettawut , does he mainly deal in soft tissues or is he a cranial surgeon too
Mementomori
Dr. DiMaggio quoted me $18k for the forehead reconstruction, brow lift, rhinoplasty, upper lift lip, and jaw/chin reduction. The tracheal shave is another $2k. And cheek implants were another $4.2k. Dr. Zukowski quote me $25 (without the implants) for the same procedures. Adding implants would cost another $4k. Taking into account the more expensive flight to Argentina vs Chicago (since I'm in the USA), Dr. DiMaggio ends up being $4k cheaper when comparing the same set of procedures.
For the same procedures (including the cheeks), I was quoted the following:
- Dr. Spiegel - $38k
- Dr. Ousterhout - $42k
- Dr. Meltzer - $48k (two stage operation requiring at least 7 days between operations)
SandraJane
Well I didn't read the whole thing, but I did read the chapters I was concerned with at the time (back in Sept 2011). The book belonged to a friend, so I had to give it back. As far as doctor's go, I've also had consultations with Dr. Spiegel, Ousterhout, Metlzer, and Leis. I like Dr. Meltzer the best, but he's too expensive and unable to do the surgery in a single day. I don't think Dr. Speigel is aggressive enough. And I don't like the "slope" of Dr. Ousterhout's forehead/noses.
I just found out about Dr. Weinzwieg yesterday, but I don't know anything else about his practice. I've never heard of Dr. Eppley. If I haven't heard about them by now, I'm not sure I'd want to consider them. I want to pick a doctor that's been recommended by many others with direct experience. If you have any info on the docs you mentioned, I'd be curious to know though. Thanks!
Girl you look good
I forgot to mention this in the opening question:
I've only been on hormones for 13 months, so I know that the changes in fat redistribution in my face aren't done yet. Because of this, I'm thinking of holding off on the cheek implants for another year (to see if they just naturally plump up). Can I expect much of a change by waiting another year though? Has anyone tried this approach with their FFS before?
Thanks! Lisa
Quote from: lisakmoore on March 31, 2012, 11:47:25 AM
I forgot to mention this in the opening question:
I've only been on hormones for 13 months, so I know that the changes in fat redistribution in my face aren't done yet. Because of this, I'm thinking of holding off on the cheek implants for another year (to see if they just naturally plump up). Can I expect much of a change by waiting another year though? Has anyone tried this approach with their FFS before?
Thanks! Lisa
I had only been on hormones for 15 months when I had ffs. I know a lot of people will advise that you should wait 1.5-2 years before ffs but my ffs surgeon said that it didn't matter so much
I'm trying to decide between these two surgeons as well. Both are excellent and each have there own strengths and weaknesses. I don't like Dr.Z's noses but I like his endoscope technique and for me personally i think burring will be enough for my brow/forehead area. Dr. D is very talented and his style mimics that of Dr.O. I don't like the flat slope forehead look either but overall his work is impressive and he's cheaper, the only problem is distance.
Quote from: MacKenzie on March 31, 2012, 05:35:59 PM
I don't like Dr.Z's noses
Everyone always says this, but I was really happy with the work he did on my nose.
Quote from: MacKenzie on March 31, 2012, 05:35:59 PM
I'm trying to decide between these two surgeons as well. Both are excellent and each have there own strengths and weaknesses. I don't like Dr.Z's noses but I like his endoscope technique and for me personally i think burring will be enough for my brow/forehead area. Dr. D is very talented and his style mimics that of Dr.O. I don't like the flat slope forehead look either but overall his work is impressive and he's cheaper, the only problem is distance.
If you don't like Dr Z's noses then you can always tell him not to leave the nose alone and then go see a specialist rhinoplastry surgeon.
When you say dmaggio uses full forehead construction , does that mean he takes it out as rassembles the bone or does he grind bits and build up again with the bone paste , does dr z use bonde paste too ? ,
Bone * reassemble *
Swan
It's funny to hear someone finally recommending cheek implants. ALL of the feedback I've received on the Yahoo FFS-Support group has been against the them strongly. Dr. DiMaggio gave a very pragmatic explanation for suggestion the cheek implants which I liked. He stated that it appeared I use to have an under-bite that was corrected with orthodontics and not surgery, so this made my cheeks appear more sunken. He reasoned that implants would help the cheeks stand out given the strong lower projection. I did in fact have a strong under-bite as a kid and had braces twice... pretty impressive he could determine all that based on just my current photos and my x-rays. I'm wondering if it would make sense to hold off on cheek implants to see how things turn out first though. And then if I still want them, I could go to any surgeon in a year.
I am sorry for my late reply. My advice is to get the bone job done and to wait for the swelling to go completely and then to proceed with the cheeks reshaping. My advice is to go for dermal fillers. You can try with hyaluronic acid based filler and if you like the results you can have the same done with some of the permanent fillers. There are some that are FDA approved, and in London you have many permanent fillers to choose from. With dermal fillers you can get totally unique result that looks natural and you can do it little by little until you are happy with the results. The only problem is that you may need several syringes and it may be more expensive then having a surgery. Also in rare cases you may develop a foreign body reaction to the filler and you may need a surgery to get it removed.
does anyone know any blogs or livejournal pages where i can look at some more results of before and afters with dr maggio , other than the ones on the t change website
Yes join the yahoo group for ffs there are two actually both with quite a few Di Maggio pictures. Search yahoo groups for ffs support.
Quote from: lisakmoore on March 30, 2012, 12:45:11 AMSo if anyone has had experience with Dr. Z, are you satisfied with the amount of forehead reduction and the shape?
The orbital rim bone burring done by Dr. Z was a very subtle change for me. Then again, I didn't really have a prominent brow bone to begin with. I wasn't able to look at your pics but if you have a very prominent brow bone, I'd personally consider going to someone else.
Yes the endoscopic brow and bone contouring just isn't aggressive enoght for most. Type III reconstruction will give the best results. Remember less than 5% of people have no forehead sinus.
Quote from: JenJen2011 on April 04, 2012, 12:11:19 PM
The orbital rim bone burring done by Dr. Z was a very subtle change for me. Then again, I didn't really have a prominent brow bone to begin with. I wasn't able to look at your pics but if you have a very prominent brow bone, I'd personally consider going to someone else.
i have no idea if mine is prominant or not i think i have a strong orbital rim appearance but the actual physical projection of it from the profile of my face isnt a lot . maybe i should post some pictures on here with me with makeup and without to get some opinions . its good to get other peoples opinions besides just surgeons , someone who can be objective and doesnt have vested finacial interests etc
ill probably delete them soon , it freaks me out having pics up with no makeup on , on the internet hahaaha
The pictures are good, hard to tell what type brow (1234). Sounds like you haven't had the Cephlagram X-Rays yet, those will allow the Surgeon to determine your forehead type.
I already commented on yahoo fss. For optimal results:
Forehead reconstruction (type III likely)
Hairline correction
Brow lift
Feminising rhinoplasty
Lip lift
Chin and jaw reduction
Fat filler to forehead, cheeks and upper lip.
Amber
Xxxx
Mementomri any chance of a frontal shot with some light as your face is shadowed?
Hi Mementomori,
I hope you will not take an offense from my comment. You pass 100% as a woman without make up but you look like an ugly woman. I don't see your eyebrows on the photo and I think that makes you ugly. In case you miss them more then anything else you need hair transplantation to get eyebrows.
Other than that I think that you pass. In case you still want to look more feminine you can have nose job, forehead work, hairline work, mandible work and perhaps lip lift.
Quote from: swan on April 04, 2012, 11:37:21 PM
Hi Mementomori,
I hope you will not take an offense from my comment. You pass 100% as a woman without make up but you look like an ugly woman. I don't see your eyebrows on the photo and I think that makes you ugly. In case you miss them more then anything else you need hair transplantation to get eyebrows.
Other than that I think that you pass. In case you still want to look more feminine you can have nose job, forehead work, hairline work, mandible work and perhaps lip lift.
lol its ok i know what you mean , the eyebrows well when i wear makeup i pencil them on my natural eyebrows are very low and i shave them off and pecil them in fromt scratch
Hum, shaving off eye-brows not very subtle... very 30s, early 60s or Goth...?
All is of course a question of personal taste (style?)
Your profile looks good - spare the nose. I agree a GOOD subtle nose job be a thing to consider. Quite so.
From the front the chin looks too 'substantial' and would need some attention.
Hairline... oh well, some women do have those issues too and it be of a lesser priority IMHO.
There you go, and good luck :-)
Axélle
Quote from: Axélle-Michélle on April 04, 2012, 11:50:53 PM
Hum, shaving off eye-brows not very subtle... very early 60s or Goth...?
All is of course a question of personal taste (style?)
Your profile looks good - spare the nose. I agree a GOOD subtle nose job be a thing to consider. Quite so.
From the front the chin looks too 'substantial' and would need some attention.
Hairline... oh well, some women do have those issues too and it be of a lesser priority IMHO.
There you go, and good luck :-)
Axélle
yea i knew id get comments on the eyebrow thing : P yea into the " goth" thing plus i just love the look penciled eyebrows think jean harlo or marlene dietrich , yea i would like my hairline rounded out i have these peak things in the side that ive always had even when i was 7 years old i had them a lot of woman also have that but i do agree it defiantly is a ' mauscline " thing regardless
swan i dont know if i agree with the passing for female thing though lol even if i put on a t-shirt and pants people do stare at me i guess trying to asses if im male or female , so i do have natural androgny so im hoping with ffs my face should be easy to feminize taking that into account as im not starting off with a hyper mauscline look
and yea the eyebrow thing a lot of my genetically female friends also shave off their eyebrows and draw them on , i like to think i have my own style but i guess it is quite a typically " goth' thing haahha
ive already had one nosejob you should have seen what my nose looked like BEFORE this one haha , i defiantly do what a second rhinoplasty though
Let me be honest again, you look better with your eyebrows and YES you do pass. You have a very specific style, and people may stare at you because of that. I don't think they wonder if you are male of female. I think that the FFS will make you beautiful, but regarding your style I am not sure you are after that kind of looks. Take everything into consideration before you go under anesthesia.
Quote from: swan on April 05, 2012, 12:39:43 AM
Let me be honest again, you look better with your eyebrows and YES you do pass. You have a very specific style, and people may stare at you because of that. I don't think they wonder if you are male of female. I think that the FFS will make you beautiful, but regarding your style I am not sure you are after that kind of looks. Take everything into consideration before you go under anesthesia.
haha im confused what your saying ? are you asking if thats the look i want to be " beautifal' in a conventional way . yea despite my clothing and makeup not being to a lot of peoples taste i do still want to look beautifal/ pretty feature wise :p
Hey sweetie,
I am sorry for my English, it is not my first language. I am also a bit drowsy as I am recovering from my SRS. I hope you understand what I am saying. If a conventional beauty is what you are after, FFS is for you. Go for it :)
i had not even started hormones till 2 weeks after my FFS
Quote from: Tristan on April 06, 2012, 08:43:15 PM
i had not even started hormones till 2 weeks after my FFS
a few people are like that they want to see what the ffs results will be like before they go ahead with hormones
@Memento: I don't see you as needing any FFS, actually. Especially if you've already had a nose job. You have a great hairline and your face looks good, on the feminine side of androgynous, I'd say.
@Lisa: Honestly, you're a bit ugly and masculine-looking, and your face is definitely very flat and long. I would recommend all the ones you were considering, cheek implants included.
Quote from: Stealthy on April 11, 2012, 07:35:10 AM
@Lisa: Honestly, you're a bit ugly and masculine-looking, and your face is definitely very flat and long. I would recommend all the ones you were considering, cheek implants included.
Thank you for the comments, although stating someone is "ugly" does not provide much constructive feedback. In the future, it would be more helpful if you stated what features you thought looked masculine.
Also, I don't believe beauty is tied directly to "passing". You comment seems to imply that because I have masculine features, I am ugly. I disagree with that logic. A trans woman can be beautiful and still have masculine features. However, in those cases it's more obvious the woman is trans, and that is what I seek to change.
Yeah, I understand what you're saying. I find androgyny is often beautiful, myself-but your facial features don't say 'androgyny', it says 'unattractive woman with distinctly masculine facial features'. (And not every woman who looks androgynous or masculine is trans-at this point at the very beginning of my FTN transition, I'm read as an androgynous girl, but I'm trans the other way.)
I believe what the message one might want to get across to you, Stealthy, is that while you are a critic ... and that fact is appreciated... you could word your critiques better, as they come across as insulting at times. You can be nicer and still emphasize the same points to similar effect.