So looking up docs on certificationmatters.org and seeing both Spiegel and Mardirossian are certified for otolaryngology. Looking that up, it seems to be ENT stuff. Is that what everyone refers to when saying craniofacial surgeon?
Also, looking up Deschamps-Braly, he is only certified for Plastic Surgery and not the ENT stuff. But everyone says he was trained by Dr. O. Looking Dr. O up, he's also only Plastic Surgery certified.
So which of these matter? plastic surgery or the ENT stuff? Shouldn't these docs have both or something?
Basically, as I understand it, craniofacial surgery is a sub specialty of both plastic surgery and maxillofacial surgery, so Dr O being a plastic surgeon who went the dental route (correct me if I'm wrong) and sub specializing in craniofacial surgery makes him very qualified. If DB then studied under O, maybe that was his craniofacial residency? I'm not sure how these things work tbh. Someone correct me if I'm wrong, I don't want to make assumptions. However, one thing seems clear: the more aggressive surgeons produce more dramatic results. They don't seem to be worried about increased risks. They know what they are doing. They also seem to be craniofacial surgeons. The ones who produce less dramatic results or don't perform type 3 at all like to talk about the dangers of it and how unnecessary it is, claiming everything else is just as good etc.. They also coincidentally seem to be uniformly less qualified.
When it comes to making dramatic and attractive changes to the jaw, the surgeons seem to have some sort of maxillofacial background as well. You might disagree, but so many ffs surgeons leave the chin at a weird, tall angle from the mandibular angle resulting in a strange banana face effect.
Why is it preferable that your surgeon is either a maxillofacial and craniofacial aesthetic surgeon, or to visit different surgeons with different backgrounds for optimal results? This is why. In my opinion. But if you enjoy what someone like Spiege or Zukowski does, good for you. Go there. I don't have to like their ffs results for you to feel validated nor does anyone else. Of course some of their patients look good. I think Raiden Quinn (youtuber and Zukowski girl) looks female, completely. But I definitely feel, looking at her face from a critical perspective and knowing how expensive Ffs is, her money would be better spent elsewhere as I would never have paid the money I did for mine, just to look si liar to every other patient. But again, that's a preference.
Surgeons get craniofacial training (usually 1 year residency) through advanced craniofacial fellowship programs, with extremly high requirements for acceptance such as broad surgical expertise and years of adequate experience in general surgery and plastic-reconstructive surgery. Such programs are not to be confused with a lot more common oral&maxillofacial programs which could include some aspects of craniofacial surgery. These craniofacial programs are usually led in pediatric (80-90% pediatric 10-20% adult) environment treating high number of congenital craniomaxillofacial abnormalities, trauma reconstructions, etc.. through which a participant directly learn the advanced surgical (craniofacial, orthognatic, maxillofacial) skills on a case by case basis in the operating room.
You can find about surgeons qualifications through their website, and then use google to research what kind of program they went through...
Lagertha how you know this? Why you so knowledge?
I just spend way too much time on the internet ...
Quote from: Debra on December 13, 2015, 11:12:37 AM
So looking up docs on certificationmatters.org and seeing both Spiegel and Mardirossian are certified for otolaryngology. Looking that up, it seems to be ENT stuff. Is that what everyone refers to when saying craniofacial surgeon?
Also, looking up Deschamps-Braly, he is only certified for Plastic Surgery and not the ENT stuff. But everyone says he was trained by Dr. O. Looking Dr. O up, he's also only Plastic Surgery certified.
So which of these matter? plastic surgery or the ENT stuff? Shouldn't these docs have both or something?
[ Way too much time on the internet ? Yes ! ]
Debra, Bella & Lagertha - -
Frustrating at how convoluted it can be !
Lagertha's description is pretty good.
I have spent a lot of time studying the details in the web sites on the training, and then researching these credentialing issues. There sure is a lot of smoke and mirrors stuff apparently designed as marketing hooks for the casual internet user.
My understanding of this is still limited, but I think, as Lagertha suggests, that in order to do the normal full range of FFS procedures - - one needs to be trained in areas not fully covered by either regular ENT or Plastic Surgery programs.
After medical school, plastic surgeon "residents" "see" and "assist" in a limited amount of jaw surgery and they "see" and "assist" in a limited amount of cranial vault skull surgeries during their 5 or 6 year surgical training as "residents" - - but unless they go further and do a later full "fellowship" in those areas - - their experience actually "doing" those surgeries is limited. ENTs may not even see cranial vault surgeries during their training as ENTs.
Not sure, but it looks like the normal way to get trained as a craniofacial surgeon is that you have to first be formally trained as a plastic surgeon. I do not think a max/fac dental background person can even apply for one of the currently recognized one-year long craniofacial programs (unless they also went to med school and did a plastic surgery residency.)
Dr. O describes the essential three areas of training in his book - - A) plastic surgery; B) craniofacial surgery and C) jaw (orthognathic) surgery. His training history is set out in one page at the back of his book.
Dr. O had the jaw surgery training from dental / max fac training. Then he switched and did medical school and plastic surgery. Then went to Paris for a year of craniofacial surgery with the guy that invented craniofacial surgery.
Dr. DB did the same training, but in a different sequence: full plastic surgery, then the full one year craniofacial fellowship at Children's hospital in Wisconsin, then did more craniofacial and aesthetic surgery in Paris, and then did the jaw surgery training in Switzerland.
From his web site history, that was all done before Dr. O asked him to take over O's practice. They both ended up trained in all three specialties, which is probably one of the primary reasons Dr. O asked him to take over his practice.
ENTs are trained in Ear - Nose & throat surgery. Mostly soft tissue surgery, re-setting broken nose or correcting septum deviations, opening up sinus internally, and maybe some mandible surgeries. That is not cranial vault remodeling of the skull and facial bones. The most complex stuff they commonly do are radical neck dissections for people with head and neck cancer. Plastic surgeons are also trained to do those, but I think they generally defer to the ENTs who do those more commonly.
At present, I think the only way (at least in N America) to meet the minimum requirements to get admitted into one of the handful of formally recognized one-year long craniofacial training programs (Fellowship) is to first be trained as a plastic surgeon.
There really just are not any legitimate "short cuts" to get the necessary training and experience. THEN - - after all of that - - someone has to show you how to use all of that training to do the very unique and specific FFS stuff.
Thank you so much for that in depth description! I believe maxillofacial surgeons can do craniofacial residencies, but that's just according to my research online.
Anyway, yet another reason I'd only to go Doctors O, DB, VdD, DiMaggio, and Suporn. I'm not sure I'd even go to Suporn for anything but forehead (and srs, duh). And I'm not sure if I can remember Dimaggio's chin/jaw work to be of any particular standard. Anyone care to remind me of his abilities?
Quote from: BellaSwan on December 13, 2015, 03:19:13 PM
And I'm not sure if I can remember Dimaggio's chin/jaw work to be of any particular standard. Anyone care to remind me of his abilities?
Quite hard to judge chins and jaws because he likes to publish after photos taken 14 days after surgery (taken during last check-up).. if you ignore bruisings and bloody eyes, you can still have a fairly good idea of upper facial area.. but it's a little more tricky to tell about still very swollen chins and jaws.
There are pics that are taken later by patients themselves... where you likely need to take into account selfie-pic lense deformation because of close distance... patients sending the surgeon pics they like the best.. etc...
Thanks for all the good info everyone.
So if someone only has ENT experience / certification and not Plastic Surgery, is that a red flag ? For FFS?
Quote from: Debra on December 14, 2015, 04:35:17 AM
Thanks for all the good info everyone.
So if someone only has ENT experience / certification and not Plastic Surgery, is that a red flag ? For FFS?
No. If they have adequate training in either oral-maxillofacial surgery or orthognatic surgery and years of working experience in plastic surgery, they can be more than enough competent in performing standard procedures regularly used in FFS. They can be far more competent than an average local plastic surgeon who spent his career injecting botox, fixing eyelids, raising eyebrows, augmenting boobs and removing fat under the chin.
But honestly, I would shy away from any surgeon who kept warning about the dangers of a type 3 procedure, or who says you look female enough for it to not "warrant the risk" whatever. Truth is, 90% of us need type 3. That's is not a random number - that is how many of Dr O's patients need them. I know some surgeons and patients want to say that's all about money, but I think their results speak for themselves.
Dr Suporn states he uses Type 3 in around 85% of the cases. In situations where other would burr, this is what he does:
Forehead Contouring/Resetting. This procedure involves contouring by shaving across the forehead and brow bossing/orbital rims followed by performing a controlled fracture of the anterior wall to realign (reset) it to a more posterior position. This proprietary technique, developed by, and exclusive to Dr. Suporn is applied in about 10% of cases.
Why the evolved technique? Because while burring alone, in the few cases where it's preferable, is still sub-optimal. Just do yourselves a favor and at least recognize this.
Plastic Surgeons are MD specialists who perform medical procedures designed to alter or restore the body's shape or form. Though cosmetic or aesthetic surgery is the most well known kind of plastic surgery, plastic surgeons are also trained in reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and in the treatment of burns. In most countries, plastic surgeons must complete medical school followed by a residency in general surgery and finally a residency in plastic surgery. Due to these two separate residency requirements, a doctor can't be a board-certified plastic surgeon until several years have passed after medical school.
Oral & Maxillofacial Surgeons specialize in treating both the hard and soft tissues of the mouth, jaws, and face. In the United States and Canada, oral and maxillofacial surgery is considered to be a subspecialty of dentistry. Oral surgeons are most familiar to Americans as the doctors who surgically remove wisdom teeth and implant certain types of dental hardware. But, they are also trained in other procedures such as treating the misalignment of the jaws & teeth as well as correcting cleft lips & palates. Doctors who pursue this specialty must first complete dental and/or medical school, depending on the country, followed by an oral & maxillofacial residency program. In the United States, both dentists and doctors may train to be board-certified oral & maxillofacial surgeons.
Craniofacial Surgeons treat deformities of the jaws, head, neck, face, teeth, and associated areas. These surgeons are typically plastic surgeons, oral & maxillofacial surgeons, or otolaryngologists (ENT's). Once they are board-certified in one of these specialities, they then choose to practice as a "fellow" under another surgeon or surgeons who already specialize in craniofacial surgery. The length of the fellowship varies and most countries do not have a board that oversees this.
Thank you for that informative post, radialan! I still stand by what I said though in my post above yours ;)
lots of good info. Thanks everyone!
Quote from: radialan on December 14, 2015, 01:18:16 PM
Plastic Surgeons are MD specialists who perform medical procedures designed to alter or restore the body's shape or form. Though cosmetic or aesthetic surgery is the most well known kind of plastic surgery, plastic surgeons are also trained in reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and in the treatment of burns. In most countries, plastic surgeons must complete medical school followed by a residency in general surgery and finally a residency in plastic surgery. Due to these two separate residency requirements, a doctor can't be a board-certified plastic surgeon until several years have passed after medical school.
Oral & Maxillofacial Surgeons specialize in treating both the hard and soft tissues of the mouth, jaws, and face. In the United States and Canada, oral and maxillofacial surgery is considered to be a subspecialty of dentistry. Oral surgeons are most familiar to Americans as the doctors who surgically remove wisdom teeth and implant certain types of dental hardware. But, they are also trained in other procedures such as treating the misalignment of the jaws & teeth as well as correcting cleft lips & palates. Doctors who pursue this specialty must first complete dental and/or medical school, depending on the country, followed by an oral & maxillofacial residency program. In the United States, both dentists and doctors may train to be board-certified oral & maxillofacial surgeons.
Craniofacial Surgeons treat deformities of the jaws, head, neck, face, teeth, and associated areas. These surgeons are typically plastic surgeons, oral & maxillofacial surgeons, or otolaryngologists (ENT's). Once they are board-certified in one of these specialities, they then choose to practice as a "fellow" under another surgeon or surgeons who already specialize in craniofacial surgery. The length of the fellowship varies and most countries do not have a board that oversees this.
Radialan, I may be wrong, but at least in the U.S., so far as I can tell from researching the net, the two formally trained craniofacial people doing FFS both came out of approved plastic surgery programs. Do you know of any that came out of max/fac or ENT programs that completed one of the recognized one-year craniofacial fellowship programs ?
This is a fascinating read, very educational but also very scary.
Gee, we girls sure are a bright lot although sometimes I doubt my intelligence ... LOL ... ;D
The surgeon that I went to in London in October 2014 is a world renowned craniofacial facial surgeon and a delightful man.
But his ideas on FFS were different to say the very least and as a result I need further surgery.
Just goes to show this whole area was ( back in 2004 when I researched FFS ) and still is - a minefield ... :o
Quote from: myfairlady49 on December 14, 2015, 10:18:57 PM
Radialan, I may be wrong, but at least in the U.S., so far as I can tell from researching the net, the two formally trained craniofacial people doing FFS both came out of approved plastic surgery programs. Do you know of any that came out of max/fac or ENT programs that completed one of the recognized one-year craniofacial fellowship programs ?
FFS is a niche set of procedures performed by a small group of surgeons around the world. We can almost name them all if we sit down with a pen and paper. I think that you are correct that the two U.S. based FFS surgeons using the craniofacial title came from the plastic surgery side. It is a little more difficult to determine who is entitled to call themselves a Craniofacial Surgeon because there is no board that defines what merits the title. There is, however, a medical society in the United States that grants membership to Craniofacial Surgeons based on certain criteria that they have established, but it's not really board certification and they don't appear to offer a searchable database of members. But, I think that a one year fellowship in an approved program is among their requirements.
As some here have pointed out, board certification should play a role in your decision. But, which certification? As a general rule of thumb, patients seeking FFS should probably start with verifiable board certification in plastic surgery and then consider a variety of other factors in arriving at a decision. These other factors could include: FFS experience (number of years performing FFS on a regular basis), references, before/after photos, location, pricing, and any additional speciality training that you consider important. Each patient will have to determine for themselves how much weight to give to each of these qualifiers based on her own needs.
Quote from: BellaSwan on December 14, 2015, 08:52:08 AMTruth is, 90% of us need type 3.
In other words, "if you're MtF and you haven't had this procedure done, there's a 9/10 chance that you won't pass"? Can you not see how insulting and untrue this is?
We need to stop spreading this "fact". It's true only in relation to Dr. Ousterhout's practice and experiences, and in no way accurately reflects:
1 - the needs of the MtF community as a whole; there's clearly no way that 90% of us "need" to have this procedure performed, although many of us may benefit from it;
2 - the aesthetic abilities of other competent plastic surgeons, many of whom can produce feminine results without performing such an invasive procedure on almost every patient; and
3 - the clear facial characteristics of cis women, most of whom have nothing even coming close to the foreheads produced by the type 3 procedure.
Spreading this "fact" is detrimental for numerous reasons. It causes people who otherwise pass rather nicely to doubt themselves because they haven't had a type 3 forehead procedure. It causes some people to undergo invasive surgery which isn't actually necessary. It causes great stress for many a beautiful MtF girl who can't afford the surgery and who thinks it's necessary because of the "90% of us need it" fallacy. It invalidates the fine work of FFS surgeons who don't typically perform the procedure. It makes MtF girls who have had FFS but not a type 3 procedure feel like they have made the wrong choice.
Is it a powerful technique for those of us who have prominent brows? Absolutely. Is having it done a "need" for 90% of those of us in transition? Of course not. While I have no issue with the idea that a type 3 procedure is sometimes the only way to reduce a prominent brow enough to get it into female ranges, it's time to stop taking the 90% statistic out of context and pretending that it applies across the board when in reality its scope is rather limited.
I have no issue with stating that 90% of MtF girls could
benefit from a type 3 forehead procedure (even though observation suggests otherwise, but that's another post for another day). It's the way that it's being portrayed as an absolute
need that is clearly untrue.
This may not be directly related to the discussion, but I know someone who was turned down by Dr Suporn for FFS. He said she didn't need it and refused to do it. It does suggest that whatever he does do is "necessary", and that he has decent ethics.
Regarding the 90% quote. Are you sure it's not 90% of the patients who came to Dr O needed Type III? I would find that more accurate. MtF who don't need FFS don't see surgeons for evaluation.
Quote from: deeiche on December 16, 2015, 07:09:17 AM
Regarding the 90% quote. Are you sure it's not 90% of the patients who came to Dr O needed Type III? I would find that more accurate. MtF who don't need FFS don't see surgeons for evaluation.
This is pretty much what I wanted to say. 90% who went to Dr. Ousterhout needed it done. Which omits the underlying fact that they're going to Dr. Ousterhout because they have prominent brows in the first place (and if they didn't, they wouldn't be consulting with an FFS surgeon), so obviously they'll be more likely to need it. Those with less prominent brows would not be seeking out a surgeon capable of that procedure in the first place.
To illustrate this point somewhat differently, it would be like me claiming that "90% of people are ill", when my data comes from my family doctor describing the typical patients he sees (i.e. ill people). It can't be extrapolated to the entire population, and it doesn't take very much logical reasoning to figure out why; ill people go to see doctors, while the vast majority of well people don't stroll into the doctor's office.
Yet somewhere along the line, the 90% has become generalized and used out of context, resulting in the thoroughly stupid idea that 90% of MtF girls "need" the procedure done. And of course few FFS surgeons (except, notably, Zukowski) challenge this misconception because it drives lots of lucrative business their way. Free marketing, etc.
If someone doesn't need a type 3 should they still get it? can a further setback look more aesthetically pleasing?
I have been told I only need shaving but I am still conflicted wether to go with that or not...
Quote from: JaniceNL on December 16, 2015, 08:08:53 AM
If someone doesn't need a type 3 should they still get it? can a further setback look more aesthetically pleasing?
I have been told I only need shaving but I am still conflicted wether to go with that or not...
Depends on what you want. If you will be happy with subpar result then go with type1. I would say if you are paying thousands and thousands and you are going under anesthesia and through hardcore recovery, might as well do it right not just halfway right.
Quote from: JaniceNL on December 16, 2015, 08:08:53 AM
If someone doesn't need a type 3 should they still get it? can a further setback look more aesthetically pleasing?
NO!When it comes to FFS,
more is not better! Erase the obvious male traits, tweak a few things that you want tweaked if you absolutely must, but stop there. Too much FFS, like all plastic surgery, is just ugly and certainly not more feminine than subtle FFS.
The face is a delicate balance. Mess with it at your peril.
Quote from: Lagertha on December 16, 2015, 08:30:58 AM
Depends on what you want. If you will be happy with subpar result then go with type1. I would say if you are paying thousands and thousands and you are going under anesthesia and through hardcore recovery, might as well do it right not just halfway right.
THIS IS LITERALLY THE WORST ADVICE EVER!!!!!
Where are you guys getting these ridiculous ideas about FFS from? Type 1 forehead work is not subpar by definition; it's a valid FFS technique that's appropriate for many patients who don't need type 3 work. If that's all Janice needs, then that's all Janice should get and nothing more. Using your reasoning, Janice should also add in lip work, cheek implants, jaw bone and chin work, hairline changes, brow lifts, eyelid surgery, breast augmentation, liposuction, etc. After all, she's under anesthesia and might as well throw in everything including the kitchen sink to "do it right"...::)
I too want to say Type I procedure is not less of a procedure if that is all someone needs.
The Type definitions ( I, II, III and IV ) were created by Dr O, to define forehead feminization procedures. They are ALL legitimate procedures for specific cases.
Dr O's book "Facial Feminization Surgery: A Guide for the Transgendered Woman" is a very good read for someone considering FFS. I own a copy, it cost $40 on Amazon. Considering the $29k I spent on all my face procedures / lodging / travel it was a minor cost.
Fine, 90% of people who need FFS need a type 3. It not a coincidence that all the doctors who competently perform type 3 have the same statistics, whereas the ones who don't perform it at all claim it's invasive and unnecessary. I have seen the results from the doctors who don't do type 3, and these women have been cheated. What a waste of money. I don't care if you find it offensive - I'd rather no others waste their money in the future by calling it like it I see it. The only type 1s I've seen that were satisfactory were from a Dr O's book. Even if I were a type 1 and shaving is all that I would need, I would go to Suporn to have the forehead "setback" technique that he developed. That's s matter of aesthetic. The ffs surgeons who don't do type 3 - that's not a matter of aesthetic, but lack of competence and training. I guess it's better they don't attempt it then. Type 1 foreheads exist, but on the results page of thesE ffs surgeons that only do type 1 contouring, I have yet to see a type 1 forehead.
Someone posted the following earlier, but I can't find it anymore in this thread. In any case, my reply is below the quote and addresses this.
Quote97% (not 90%) can have more or less significantly better forehead result with forehead reconstruction than with shaving technique. And if forehead reconstruction is done right, it is far more safe than having thin shaved down frontal sinus wall. With shaving technique the surgeon burrs down the strongest outside surface of bone, and what is left is very thin and far more fragile bone.. Accidents can happen.
I'm not aware of any peer-reviewed studies that have determined the actual ratio of patients that need Type III, so I won't wade through the mine field of percentages. I'll just say that many patients seeking feminization of the forehead are Type III candidates.
Forehead Bone Contouring (bone shaving method) is also an appropriate option for many FFS patients. From a risk standpoint, it is not true that the patient is at greater risk than if she had the Type III procedure. A competent surgeon who specializes in FFS will not leave the the bone covering the sinus as thin as a piece of paper. This would indeed put the patient at greater risk of an accident-related fracture. Instead, the bone is shaved down to a point that still permits it to retain most of its protective qualities. We know of no forehead bone contouring patients who have suffered subsequent fractures attributed to this.
Type III reconstruction involves removing a section of bone covering the frontal sinus. This section of bone is also shaved and contoured before placing it in the new setback position. If the bone were not shaved, it would still retain some of its undesirable contours, albeit a little farther back. Like forehead bone contouring, the section of bone is not made to be so thin that it would result in a significant risk of fractures down the road. Both Type III reconstruction and conventional contouring involve shaving of the bone that covers the sinus and both result in a similar bone thickness. The main difference is that Type III involves removing the bone and setting it farther back on the frontal sinus.
Quote from: radialan on December 16, 2015, 06:56:26 PM
We know of no forehead bone contouring patients who have suffered subsequent fractures attributed to this.
Actually we do. Since 2007, that I have been following FFS field, I remember 4 patients that shared their pictures of collapsed frontal sinus wall (not a pretty sight). There has also been quite nicely documented series of photos shared by a surgeon, presenting how to resolve this kind of problem. After a year or so this surgeon, sadly for us now, decided to remove this pictures. I guess we will never know the approximate numbers of all such cases... but we could kindly ask a surgeon from Boston and a surgeon from Buenos Aires how many of this "collapse after type1" cases they had to fix.
Quote from: deeiche on December 16, 2015, 01:06:25 PM
I too want to say Type I procedure is not less of a procedure if that is all someone needs.
The Type definitions ( I, II, III and IV ) were created by Dr O, to define forehead feminization procedures. They are ALL legitimate procedures for specific cases.
Dr O's book "Facial Feminization Surgery: A Guide for the Transgendered Woman" is a very good read for someone considering FFS. I own a copy, it cost $40 on Amazon. Considering the $29k I spent on all my face procedures / lodging / travel it was a minor cost.
The kindle version is still less expensive! But rather than guess at what was written, here is a copy/paste from my Kindle copy:
> " A Type III approach tackles the frontal sinus,
which appears in 95 percent of all people, and the masculine projection of the forehead,
which, in nearly every male, extends well beyond any female projection. (See Figure 4-7a.) The great majority, some 82 percent, of my forehead feminizations are Type III operations. I've performed it in more than 750 MTF patients and many other non-transsexuals as well." <
That statistic does not appear to be an artifact of patient self selection, as was suggested in another post. I think that the source for that statistic came from the extensive male/female / ethnic skeletal study that Dr. O says he did from a local skeletal collection in San Francisco, prior to developing the Type I, II, III, IV procedures. That is an observation that is also consistent with my somewhat limited reading from some other skeletal anthropology/forensic books & articles.
This is a very informative post and helps me understand more about forehead procedures ... :) You would have thought that I would know everything about them now but I still don't and back in 2004 , I was very uneducated about it all. In those days I just thought " Well the surgeon seems to know what he is doing, so I will be fine "Quote from: radialan on December 16, 2015, 06:56:26 PM
Someone posted the following earlier, but I can't find it anymore in this thread. In any case, my reply is below the quote and addresses this.
I'm not aware of any peer-reviewed studies that have determined the actual ratio of patients that need Type III, so I won't wade through the mine field of percentages. I'll just say that many patients seeking feminization of the forehead are Type III candidates.
Forehead Bone Contouring (bone shaving method) is also an appropriate option for many FFS patients. From a risk standpoint, it is not true that the patient is at greater risk than if she had the Type III procedure. A competent surgeon who specializes in FFS will not leave the the bone covering the sinus as thin as a piece of paper. This would indeed put the patient at greater risk of an accident-related fracture. Instead, the bone is shaved down to a point that still permits it to retain most of its protective qualities. We know of no forehead bone contouring patients who have suffered subsequent fractures attributed to this.
That's good to know as my forehead was burred down and occasionaly I still partake in extreme sports !! .. :o
Type III reconstruction involves removing a section of bone covering the frontal sinus. This section of bone is also shaved and contoured before placing it in the new setback position. If the bone were not shaved, it would still retain some of its undesirable contours, albeit a little farther back. Like forehead bone contouring, the section of bone is not made to be so thin that it would result in a significant risk of fractures down the road. Both Type III reconstruction and conventional contouring involve shaving of the bone that covers the sinus and both result in a similar bone thickness. The main difference is that Type III involves removing the bone and setting it farther back on the frontal sinus.
Unfortunately my left frontal sinus was penetrated during my burring surgery and ever since has caused me problems. This is explained more fully in my post " Thank God for the UK's NHS " thread
See: https://www.susans.org/forums/index.php/topic,180029.msg1784396.html#msg1784396
and now the forehead is going to be reconstructed for the very first time by Facial Team in April 2016. So I was a Type III all along despite Dr Z saying at the time that there was no need for X-Rays and he said that he knows when to stop burring as the colour of the bone changes ... It has worked for many of his patients but not me sadly ... :(
someone asked me in a message if I could share Dr Ousterhout's description of Type I. Below is a quote from his book.
In his book, "Facial Feminization Surgery, A Guide for the Transgendered Woman", Douglas K. Ousterhout, MD says
"Type I
Individuals who undergo a Type I procedure usually don't have as severe an issue with their foreheads as other MTF patients. (See Figure 4-4) Only 9 percent of my MTF forehead patients, eighty-five individuals, have needed this type of forehead correction. It is designed for those who had no frontal sinuses (fifty-three of the eighty-five) or had a very small frontal sinus and/or a very thick anterior frontal sinus wall (thirty-two of the eighty-five). A Type I approach consists of burring away the excess forehead bone and developing a desired female contour without entering the frontal sinus, if it exists. (See Figures 4-3a,4-3b.) Although it is the easiest of my four forehead approaches, it must be accomplished in such a way that the bone is not burred down so thin that the underlying frontal sinus, if there is one, is vulnerable to trauma to injury." (39-40).
Quote from: StartingOver on December 16, 2015, 08:38:54 AM
NO!
When it comes to FFS, more is not better! Erase the obvious male traits, tweak a few things that you want tweaked if you absolutely must, but stop there. Too much FFS, like all plastic surgery, is just ugly and certainly not more feminine than subtle FFS.
The face is a delicate balance. Mess with it at your peril.
For me personally, I agree with this. I just want what's needed to get fixed and get a few things tweaked (FFS)....worried about doing too much because any little thing could potentially have issues.
I also feel like as trans women, we get roped into a lot of surgeries and it might cause some of us to fall into an endless loop of never being satisfied with who we are and how we look and can potentially lead into a plastic surgery addiction.
I've had 4 different areas worked on on 3 different surgery dates over the last 6 years since I transitioned and I've considered/researched a few other areas as well (and not just for transition-related).
At some point I really just want to be 'done' and I feel like I have to learn to be satisfied with what I have.
Quote from: Debra on December 17, 2015, 08:31:05 AM
SNIP
At some point I really just want to be 'done' and I feel like I have to learn to be satisfied with what I have.
You and me both, I thought I was done 30 years ago after 4 years of one surgery per year. If FFS had been readily available 30 years ago I'm sure I would have had FFS too. I'm still looking at non face surgery in the next couple years, to replace 33 year old breast implants.