Due to the fact that doctors usually use medical language and I'm not a native speaker, I struggle to understand the difference between type I and type III?
What more do they do in type III that they don't do in type I? I've read that in the most invasive reconstructions they take the plate of your skull and then re-attach it with metal screws?
I'm curious cause I would like to have as flat forehead as possible, but dr Bart van der Ven who I chose to go with, suggested type I, however when I look on his before and after pics, I can't really pinpoint which one is type I or III because in all of them he seems to shave them to a similar degree, and sufficiently so
Thanks for answering!
http://www.virtualffs.co.uk/Forehead.html
It would be hard to explain it as well as Alexandra has on her website.
I also highly suggest dr. Ousterhout's book Facial feminization surgery.
Two examples of similar forehead before surgery.. type1 and type3, just for comparison...
http://content.screencast.com/users/ma5642/folders/Jing/media/e788dab8-4376-4ef4-bc02-9d3959850094/2016-01-13_1947.png
http://content.screencast.com/users/ma5642/folders/Jing/media/d97ff599-0554-4a94-9ea4-d3108ec47498/2016-01-13_1946.png
From everything I've read, the first one basically grinds down the edges to smooth things out (that part of your skull is hollow so there's a limit to how much they can safely do), the other is grinding things down AND cutting the bone out over your sinuses and replacing/reconstructing it so that your sinus cavity is smaller. Not every place does type 3, it's a more complex. Also there are different benefits and risks with each one.
Quote from: Kova V on January 13, 2016, 01:19:42 PM
Also there are different benefits and risks with each one.
Technically there are no risks involved with type3 reconstruction
IF a surgeon has appropriate training and experience with this technique. If someone who isnt skilled and trained enough performs it, then yes there are risks for serious complications.
Oh I see, makes more sense now.
Looks like type I is often what's enough, but when I see type III I get so jealous of how flat their forehead is and I'd ideally like to achieve it..
It's the other way around, a type 3 is often more required to bring the forehead into a female range. I was advised to get a type 1, which I am still conflicted about. Especially after comparing the two pictures.
Quote from: crowcrow223 on January 13, 2016, 02:26:32 PM
Looks like type I is often what's enough...
This is very individual, the only thing that really matters is what is enough for you, what are your expectations and what kind of result you want. Some are indeed happy with only little smoothing and subtle feminizing effect, while others want typically feminine forehead shape.
I thought that type lll involved grinding down the bone over the sinus cavity to the mucosa membrane, and then covering it with a Titanium mesh? Whereas type l involved grinding it down to a reasonable thickness.
Quote from: Christina308 on January 13, 2016, 05:53:49 PM
... Whereas type l involved grinding it down to a reasonable thickness.
Sometimes also to unreasonable thickness! :)
With type 3 they remove the frontal sinus wall, and reshape/remodel it as desired. They place it in new position and shave down the bone around it to create uniform forehead shape.
Surgeons in FFS field who do type3 reconstructions usually doesnt mess much with sinus cavity. Except in cases where patients had underdeveloped sinus and really small cavity to start with. Which would be even smaller, like non existant, after surgery, therefore in small percentage of patients (like 1-3%) it is better to just fill up whole remaining micro cavity with bone paste. Most surgeons use special titanium screws and plates to hold reconstructed bone plates in place, except or dr. Di Maggio who shapes modified frontal bone in a conical shape which holds itself (forehead skin holds it from the other side), with which he avoids using any titanium screws.
That was a good explanation.....I guess i'm going to have rethink my situation.
Your result is very impressive..... Was it DiMaggio?
Dr. Meltzer
Well, type 1 can certainly be indicated, but that can only be decided based on X-rays. Did Dr Bart look at any cephalograms?
To whom is that question directed? :)
I suppose you and crow :)
No he didn't he just looked at my face and pushed hard at a few places. Point is I don't know to just go along with the type 1 or specifically ask him to do a type 3. I think he is able to make that judegement call right...
And what happens if I ask him to do a type 3? is it possible that I turn up with a too flat forehead? isn't it true you need to also maintain a sort of slope with a certain angle to make it not look weird?
Quote from: JaniceNL on January 16, 2016, 09:52:58 AM
No he didn't he just looked at my face and pushed hard at a few places. Point is I don't know to just go along with the type 1 or specifically ask him to do a type 3. I think he is able to make that judegement call right...
And what happens if I ask him to do a type 3? is it possible that I turn up with a too flat forehead? isn't it true you need to also maintain a sort of slope with a certain angle to make it not look weird?
You could post your side-profile pic here... or if you are uncomfortable with that, you can send PM.
Dr. Bart often recommends type 1. I have seen more than few results from him, where type1 wasn't enough, and result could be better if done with type3 reconstruction. I think you should make this decision...
I was always a Type III ( as Dr O advised me) but I was sold on burring sadly that has been the cause of all my problems ... :'(
way too much trouble to go through all that to post a pic. Why doens't this site just allow to just insert a pic ?
I had Type III with Facial Team and I am very happy. It looks 100% natural feminine even for a MD. I have very small titanium screws in my forehead now (and in my chin). Only remaining side effect is that my nose is running when going from cold into warm air and vice versa.
I would not choose a surgeon who uses bone paste. There are many short and long term complications connected.
Quote from: Lara1969 on January 16, 2016, 01:41:05 PM
I would not choose a surgeon who uses bone paste. There are many short and long term complications connected.
You do realize that all surgeons performing forehead reconstruction use bone paste as filler material, including Facial team you had surgery with? Please list those many short and long term complications.
Quote from: Lagertha on January 16, 2016, 01:56:02 PM
You do realize that all surgeons performing forehead reconstruction use bone paste as filler material, including Facial team you had surgery with? Please list those many short and long term complications.
Sry I was incorrect and I meant: Less bone paste as possible should be used. For your information I had forehead type III, nose and chin job without bone paste as requested from me. I just had some titanium screws inserted. Just my bone was reworked outside the face and inserted. My passing seems to be perfect and I think Facial Team did a great job.
Main side effect is infection even many years after surgery. It depends on the bone paste but currently the risk was too high for me:
Use of Calcium-Based Bone Cements in the Repair of Large, Full-Thickness Cranial Defects: A Caution
Zins, James E. M.D.; Moreira-Gonzalez, Andrea M.D.; Papay, Frank A. M.D.:
"Results: The mean patient age was 35 years (range, 1 to 69 years). The mean defect area was 66.4 cm2 (range, 30 to 150 cm2). Cases were equally divided between BoneSource and Norian CRS. The mean amount of bone cement used was 80 g. Follow-up varied between 1 and 6 years (mean, 3 years). Major complications occurred in eight of 16 patients, with one occurring as late as 6 years postoperatively. Complications occurred throughout the course of review, indicating that they were not caused by a learning curve.
Conclusion: Because of the unacceptably high complication rate with the use of calcium-based bone cements in large skull defects, the authors believe that their use is contraindicated and have returned to using autogenous split skull cranial bone reconstruction for these patients.'
H'mmmmm this is interesting.
Wonder if my forehead problems began with Dr Z putting in bone paste two years after my FFS to fill in a void.
It was loose in my forehead and dropped out on to the operating theatre floor when the area was opened up in October 2014 at the Chelsea & Westminster Hospital in London.
Quote from: Lara1969 on January 16, 2016, 04:38:46 PM
Sry I was incorrect and I meant: Less bone paste as possible should be used. For your information I had forehead type III, nose and chin job without bone paste as requested from me. I just had some titanium screws inserted. Just my bone was reworked outside the face and inserted. My passing seems to be perfect and I think Facial Team did a great job.
Main side effect is infection even many years after surgery. It depends on the bone paste but currently the risk was too high for me:
Ok, Thanks. I understand your concern. The percentage of bone-paste related complications after facial feminization procedures is very small. In most cases it's about partial reabsorbtion of bone paste, which can leave more or less significant deformity. Just to be clear, bone-paste reabsorbtion happens in larger percentage of patients, but its usually so small that patients dont even notice any difference. In very small percentage of patients body reacts differently to bone-paste, and larger amounts get dissolved and reabsorbed, which could leave exposed microplate and screw after sliding genioplasty, or it can create visable crease on otherwise normally healed forehead. FFS surgeons usually only use bone-paste as a crease filler, or as additional temporary support while bones heal. I wouldnt discourage any patients from FFS surgeons who use bone-paste, because all FFS surgeons use it, even though they generally use it as little as possible.
Thanks Lagertha for your latest post.
As I said in my last post "Wonder if my forehead problems began with Dr Z putting in bone paste two years after my FFS to fill in a void."
This insertion of the bone paste was in 2006.
In 2010,2012 & 2013 Dr Z reburred the same area that was deformed ( which had the bone paste in it ) and within weeks the deformity reappeared again each time and progressively became worse.
But as soon as the bone paste was removed in 2014, the forehead in that area is now fine which was proved by a CT Scan in May 2015. So this all leads to the likelihood that the bone paste was reacting to my bone.
Originally I thought it might have been due to my taking the anti-osteoporosis therapy Fosamax ( Alendronic Acid) for some years and in 2013 I suggested this to Dr Z and he said " This problem could be a result of older women like you taking this therapy". Funny eh that since the bone paste was removed the area has remained stable ... :o
Mr Eccles at the Chelsea & Westminster Hospital in 2014 thought this Fosamax theory was a red herring and did not think that my theory was correct and subsequently has been proved right.
Of course, I still have the problems with the left frontal sinus to be sorted out as well as the constant nose bleeds which FT think that might be as a result of any bone paste residue in and around the left frontal sinus.
This is all a learning curve and we patients are the guinea pigs and I say that in the nicest possible way.
We shall see what happens in April.
Quote from: JaniceNL on January 16, 2016, 09:52:58 AM
No he didn't he just looked at my face and pushed hard at a few places. Point is I don't know to just go along with the type 1 or specifically ask him to do a type 3. I think he is able to make that judegement call right...
And what happens if I ask him to do a type 3? is it possible that I turn up with a too flat forehead? isn't it true you need to also maintain a sort of slope with a certain angle to make it not look weird?
Someone can't simply have a feel of a forehead and decide what type it is. It can only be known through a cephalogram. I would go with another doctor.
I can't I don't have the money to spend 25k euro on FT and then do the other things transition related. Though I do like their foreheads but on chin and jaw I find them too conservative.
I have such a dilemma!
I believe Type III would be the best for me due to my obsession with beauty. I respect Bart's minimalistic approach but when my forehead is set back it will bring out my eyes more, type I will do that but I want an extremely flat forehead. I'd hate to heal and still see room for improvement... and then another 10k down the drain to get it redone, holy cow!
I am booked with him already, I tried to speak with him but he won't talk to me untl the day before during the consultation which is very bad, cause if he declines type III I will have two options mess it all up by sticking to just a nose job and chin reconstruction literally only one day before the surgery, and save the money from forehead (which isn't even that much, anesthesia hospital and nose job is like 60-70% of the cost), I believe he charged me 3300 euros for the forehead which is not that much so might as well just try I dunno... Another problem is, they said IF dr thinks type III is better, he will do it free from additional cost, so I think, he will fight and convince me I don't need it just so he doesn't have to work harder for free, and I even told him I can pay more for type III...
We'll see, I want type III desperately, may take more cash with me
I'm just so tired of having to redo every surgery cause first time is never good enough and the cost involved is just extremely draining
Long story short, day before my surgery I will fight to get type III
So you girls are saying I should get that forehead scan that starts with the letter M i don't remember the name of for him to better judge that type III would be ideal?
I am not sure but would it be possible to reconsider you choice? I had consultation with him and a similar discussion. This was one of the reasons I had chosen Facial Team. I am now very happy with my forehead.
Hi crowcrow223,
I am concerned for you.
No patient should be in possible conflict with their surgeon prior to surgery.
Hugs
Paula
Quote from: crowcrow223 on January 21, 2016, 06:42:31 AM
I am booked with him already, I tried to speak with him but he won't talk to me untl the day before during the consultation which is very bad,
Long story short, day before my surgery I will fight to get type III
So you girls are saying I should get that forehead scan that starts with the letter M i don't remember the name of for him to better judge that type III would be ideal?
1) Do we understand your situation properly - - you have never had an in person and face to face consultation with Dr. Bart and he has you already scheduled for surgery ?
2) Also - you have not had any radiographic images reviewed by the surgeon that has scheduled your surgery ?
If the answers to those questions are that
you have not been evaluated IN PERSON and that you have not had any radiographic images - - then you really are properly concerned.
The decisions to do or not to do a Type I verses a Type III - - - really should only be made after both an in person consultation and a review of the radiographs. Anything less is just simple guess work on the part of the surgeon - - and it obviously has caused you a LOT of anxiety. Your anxiety is not mis-placed or over stated.
Surgeons who do that are putting their patients in a position to have to make very important surgical decisions under last minute circumstances of extreme personal, time, travel, and financial distress. That hardly qualifies as "informed consent" for the subsequent next day surgery. That is really - - really unfair to the patients !
Great post myfairlady49 ... :)
Could not have put it better myself
I HAVE had in person consultation with Dr Bart. No scan though. He kind of pressed his finger on my forehead, took couple pictures, then I received the proposal with type I.
I've tried to discuss possible type III over e-mail but as I mentioned, I have to wait to discuss it until the 7th of March, day before my surgery is scheduled.
I trust him with my nose and chin, he has a lot of knowledge and experience, and done some great forehead work, it's just... how easy is it gonna be to convince him to do type III?
Did I understand correctly that the price quote for type 1 reconstruction by Dr. Bart was 3300 EUR? And how much is his quote for Type 3?
Quote from: Emily.P on January 24, 2016, 08:36:17 AM
Did I understand correctly that the price quote for type 1 reconstruction by Dr. Bart was 3300 EUR? And how much is his quote for Type 3?
I am not OP but the OP did state in this (https://www.susans.org/forums/index.php/topic,202486.msg1804958.html#msg1804958)
Quote from: crowcrow223 on January 21, 2016, 06:42:31 AM
I have such a dilemma!
SNIP
IF dr thinks type III is better, he will do it free from additional cost
SNIP
Yeah, he quoted 3300
Its about a month away now, we will stay in touch
Quote from: crowcrow223 on January 24, 2016, 08:04:15 AM
I HAVE had in person consultation with Dr Bart. No scan though. He kind of pressed his finger on my forehead, took couple pictures, then I received the proposal with type I.
I've tried to discuss possible type III over e-mail but as I mentioned, I have to wait to discuss it until the 7th of March, day before my surgery is scheduled.
I trust him with my nose and chin, he has a lot of knowledge and experience, and done some great forehead work, it's just... how easy is it gonna be to convince him to do type III?
My dear girl,
I've had similar experience with Bart and turned him down. I turned Suporn down two days before surgery because he couldn't deliver as promised. It is you who decide in the end-not the surgeon.
What you need to decide for yourself is wether you need an aggressive approach or not when it comes to forehead countoring. Then look for a surgeon who has sufficient experience and can provide references. In additon you need to have confidence in the surgeon and his team. If I were in your situation I would look for another surgeon.
All the best
Jannicke
follow up here https://www.susans.org/forums/index.php/topic,205779.new.html#new