Susan's Place Transgender Resources

I have decided on my facial surgery. Before I declare my hand, I consulted with:

1. Dr Rossi

2. Dr Bart van der Ven

3. Facial Team

4. Dr Sutin at Preecha Aesthetic Institute

I discounted Dr Zukowski for no massively strong reasons so those were 4 of the world's leading non-US FFS places.

After much thought, including nearly a whole day Sunday scouring the internet for further reviews and comments, I came to the following conclusions:

1. Dr Rossi
Good quick responses from Amanda their agent. Whilst I liked a lot of their thoughts I get the impression Dr Rossi is basically a one-trick pony: it's forehead reconstruction or nothing. Since I don't have a so-called type III forehead, and am pretty dubious about this whole reconstruction malarkey, this turned out to be a sticking point beyond which we could not budge. They did back down when I told them the findings of both Dr Sutin and Dr Bart.

2. Dr Bart van der Ven
I had a good face-to-face consultation but this turned out to be a different viewpoint to others. Dr Bart doesn't think I need much work on my forehead except to lower my hairline. He thinks I don't have much brow bossing and am not type III so he proposed very little work there. However, to my slight surprise he did want to do a little jaw and chin shaving. No one else thought this was necessary in my case and when I said I'd rather focus on a full face lift to achieve the effect he steamrollered my viewpoint. I was also rather unhappy about his nose simulation. There was almost no difference at all in the before and after and he didn't seem to listen to what I was proposing. I was really quite underwhelmed by his before and after simulation. I also raised with him the issue of operations in a clinic not a hospital and what happens if something goes wrong? He was a bit casual in response on this which I really didn't like. Look at what happened to Kelly Maloney there: things can sometimes go wrong for whatever reason and when they do every second counts. Finally, I emailed them several times and received no reply. Sorry, Dr B, you're very nice but for those reasons I'm out.

3. Facial Team
Appalling at email replies. Simply appalling. Made me feel like I was on a conveyor belt. When I eventually got a response from them they completely agreed with Dr Sutin (see below). "looking at your photos and wanted to congratulate you have a feminine face. And we believe that with a facial feminization'd look great. For your case we suggest a lifting of the lower middle third to lift the soft tissues andcan rejuvenate and feminizarte the same time."
They also operate in a clinic, not a hospital. That's okay providing nothing goes wrong but 8 hours under GA is not a short operation. 
Anyway, lousy response timing from them has put me off.

4. Dr Sutin at PAI (Preecha Aesthetic Institute)
He palpated my face, simulating the different face lifts which were impressive. He clearly and unequivocally stated I don't need forehead work except an orbital rim shaving alone if I want (50:50 on that): nothing else was necessary except for lift work and hairline lowering. He was equally clear that the jaw and chin don't need shaving but that a FFL will be perfectly sufficient given my face shape. He offered two clear options on my nose which I liked: unlike Dr Bart he wasn't pushing a full rhinoplasty and conveyor belt nose job. He felt I could alternatively have tipplasty if I didn't want my nose in cast for 4 weeks etc.
I had my bilateral orchiectomy with PAI and they were superb. I really like Dr Sutin.
And the best FFS facial surgery I've ever seen (Warlockmaker) was performed by PAI. These Thais do really know their stuff in this field: they must still be considered the most aesthetically sophisticated and beautiful in the world, surely?
What I particularly like is that they tailor it to your needs. They're also brilliantly quick with email response.
So, for me, it's now a no brainer. I've booked the surgery with Dr Sutin at PAI in December, booked my flight, booked my hotel.

Oh, and PAI is half the cost of Dr Bart and they operate in a superb hospital (Piyvate).

Decision made.

Can I ask how much did they quote you on everything?

ps- trying to send a private message but wouldn't let me

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Hi Rachel,

Congratulations on your decision and I am sure you will look great ...  :)

Sorry to hear that you had communication problems with Facial Team.

Just to put the record straight Facial Team do work out of a hospital, the HC Hospital in Marbella with an intensive care unit in place.

See:  http://www.marbellahighcare.com/en/

Take care

Hugs

Paula

Oops my apologies Paula. I was going on what others have posted here but I can see that HC is a brand new private hospital. It looks very good.

Bunny, PAI quoted me 14,900 USD for the following:

1. Hairline lowering, orbital rim shave and full brow lift

2. Tipplasty and Alarplasty on my nose

3. Full Facial Lift


Re. no. 2, those two combined = 4200 but you can have full rhinoplasty nose job for the same amount.

Hi Rachel,

Hope your day is going well.

Apparently HC Hospital has been there for decades and Facial Team has been there for nearly ten years.

FT have offices in the grounds and both my friend and myself who had surgery in April were incredibly impressed with the hospital, the nurses and other staff who care for Facial Team's patients. The place does look new, I agree, so must be refurbished regularly. Also when there, I noticed that the original building had been extended.

I was looking at FT's website this morning and spotted this.

Looks like Dr Preecha and his team has close connections with FT which is great.

See:  http://facialteam.eu/transhealth-initiative/
http://facialteam.eu/blog/ffs-surgery/3-transhealth-initiative-workshop/

Hugs

Paula

Quote from: Rachel Richenda on September 29, 2016, 01:10:51 AM
Oops my apologies Paula. I was going on what others have posted here but I can see that HC is a brand new private hospital. It looks very good.

I absolutely agree Paula. I wonder if the initiative might become a gold standard for global trans surgery? That would be so good for all of transitioning around the world. When I mentioned PAI to my GiC consultant in July he said, 'oh they're excellent. I gave a paper there at the 2014 conference.' I know you were previously on the receiving end of some poor work elsewhere and there ought really to be some accountability.

It sounds as if Facial Team are truly excellent. I must have just caught them in a very busy phase so they were slow to reply. I probably should have gone out there for my consult to be honest. As you say, I think I'm in good hands as you evidently were too. That's the way forward.

Hugs

x

Your experience is not a one time event, I contacted FT May 2015, heard back from them January of 2016.  I was already 3 months post FFS by the time I heard back from them.  They were high on my list of surgeons for consultation and recommendation.  I guess they have enough customers. <shrug>

Quote from: Rachel Richenda on September 29, 2016, 10:07:47 AM
SNIP
It sounds as if Facial Team are truly excellent. I must have just caught them in a very busy phase so they were slow to reply.
SNIP
Hugs

x

That's kind of odd with Facial Team, as one of the things that puts me off them a bit is the huge amount of marketing they do. Its hard to imagine how they could be bad at communication.

Interesting decision - but it makes sense that if you wanted no full FFS but rather some less extensive procedures, you would want to stay away from The North and South American surgeons, as they seem to tend towards doing rather more than less. Facialteam seems to be more conservative and give you more options  - with the downside of course that its up to oneself to make all those decisions on what procedures to pick. Apparently the PAI seems to be similar then, makes sense again considering they are somehow associated with Facialteam. Dr Kim from Yeson is also in that association, which for me is a point that increases my trust in those surgeon teams, as I think he is very professional. However he also took a couple of days or even 1-2 weeks to reply on some occasions. With Facialteam, I think they are quite oriented towards the social networks - if you post something in their support group on Facebook or write one of their coordinators a message on Facebook, I usually got fast replies, when I was asking some things about the surgery or about making an appointment for a consultation. One nice thing they do is they do checkups for patients whenever they can come to their consultations they regularly have all over Europe - so one does not have to fly to Marbella to have a face to face post OP checkup of the results.

Are there any before & after photos available for FFS at PAI?

Quote from: anjaq on October 12, 2016, 09:11:02 AM
Interesting decision - but it makes sense that if you wanted no full FFS but rather some less extensive procedures, you would want to stay away from The North and South American surgeons, as they seem to tend towards doing rather more than less.

I'm really quite offended by this statement.  It is an over-generalization and more importantly simply not true.  Granted, if you give your surgeon a blank check and tell them to "do whatever you want", then they might do a lot of procedures.  But that's not how a relationship between an FFS surgeon and a patient should be.  There should be a lot of back-and-forth discussions about what is needed vs. what is wanted.  You should do your own research and ask the surgeon a lot of questions.  And have everything set in stone (in writing).  Much of the responsibility is on you, the patient, to make sure that there is no misunderstanding.

Recently, I had subtle work done on my forehead by Dr Zukowski in Chicago.  Granted he did also recommend jaw and chin work (and I bet it would have made me more beautiful) but I opted not to get it done, and he completely respected my decision.  And archlord also recently posted her own experience by another North American surgeon, Dr Bensimon, and that too was just subtle forehead work, not "extensive procedures".

I believe that the criteria for selecting an FFS surgeon should be based on the techniques they use, their early educational and training background, their years of experience in the field, pricing, and location, among other things.  Making sweeping statements such as "stay away from North and South American surgeons if you want less extensive procedures" is more harmful than helpful.

I think there's a lot of truth in what Anjaq put, Emily. By and large based on my research I'd say she's got a real point: north and south American surgeons do tend to default to invasive surgery, as does for instance Dr Bart van der Ven for instance. I felt some of them, him included, didn't listen to where I was coming from.

By contrast Thai places do tend to default to less invasive techniques, which might be partly because of Asian skull shapes? Or because it makes it so prohibitively expensive?

Frankly I felt some of the places I contacted in 'the west' were trying to pedal totally unnecessary procedures in order to make more than a few bucks. Sorry but it needs saying, but having done so there are also plenty of girls who do need all of that procedure and will really benefit from the skills they will find there.

Ok, I did not want to overly generalize this statement, it was more a comment regarding Rachels choice specifically and based on my impressions. I have the impression that the more known surgeons often mentioned here tend towards doing more procedures and more drastic changes, while Europe or Asia has some known doctors that are less inclined to do so much. I think it is a cultural difference as well - Europeans generally tend to be less fond of plastic surgery and americans generalls tend to have more binary gender perceptions. Its just my impression that I hear a lot from American Transwomen that they want to change their face as much as possible, to get really feminine, that they hate their faces so much for being so masculine - while in Europe people seem to tend more towards double-questioning each procedure and trying to stay natural and are more sceptical towards surgeries. In Germany I was several times verbally attacked online for mentioning that I believe almost all trans women can benefit from FFS - or that FFS should become part of the NHS at some point. Ideologically even for trans women a FFS is a aesthetic surgery and thus not really needed except in severe cases. I think the US is different.

Also I did not want to judge over this and say that doing more and more extensive changes is in any way a bad idea compared to doing less and more subtle. Absolutely not. Its a matter of personal preference of course - some want to change their face radically to not be able to see a trace of the previous face anymore, nothing to remind them of it - while others want to keep the face they have just feminized in some ways that allows them well enough to "pass". No approach is better or worse and both have its lure and its fear.

There are some surgeons in Thailand that can be really really aggressive with facial surgery, like Dr. Suporn or Dr. Chettawut. Some Korean surgeons are very aggressive with jaw surgery as well

Very best of luck with your imminent surgery, Rachel!

Good point Celia!

Thank you Sophia so much.

I've begun a new thread on it: https://www.susans.org/forums/index.php/topic,216392.0.html

Eeeeek  :o ::) xx

Hi Rachel!

Here's a quick question that seems to belong better here than in the other thread -- do you have any thoughts on the value of getting a remote (email) consultation with PAI, rather than face-to-face? I've added them to my list based on your story, but there's no way I can go there in person until I'm actually ready for surgery. You mentioned face palpitating? How big a part of the consultation was the touchy stuff that needs personal contact?

Well I have to say that I did really appreciate the way Dr Sutin did the palpitating in front of the mirror, showing me how different emphases may look.

But in terms of practicalities, various places do online consultations these days so I'd like to think PAI would be able to set up one e.g. via Skype. It has to be possible these days and whilst not ideal it would really help.

x

So, I did send in some pictures to PAI for a remote consultation but I am a bit underwhelmed. The assessment was very short - basically just a very short list of recommended procedures - it is shorter than any other surgeon so far, but the price is still considerable for what they suggest. They only would do burring, apparently, no reconstructions - no type 2 forehead, no change in the bones of the chin, just tapering it by burring and also burring down the brow ridges a bit plus hairline advance with hairline incision. Still the pricetag is between $10000 and $20000, which I regard expensive for "just burring/shaving". I tried to ask for more information on these procedures - details - type of forehead work etc - but the answer was not really well understandable in english and they did not really reply to the questions but basically said that it is all about overall aesthetics and the doctor would do things in a way that look good, no worries about what is done in detail. They would not change the nose, which is something everyone else recommended together with forehead work to make a smooth transition from nose to forehead, but it makes sense if they do not touch the forehead, really, just burr down some of the ridges.

So, I do think I am not so much in favour of PAI right now - if I want "just burring" of the forehead, I could choose Dr Z which does it without cutting open the whole scalp.

Well all I can say is that the aesthetic tailoring to your own features is very much their approach i.e. to do things in the way that looks best or good for you. They will certainly do nose work if you ask them for it, and it's a feature of their list:
http://pai.co.th/category/aesthetic-plastic-surgery/
http://pai.co.th/alar-plasty/
http://pai.co.th/nose-reconstruction-surgery-total-nasal-surgery/
http://pai.co.th/tip-plasty/


Here are my latest two photos on the flickr wall, taken at around the seven week mark from surgery:
https://www.flickr.com/photos/145930757@N08/?


Personally I think the results are absolutely outstanding. I'm trying to write that in as objective way as possible but I'm thrilled with the results. Have a look at the two top left compared with the three bottom right taken before any work. Incredible work by Dr Sutin imho.

xx

Well, I do not doubt that they do good work. Looks good to me, but I am always someone who likes to know what they are doing to you. I am not someone who likes to go there and just submit to their judgement on what the aesthetics can be. I know one needs a certain amount of trust in a FFS surgeon to do something that is aesthetically pleasing, but I felt a bit left out in their assessment when I asked about details of the procedures - for example if they do type 1 or 2 or 3 forehead. "If doing the same type 1,2 or 3. The result will be the same block like other. Cosmetic surgery is about art of aesthetic." is in my perception not really an answer that satisfies me as all I can to is interpret it as "we will do whatever we think is good".

So my conclusion about PAI is, basically one can check before and after pictures, see if the aesthetics they do is a match to ones own desires and then go there and say "do whatever is needed" and then they do what they see fit. I have not experienced this with other surgeons so far, who always were able to at least make an estimate about what parts have to be changed in what way (eg.g. type 1 or 3 forehead, orbital shave, sliding genioplasty or just burring - which parts would be burred etc). I was comfortable with Yeson even though they have not perfect english, but it was enough - with PAI I feel a bit of a langage barrier or maybe it is a cultural barrier which consists of me wanting to know details on what is done, while maybe most other patients of them just want it to get done...?

I understand it that you did mostly a facelift with them, not a full FFS, though? From the initial post it reads like you did face lift, hairline lowering and some minor change to the nose. So in that case, I guess it makes more sense. They did not shave any bones or did any reconstructive work then?

I had a full sit down consultation where Dr Sutin talked me through lots of different options. He manipulated my face to simulate the effects of different types of intervention. His conclusion, which was identical to three other international specialists, was that I didn't require major reconstructive surgery. Some of the things we discussed were very much left to me as options to consider but not considered 'vital.' I particularly, and it was I, did not wish to have jaw and chin shaving. Fortunately other clinics felt this was also unnecessary in my case. So I had:

Scalp hair advance
Orbital rim shave brow bossing
Brow lift
Nose alarplasty and nose tipplasty reconstruction
Neck liposuction
Neck lift
Full facelift

Ok, sounds a bit like what FacialTeam told me - nothing big is really needed, everything is optinal...

So I guess it makes more sense then to actually go there for a consultation which is a bit far away though - about 15 hours flight or so...

I tried to manipulate my face to make those things that annoy me go away, but it does not work  I guess that is because with that, I can only simulate soft tissue work, no change in the bones. Glad you did not need more severe surgery and you are happy with it.