Susan's Place Transgender Resources

Community Conversation => Transitioning => Facial feminization surgery => Topic started by: mistyjensen on August 16, 2018, 07:03:04 AM

Title: Thoughts about FFS
Post by: mistyjensen on August 16, 2018, 07:03:04 AM
Hi, All of the FFS surgeons, including Dr. Lee, who I have consulted with about a FFS revision for me have told me that I don't need forehead feminization. Therefore, I deduce that it's not as imperative for me to have a FFS surgeon with extensive craniofacial surgery training perform my revision. An oral and maxillofacial surgeon, who has extensive experience with FFS would suffice in my case. Thoughts?

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Title: Re: Thoughts about FFS
Post by: Virginia on August 16, 2018, 10:20:45 AM
To quote Dr. Christian Troy from the TV series "NipTuck," tell what you don't like about yourself mistyjensen."

I had fat transfer to fill out my cheeks after cancer surgery. Most people never noticed the original 3 1/2" scar running from below my eye to my jaw, let alone the effect the restoration procedure had on my face. But the difference it made to my female alter was life changing.

If you are relying on insurance to pay for the procedure, your options may be limited. But plastic surgery is about what the patient needs to feel better about themself, NOT what any doctor or person says is "necessary."



Title: Re: Thoughts about FFS
Post by: MissyMay2.0 on August 16, 2018, 11:29:59 AM
Quote from: mistyjensen on August 16, 2018, 07:03:04 AM
Hi, All of the FFS surgeons, including Dr. Lee, who I have consulted with about a FFS revision for me have told me that I don't need forehead feminization. Therefore, I deduce that it's not as imperative for me to have a FFS surgeon with extensive craniofacial surgery training perform my revision. An oral and maxillofacial surgeon, who has extensive experience with FFS would suffice in my case. Thoughts?

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It's just my opinion, but experienced FFS surgeons are more detail oriented when it comes to determining key differences in male and female faces, so I would be concerned that a standard maxillofacial surgeon may not be as concerned with feminization when they operate.
Title: Re: Thoughts about FFS
Post by: mistyjensen on August 17, 2018, 06:29:32 AM
Quote from: MissyMay2.0 on August 16, 2018, 11:29:59 AM
It's just my opinion, but experienced FFS surgeons are more detail oriented when it comes to determining key differences in male and female faces, so I would be concerned that a standard maxillofacial surgeon may not be as concerned with feminization when they operate.

Hi,

You make excellent points. 1 out of the 3 FFS surgeons I consulted has extensive craniofacial training. The other accomplished FFS surgeon, who my insurance wants to perform my revision, is an oral and maxilliofacial surgeon and trained as a dentist. I realize that not all of the FFS surgeons I consult will recommend the same procedures. With that in mind, I look at common points that they raise which I too want like to address.
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 03, 2018, 10:02:48 AM
Hi,

I wonder if it's worth the added discomfort/expense in my case with having forehead remodeling to get my forehead to look the ideal feminine, meaning little or no visible bossing.  I stand corrected from one of my earlier posts. One of the surgeons I did consult recommended brow bone bossing. The three other surgeons I consulted I said I don't need brow bone bossing. As you may know, cis women have little to no brow bone bossing. I notice that the photos on various FFS surgeons' websites show patients with no conspicuous brow bone bossing following forehead remodeling.

I'm also having similar personal thoughts about the trachea shave. I wonder if I should take on added discomfort/expense and the risk of having conspicuous scarring from a trachea shave when my Adam's Apple is already very inconspicuous.  Perhaps a surgeon can only take away a little from my trachea because I don't have much start... However, I want to remove all of my remaining masculine features that I can done within reason.
Title: Re: Thoughts about FFS
Post by: Michelle_P on September 03, 2018, 06:21:20 PM
Caitlyn, it is a LOT to go through.  If you have 3 out of 4 surgeons saying brow work is not needed, you can save having to deal with a LOT of work, from huge hairline incisions, possible transplants to cover, through a year of healing and recovering sensitivity. 

I did NOT do the trach shave because my bump is pretty inconspicuous at my age and the scar would likely be visible.  IF I do a lower facelift in a year (depends on how much damage and loose tissue there is from my jaw work) I will do the trach shave then when it can be shaved through the facelift's incisions.
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 04, 2018, 06:44:05 AM
Quote from: Michelle_P on September 03, 2018, 06:21:20 PM
Caitlyn, it is a LOT to go through.  If you have 3 out of 4 surgeons saying brow work is not needed, you can save having to deal with a LOT of work, from huge hairline incisions, possible transplants to cover, through a year of healing and recovering sensitivity. 

I did NOT do the trach shave because my bump is pretty inconspicuous at my age and the scar would likely be visible.  IF I do a lower facelift in a year (depends on how much damage and loose tissue there is from my jaw work) I will do the trach shave then when it can be shaved through the facelift's incisions.

Hi Michelle,

Thank you for your helpdul feedback.

I'm actually a FFS revision patient. After my FFS, I experienced scalp numbness. I'm ambivalent about whether I will take the risk of numbness again. That said, I dont want to revisit forehead remodeling further down the road of life. I want to maximize the use of incisions (I will also have a brow lift). I hope to wrap up my FFS surgeries with this revision.

I have a lot to think.

Title: Re: Thoughts about FFS
Post by: josie76 on September 07, 2018, 05:07:05 AM
Quote from: mistyjensen on August 17, 2018, 06:29:32 AM
Hi,

You make excellent points. 1 out of the 3 FFS surgeons I consulted has extensive craniofacial training. The other accomplished FFS surgeon, who my insurance wants to perform my revision, is an oral and maxilliofacial surgeon and trained as a dentist. I realize that not all of the FFS surgeons I consult will recommend the same procedures. With that in mind, I look at common points that they raise which I too want like to address.

Generally I would stay away from those doctors that trained as dentists and now offer cosmetic surgery.
Look up their training. If a maxiofacial surgeon studied that and did their surgical fellowship in a plastic surgery setting, then I would trust them.

I have been considering similar options. There is a maxiofacial surgeon near me who specializes in cosmetic surgery but also does most of the children's hospital cleft pallet and other birth defect surgeries. Him I would trust. I sent in an inquiry to his practice web site. He emailed back himself. He said he would have no problems doing nose chin, and jaw surgeries but was right up front saying he would not be the doctor for brow bossing as he is not practiced in that area. I am ok on my jawline but I would like some chin work. Along with that I have an underbite which he said is no problem at all to set back the jaw to align the teeth. That is something I don't think most FFS surgeons will touch. This leaves me wondering where I should go. I am also considering a cranialfacial plastic surgery practice in St. Louis. The doctors there are also the crainialfacial dept professors at the university medical school there.
Title: Re: Thoughts about FFS
Post by: reborn on September 07, 2018, 06:08:39 AM
let me correct you. In most of the European countries and USA in order to specialize in maxillofacial surgery one must be an MD and a dentist. Dentists are far more experienced when it comes to neck and face. Most of the doctors offering FFS are dentists and MDs at the same time. I would not trust a medical doctor performing maxillofacial surgeries
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 07, 2018, 06:35:20 AM
One of the FFS surgeons, who I consulted with and I would like to perform my FFS revision is Dr. Harrison Lee, who originally trained as a dentist.

A craniofacial surgeon, who I had a consultation with, has very limited experience performing FFS.

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Title: Re: Thoughts about FFS
Post by: josie76 on September 07, 2018, 09:02:19 AM
Quote from: reborn on September 07, 2018, 06:08:39 AM
let me correct you. In most of the European countries and USA in order to specialize in maxillofacial surgery one must be an MD and a dentist. Dentists are far more experienced when it comes to neck and face. Most of the doctors offering FFS are dentists and MDs at the same time. I would not trust a medical doctor performing maxillofacial surgeries

I suppose it depends. I have seen some instances where a dentist who spent very little time in any surgical training, offer everything face plastic surgery and more. There are many reports of issues from this particular doctor. That makes me worry about some of them. On the other hand, someone who trains specifically for surgical procedures and then practices plastic and reconstructive surgery seems far safer bet. Those who have a history specifically for FFS obviously have been specializing in that and have good track records.
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 09, 2018, 03:28:07 PM
Hi,

I'm undecided if I have a type 1 or 2 forehead. Can anyone tell from these photos?

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi86.photobucket.com%2Falbums%2Fk118%2Fcaitlynjconklin%2Fcroped%2520version_zpsepmibbet.png&hash=8b0ff91dab29a62ecf2af2ac4b4227e7d0db160c)

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi86.photobucket.com%2Falbums%2Fk118%2Fcaitlynjconklin%2Fcroped%2520version%25202_zpsffug6t77.png&hash=a902254412676ecaf64b1bc825dd723569cb995c)
Title: Re: Thoughts about FFS
Post by: reborn on September 10, 2018, 05:17:23 AM
Looks like type 1 but not sure
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 10, 2018, 07:09:07 AM
Quote from: reborn on September 10, 2018, 05:17:23 AM
Looks like type 1 but not sure

Hi, I can be a little slow at times lol. But, yes, it's hard to tell in my case. My forehead doesn't exactly match any of the foreheads shown in the general diagrams at https://www.researchgate.net/figure/Forehead-shape-classifica-on-A-Type-1-B-Type-2-C-Type-3-D-Type-4_fig2_32215798

My frontal bossing is very inconspicuous. As I mentioned, Dr. Lee told me that I don't need forehead remodeling. And another surgeon said I'm within the female forehead range. However, Dr. Di Maggio, without him going into specifics, recommended frontal bossing reduction for me.  I take it that he was thinking that I should have no (visible?) bossing as is the case with many cis women. But other cis women have little bossing. I have sort of a flat forehead. I'm starting to desire that I have a have a rounder, more convex one that conveys feminity. I wonder If I can get that...
Title: Re: Thoughts about FFS
Post by: reborn on September 10, 2018, 08:06:02 AM
I believe that you have a gap just above your forehead sinus. You can easily identify it in your profile picture. I believe that all you need is filling of this gap with bone cement, fat or dermal filler.
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 10, 2018, 08:08:21 AM
Quote from: reborn on September 10, 2018, 08:06:02 AM
I believe that you have a gap just above your forehead sinus. You can easily identify it in your profile picture. I believe that all you need is filling of this gap with bone cement, fat or dermal filler.

Those are good ideas!
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 10, 2018, 08:25:07 AM
P.S.

https://www.realself.com/video/filling-a-concave-forehead-restores-femininity-to-the-face

I realize that the effects of filler are temporary, though.
Title: Re: Thoughts about FFS
Post by: reborn on September 10, 2018, 12:38:00 PM
that video is exactly what you need. You can use permanent fillers, fat transfer or bone cement which all deliver permanent results.
Title: Re: Thoughts about FFS
Post by: mistyjensen on September 10, 2018, 01:00:51 PM
Quote from: reborn on September 10, 2018, 12:38:00 PM
that video is exactly what you need. You can use permanent fillers, fat transfer or bone cement which all deliver permanent results.

Thanks again for your helpful feedback.

I'm very thin.

I was interested in using fat grafting to augment my cheeks. But one of the surgeons I consulted doesn't think I would be a good candidate for fat grafting because I have no extra fat. I realize that the effects of dermal fillers are temporary. With all this mind, I wonder if using bone cement to feminize my forehead would be the best option for me.

Title: Re: Thoughts about FFS
Post by: josie76 on September 10, 2018, 05:31:53 PM
Hey Misty, one thing I notice is that your forehead is really cis female. You have a verticle forehead with slight frontal prominence and very small supercillary arches and it looks like almost no rise in the glabella. Your forehead looks really cis female as it is.
Title: Re: Thoughts about FFS
Post by: Janes Groove on September 10, 2018, 08:59:14 PM
Quote from: mistyjensen on September 10, 2018, 07:09:07 AM
Dr. Di Maggio, without him going into specifics, recommended frontal bossing reduction for me. 

I had a consultation with him too via the internet (I sent him a ton of pictures).  He came back and said I needed Type I forehead work.  I then responded back that I didn't want Type I forehead work and his assistant basically wrote back that they wouldn't consider NOT doing it and wouldn't even give me a quote for the job without the Type I forehead surgery.   I knew I didn't need it.  The surgeon I eventually went too agreed as well, so did Doctor Z when I had a consult with him.

Needless to say I passed on Di Maggio.

Oh and FWIW I don't think you need Type I forehead surgery at all.  Your forehead looks fine.



Title: Re: Thoughts about FFS
Post by: mistyjensen on September 10, 2018, 09:36:31 PM
Quote from: Janes Groove on September 10, 2018, 08:59:14 PM
I had a consultation with him too via the internet (I sent him a ton of pictures).  He came back and said I needed Type I forehead work.  I then responded back that I didn't want Type I forehead work and his assistant basically wrote back that they wouldn't consider NOT doing it and wouldn't even give me a quote for the job without the Type I forehead surgery.   I knew I didn't need it.  The surgeon I eventually went too agreed as well, so did Doctor Z when I had a consult with him.

Needless to say I passed on Di Maggio.

Oh and FWIW I don't think you need Type I forehead surgery at all.  Your forehead looks fine.

Hi, That's helpful and encouraging info for me to know.

I do suffer from body dysphoria and gender  dysphoria. But I'm trying to differentiate what is a body dysphoria issue and that which is a gender dysphoria.

FFS has always been the most important gender affirming surgery for me.

Some of my facial features, such as my forehead and inconspicuous Adam's Apple that didn't concern me before my FFS have been bothering me.