I finally received my consultation information with Dr. Suporn, at first I was like OMG how is it THAT much? but then I kept on reading and that price quotes is in their currency (whew!) I am going to request some testimonials with some of his previous clients but for those who have had him on this site, how was your experience with him? his staff? how was his post-op care? and how do you like the results? Thank You.
Dear Emily,
I am pleased to be able to send you your FFS assessment from The Suporn Clinic. I am sorry that it has taken a little while longer than usual to get back to you. Thank you for patiently waiting.
INTRODUCTION
Thank you very much for submitting your photographs for a Feminizing Facial Surgery assessment by Dr Suporn. They were ideal for assessment purposes, thank you, and this has made our assessment task easier.
The Assessment Procedure
Dr Suporn has studied the photographs in detail, and his considered opinion is completely reflected in this assessment. He adopts a very artistic approach to his assessments, preferring to rely on his artistic background to find a good balance and harmony of 'feminine', rather than rely solely on mathematically derived proportions. That said, the objective of FFS is to bring your head and face as closely as possible to normal female proportions as can realistically be achieved through surgery.
Apart from proportion, Dr Suporn's emphasis is on achieving regularity (smoothness) of facial features, and facial symmetry.
He does not offer to achieve "beauty" for any patient; definition of beauty is an individualistic definition, and every person's definition of it will be different. 'Beauty' can also tend to be very much determined by fashion; features sought because they are considered 'beautiful' today, may become unfashionable tomorrow. However, he strives to achieve the most feminine result he can, which - in a great number of cases - have, indeed, been considered to be 'beautiful', irrespective of fashion.
Dr Suporn's assessment looks at 4 basic areas. The first is gained from a first-impression of the overall look, proportions and aesthetics of the face. After that, he considers the face in 3 broadly divided areas - the upper-, mid- and lower-face. Dr Suporn prefers to integrate work in each area as one complete group of procedures, rather than 'picking and mixing' small procedures in individual areas. However, he is always sure to only recommend those procedures he considers necessary or beneficial. Where he has considered a procedure to be unnecessary, he will not have recommended it.
The assessment is done by a small team at the Clinic, headed of course by Dr Suporn. Each member of the team has considerable FFS experience. We take this approach to get the best and most balanced set of opinions we can offer you in terms of aesthetics, while Dr Suporn additionally provides all the essential advice on what can best be achieved surgically. Where in this assessment, the word 'we' is used, it is emphasized that the assessment completely reflects Dr Suporn's considered surgical and aesthetic opinion. Moreover, where you have submitted your own views concerning aesthetic desires, preferences and concerns, those have been taken into account.
STRUCTURAL FEMINISATION OBSERVATIONS
General Comment
Overall, your face presents a number of already feminine characteristics, along with a small number that would benefit from correction to give an overall excellent female appearance.
UPPER FACE REGION
Forehead Recontouring
In general, forehead and supraorbital rim prominence is far less present in a female than it is in a male. The general appearance for a female is a rounded, open-eyed appearance with no apparent prominence of bone over the sinus cavity where it integrates smoothly with the nasal bone. Over the eyes, the supraorbital rims in a genetic female tend again not to be prominent, and give a more open-eyed appearance without being deep set.
In profile your forehead shows considerable evidence of typically prominent male-like brow bossing, and this is further evidenced in the oblique face-on photograph which shows prominence over the orbital rims. The need for forehead recontouring is evidently indicated.
Supraorbital Rims
The supraorbital rims over your eyes are very prominent. This is a typical characteristic found less in females than in males. We would recommend removal of the prominence to open up your eyes, and give a much more pleasant, female and younger appearance.
In addition, the extent of the overhang of your orbital rims gives the effect of making your eyes seem quite deep set. Recontouring the rims will open them up considerably, giving a characteristically female "open eyed" and brighter appearance. The prominence is particularly visible when seen in the oblique pictures you sent.
Indication
The need for forehead recontouring is indicated to re-profile your forehead and supraorbital rims and remove the evident prominence, resulting in a smoother, more gently rounded and pleasingly feminine appearance. The amount of prominence you display can be almost eliminated to create a flowing profile which will run smoothly into your upper nose area, giving characteristics more usually found in a female than in a male. In addition, removal of the prominent supraorbital rims will 'open up' the eyes giving them a more feminine and younger appearance.
Dr Suporn uses 3 degrees of surgical procedure to remove this bossing, and it is most likely that he will need to perform either a technique known as 'resetting' (which he developed), or - more likely in your case - by a reconstructive forehead surgery. It is not possible to determine whether this is the case for certain without being able to see X-Rays of the head to see the thickness of the anterior wall (forehead) over the sinus cavity (above the top of your nose). There is no need for you to send any radiographs to assist with this analysis. Occasionally even X-rays are inadequate to determine the thickness of the anterior wall for certain, and it is not unusual that the thickness cannot be determined until the patient is actually undergoing surgery. Dr Suporn is always prepared for the most extensive case, but equally always performs the least extensive case actually necessary on his patients. He can determine this contemporaneously if necessary.
He is confident in your case that he can remove all evidence - or mostly all - of the bossing you currently display, and leave an extremely female and pleasing shape to your forehead and supraorbital rims.
Brow Level
The ideal position for the eyebrows is to be positioned a little above the supraorbital rims, and lifted a little higher at the outer third than in the inner two thirds.
In your case, your eye brows appear to be on or below your supraorbital rim, and run in a fairly flat shape following the contour of the supraorbital rims. Overall, they appear to be symmetrical.
Because of their low positioning, we suggest you would benefit from a brow lift. This will open up your eyes, and give your mid and upper face a much more pleasingly feminine appearance. To enhance the typically female 'open eye' appearance that will be created by removal of orbital rim bossing, we would recommend a lift of the eye brows by some 4-6 mm at the inner region, and proportionally higher at the outer one third bring them superior (above) the new supraorbital ridge.
Hair and Hair Line
Your head hair is mostly good, and the prognosis would be that you would show a very full head of hair following recovery after surgery.
Your hair line is showing some considerable evidence of recession - particularly at the temples in the traditionally named 'male pattern baldness'.
Your hairline is higher than would normally be found in a natal female, and more in proportion with a typical male hair line. We believe you would show a better and more female appearance by bringing the whole hairline forwards. We recommend a scalp advance.
Based on the evidence in your photographs a scalp advance would bring forward the hair by some 2-3 cm at the front, and proportionally further forward in the temporal region to define a more typically curved female hair line.
While the present degree of your recession is considerable, Dr Suporn is quite confident that the improvement in your hairline should be sufficient to enable you to be happy with the general appearance without the need to resort to any basic hair transplant treatment. That decision will ultimately be yours of course, and will depend on your own level of satisfaction with the density of your hair over the coronal and templar region.
Frown Lines
Your forehead appears to be smooth and free of any vertical or horizontal frown lines that might need attention.
Upper Eye Lid
Removal of the orbital rims tends to increase the effect of 'bagginess' around the upper eye-lids and to considerably open up the eyes to give them a youthful appearance. Dr Suporn normally removes this by performing an upper blepharoplasty (UB) during the same upper face procedure. In your own case there is already some evidence from the photographs that you would benefit from a UB, and we recommend undertaking the procedure.
Lower Blepharoplasty
There is no evidence below your eyes of any excess skin folds or "bagginess". A lower blepharoplasty is not indicated.
Upper Face - Summary
To summarise, we feel your upper face would benefit most from the following feminising procedures:
· Forehead and Supraorbital Rim Recontouring to remove prominence.
· Scalp Advance
· Brow Lift
· Upper Blepharoplasty
Upper Face Procedure
Dr Suporn's technique for the upper face is such that he performs it as a complete set of procedures, and there is no reduction in price for eliminating one aspect or another. A scalp advance will always involve some degree of brow lift, and vice versa. There is very little difference in surgery time between the various forehead and supraorbital rim contouring techniques, so the price is the same regardless of technique applied.
Undergoing forehead contouring almost invariably introduces surplus skin on the upper eye lid, and Dr Suporn removes this during the same set of procedures. In rare cases this is not necessary, however, and an allowance is made for not doing so.
The suture line is always covered with hair transplants taken from surplus material removed during the scalp advance. It is important to understand that these transplants should not be confused with a full hair transplant operation intended for area coverage. The transplants done during the upper face procedure are done solely to cover as far as possible the suture line, and hide the scar line within the new hair line. As a result, they are quite limited in coverage because they depend solely on the amount of hair-bearing tissue that was removed during the scalp advance procedure. As far as we know, Dr Suporn is the only surgeon who applies this additional detail.
MID FACE REGION
Your nose when seen in profile is a good size in proportion to the rest of your face and it would appear that it needs no major surgical alteration. However, there are a number of features that we suggest you consider in order to give you the most feminine and youthful appearance.
When seen in profile your nose is already pleasingly shaped , well in proportion to the rest of your face, and is feminine in appearance; it does not appear to be in need of any revision. Naturally that is a matter of personal preference. However, we do not make any specific recommendation to alter the shape or size of your nose based on the profile view alone.
Face On
Your nose appears to be quite wide at the mid region, and we would recommend thinning this somewhat to draw some of the visual attention away from your nose.
In the lower region Dr Suporn recommends an alarplasty to narrow the distance across the nostrils and to reduce as far as possible the broadness of the nose in the lower region.
Please be aware, however, that the flesh surrounding your nostrils is quite thick, and this will limit the amount of reduction that can be made. A major reduction would not be possible, and if you wished to proceed we advise it would be on the basis that you accepted some limitation to the degree of reduction that could be made. Apart from narrowing the nose across the widest part of the nostrils, the suggested alarplasty would subtly raise the tip of your nose, giving it a more feminine and soft characteristic, when seen in profile.
When seen face on, your nose appears to be quite symmetrical
Indication
From the evidence shown, it would appear that you would benefit from a rhinoplasty to enhance the shape, appearance and overall femininity. Dr Suporn would include all the features discussed (unless you indicate to the contrary). This would ensure as closely as possible that your nose is better in proportion with the rest of your face, would ensure symmetry as far as practicable.
In front-view, we believe it will be possible by alarplasty to substantially reduce the broadness you currently display, and are confident that a significant reduction and improvement can be made with which you would be very satisfied and pleased.
Upper Lip Lift
The distance between the lowest part of your nose (columella) and the upper lip is quite long. Typically, this distance is much shorter in females, longer in males. You would benefit from an Upper Lip Lift (ULL) to decrease the distance between the nose and your upper lip. This procedure is normally carried out in conjunction with the recommended rhinoplasty, and is effected from a small incision made immediately beneath your nose, which will subjectively disappear a few weeks after surgery.
The lift will expose your upper teeth a little when you smile, giving a more pleasingly feminine and juvenile appearance. Additionally, it will have the effect of slightly opening up the upper lip, and making it appear a little less thin.
Mid Face - Summary
From the foregoing observations, the following procedures are recommended in the mid-face area:
· Feminizing rhinoplasty
· Alarplasty (to reduce width across nostrils)
· Upper Lip Lift
Lips
Although your upper lip is quite thin and would benefit from some enhancement, we would advise that the suggested upper lip lift will benefit this by rolling up and outwards the upper lip, exposing more of it, and giving an impression of fullness.
Your lower lip is also perfectly proportional, and requires no surgical alteration.
The shape of your lips is acceptably feminine already. The upper lip precedes the lower lip and in profile is angular, relative to the frontal facial plane. The lower lip is fuller than the upper. We do not recommend any surgical alteration or enhancement of your lips.
LOWER FACE REGION
The immediate impression is that your lower face is quite rounded in the lower region, due mainly to a long, broad and heavy chin.
Chin
Front On
Your chin is a little wide at the lower extremity and would benefit from reprofiling to give it a more feminine appearance.
Seen from the front, your chin is quite rounded, and rather heavy-looking giving a non-feminine appearance to your lower face. We recommend a full re-profiling of your chin area to alter the shape to be closer to a classical "almond" shape.
The depth of your chin is a little longer than we would consider ideal, and at the same time as we would recommend shaving the frontal profile and width, we would recommend a reduction in depth would be advised.
In Profile
When seen in profile, your chin appears to be quite deep in proportion with the rest of your facial features. We recommend reducing this depth by removing some of the bone to bring the appearance more closely in line with female norms.
It is a generally held view that an attractive female face will have the following characteristic: if - when viewed in profile - one draws a straight line that just touches the foremost extremities of both the forehead and the chin, that line will pass behind or on the forward extremity of the lower lip, and usually somewhat further behind the outer extremity of the upper lip. This is not a rigid 'rule' of course, but it is a guideline that Dr Suporn uses to produce the most pleasingly female appearance in profile.
In your case, your profile already fits quite well this norm, so we do not recommend any change of profile in the anterior or posterior direction.
Jaw
Your jaw is well shaped when seen from all angles, and there is no sharpness or massiveness that suggests that you would benefit from alteration of the jaw. There would appear to be no significant feminising effect from undergoing any jaw recontouring.
Lower Face Summary
In the lower face region it would appear that the following procedures are indicated:
· Chin Re-profiling and reduction
Thyroid Cartilage Reduction
From the evidence in your photographs, you do not appear to be in need of undergoing Thyroid Cartilage Reduction (TCR)
PRICE QUOTATION
To perform the surgical procedures recommended, I can offer you the following prices:
Schedule of Procedures
Date:
To be agreed
Price
FFS Comprising:
Upper Face:
Forehead Reduction, Scalp Advance, Brow Lift, Upper Blepharoplasty, Hair Transplants to incision line
495,000
Mid Face:
Rhinoplasty + Alarplasty + Upper Lip Lift
235,000
Lower Face:
Chin Reduction
190,000
Total:
920,000
General Comment
Prioritisation
As a general principle we do not try to influence a patient as to which features she "needs most" or are the "worst". Where a budget constraint exists, or where the patient feels particularly uncomfortable with specific procedures but feels unable to proceed with all that we have suggested, it is her prerogative to select the most appropriate procedures for herself.
As general advice, we would suggest that gender recognition between humans is normally carried out at or above eye-level. While the general public is consciously aware of the "Adams Apple" as a male marker, that feature does not tend to be the initial feature that enables a human to distinguish "male" from "female". The most dominant difference between the sexes is in the upper and mid-face face region - hair height, brow and supraorbital rim ridging, and eye brow height and openness, as well as the eyes and nasal features.
The least subconsciously recognised difference between male and female characteristics are usually in the chin and jaw, unless the features are particularly prominent. In our experience, chin and jaw work tends to contribute least to the overall feminisation in a typical "full" FFS operation.
IN SUMMARY
Please remember that this assessment is not definitive - it is a suggestion. If you wish to amplify any of the remarks that have been made, or put more or less emphasis on any of the recommended procedures, be sure to tell us what you would like to be changed. The more input Dr Suporn has from you, the better the prognosis for an outcome that will satisfy you.
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