In the end I decided to send my photos, and the results were far better than I was expecting. Although the part marked in blue has left me with a weird doubt
QuoteHello.
Please remember that these virtuals are not and could not be 100% accurate but I hope they will give you a good idea of the possibilities and take you a long way towards planning how best to proceed.
Also remember that just like a surgeon, I am fallible and although I take quite an obsessive amount of care over virtuals, I will inevitably make a mistake every so often.
Working from photographs is not the same as seeing the person in real life. Camera lenses can affect the facial proportions to some extent and the lighting in a photograph can also affect how a face looks. So, a face or feature that looks masculine in a photo might not look quite as masculine in real life or might not be quite as important if the person has a very feminine presence about them.
Facial surgery is not an exact science and while I can control the changes I make in Photoshop completely, a surgeon may not be able to control things with quite so much precision in real life.
The eye takes a little while to tune-in to facial changes so you may be disappointed at first glance. It is best to spend a few days getting used to the pictures before you make any decisions and it is important to imagine the face in a more feminine context with a little make-up and female hairstyle.
Hairline:
The height of your hairline in the middle is fine but you do have some recession in the corners giving your hairline the masculine "M" shape. I have filled in the corners to give your hairline a more rounded and feminine shape in all versions of the pictures and this can be achieved with a scalp advance or hair transplants. If you have forehead surgery then some surgeons might recommend that you fix the corners with a scalp advance as both procedures can use the same incision. However, hair transplants are a better option in my opinion as they are less invasive, the end result looks very natural and you avoid the scar along the hairline of a scalp advance. It would probably take 2 sessions of "micro follicular grafts" and the first session would be done a few months after any forehead work.
Forehead:
You have moderate brow bossing in the centre above your nose but less above your eyes. I have removed the bossing in all the pictures to bring your forehead into normal female ranges.
Eyebrows:
Your eyebrows sit in medium position neither high nor low and I do not think you need a brow lift. They are likely to lift a little with forehead surgery and I have simulated that but I do not think you need any additional lift. They are quite thick at the moment so I have plucked them, mostly along the underside to give them a thinner and more feminine shape.
Eyes:
I see the ptosis of of your left upper eyelid but this is a small detail and is not really outside normal ranges for facial asymmetry. I probably would not have mentioned it. It also has nothing to do with facial gender so you do not need to worry about it affecting your transition. I have corrected it in the third version of your pictures (c) but please bear in mind that this is not my area of expertise so there is some guesswork involved.
Nose:
Your nose is a touch large with a slightly humped bridge. From the front your nose is not wide overall because it is not wide along the sides where the nose meets the face. However it is quite wide along the roof of the nose. I have lowered the bridge to make your nose smaller overall; I have reduced the tip to balance it with the lower bridge and I have narrowed the roof of the nose to give it a more refined shape. These changes are in all the pictures. There are ways to open the nostrils a little and I have simulated wider nostrils in (c) but it is very optional and does not have a feminising effect. You might find that the nostrils look a little wider when the bridge is narrowed. Also, be careful not to overdo it as men have wider nostrils than women.
Cheeks:
I don't see any notable problems with your cheekbones that would require implants. Hormones will make the apple of your cheeks fuller and rounder and I have simulated this for you. It is impossible to predict exactly how the hormones will affect you (everyone's different) but I've given you an idea of the kind of change you can expect.
Lips:
The mouth asymmetry you have is actually a small detail and within normal ranges for facial asymmetry. I do not think you need to worry about that and I do not know of a way to lift one side of the mouth. Overall your mouth has a feminine shape and is reasonably full as well. I do not recommend a lip lift because you already show quite a lot of your upper teeth when your mouth is open - this is a good thing and is feminine but it is not a good idea to take it too far as it will look unattractive. If you wanted to lift the lip you would need to reduce the upper jaw and this can be done with an operation called a Le-Fort procedure but it is very invasive and I don't think you need it. Another reason a lip lift would not be good idea of you is that the corners of your mouth slope downwards. This is quite a feminine look but again, if you take it too far it will not look good. I have therefore left your lips as they are. I have only heard of one surgeon trying to angle the soft tissues under the nose backwards by puling them in a little. I do not know if this is successful and I have not tried to simulate it. I think it would make very little difference to either beauty or femininity.
Chin:
Your chin has a fairly rounded shape but it is tall. It is also more developed on your right side making it somewhat asymmetrical and it also recedes a little. In (b) and (c) I have reduced the height, corrected the asymmetry and set the chin forwards slightly.
Jaw:
Your jaw is within normal female ranges however, the chin surgery is likely to extend some way into the jaw, particularly on your right side. This is because the chin asymmetry extends into the jaw meaning that the jaw is asymmetrical too and is more developed on your right side.
Adam's apple:
You have a visible adam's apple and I have simulated a tracheal shave to reduce it for you. It is not a particularly strong adam's apple so I think there is a good chance that you will be able to hide it completely.
Hormones:
I have simulated hormonal effects for you - mainly filling the cheeks but they add layer of fat that rounds off your features and they make the skin texture itself softer and more feminine. These changes can be very powerful, especially when combined with beard removal.
Face lift:
I do not think you need to consider any rejuvenation yet.
Other points:
I have reduced your beard shadow for you.
Overall:
Don't worry too much about the facial asymmetry and eyelid ptosis - these are fairly small details and within normal ranges for asymmetry. They also don't have any effect of facial gender. Don't under-estimate the effects of hormones - these can make a big difference to facial femininity. Also, you are only 5' 8" which is a very good height and well within normal female ranges.
I am sending you an extra version of the 3/4 shot with some hair and make-up added to help you visualise the possibilities.
The BDD is very important and it is great that you felt able to mention it to me because if you recognise that you have it, that is the most important step to getting it fixed. I have been through it myself so I know that it can be fixed. I still have to work on it as I still have the kind of mind that looks for faults in my face! but I can handle it now and know what to do. I strongly recommend that you get a copy of the book that I mentioned at the bottom of my page on BDD on the website. This would be a very useful compliment to the work your therapist does and can also help with the general trauma of transitioning.
BDD affects your judgement and makes everything look worse to you than it really is. You can see this in your email. For example when you talk about having gigantic shadows over your eyes from a neanderthal forehead. In truth your brow bossing as about average and the kind of description you gave would only really apply to very strong brow bossing. Also, your adam's apple is not particularly strong. The key thing to learn here is that you cannot trust your own judgement at the moment so when something about your face looks awful to you, just remember that you have BDD and that means that however awful it looks to you, it doesn't look that bad in real life. I find that when I look in the mirror, I often look like a man to myself but I pass easily so I know that I don't look like a man.
Thank you very much for entrusting me with your virtual FFS - I very much hope the pictures are helpful.
Good luck and best wishes,
Alexandra.
http://www.virtualffs.co.uk
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What I was wondering is if a FFS surgeon could reduce the chin. I know that they can cut and advance the bone with a procedure such as a sliding genioplasty, but... Could they do what she proposes or I would need a separate maxillofacial surgeon? The closest thing I can think of is this, as it appears in Meghan's post.
https://www.susans.org/forums/index.php?topic=111721.0Overall, I'm quite happy with the results. The Facial assimetry seems to be caused by a TMJ disorder . My jaw is slightly misaligned / tilted due to teeth differences and a bad postural habit I have kept doing involuntarly for years (resting the head on the left hand by the jaw, since I was a kid until today). So with a bit of luck, ortodhontics and phisioterapy I may be able to put it back in its original shape, which would need to be done before any FFS procedure. Plenty of time to plan it.
