Hi everyone,

In the past few months, I have been getting consults on facial feminization surgery from Virtual FFS, and Dr. Spiegel. After some advice on these forums, some advice from Virtual FFS, and some of my own research, I have decided that Dr. Spiegel is most likely the surgeon I will go to. It sounds like the most important things I need to get done done to be more passable are forehead contouring and rhinoplasty. Everything I'm hearing and reading suggests that Dr. Spiegel has the safest and best technique in the United States for forehead work.

Here are some recent pictures of me without makeup, and with my hair pulled back so that you can see my hairline:







Here are some of the results of my consultation with Virtual FFS (note that these are not all of their recommendations. They suggested a lip lift as well, but I asked them to take that part out):







The changes made to these pictures by Virtual FFS were changes to my forehead and orbital rims, changes to the shape of my nose, shortening my chin, adding a chin implant, and filling in the hair at my temples.

The reason I asked the Virtual FFS person to leave out the lip lift part was because she told me that it would result in my teeth showing a lot more often, and I don't have the best teeth. I wasn't sure I wanted people to see them all the time. Dr. Spiegel disagreed, and told me that my teeth would not show often if I got a lip lift. I'm not sure who to believe on that part.

After seeing these pictures and chatting with me on Skype, Dr. Spiegel also recommended mandible contouring, otoplasty, cheek implants, scalp advancement, and brow lift. All of my discussions and research so far suggest that it's better to get hair transplants than a scalp advancement, so right now I'm leaning that way. Virtual FFS specifically said that I don't really need a brow lift, so I'm working on getting estimates with that removed. I don't really feel like paying for otoplasty right now, so I'm not doing that. While mandible contouring would probably help, I'm not sure that that's what I really need the most.

The thing I'm most on the fence about right now is cheek implants. When I do my makeup in the morning, I notice that contouring my cheeks helps a lot in perceiving myself as female. Dr. Spiegel's advice was that while my cheekbones stand out from the side, they don't stand out much from the front. I think I agree with him on that, and am considering the cheek implants, even though the Virtual FFS person specifically told me she didn't think I needed them. My concern there is that Dr. Spiegel is recommending medium cheek implants. I don't know how big those would be, but I feel like small ones might be enough. I'm not trying to look like a model here, I just want to feel more like I look like a woman.

My other big concern is that my jaw has never fit right. My teeth never all hit at the same time; sometimes one set are hitting, and sometimes another set are. A dental surgeon I once saw for a consult told me that he thinks my jaw actually fits differently every day, and is essentially out of place all the time. I'm concerned that if I get any chin or jaw surgery done before I deal with that, I might regret it.

Currently, my plan is to get a consult with a specialist on misshapen bites, and see if they think I should hold off on jaw and chin work until I've got that worked out. If they think I can go ahead, I'll most likely get the chin work done. I plan on getting the nose and forehead work done. I'm still really unsure about the cheek implants.

I'm just wondering what people think about everything I've gathered so far.

I think dr. Spiegels evaluation is very good. I know nothing about jaw problems like yours, but that should definitely be the first thing to look at, instead of resolving it after any jaw/chin aesthetic procedure.

While virtual ffs lady is right that you don't need excessive browlift, some browlift will happen on its own with change to forehead and orbital rims, and it will be enough. Browlift usually isn't charged for when done with forehead/upper-face surgery.

While this photos aren't ideal to evaluate the need for cheek augmentation, it's obvious enough that you would benefit with only-frontal malar implants (nothing on side). What size exactly is a decision only a surgeon can make during in-person consultation.
Dr. Spiegel definitely won't go to something excessive which would make you look strange. Be shure on this... if anything you need to ask him to be aggressive (in general) because most of those who ask him to be conservative in his approach, end up looking androgynous (unless you want that?).

Lip lift definitely. VFFS lady meant by that it would show the tips your upper teeth more often, not the full line of teeth, in normal situation like talking, smiling... Wwhen laughing (with raised upper-lip) your teeth would show regardless of having or not having lip-lift, not much difference there. Longer upper lip is quite important masculine trait. 

You don't need any hairline advancement, but there are different approaches how to make an incision. There is coronal incision and hairline incision and combinations of both. If you have thousands of dollars too much for hairtransplant coronal incision makes the most sense. If not, talk with doctor and figure out together which approach makes the most sense for you. Its possible to close some corners with 2 different approaches, and you would need to pay a lot less for hairtransplant later. 

You can have two separate surgeries, have the most neccessary procedures first, and have other additional things later (if needed), if you are not certain to have them now. I would include jaw surgery in first surgery, but more important is to have it together with any chin work.