Cool it down a little and take a break gals.

Let's drop it and let some others chime in to Kaley if they want.

Thank you!

Kaley- the best course of actions is to get the bilateral skull xrays and speak with multiple surgeons about them. I am sure that my xray's would have lead any of the Type 3 surgeons to tell me I "must get a type 3 for success", and yet I had a great result from Type 1. It's your judgement call!

And I would say if you are looking for a great & affordable Type I surgeon in the states, I have nothing but great things to say about Toby Mayer. He's a wizard with suture closure and natural looking noses. A true perfectionist.

If you don't mind going to San Francisco CA for the surgery, Dr. O is working in an advisory/assissting capacity with Dr. Deschamps-Braly to pass the FFS baton as it were. I am quite happy with my results with them, although I'm pretty sure it would cost a bit more to get all that list done. I had a type-3 forehead reduction with them as well as several other procedures.

Personally, I'd avoid getting a chin implant. If you do the chin advancement as described in Dr. O's book, you wouldn't need it anyway. But I think from your pictures I would stop after nose/brow and chin. The nose and brow procedure have to be done at the same time, but you don't have to do everything at once otherwise. If you're worried about widow's peaks, you might want to do a hairline procedure, but from your picture I can't tell if you have any issues with them. As your hairline is now, it seems fine, and I can't see any recession from your pictures. Just know that if you have any issues growing hair through your scar tissue, you may have to get transplants to obscure visible scarring.

I totally understand wanting FFS, and it has helped my self esteem a lot. It also had the added benefit of showing my family how determined I am, and makes the world see a different person than who I used to be outwardly. Nevertheless, good luck, and I hope you find the right surgeon for you and are happy with the results

Quote from: Jennygirl on June 17, 2015, 10:37:35 PMKaley- the best course of actions is to get the bilateral skull xrays and speak with multiple surgeons about them. I am sure that my xray's would have lead any of the Type 3 surgeons to tell me I "must get a type 3 for success", and yet I had a great result from Type 1. It's your judgement call!

And I would say if you are looking for a great & affordable Type I surgeon in the states, I have nothing but great things to say about Toby Mayer. He's a wizard with suture closure and natural looking noses. A true perfectionist.

Great advice, and Jennygirl is living proof that Type 1 surgery can be very effective (as am I).  I was told by the big name FFS surgeons that I must have a Type 3 to get the best results.  To a surgeon who can perform a Type 3, every forehead looks like it needs fixing with a Type 3 procedure.  I went for the Type 1 because the entire surgery package was cost-effective, subtle, and the surgeon was wonderful and local.  No regrets whatsoever.  And many of the "cheap" FFS surgeons had, in my opinion, some rather ugly results that looked not particularly feminine and very artificial.  One of my main goals was to still look like "me" afterwards, not someone who had obviously had plastic surgery.  Small changes were perfect, not a sledgehammer approach to reconstructing the entire face.  I tend to find that the more plastic surgery one has and the more invasive it is, the more obvious it ends up being.  And looking at faces that are have obviously been worked on, it's sometimes far easier to figure out that the person underneath used to be male.  It stands out in a crowd for the wrong reasons, not the right reasons.  Blend in, don't stick out.

The forehead is just one piece of the beauty/femininity/passing puzzle - and that's a puzzle with a thousand pieces.  Nose, skin texture, hair, ears pierced, makeup, hairline, boobs, posture, mannerisms, speech, movement, clothing, hand size, etc.  The list goes on and on.  One can have the flattest, smoothest, most beautiful forehead in the entire world and still be pegged as a guy 99 times out of 100 if the other things aren't right.  Some of it is luck, some of it is hard work, some of it is a case of being able to throw money at the problem to fix it.

Shop around when it comes to surgeons.  Go with who makes you feel comfortable.  Don't obsess over the forehead.

Woah!! Got a little heated there, but thanks again for all the replies!  I really actually appreciate the competing views!

My situation is such that I am definitely going to have to travel a pretty good distance to get any decent facial surgery done as I don't think there are many reputable (if any) surgeons in Hawaii who perform this type of surgery.  Cost isn't a HUGE deal, although I don't want to spend over 30K in total on the face since I want to do voice within 6 months or so after doing the face.  Cost of GCS also isn't an issue since my insurance will cover it after getting the necessary approval(s).

As I stated previously, I will be consulting with Dr. Spiegel on July 15th and just set up a consult with the Facial Team on June 25th.  I do want to minimize overall downtime and leave taken from my job as much as possible so if I can get everything done at one time by one Dr that would be preferable!  Especially due to the distance I would have to travel for this!  So I feel like I don't want to go to anyone specifically because they are the best at X or Y, but rather at their work in totality.

I will definitely look into Dr Toby Mayer and Dr. O/Dr Deschamps-Braly!  And I will try to get the xrays done if I can to potentially help the eval process.  As far as the Type 1/2 vs Type 3 debate...I don't think I care TOO much either way and obviously don't have MAJOR issues w/ passing, but I do want to minimize as much masculinity as possible on my face.  I absolutely hate what testosterone has done...really wish I had the courage to tell my parents when I was a pre-teen/teen and knew with 100% certainty that something was really wrong.  So, I will try to trust in the particular Dr's techniques and definitely go with whomever makes me feel most comfortable with everything, but I really like the VFFS simulated forehead result and it would seem that it will only be possible to achieve with the Type 3 procedure so I am definitely strongly considering it!

Hey, it looks like you want to stay in the States, if so you might want to contact Dr Mardirossian for a Skype consult.  He trained under Dr Spiegel and now has his own practice.  I seriously considered him but ended up deciding on Dr Rossi.

Quote from: StartingOver on June 17, 2015, 02:13:23 PM

Careful with the misconception about the local docs too.  I'm not talking about laying down in the office of some backass town's family practitioner and asking him to shave your skull.  I'm saying that in any major metro area with a good hospital (e.g. any of the top fifty cities in the US), there's going to be experienced plastic surgeons who can perform full-range FFS with their eyes closed, although they may shy away from a type 3 forehead reconstruction.  Just because they haven't specifically branded their web sites around a narrow service like FFS, doesn't mean they haven't done it, can't do it, or won't do it.  Remember, they make their money catering to some rather vain women who want to look as feminine as possible.  They don't want to push that regular business aside by being known as the "transgender" doctor - half their regular clients would run because they don't want to end up looking like a transgender woman.  But most plastic surgeons will (and have) happily and successfully operated on transgender women even if they don't brag about it online.

StartingOver,

I really think there are sound reasons for not  using typical  plastic surgeons for most FFS work.  One of my close personal friends is a successful ABPS Brd Certified plastic surgeon.  We have dinner together every month or so.  Practices in a major metro area.   I raised this same issue you raised a few weeks ago when I asked for some comments on some before / after pictures I had seen.  The whole reason FFS surgery is FFS surgery is because one has to alter the bone structure to get the desired result.  Even the very good general plastic surgeons  who are board certified by the Am Brd of Plastic Surgery - - normally do not do any serious bony work.  Or very little.  They almost ALL just do soft tissue work.  That is 98+% of their practice.  Breasts, face lifts (totally soft tissue),  lipo suctions, tummy tucks - -  all of that is just soft tissue work.  And that is the vast majority of their practices.  They rarely ever see an FFS patient just due to the raw demographic statistics and they rarely do any serious bone work that would prepare them and keep them comfortable doing that type of work.

Many of the best of them are uncomfortable doing simple facial implants.  The very best facial plastic surgeons that are famous nationally for their soft tissue work - - often simply refuse to do bone work and refer those patients to the surgeons specially trained in craniofacial and maxillo-facial or orthognathic surgery.   There is a reason surgeons  spend the extra two or three years learning to do  bone work.   You can't learn to do that right by practicing on patients !  If it were as routine as you suggest - -  why on earth would those surgeons ever waste two or three years of their productive careers learning to do that facial bone work  ?   
 

Quote from: myfairlady49 on June 19, 2015, 12:11:32 AMThe whole reason FFS surgery is FFS surgery is because one has to alter the bone structure to get the desired result.

Except that this isn't actually true - and my comments were generally aimed at the OP who, in my opinion, doesn't need any bone work performed other than a Type 1 forehead, and that's something any facial plastic surgeon can do.  FFS does not have to involve alterations to the bone structure.

Sure, you're absolutely right - in many cases, where the underlying facial structure is too far to the male side of things, bones do have to be altered and one should seek out an experienced surgeon to do this.  But in many cases, significant feminization can be achieved with a good brow lift, a little forehead recontouring (in those who don't have huge brow bones), and a very feminine rhinoplasty.  This would still constitute FFS, even though bones aren't really being restructured or altered in any significant manner.

I'm not trying to discourage anyone from undergoing FFS.  I'm merely trying to highlight the fact that there are other options out there which are extremely effective solutions for those of us blessed with faces that aren't particularly masculine to begin with, or who aren't blessed with money.

Would I ever recommend someone with a prominent brow bone or a huge square jaw to go to a local plastic surgeon for a Type 1 or jaw work?  Of course not.  FFS surgeons do have a role to play.  But for mild feminization that doesn't involve jaw work, chin work, or necessarily require a Type 3 forehead reconstruction?  The local expert in plastic surgery may be a choice worth checking out.

My agenda in giving this advice?  (I do have one!)  There's a far wider trans community out there than exists on this board.  Many of them get advice here without participating.  Many in the trans community are unemployed, underemployed, uninsured, poor, etc.  I want them to know that FFS isn't an impossible goal.  There are cost-effective options available.  For a girl struggling out there with a heavy (fleshy) brow, or a huge masculine nose, or high hairline, whatever needs to be tweaked, they don't necessarily need to save up their pennies for a decade to be able to afford surgery in Mexico or Boston or Chicago or Marbella or wherever the handful of FFS surgeons operate, and they don't necessarily have to give up their dreams of looking more feminine.  They might be able to have their own FFS needs met very cheaply (in a relative sense) by looking at local plastic surgeons, many of whom can make a face just as beautiful as the big name FFS surgeons (whose work - in many cases - to me looks so invasive that the results are anything but natural and beautiful.)

Just throwing it out there in the spirit of sharing information.  Not trying to start a fight!  We're arguing semantics here: your definition of FFS is "surgery that includes major bone work to make a male face look as feminine as possible," while my definition of FFS is "any surgery that causes a face to look more feminine."

Remember that FFS isn't a "thing"; it's just the collective name for a standard set of routine cosmetic procedures that typically can be used to feminize a face (other than a Type 3 reconstruction, which is something of a niche procedure.)  One can pick and choose which procedures out of that set one needs; it's not all-or-nothing, and if one wants soft tissue FFS, it's still FFS!

OMG...

That's the only surgery I had because that's the only surgery I needed!!!!!  And for where I had it, who performed it, and the overall package of care I received, it's cheap.

Could I have traveled overseas to some foreign country for cheaper surgery in dubious surroundings with zero hands-on follow-up care; a surgeon I'd never met before and who I chose based on internet reviews, "best case" pictures and perhaps a Skype consult; spent more money on all kinds of procedures that were "recommended" but certainly not "necessary"; a miserable recovery away from home and family; and ended up looking like someone who had clearly done too much?  Sure.

Or could I have gone to another US surgeon for an (unnecessary for me) Type 3, chin work, jaw contouring, cheek implants, a lip lift (which always seems to look artificial), and all manner of procedures that I could afford but didn't need?  Sure.

But I'm very comfortable with the work I had done, it's absolutely beautiful (my surgeon is frickin' artist), and it's backed up with the guaranty of a surgeon I consulted with numerous times in person before having surgery, a top-class US hospital, recovery at home and with family, regular follow-ups for the next year, and the peace of mind that if anything didn't go right or anything goes wrong in the future, my surgeon is ten minutes away and can fix it.  And no travel or accommodation costs.

FFS isn't linear: the more we get, the prettier we become, just isn't true.  It's a bell curve: many of us could use a little, there's a point where the procedures we get give us a peak of prettiness, then adding in more procedures actually makes us uglier (or less passable.)

(Perhaps I should have made it clearer that I wanted to stay in the US for my surgery.  I'd never let a surgeon who hadn't examined my face in person start hacking away at it.  But that's just the level of risk I wanted to accept.)

Again, just highlighting options.  So many people see FFS as like an all-you-can-eat buffet at Golden Coral: how much food they can they fit on their plate for the cheapest price; the more the better, right?  (No, wrong.)  There's intangibles that need to be considered; quality, location, comfort with the surgeon and his or her team, minimizing the risk of errors that can't be corrected, safety, recourse (legal and medical) if things did go wrong, etc.

This is important: I'm not saying that people should avoid FFS surgeons.  I'm not saying that local surgeons are better.  I'm merely saying that as part of a thorough research process prior to jumping into relatively minor FFS that doesn't necessarily require a Type 3 forehead reconstruction, you'd be very wise to see what the best local plastic surgeon can offer.

Expanding options, that's all.

Ultimately you have to choose the right surgeon based on YOUR personal needs, not what someone else says you need. Also, because faces vary so widely, there is no way to deem one procedure "proper" over another.

It's always a good idea to know what the surgeon's most practiced procedure is. If those techniques line up with your main goals, then perhaps they are the best decision.

Take Toby Mayer, for example. His specialties (rather what he is known for) are suture closure, scar-hiding hairline procedures, and extremely natural looking rhinoplasty. That is why I chose him. As well, I wanted the subtle touch rather than the bazooka approach that Dr. O suggested. If I felt that I needed more help in the forehead department, my choice would have been different- as Dr. Mayer only does Type I.

Once again, this is all personal choice. There is no proper way to do FFS.

Just wanted to say thanks again to everyone for providing all of the really great feedback, personal opinion, and experiences!  I was honestly pretty clueless before, but now I have a really good idea of what I want to for sure have done!  I'll try to keep everyone updated after my upcoming consults with The Facial Team and Dr. Spiegel and hopefully a couple more surgeons suggested here that I have begun researching.

Update for everyone!

So, I just recently did a skype consult with the Facial Team (Dr. Capitan) and (despite the skype connectivity issues), I was really impressed!  I received the quote today and wanted to know what you all think.

Procedure	Cost (EURO)	Cost (USD)
Forehead Reconstruction	4500	5025.60
Rhinoplasty	3600	4020.48
Hospital Fees/Meds/OR/2 nights room/board	2500	2792.00
General Anesthesia	1600	1786.88
Material Costs/Pre&Post op CT scan	1100	1228.48
TOTAL	13300	14853.44
OPTIONAL Procedures	Cost (EURO)	Cost (USD)
Chinplasty/Sliding Genioplasty	3500	3908.80
Immediate Microcapillary Transplant	6590	7359.71

So...any thoughts on cost?  Seems really reasonable and definitely well under my budget of 25K.  I will probably add on the chinplasty/sliding genioplasty, but I am sorta wondering what you guys think about the hair transplant.  It was suggested by Dr. Capitan that if I wanted to fill in the corners of my hairline we could go the hair transplant route to help.  Its hard to tell when my hair is down (or even when loosely tied back as in my pictures from the first post in this thread), but if I pull it back really tightly to make a pony tail, it sorta exposes a slightly masculine hairline as my corners are not fully filled in.  I will try to post a picture later tonight to show this.  Is the pricing quotes for the hair transplant in line with other surgeons who do this?  Would I be able to get this done at a later time for a better price with comparable results?  If I decide do it at a later time with a different surgeon, what is the recovery/down time?

So, I'm thinking Dr. Spiegel will definitely come out costing more for the same procedures, but does anyone have an idea around how much more??  Is his markup even really worth it?  I'm probably going to cancel my Skype consult with Dr. S (scheduled for july 15) and apply that $100 to my deposit for the Facial Team because the price seems really good and all of my correspondence with them so far has been excellent!  Overall thoughts???

I think that price will be hard to beat for sure.

Lots of people seem to love their results from Facial Team, so I would say go for it- especially if you have good feelings about them!

Quote from: Kaley on June 26, 2015, 09:37:29 PM
Would I be able to get this done at a later time for a better price with comparable results?  If I decide do it at a later time with a different surgeon, what is the recovery/down time?

Definitely. Their price for hairtransplant is on higher side of what you can find. But if you don't have affordable option locally, it still means travel costs, etc...

Much cheaper option is to improve the hairline surgically and close the corners as much as possible (with combinational incision). And then later use hairtransplant for some roundening, or just to cover any visable parts of scar which didn't heal ideally, or maybe you even won't have to do anything.
They can easily do hairline correction if you request.. but they do have this agenda to promote their hairtransplant option and take $7000+ more from you. They even started saying how very high hairlines are the ideal feminine hairlines (which is complete BS), because they are unable to do any significant hairline lowering in the front (for those who need it). Hairtransplant which they can offer is not thick enough for natural looking hairline lowering in front and closing the corners. But it is great for closing/roundening of corners. Now this depends on whether you want to pay $7000+ for closing of corners, or you want to do it with surgical approach and then later pay $1000 or $2000 for little roundening.
(There isn't any real recovery for hairtransplant alone)

Question: What's the most natural approach, the combinational surgical incision or the hair transplants?

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Hi Kaley,

I have surgery scheduled with Facial Team for September 7th.  I went back and forth over which hairline approach to use. In the end I will be doing the hairline incision *without* the immediate transplant.  Facial Team (Dr. Simon) initially recommended the crown incision and immediate hair transplant. After a second Skype consult, I sent in more pictures of my hairline and hair density. After conferring, Dr. Simon and their hair transplant doctor both ended up recommending the hairline incision for me instead (no immediate transplant).

My initial quote contained the same transplant quote as you and I also thought it was very expensive. With either approach I was going to need additional transplants, done locally. I still have more research to do in choosing a local transplant doctor, but the best price I've found for a seemingly reputable practice is $4/follicle unit if you do a lot of them.  For the Facial team quote to be that low, you would need about 1800-1900 follicle units transplanted

The original quote I received said to expect 1500-1700 follicle units in the transplant.  In the follow-up consult I asked if I should expect less than that given my low hair density.  Dr. Simon said that I should expect a minimum of 1500 units, the "typical" range is more like 1800-2200 units but that they quote the lower range to be conservative.  That would seem to make the Facial Team quote competitive rather than expensive.

However, if *you* don't need that many transplants (or maybe don't really need *any* transplants) then the Facial Team quote to you would be expensive and/or unnecessary.  Choose the approach the works best for your situation!

Here's the pics I promised!




According to Alexandra's VirtualFFS evaluation: "Hair transplants look more natural than a scalp advance and you don't end up with a scar along the hairline." 
Alexandra also told me the following in her eval: "I am sending you a copy of your frontal with the lupuhai rule drawn on so that you can see how your hairline is low. I therefore disagree with Dr Zukowski. Not only that but lowering your hairline by means of a scalp advance would leave you with a permanent scar long the hairline.  If you have forehead surgery with the incision over the top of your head (this hides the scar under your hair) it would have the effect of raising your hairline slightly. This would be mildly feminising for you and I have simulated the effect."

Dr. Capitan also suggested the crown incision w/ hair transplant for my case.  I think that would be the best option for me.  I feel like I don't absolutely need a hair transplant, but it could help a little.  My hair is still fairly short and I hardly ever tie it back into a tight pony tail, but I can probably hide it with some bangs anyways.  I wonder if there is any wiggle room in price if I tell them I only want say 1000 follicles harvested and transplanted??  I'm not quite sure how many transplanted follicles would give me a decent amount of coverage in the corners?  I guess I should send the Facial Team the pics of my harline corners so they can evaluate better.

Just a quick update!!

I paid the 2000 Euro deposit and my surgery date is set for December 11th with the Facial Team!  Total cost came out to 15690 Euro which includes the chinplasty/sliding genioplasty option (after a 10% discount for doing pictures).  I chose not to do the hair transplant option as the cost was a little too much for me at just under 6000 Euro.  Maybe in the future I will pursue hair transplants, but as of right now I'd rather put that money towards voice feminization surgery which I am planning on doing next summer.

Thank you to everyone who contributed information!!  It really helped me with my decision and I look forward to giving more updates as the surgery date nears!
♡Kaley