This is way down the road for me but I want to start to prepare myself if/when I get to that point.

I'm not very well informed about this yet. Are the results acceptable from the surgeons that just shave portions of the
forehead/orbital rims rather than replace the entire forehead with plates? It sounds so drastic and I'm not sure I even need
forehead work.

Amanda

It depends on what you start with, if your sinus cavity is small and bossing not too strong, they easily shave right over the sinus cavity. They did it for me. See my Avatar.

Quote from: AlwaysAmanda on November 13, 2007, 03:40:35 PM

I'm not very well informed about this yet. Are the results acceptable from the surgeons that just shave portions of the
forehead/orbital rims rather than replace the entire forehead with plates?

It depends what you consider "acceptable" And when it came to my face, I wasn't looking for results that were just "acceptable" I followed Dr O's recommendation and it is the best decision I ever made in my life. His work, plus my BA, SRS, getting in good physical shape and GETTING SOBER has turned a marginal troubled existence into a life I can only describe as magical.

Melissa, if the sinus cavity is small, the results of shaving the bossing is basically the same as reconstructing the forehead, except the nose bridge is usually higher because the orbit is not completely shaved down(Which is better in most case, since you'd remove most ressemblance to a member of your family (male or female) if you remove to much of the orbit). When the sinus is bigger and in a more frontal position, the orbit needs to be shaved down and the forehead reset back.

In my case, Brassard shaved the forehead to very slightly above the base of the nose (he said he could have gone further), to leave the glabella, which is seen as esthetically superior than a smooth nose to forehead transition.

A higher bridge is also seen as esthetically superior in rhinoplasty, check the rhino boards. That's what most models have. If you can avoid having to have a low nose bridge because they reset your forehead, that's the way to go.

Thanks!

Does the sinus cavity get removed if they "shave over it" as you described? Or are they just
shaving the outer wall?

Also, could you share the links to the rhino forums?

Amanda

They keep the sinus cavity intact, they shave partly into its upper wall and you'll feel a slight pressure there for quite a while because the bone over it will be swollen and it takes a long time (9 months in my case) for the swelling to go down completely (its not really visible to anyone but yourself)

Some surgeons that don't do reconstructive work don't feel comfortable shaving too close to the cavity and it this case you would case suboptimal results. But, brassard did it well in my case.

Quote from: Keira on November 14, 2007, 06:02:22 PM

brassard did it well in my case.

Sure did!  You look great, Keira.

Kristi

Does anyone have a link that describes the type I, II, III brow bossing?

I've heard it mentioned a lot but cannot find a description.

And Keira.... your forehead looks amazing!

Quote from: AlwaysAmanda on December 06, 2007, 05:11:32 PM
Does anyone have a link that describes the type I, II, III brow bossing?

I've heard it mentioned a lot but cannot find a description.

And Keira.... your forehead looks amazing!

I'm not sure you will find a link.  I don't think types I, II, and III are standardized in the medical world and may mean different things to different surgeons.

Type I is the least severe, perhaps Keira's situation where shaving of the orbital rims provides sufficient feminization.  Type III is where is the bone over the sinus cavity, which is relatively thin, is removed, reshaped, and then placed back and fastened using wire after underlying bone-shaving is completed.  I'm not sure what Type II is exactly.  Obviously, somewhere in between types I and III.  This link might be useful to you:  http://www.virtualffs.co.uk/ffs%20techniques.htm

Forehead work is definitely worth considering if you can afford it because I think it makes a difference.  Especially, if you are type III.

"Forehead Types" (I-IV) are a terminology created by Dr. O, but used VERY loosely by community members.  For example, Dr. O gave "Type I" the meaning for the small minority who are born without a sinus cavity at all; you will find "Type I" to be used to mean a wide variety of things by the average transperson with a bare minimum of FFS knowledge.  So... there aren't really any standard definitions, unless you go exclusively by Dr O.'s original definitions.  It's kind of taken on a life of it's own.

I think the only worthwhile
definition is buring the bone, vs reseting the bone.
Buring means the Sinus Cavity is left alone.
I don't think no sinus cavity really exists, though
very small ones do. Females have much smaller
sinus cavities than males, which explain why
they have more sinus infections, its easier to get
it blocked, drainage is not so easy.

Mine was quite small, type I by any
meaningful definition
and Brassard could have bured even more over it to create a totally smooth nose to forehead transition and a
slighty more open orbit, but a more defined orbit and
glabela is seen as better esthetically.

A lack of sinus cavity above the brows does exist, I can't remember the percentage, something like 5% of the population lack one.  It's one of those things that one really wouldn't know about oneself short of a scan.  I'm certain that I've got one, though, due to drainage issues.

If the absence of sinus exists,
its prevalence is way under 5%, less than 1%
for sure. I checked all the main
encyclopedia's plus several medical reference
libraries and couldn't
find any reference to inexistent sinuses in
adults.

Though before puberty, the cavities
may be so small as they be defined as
inexistent.

Were did you get your 5% number?

I was actually referring only to the sinus cavity behind the supraorbital torus, rather than all of the sinuses; I'm sure the individual without any sinuses at all must be EXTREMELY rare.  I got the 5% figure from attending Dr. Ousterhout's FFS presentation at SCC 2007 (I'm local to Atlanta so I got the chance to check him out), I found it to be a very interesting factoid and just kept it in memory.  I could be mistaken, but I'm pretty sure that that was his claim.  I'll do some checking around to see if I can corroborate it.

Edit: Ah, here we go: http://www.utmb.edu/otoref/grnds/Sinusitis-acute-9703/sinus-acute-9703.htm .

Now, that I've looked at just frontal sinuses I've found a few stats.

There is a very wide discrepancy in estimation of the prevalence of no sinuses from 2% to 20%, with most estimates from 5-10%.
So, yes, there are some with no sinuses and seemingly this has no ill effects. Maybe the evolutionary advantage of the sinus was much stronger when we lived outside (warming cold air) and we hunted on foot with spears (sinus protects the brain from impact).

I have surgery booked for the forehead and eye area but I'm not sure what's being done or needs to be done at this stage.

Dr. Ousterhout came up with the type III forehead reconstructive surgery.  As it stands I know of three doctors who do it in North America.  Dr. Ousterhout (of course), Dr. Spiegel, and Dr. Cardenas Camera (in mexico), these are pretty much the ones I know of in North America.  There are a few others scattered across the globe.  Its a technique that takes a very talented and skilled surgeon to do.  Not everybody doing facial surgeries knows how to do this. 

I think Bensiomon in Brassard's office does it to (look at ffsmontreal).
He's a facial reconstructive surgeon in Montreal, so he's got the skills to do it for sure.

You can add Dr. Leis from Philly to the list of those who do type III forehead surgeries.  He also worked with Dr. O for a number of years (both Leis and O trained under Dr. Tessier).  So it should not be surprising that he knows how to do that technique. 

I wondered if there are any good facial surgeon's available in Scotland?