Hi, I'm new. I've been on hormones and electrolysis for several months. I'm having a hard time finding a list of surgeons who people in here have used successfully to complete FFS which I plan to get soon.

My criteria is doctors in the US who are certified (American Board of Plastic Surgery) which I can confirm on the certificationmatters website.

For FFS I will do forehead contouring, scalp advancement, browlift, and mandible contouring (chin). Below are a few doctors I talked to and their pricing for the procedures I mentioned.

Jeffrey Spiegel = $27,000
Mark Zukowski = no price yet
Douglas Gervais = $18,000

Spiegel and Zokowski are discussed in detail in the forums here, favorably, so no need to talk about them. Has anyone had FFS with Gervais?

And if you've have FFS with a different doctor in the US please could you say their name and if you're happy with the results or not?

Thanks so much!

Welcome to Susan's Place. I have moved your thread into the FFS Section where you will get more responses to your questions. The link will take you to there and you can explore the many posts that others have made on the subject. If there is anything I can help you with, let me know.

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I also heard about Toby Mayer, from Beverly Hills. Don't know what he charges though...

Both Dr. Mayer and Dr. Zukowski don't do forehead reconstructions, you might want to look into if you need that and factor that into your decision making.

I do agree that it is odd that there isn't a big list whith all/most FFS surgeons yet, possible a pinned post. That way it would be easy to find one. 

Jeffrey Spiegel isn't board certified Plastic surgeon. I just thought you might wanna know, as that was criteria you mentioned.

Funny I have had work done by these 3 doctors.  I would recommend Dr Zukowski out of the 3.  I would not go to Dr. Gervis, if you want to go to Mpls Plastic Surg then I would see Dr. Tholen he is much better then Gervis hands down,  I have also had work done by Tholen.  But out of all I would say Dr. Z

Dr. Spiegel did a type 3 forehead, orbital shaving and mandible and chin shaving, fat grafting at temples cheeks and upper lip, lip lift, lower and mid face lift and blethoplasty. 

You may want to add Deschamps-Braly to your list (I think I spelled that correctly) out in San Francisco. 

I had my facial work done by Meltzer way back -- like, when Dr O was just getting popular.  Excellent rhinoplasty, very good forehead/scalp advancement, adequate work on the jaw and chin. 

Quote from: Uriahheep on December 06, 2016, 03:15:16 PM
Jeffrey Spiegel isn't board certified Plastic surgeon. I just thought you might wanna know, as that was criteria you mentioned.

This may surprise many of you, but this is actually completely true.  Dr Jeffrey Spiegel is not board certified in plastic surgery.  He instead has a certification from the American Board of Otolaryngology.

Both Dr Mark Zukowski and Dr Douglas Gervais, on the other hand, do hold a certification from the American Board of Plastic Surgery.  Sophia Sage mentioned Dr Deschamps-Braly and Dr Toby R Meltzer.  These surgeons are also board certified by the American Board of Plastic Surgery.

This is all public information, so if you want to find out in which specialty a doctor is board certified, you can look up the answers yourself at http://www.certificationmatters.org/

There are obviously lots of qualifications to consider other than just board certification in Plastic Surgery.  And an otolaryngologist can specialize in facial plastic surgery.  But the original post did specifically mention certification from the American Board of Plastic Surgery as an important criteria for them personally.

I do not really understand the obsession with Americans about board certification - is this some sort of mandatory quality assurance? AFAIK in Europe a surgeon must have had a training in the area he performs surgeries in - so there is more a sort of membership in some associations that he can have, but doe snot need to have it. I know about some surgeons who are in such associations but do less good work than some who are not in it - so I am not sure what the difference there is to the USA - maybe it is more important in the USA?

Quote from: anjaq on December 16, 2016, 01:51:40 AM
I do not really understand the obsession with Americans about board certification - is this some sort of mandatory quality assurance? AFAIK in Europe a surgeon must have had a training in the area he performs surgeries in - so there is more a sort of membership in some associations that he can have, but doe snot need to have it. I know about some surgeons who are in such associations but do less good work than some who are not in it - so I am not sure what the difference there is to the USA - maybe it is more important in the USA?

Exactly. I would rather look at the surgeon's previous results, their technique and their bedside manner. I don't care how many hoops they have jumped through to get specific certification...No certification is going to guarantee that your results will be just how you want.

Quote from: anjaq on December 16, 2016, 01:51:40 AM
I do not really understand the obsession with Americans about board certification - is this some sort of mandatory quality assurance? AFAIK in Europe a surgeon must have had a training in the area he performs surgeries in - so there is more a sort of membership in some associations that he can have, but doe snot need to have it. I know about some surgeons who are in such associations but do less good work than some who are not in it - so I am not sure what the difference there is to the USA - maybe it is more important in the USA?

  www.ebopras.org

Then find:

European Training Requirements for the Specialty of
Plastic, Reconstructive and Aesthetic Surgery
European Standards of Postgraduate Medical Specialist Training


Google the European Union of Medical Specialties.   Then find the specialty training requirements for plastic surgery, and the associated certification in Europe for that specialty.   This is the European adoption (from the early 1990s) of the American Board of Medical Specialties and its subspecialty of  the American Board of Plastic Surgery.

There are a number of surgeons conducting FFS in Europe (and a few in the U.S. and a LOT in other places)  that do not meet those minimal EUROPEAN requirements.   

Generally,  in the U.S.,  in order to be a surgeon with privileges to operate in a U.S. hospital,  you must in fact be board certified or at least eligible and pending certification. 

Do  YOU really want to have someone cutting bone around YOUR mental nerve in your chin, or re-shaping your forehead sinus cavities,  who was not sufficiently personally motivated to acquire the minimal training and the associated verification of that training in order to become board certified ?   Really ?     

Ask yourself,  WHY ON THIS EARTH WOULD ANY QUALIFIED SURGEON not go to the trouble to obtain that Board Certification ?   

Is there really more than one rational answer to that question?

Since this is mostly about Spiegel's qualifications, I'd like to add that the American Board of Medical Subspecialties recognizes facial plastic and reconstructive surgery as a subspeciality within otolaryngology. An ENT so trained is not qualified to do other body procedures, as a general plastic surgeon is, but someone who's had fellowship training in facial surgery, after residency training in anatomy and surgery of the head and neck, is more than qualified in my opinion. I wouldn't hesitate to choose a surgeon based on whether their background was in ENT or plastics, so long as they have the appropriate training along either pathway and have done quality work before.

As I understand it especially in Europe there are a number of different associations that give out certificates (there is a list of several of them at that link http://www.ebopras.org/organisation.php) - A surgeon has a hard time to get one from all of them and probably it all takes money and time to do these certificates. I know some people like certificates - I am working in a lab and we had one applicant for a job there who sent in a pile of certificates for all kinds of instruments. We did not take him because we do not need someone with certificates but rather someone whose CV tells us she has worked with these instruments in a lab hands-on. I can get a certificate for some of the instruments by paying $1000 and do a half week long course. Then I have a certificate but no experience - its nice to have it when I already work with the instrument for the past 3 years, but I would rather think that those 3 years of hands on experience are more important than a certificate.

                                                                                                                                         
I get the impression that maybe in the US or elsewhere people need to have these certificates to show they are not butchers, in Europe I think someone who is ot qualified will loose the license to do surgeries - something which you need here to do anything at all.

So I am overall sceptical about the importance of certificates. Often they are not telling much about the quality of the work someone does, they are just very expensive and time consuming, especially if you have to make several of them which are stacked on top of each other to get the one you want.

A surgeon I have had a consultation with recently is the president of a plastic surgeons association. I bet she has many certificates or rather is probably one who signs these certificates. Still, I do not trust her blindly and actually consider not choosing her for the procedure I intend to do because I lack patients records and photos - something other surgeons can provide more freely.

Quote from: anjaq on December 23, 2016, 05:40:08 PM
As I understand it especially in Europe there are a number of different associations that give out certificates (there is a list of several of them at that link http://www.ebopras.org/organisation.php) - A surgeon has a hard time to get one from all of them and probably it all takes money and time to do these certificates. I know some people like certificates - I am working in a lab and we had one applicant for a job there who sent in a pile of certificates for all kinds of instruments. We did not take him because we do not need someone with certificates but rather someone whose CV tells us she has worked with these instruments in a lab hands-on. I can get a certificate for some of the instruments by paying $1000 and do a half week long course. Then I have a certificate but no experience - its nice to have it when I already work with the instrument for the past 3 years, but I would rather think that those 3 years of hands on experience are more important than a certificate.

                                                                                                                                         
I get the impression that maybe in the US or elsewhere people need to have these certificates to show they are not butchers, in Europe I think someone who is ot qualified will loose the license to do surgeries - something which you need here to do anything at all.

So I am overall sceptical about the importance of certificates. Often they are not telling much about the quality of the work someone does, they are just very expensive and time consuming, especially if you have to make several of them which are stacked on top of each other to get the one you want.

A surgeon I have had a consultation with recently is the president of a plastic surgeons association. I bet she has many certificates or rather is probably one who signs these certificates. Still, I do not trust her blindly and actually consider not choosing her for the procedure I intend to do because I lack patients records and photos - something other surgeons can provide more freely.

Anjaq,

There is no guarantee with any surgeon.

And there are any number of  "you and me - - we are both surgeons - -  let's create a "Board" Certificate and give it out to each other and our friends"  type of Board certifications.   They are marketing devices.  They are printed pieces of paper, with little substance.

But then there are REAL Board Certifications by the long time organizations.   The organization you mention in Europe is one of them.   In the U.S.  there is only ONE that is legitimate.   American Board of Medical Specialties.  And the website they maintain, as a public service, is the www.certificationmatters.org.

So what does a  LEGITIMATE  board certification mean to a prospective patient?   

Here is what I understand about the process from having watched as some friends have gone through that process:

At a minimum it means that their surgeon has completed a recognized medical school and then a recognized surgical residency program for the prescribed number of years and has personally performed a defined number and set of procedures while supervised by a person who is well trained and already board certified.   It also means the surgeon has passed multiple written tests on the subject matter.   And after all of that,  it means the surgeon has,  after all of that training,  also performed a large number of procedures and then later had the results of those procedures individually reviewed by a committee within the board certification organization.  And then they have to defend their surgical results in a face to face interview - -  much like defending a dissertation.   In other words,  they have demonstrated competence in their specialty to their peers.

Then, after all of that,  they become board certified.

Does that guarantee you will get a great result ?   No.   Of course not.

On the other hand,  going to surgeon who does not have a board certification through the recognized process,  is a decision that should raise a BRIGHT RED CAUTION FLAG.    Why did the surgeon not go through that process? 

If they are properly trained and they are competent - -  going through that process is a matter of routine.  And the added cost is really almost trivial.

If they are not properly trained, or they cannot demonstrate competence to their peers  - -  then they cannot go through that process successfully. 

And of course, being board certified by a real and legitimate board certification organization, is just a starting point.  A board certified plastic surgeon then needs to be further trained in craniofacial and jaw surgery in order to be ready to learn to do FFS - - properly.

It is of course a personal decision to pick a surgeon who lacks those qualifications.  But why would any well informed individual take the risk ?

QuoteOn the other hand,  going to surgeon who does not have a board certification through the recognized process,  is a decision that should raise a BRIGHT RED CAUTION FLAG.    Why did the surgeon not go through that process? 

If they are properly trained and they are competent - -  going through that process is a matter of routine.  And the added cost is really almost trivial.

Well I would not call this procedure listed below "trivial" and I think it is quite an understandable reason for a surgeon to rather concentrate on his work than doing all of these tests and exams and trainings - many of which are in areas not relevant to his speciality - I saw that list in the PDF of the website you linked - it includes surgery on almost all parts of the body, which seems to make little sense if someone specializes in cranial and facial surgery.

Quote from: oneoftwo on December 23, 2016, 07:39:54 PM
Here is what I understand about the process from having watched as some friends have gone through that process:

At a minimum it means that their surgeon has completed a recognized medical school and then a recognized surgical residency program for the prescribed number of years and has personally performed a defined number and set of procedures while supervised by a person who is well trained and already board certified.   It also means the surgeon has passed multiple written tests on the subject matter.   And after all of that,  it means the surgeon has,  after all of that training,  also performed a large number of procedures and then later had the results of those procedures individually reviewed by a committee within the board certification organization.  And then they have to defend their surgical results in a face to face interview - -  much like defending a dissertation.   In other words,  they have demonstrated competence in their specialty to their peers.

But ok, it would be interesting to know what a surgeon who did not get the certificates of certain organizations reply to this - but I am not going to ask them unless I do not consider getting any surgery with them anyways - I know that no one and especially not surgeons are fond of having their capabilities or quality of work challenged and i would not even want to piss off my dentist by asking him uncomfortable questions about his qualification right before He takes out the drill. So I guess its a question someone has to ask who has had FFS already or who does not consider it anyways - maybe if I decide one day to really not do it, I can ask, just for the heck of it.

The fact however seems to be that quite a few of the world class FFS surgeons who are used widely and provide good results and get a lot of positive feedback here and elsewhere are not having all those official certifications done - but they still seem to do good work, so whatever the reason is, that they did not get those certificates, it seems not to be that they are incapable of doing good surgery in their field (maybe they just have enough patients without having a certificate and do not want to invest the time in it, or maybe they are not interested in completing foot surgery training courses when they are actually already working as FFS surgeons or maybe they have gotten their knowledge in their field without planning it years ahead and thus did not go though all that lengthy process of certification and traning in all these classes - they did something else and then switched over to FFS surgery and got really good at it.)

I am woking in a field that was not planned, too . If I would have planned to work in this job when I started studying, I probably would have planne dit differently. And when I will switch jobs and work in industry in a commercial lab, I will not have the certifications and special courses that one could have done when one was to plan such a carreer during university - I will have the knowledge from using all the instruments for years, but since I grew into that job , I never did specific courses and classes and training units with examinations and certificates - I learned it as I went ahead and frankyl for me to now get all these certificates of all the things I can do would mean I would have to quit my job and go back to studying and doing courses, which cost money and time while I cannot earn money in that time - just so that I can have a piece of paper shoing that I really can do what I can do already. It seems very buerocratic to me. I will only do that if I cannot get a job otherwise.

Quote from: anjaq on December 24, 2016, 05:11:53 PM

[ . . . ]

or maybe they have gotten their knowledge in their field without planning it years ahead and thus did not go though all that lengthy process of certification and traning in all these classes - they did something else and then switched over to FFS surgery and got really good at it.)

I never did specific courses and classes and training units with examinations and certificates - I learned it as I went ahead ...   

Quote
- they did something else and then switched over to FFS surgery and got really good at it.)

In the field of medicine - -  there is a name for that activity.  If you do that without getting further supervised training by a well qualified surgeon - -  it is called practicing on your patients.  It is unethical. 

If the would-be FFS surgeon does it long enough,  then he or she may learn from enough mistakes. One of those mistakes may be during YOUR surgery.

Your observation that there are some web site before and after photographs that look pretty decent for surgeons who do not have the necessary training is accurate - -  so far as it goes. 

But some, or even a lot or most, of those web site pictures you are referring to are A) photoshopped;  B) Involve post surgery makeup / hair styling;  or C)  "cherry picked".  Or all three. 

One recent set of pictures of FFS surgery from one of the "under trained / under certified - - self taught"  surgeons involved a patient that was going back to that surgeon for a second or third  "re-do" - -   but the pictures "looked good".   There is another girl who went to the same surgeon ended up posting beautiful pictures  (on ->-bleeped-<-) of her face.  There were a lot of comments about how good they looked.  Later, she posted up the 3-D scan that showed the results of the underlying surgeon on her jaw remodeling.   The surgeon had completely severed the mental nerve (which was then totally "missing") on both sides of her cheek.   So far as I can tell from the public information, that surgeon was never trained in any but one of the three critical specialties required to do the full range of FFS procedures - -  and was, apparently,  in an on the job training exercise on how to do orthognathic jaw surgery - - when he operated on that patient's jaws.   That patient's functioning is seriously impaired - -  for life.  The severing of the large mental nerve complex will never grow back.  Google it and look up where the mental nerve comes through the jaw bone - -  and then whack that portion of the lower jaw off - - including the mental nerve.   You will get the idea.

But - -  what the heck.... those pictures of her face are beautiful !  Her jaw was really beautifully re-modeled from a strong male jaw line to a tapered feminine jaw line. 

FFS is not  just one "procedure" - -  it typically involves  3 to 7 different surgical procedures.   Most of them require different skill sets. 

And there are different ways to do each of them.   And most of those different ways are less good than doing them the right way - -  the first time.

And what is the motive for using a surgeon that is not trained and experienced in all three of the surgical specialties involved in the multiple different FFS procedures?

The motives typically are either geographical convenience - -  or an effort to save some money.

Do those considerations overcome the other "peace of mind"  or actual safety and quality issues ?






     

Well, as far as I know there is no training prgoram for FFS. A surgeo only can get training for other fields and then has to learn FFS in a different way. I know some of the surgeons who are good have learned FFS by being assistant to more experienced FFS surgeons for a while. So they work together and then eventually the new surgeon has learned enough. I think thats the best training, more worth than studying books or doing theoretical courses only. Of course there will be surgeons who are just trying to figure it out themselves, I think that is definitely a bad idea. In germany there is one famous or infamous GRS surgeon who tries to mimick Dr Suporns technique and most of the patients end up being impaired because he just cannot do it. I find it horrible if surgeons train on patients.
I am sure though that eben he has a lot of paperwork and certifications about urogenital surgeries - just that it is different if one can do great surgeries of constricted urethras or cysts in the bladder - or do a full blown GRS.
Experience is more valuabe than certificates, I am just saying - if one is in doubt about the experience, I guess the safer bet is looking at the certificates than just the promises of the surgeons. But certificates do not guarantee a great surgery, they just guearantee that someone is not a total butcher (although even that is possible).

That said, I have the impression that all of the well known surgeons seem to have good and less good results - I have seen very few really good ones, many good ones and a lot of decent ones - a few rather bad ones. Oh and quite a few surgeons had some failures, sadly - I guess it can happen to all of them that they cut a nerve or drill a hole or have bad healing in a patient... but I still would rather avoid those surgeons of which such stories are going around. This impression is from looking at photos in the internet - I am not much at trans meetings, so I do not meet 100 people who had FFS. Also in germany FFS is a rare thing - 99% will never get one. So far, the outcomes are a bit tempting, but considering the risks, I am not enthusiastic.

I also know some surgeons seem to ask for a choice. You can tell them to be more agressive even if it means to cut more nerves if needed - or you can tell them to be more conservative and rather preserve nerves. I know of one case where the woman elected to rather have a nerve cut and loose sensation in some part of the face than not having much change from the surgery. The nerve was growing oddly, apparently, not in the place it was supposed to grow so they had the choice to leave it ok and not change the bone or to cut it and shape the bone. For some people I guess the sacrifice is worth it, I know I would rather sign the papers that tells them to preserve nerves over getting more bone changes.

I would also recommend checking out Dr Deschamps-Braly in San Francisco... I did a Yelp on him under Ashley C that lists what I had done with him...  All the best on your quest!!!

Onward we go!!!

Ashley