Hi. I have two consultations upcoming and am a bit unclear what exactly to ask for regarding jaw and chin. I want to avoid getting a blanket statement like "we are going to feminize your jaw and chin with these procedures" (I know the procedures) or "it looks good as it is". So I need to be more specific in my requests to make sure that I get the things done that are needed and be sure that the surgeonw ill do them.
Sadly though I am not so sure myself about what part is not quite good. I have this picture - the upper one is now, the lower one is a FFS simulation. I really dislike the original, but I am not happy with the simulation yet either, so I would like to know if someone can tell me what part gives this impression of still having a bit massive and slightly masculine lower face in the simulation? Do I need to ask for more reduction of the chin height, jaw height, jaw width, more change at tje front or the back part of the jaw?

I would like to take these photos and go to the consultation and ask if they can do what was simulated plus whatever I find out here that could be done in addition.

Thanks a lot.


(Oh and I am aware that I can benefit from as lip lift as well. I will discuss a lip lift and possible combination with a V-Y-lip augmentation)

Do you like this any better?


The original edit mostly narrowed the chin, shortening the distance from the columella to the chin tip by only about 3%.
My (very rough) edit shortened this distance by about 8%, and the distance from the columella to the lip closure by a bit less than 20%.

This was just an experiment, but based on it I do think that if the total nose-chin distance can be shortened a bit more it may result in a softer impression.

	Height (pixels)	Height (%)	Vs now
Now
Columella – lip closure	88	.33	1
Lip closure – chin tip	176	.67	1
Total height	264	1	1
Original edit
Columella – lip closure	79	.31	.9
Lip closure – chin tip	176	.69	1
Total height	255	1	.97
My edit
Columella – lip closure	73	.3	.83
Lip closure – chin tip	169	.7	96
Total height	242	1	.92

Hmm - yes it looks a bit better in comparison, although the change compared to the previous simulation is subtle:
(VFFS versus your edit)

So basically what you did was to slightly reduce the chin a bit more? Did you also change something more about the jaw?

First of all, anyone looking at these photos already sees a woman, no-one sees a man even less a masculine guy. You have a tiny face, very feminine features, not even androgynous but naturally feminine, no wide or sharp angles, not to mention your nose and lips. I'm not sure why you bother with these numbers and ratios, my jaw was twice as wide as yours and my chin three times bigger, I'm not saying you shouldn't do anything but personally if I had to worry about these perfect numbers I'd be off the charts. Get a consultation with Dr Spiegel in Boston who seems to be perfect for girls who already have feminine or androgynous features, also Dr Lee Harrisson in Beverly Hills or New York who did Caitlyn Jenner. Spiegel is considered the least aggressive FFS surgeon of them all, you should give him a call. You don't need surgeons who do aggressive work, this isn't for you. Lucky you!!!

Quote from: vegantranswoman on June 09, 2017, 10:47:20 AM
First of all, anyone looking at these photos already sees a woman, no-one sees a man even less a masculine guy. You have a tiny face, very feminine features, not even androgynous but naturally feminine

Thank you. I am not that tiny - maybe the pictures give that impression but my face is large in comparison to most cis women I know. It can be seen in photos. I think it is more androgynous though - especially also the upper part, which I want to change anyways. I am lucky, I know. I also did start early for the time I did start - age 23 in 1998. Now I am 42 though and I think some more features show that did not show as much before.

I do bother with details and these numbers (although I was not the one who brought up the numbers ) because if I do FFS it has to be done right - its not like one can just do rough work here and make a masculine face into an androgynous or female one with big bone work and if it is not perfect, well better than before. Its already androgynous and in some parts feminine - so to inmprove this, once has to do the right things - not be too subtle or no change is seen and then its not worth the pain and money - and probably one cannot do big changes either because there is just not that much to remove overall. So because it is already quite good, I look even more for the details of it. If I would look like a neanderthal, I would not bother with a mm more or less, I would just be happy of the 10mm or 20mm of excess bone are removed - no worries if it is 18 or 19 or 20 mm...

QuoteGet a consultation with Dr Spiegel in Boston who seems to be perfect for girls who already have feminine or androgynous features, also Dr Lee Harrisson in Beverly Hills or New York who did Caitlyn Jenner. Spiegel is considered the least aggressive FFS surgeon of them all, you should give him a call. You don't need surgeons who do aggressive work, this isn't for you. Lucky you!!!

Well I do need a surgeon who can do changes when it is already rather good. I do not really like the face of Caitlyn Jenner, so I am not sure I want to go to her surgeon. Spiegel, I considered, but have heard mixed reports. The most criticism about him seems to be that he has a certain aesthetics that he pushes on all the patients, making them have similar features - also some say he is subtle and others say he is more aggressive. Not sure what it is. I am having a consultation with Facialteam and probably diMaggio - Facialteam is also considered to be not very aggressive. I worry however if a surgeon who is not very aggressive will basically charge me 20000 for changes that I can barely see. So I put diMaggio on the list who apparently is a lot more aggressive

Quote from: anjaq on June 09, 2017, 10:17:44 AM
Hmm - yes it looks a bit better in comparison, although the change compared to the previous simulation is subtle:
So basically what you did was to slightly reduce the chin a bit more? Did you also change something more about the jaw?

Indirectly, I did.

Since you mentioned you'd discuss a lip lift, and a comparison of the original and VVS already seemed to already show a tiny change, I first tried how one might affect the whole. Alone, it only accentuated the chin, so I next shortened that slightly to compensate. This also slightly softened the curve of the jawline.

IMO, you should ask for the maximal natural result -- which, for the jaw, will depend on where the mental nerve traverses the mandibular canal.  That tunnel in the jaw is the hard limit; it should not be breached.  Where it drops the most is where people tend to have "jowls." 

Once the position of that is determined (x-rays or CT scans would be involved), the jaw can be recontoured in a way that makes all the lines look natural -- which in turn will limit how much things like of the back jaw angle can be reduced, or the height of the chin. 

Here's another, less subtle edit for what it's worth.



The proportions and changes, again in pixels and percentages, are as follows:

	Height (pixels)	Height (%)	Vs now
Columella – lip closure	73	0.32	0.83
Lip closure – chin tip	154	0.68	0.88
Total height	228	1	0.86

         
         
         

Thank you.
I copied this in the original full face VFFS and it looks good. I was afraid at first it would be too much and not be in proportion to the rest of the face, but I think it is ok.

zirconia - I have a request. Can you tell me what exactly did you change? I mean which parts of the jaw and chin did you modify in what way? I need to talk to the surgeons about these specifics, I believe.

I'll describe what I can, but as I said, these both were rough edits so I wasn't being very scientific.

First, I used your VFFS image as my starting point. There seemed no reason to redo the work already done. I could try to describe the differences between the original and VFFS image, but believe that you probably already have some sort of an analysis regarding that.

Now, for my own work.

I left everything above the columella alone. Assuming fairly average anatomy, I positioned the upper lip high enough that the teeth would probably show a bit when you speak. The shape of the mouth in my edit remains the same. After an actual lip lift, the top lip would probably look a bit fuller when looked at from the front, and the corners might be slightly lower than in my edit. I did not try to emulate this.

Since mandibular bone work has to be done where it doesn't pose a danger to the nerves I mainly reduced the chin height under where I believe the mental foramen would be. Although I did not have a profile picture, I assumed sliding genioplasty to also shorten projection. This alone would probably make the chin too square, so I also smoothed the lower contour to maintain a smooth profile.

My primary goal was visual harmony between the positions of the nose, mouth and chin. I noted the resulting percentages in my previous post.

I'm sure you are aware of this, but when working with a picture in photoshop, the surface results are automatic. In real life, it's possible that reducing the bone to the extent shown (at least in my second edit) might require tightening the skin/soft tissues to avoid looseness.

I hope this is of some help...

I've sort of come to the conclusion that with mandible contouring there is only so much one can do. Surgeons have this reputation of being conservative or aggressive in this area but I think this is mostly just made up fiction in forums like this. Search around for DiMaggio on ->-bleeped-<- and you will find people saying he's not aggressive with mandible contouring. And yes Spiegel will do conservative work when it makes sense, but he has also done some really aggressive work too. All of the surgeons do essentially the same thing in this area so if you want aggressive, just ask for it.

When I consulted with my surgeon we talked specifically about what's realistically possible with mandible contouring. With the mandible angle there is little risk of causing damage so you can reduce it quite a bit (or in his terms "i will obliterate your angle" lol), but in terms of the rest of the jaw and chin, 5mm in the vertical direction and 5mm in the horizontal direction is about the max before you start running into issues with the bone.

Hmm ok. I have no mandibular angle, I think, so there is not much to do there. I want those mm off the lower jaw and some off the chin however.

Quote from: Sophia Sage on June 09, 2017, 06:49:26 PM
IMO, you should ask for the maximal natural result -- which, for the jaw, will depend on where the mental nerve traverses the mandibular canal.  That tunnel in the jaw is the hard limit; it should not be breached.  Where it drops the most is where people tend to have "jowls." 

Once the position of that is determined (x-rays or CT scans would be involved), the jaw can be recontoured in a way that makes all the lines look natural -- which in turn will limit how much things like of the back jaw angle can be reduced, or the height of the chin.

THAT is really important information !   

Especially when you consider that some of the surgeons do not even get x-rays before they do surgery on their FFS patients.   

Interesting read... does anyone know how much bone dr z shaves off from the midbody of jaw or as someone else her put it "the area you get jowly"? Does he request CT scans?