Hi Everyone,

I'm looking to get FFS this May/June (so in a matter of a couple months) and I've narrowed down my options to Dr. Zukowski and Dr. DiMaggio.  Both of these doctors have different styles and techniques, but I feel like their results are the best for my budget. Both doctors have recommended the same list of procedures:

Brow Reduction
Rhinoplasty
Cheek Implants (listed as "optional" by both docs)
Upper Lip Lift
Jaw/Chin Reduction
Tracheal Shave (I had to request this with Dr. DiMaggio)

For reference, here are photographs of my face currently (pre-op): http://imgur.com/a/KfCaS

Aside from the cheek implants, I agree with everything that needs to be done.  My concern is the forehead and nose.  Dr. Z only grinds/burrs and I'm worried this won't provide enough reduction in my brow.  Dr Z. has confidently stated it would be more than enough reduction, but Dr. DiMaggio has stated confidently that reconstruction is the only way to get acceptable results (and that anyone saying otherwise is unable to do the procedure properly).  Personally, I do not like the Dr. O "ski-slope" type forehead/nose, and I've seen several Dr. DiMaggio results that were similar to this (as seen in the profile here: http://www.t-change.com/img/Partial_Facial_Feminization_Surgery_11a.jpg).  When looking at the profile, I think a slight amount of brow curvature/indentation (where the forehead curves down-and-in to meet the nose) looks good.  So if anyone has had experience with Dr. Z, are you satisfied with the amount of forehead reduction and the shape?

My other concern between the doctors is the nose.  I'm concerned about the noses I've seen in some of Dr. Z's results.  I also saw some negative results when looking at the Yahoo FFS-Support site (where the nose required revision by Dr. Z and even then still looked unsatisfactory).  I understand all doctors have bad cases, but from an overall standpoint, is Dr. Z a good option when it comes to nose work? 

I greatly appreciate any input anyone is able to provide... I feel like I'm going crazy researching this all day long! Thanks!!!

Lisa

Another difference to take into consideration is the "type" of Plastic Surgeon that Dr  Z and Dr DiMaggio are. What do I mean by that? Dr Z is a Plastic/Reconstructive Surgeon and Dr DiMaggio is a CranioFacial Plastic Surgeon. A CranioFacial Surgeon (what Dr O is), works on the bone structures of the face and forehead, where as a Reconstructive Surgeon will work mainly on the soft tissues.

There is a big difference when it comes to the Forehead for instance, instead of only burring or grinding down the Brow Bossing, a Cranofacial Surgeon would remove the Frontal Sinus Bone and recontour or reconstruct it depending upon the Forehead Type (I II III IV), to feminize the forehead.

You might want to checkout Dr O's book, Facial Feminization Surgery: A Guide for the Transgendered Woman, Douglas K. Ousterhout, MD, DDS, Addicus Books, Inc., 2009. In his book, Dr O describes the principles concerning Facial Feminization and the procedures involved.

I saw your pictures and I think both doctors are right about the procedures. You have a flat face and to become beautiful you need the cheek implants. It will not ad to the feminizing process but I believe it is important sign of beauty. When it comes to the cheeks I would go for small implants. Make sure they don't overdo them. Who ever you choose you will not make a mistake, I believe they are both good doctors. Perhaps you can have your cheeks done by Dr Mayer in LA, he makes very good and natural results when it comes to facial implants.
When it comes to your frontal bone judging by the x ray that can be fixed with burring only, but you will have only thin bone remaining on the anterior wall of the sinus. There is always a possibility that the sinus will accidentally be opened during the procedure and you need an experienced doctor who will be able to do a prompt reconstruction at the same time. Good luck with your FFS.

I never thought I'd say this, but just like Swan I agree that you may want to go for small cheek implants.

As far as which Dr, you have to go with the one you feel most comfortable with.  You are welcome to dig through my thread here on susan's or our website for my results from Dr Z.

Good luck with who ever you choose and I hope you healing is quick and the results better than you expected.

I know dr z , injects fat into the temples to lift up the male depression of the bone there , do other doctors reconstruct this bit ? I want someone who will give me agressive work to my nose , but I think my limit is 25,000 for the surgery unless I get a higher paying job and can save more before next year when I want to do this , my priorities is I need a doctor who can do medphore cheek implants and allaplasty ( nostril reshape ) and aggressive nose work , I was considering eithet dr Z , chettawut , or maggio or dr bart

Someone told me something about a former clinic magio had went down and a lot of girls payed for their FFS and ended up not being able to get it , does anyone know if he made up for it in his own clinic doing those patients who had already paid . I love his results but would like to know if I can trust him

SandraJane
Thank you for the feedback.  I've actually read Dr. O's book and it was very helpful.  When looking at burring/grinding vs reconstruction, I actually have concerns with both.  With grinding (Dr. Z), I'm unsure if enough material could be feasibly removed.  However, with reconstruction (Dr. DiMaggio), I'm afraid I'll end up with a completely flat forehead and sloped nose.  Also the riskier complications with reconstruction scare me.  Although all this talk of painful massaging with Dr. Z has me equally freaked out now. 

I sent Dr. DiMaggio a series of Photoshop manipulations I made to my forehead to get his opinion on what is possible (http://i.imgur.com/xriQQ.jpg).  Personally, I think somewhere between #2 and #3 looks the best.  However, I think #4 and #5 is more common with Dr. DiMaggio.  I prefer to have an indentation at the end of the forehead because it matches my sisters' faces.

Swan
It's funny to hear someone finally recommending cheek implants.  ALL of the feedback I've received on the Yahoo FFS-Support group has been against the them strongly.  Dr. DiMaggio gave a very pragmatic explanation for suggestion the cheek implants which I liked.  He stated that it appeared I use to have an under-bite that was corrected with orthodontics and not surgery, so this made my cheeks appear more sunken.  He reasoned that implants would help the cheeks stand out given the strong lower projection.  I did in fact have a strong under-bite as a kid and had braces twice... pretty impressive he could determine all that based on just my current photos and my x-rays. I'm wondering if it would make sense to hold off on cheek implants to see how things turn out first though.  And then if I still want them, I could go to any surgeon in a year.

Jeneva
Haha, thanks for another vote on the cheek implants; I must say I'm surprised.  Thanks for the link to your thread, I've been following it.  Congrats on the progress!

Raneth
Thank you so much for posting your before/after photos!  Are you happy with your nose now?  Did you discuss the type of nose you wanted with Dr. Z beforehand, or did he just do what he felt would look best?  I think your brow looks good (this is more the result I would like).  Regarding the cheek implants, why are you unsure?  Do you feel like the fat injections would have been enough alone or something else?  Thanks!

Mementomori
I asked Dr. DiMaggio about the depressions at the temples and here is the response I received from Amanda:

"Apparently the hollowness of your temples is partially produced by the contrast between that area and the protrusion of the orbital rims and the crests of the frontal bone. These crests are the vertical boundaries between the frontal bone and the temporal fossae (the hollowing on each temple area). Some surgeons like to fill out the temples with fat or other materials, but this is usually because they don't reset the brow bossing properly. We don't recommend this approach. It could end up resembling a motorcycle helmet.  The right approach would be grinding down the vertical crests and the orbital rims protrusion, levelling them to the current hollow level, instead of filling out the hollowness. Once the forehead protrusion and the orbital rims get reduced, the hollowing will stop looking like such, or at least the contrast will be much lower. I mean, the idea of making a continuous smooth concave outline for the forehead/temples area is the same, but instead of bringing the deep areas outwards we propose to "push" the protruding areas backwards.  Your sisters have some degree of hollowness on the temples although smoother than yours, so you might expect to get something similar after the crests of your frontal bone, your brow bossing and your orbital rims get reduced."

Regarding issues with Dr. DiMaggio in the past, I had heard he use to work with a company that did the arrangements for foreign patients, but the company was unreliable.  So he he opted to bring Amanda (who handles all the patient arrangements) directly into his clinic.  I could be totally off, but that's what I briefly heard.

Thanks so much for that reply lisamoore , actually from the description. You just posted dr maggio is looking very favourable , I heard someone else online recently say he quoted them 18 K for everything , so his prices seem reasonable too

Ill just have to research the thing that went bust more to make ease my concerns about that

Thank You Lisa, glad you read his book, and I'm getting ready to read it a second time too! What other Surgeons did you check out? Did you checkout Jeffery Weinzwieg of Chicago, or Berry Eppley of Indianapolis? Both are Craniofacial Surgeons that do FFS.

All this information has been really helpfull does anyone have any info on dr chettawut , does he mainly deal in soft tissues or is he a cranial surgeon too

Mementomori
Dr. DiMaggio quoted me $18k for the forehead reconstruction, brow lift, rhinoplasty, upper lift lip, and jaw/chin reduction.  The tracheal shave is another $2k.  And cheek implants were another $4.2k.  Dr. Zukowski quote me $25 (without the implants) for the same procedures.  Adding implants would cost another $4k.  Taking into account the more expensive flight to Argentina vs Chicago (since I'm in the USA), Dr. DiMaggio ends up being $4k cheaper when comparing the same set of procedures. 

For the same procedures (including the cheeks), I was quoted the following:
- Dr. Spiegel - $38k
- Dr. Ousterhout - $42k
- Dr. Meltzer - $48k (two stage operation requiring at least 7 days between operations)

SandraJane
Well I didn't read the whole thing, but I did read the chapters I was concerned with at the time (back in Sept 2011).  The book belonged to a friend, so I had to give it back.  As far as doctor's go, I've also had consultations with Dr. Spiegel, Ousterhout, Metlzer, and Leis.  I like Dr. Meltzer the best, but he's too expensive and unable to do the surgery in a single day.  I don't think Dr. Speigel is aggressive enough.  And I don't like the "slope" of Dr. Ousterhout's forehead/noses.

I just found out about Dr. Weinzwieg yesterday, but I don't know anything else about his practice.  I've never heard of Dr. Eppley.  If I haven't heard about them by now, I'm not sure I'd want to consider them.  I want to pick a doctor that's been recommended by many others with direct experience.  If you have any info on the docs you mentioned, I'd be curious to know though. Thanks!

Girl you look good

I forgot to mention this in the opening question:

I've only been on hormones for 13 months, so I know that the changes in fat redistribution in my face aren't done yet.  Because of this, I'm thinking of holding off on the cheek implants for another year (to see if they just naturally plump up).  Can I expect much of a change by waiting another year though?  Has anyone tried this approach with their FFS before?

Thanks! Lisa

Quote from: lisakmoore on March 31, 2012, 11:47:25 AM
I forgot to mention this in the opening question:

I've only been on hormones for 13 months, so I know that the changes in fat redistribution in my face aren't done yet.  Because of this, I'm thinking of holding off on the cheek implants for another year (to see if they just naturally plump up).  Can I expect much of a change by waiting another year though?  Has anyone tried this approach with their FFS before?

Thanks! Lisa

I had only been on hormones for 15 months when I had ffs.  I know a lot of people will advise that you should wait 1.5-2 years before ffs but my ffs surgeon said that it didn't matter so much

  I'm trying to decide between these two surgeons as well. Both are excellent and each have there own strengths and weaknesses. I don't like Dr.Z's noses but I like his endoscope technique and for me personally i think burring will be enough for my brow/forehead area. Dr. D is very talented and his style mimics that of Dr.O. I don't like the flat slope forehead look either but overall his work is impressive and he's cheaper, the only problem is distance.

   

Quote from: MacKenzie on March 31, 2012, 05:35:59 PM
I don't like Dr.Z's noses

Everyone always says this, but I was really happy with the work he did on my nose.

Quote from: MacKenzie on March 31, 2012, 05:35:59 PM
  I'm trying to decide between these two surgeons as well. Both are excellent and each have there own strengths and weaknesses. I don't like Dr.Z's noses but I like his endoscope technique and for me personally i think burring will be enough for my brow/forehead area. Dr. D is very talented and his style mimics that of Dr.O. I don't like the flat slope forehead look either but overall his work is impressive and he's cheaper, the only problem is distance.

If you don't like Dr Z's noses then you can always tell him not to leave the nose alone and then go see a specialist rhinoplastry surgeon.

When you say dmaggio uses full forehead construction , does that mean he takes it out as rassembles the bone or does he grind bits and build up again with the bone paste , does dr z use bonde paste too ?  ,

Bone * reassemble *