Facial Feminization Surgery and The Standards of Care

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Hairline:Your hairline is a little high as can be particularly seen in the 3/4 profile and I have moved itforwards. As I mentioned before, I don't think this should be done too aggressively as you have along face and that can be emphasized by too short a forehead.Forehead:You have very strong bossing over the frontal sinus and the orbital rims and this is emphasizedby a deeply indented area across the center of your forehead. I have set back the frontal bossing,shaved down the orbital rims and filled the indented area to bring your forehead into normalfemale ranges.Eyebrows:Your eyebrows sit in a low position and point downwards towards the outer ends. I have givenyou a fairly strong brow lift to correct this and to open and feminize your expression.Eyes:There is some loose soft tissue above the eyes that is hiding the upper eyelids though mainly theproblem is above your left eye. I have given you an upper blepharoplasty to correct this. Theproblem may be partially corrected by the tightening caused by the brow lift and you may find youdon't need the procedure on the right eye, however I do think you'll need it on the left at least.Nose:Your nose is reasonably narrow but overall it is a bit large with a high and slightly humped bridge.There are also various bumps and asymmetries along the bridge. I have lowered the bridge tomake the nose smaller overall and to give it a fairly straight profile. I have also given the tip agentle turn-up and blended it better into the rest of the nose and I've smoothed out the variousasymmetries along the bridge.Cheeks:I think your cheek bones are fine. There is quite a bit of hollowness in the mid-cheek area butsuspect that fixing that would require a fat transfer rather than cheek implants. I've not simulatedthis.Lips:You have full lips with an attractive and feminine shape but the distance between your top lip andthe base of your nose is too long. I have given you a lip lift to correct this.Chin:Your chin has a reasonably rounded and therefore feminine shape but it is tall. I have shortenedyour chin fairly aggressively but have maintained the feminine shape.Jaw:Your jaw is not particularly wide when compared to the middle and upper thirds of your face. Ithink there is an optical illusion going on here to some extent in that the hollowness of the cheeksin front of the jaw angles makes them look more defined than they actually are. From the side thesharp angle of the mandible can be seen although the actual height of the jaw in this area is quitemild. As this seems to me a very borderline procedure, I'm sending you an extra set of pics whereI've narrowed the jaw a touch and shaved off the angle. You can then decide which set youprefer.Adam's apple:You do have a visible Adam's apple although it's not severe. I have simulated a trachial shave toreduce it for you.
Face lift:I have not simulated a face lift but there is a chance that a small lift of some kind will be requiredto take up any slack caused by the large chin reduction.Overall:I'm broadly in agreement with you and the surgeons - the only borderline decision I feel is the jawnarrowing.A good way to view your pictures is to lay the before and after shots side by side and keeplooking from one to the other or placing one print on top of the other and quickly flicking betweenthem. However, if you have a way to overlay them on your computer and click between them, thatis ideal.The pictures are yours so feel free to share them and the assessment with any support groupsyou are member of if you want some second opinions.Please email me to confirm that the pictures have arrived. If you have any questions or opinionsabout your pictures and your assessment please feel free to email me.Thank you very much for entrusting me with your virtual FFS - I very much hope the pictures arehelpful.Good luck and best wishes,Audrey.http://www.virtualffs.co.uk
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