There are a number of surgical procedures that fall within the realm of Facial feminisation surgery. Such procedures include: hairline lowering, forehead reshaping, rhinoplasty, midface procedures, and lower jaw reshaping procedures. Depending upon one’s face shape, one or more of these procedures may be undertaken to achieve facial feminisation.
In achieving such results, it is important that a comprehensive and dedicated team of medical providers are involved in the facial feminisation. journey. While Dr Reddy will be your facial feminisation surgeon, several other members form an important part of your care.
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Meet our facial feminisation team
Dr Chaithan Reddy (PLASTIC, RECONSTRUCTIVE, & COSMETIC SURGEON)
Assoc. Prof Faruque Riffat (ENT SURGEON)
Dr Sanjay Sharma (Anaesthetist)
Dr Daniel Kwok (Anaesthetist)
Dr Ernest Wong (Anaesthetist) MBBS FANZCA
Susan Garrett (Aesthetic Nurse)
Rebekah Langford (Registered Nurse)
Julianne Kim (Patient Coordinator)
CONSIDERATIONS IN FACIAL FEMINISATION SURGERY
When is the right time to have surgery?
There is no right answer to this question. The answer will often depend on various individual factors. The primary factor will largely be dictated by when you feel ready to physically feminise your face to bring harmony to your gender identity. The purpose of the surgery is to assist you in achieving an outward appearance that is in keeping with this. It is important to note that Facial feminisation can also be performed to feminise the face irrespective of one’s gender identity. Facial feminisation may be undertaken before or after sexual reassignment surgery (SRS). The decision about the sequence of surgery will often be a personal one based on an individual’s preference and what they feel will serve them most in achieving their desired gender identity. Some individuals may feel that undertaking SRS first will help them formalise their gender identity. Others may feel that changing their outward facial appearance with facial feminisation first will help them feel more accepted as a female in society.
How does Dr Reddy feminise the face?
In answering this question, the fundamental differences between male and female facial anatomical characteristics need to be understood. Anthropologic studies have clearly demonstrated key sex differences between the male and female facial skeleton. It is in understanding and addressing these sex differences that allows Dr Reddy to create a female appearance to the facial region. Whilst soft tissue characteristics such as the skin, hair growth, fatty tissue distribution, hairline and lips are important considerations, fundamental differences lie at a deeper level. We know from history and our study of human anatomy, that the male facial skeleton is typically larger and broader. Reducing both horizontal and vertical dimensions of the facial skeleton therefore play an important role in feminising the face. Once the underlying framework is addressed, the outer covering (soft tissues) so to speak can be addressed to optimise the final outcome.
Dr Reddy has extensive experience in surgery addressing both the soft tissues and bone structures associated with the facial region. He has undertaken thousands of procedures entailing these structures. By combining this experience with knowledge surrounding sexual differences in facial anatomy, he is able to achieve a feminised appearance to the facial region. The process commences with consultation involving an in-depth assessment of your desires and existing facial features and proportions. Clinical measurements combined with three-dimensional digital imaging allows for accurate assessment and documentation of your facial shape. Radiological investigations including x-rays and CT scan imaging is organised to further assess the facial skeleton. Based on this information, a clear detailed surgical plan is provided to you. The relevant procedures are further discussed in detail and an information pack pertaining to each specific procedure is provided to you. This will include information pertaining to your recovery and healing phases.
Do I need to have all the procedures at once?
There are multiple procedures that fall under the domain of facial feminisation. These include Hairline lowering, forehead reshaping, brow lift, rhinoplasty, cheek augmentation, lip lift and augmentation, jaw reduction, and facelift surgery. It is important to consider that all patients present differently and may only have certain masculine features that require correction. I.e. There is no requirement to have all procedures undertaken, or even if needed, there is no requirement to have the procedures undertaken at once. Following the consultation process, Dr Reddy will be able to advise you on what procedures may best benefit you in achieving a feminine face. Whilst Dr Reddy can undertake all relevant facial feminisation surgical procedures in the same setting, in some instances, it may be preferable to stage the surgery in the interest of patient safety, or in achieving the optimal result. DR Reddy will discuss this with you during the consolation process.
What are the risks associated with surgery?
Risks can be classed as general risks associated with anaesthesia and surgery in general, and also specific risks associated with individual procedures.
General risks include anaesthetic related complications, but these are rare. Other general risks that are very uncommon include infection, bleeding or healing related problems. Deep vein thrombosis (DVT) is a risk associated with any surgery, but the incidence is extremely low. It is important to discuss your hormone therapy regime with your treating doctor as this can be relevant to your DVT risk.
Specific risks can include prominent or visible scars, altered nerve function (numbness or altered sensation, weakness), sinus infection (Type 3 forehead reconstruction), palpable bone plate or screws.
Dr Reddy will discuss these in detail with you during the consultation process.
What are the costs associated with surgery?
There is no one specific cost for facial feminisation procedures. Every individual presents with different feminisation surgery requirements. Similarly, not all facial feminisation procedures may be required to achieve the desired endpoint. Following the consultation process an individualised treatment plan is put together and a fee schedule based on your individual requirements is provided to you. This will provide you with accurate idea of all the relevant costs. The costs to consider include surgical fees, hospital related costs, anaesthetic fees and assistant fees. Interstate and international patients need to also consider travel and accommodation costs. Providing you have a referral letter from your general practitioner, your surgical fees will cover the cost of your post-surgical care and reviews.
Choosing the right surgeon?
When embarking on the journey of facial feminisation, this can entail a big commitment emotionally, psychologically, and financially. It is important therefore that you feel completely at ease with the surgeon that you choose to proceed with and entrust. Whilst a trusting doctor patient relationship is fundamental to the entire process, it is equally important to have a surgeon that is trained and experienced in such procedures. It is also important to have a surgeon with an excellent safety profile. Dr Reddy has extensive knowledge and experience in facial feminisation procedures. He has received training in dental surgery, maxillofacial procedures and Plastic & Reconstructive surgery, all essential components of facial feminisation surgery.
The decision to proceed with a type 3 or 4 forehead reconstruction is largely dictated by the underlying anatomy and also the final forehead contour desired.
Significant brow bone prominence that is either noted by the patient or at the time of clinical assessment usually requires a type 3 forehead reconstruction. Facial feminisation of the upper third of the face commonly entails reducing this prominence in order to achieve a softer and less acute nasofrontal transition. This is referred to as the nasofrontal angle and typically ranges from 130 to 140 degrees. In females, the ideal nasofrontal angle should be ideally 135 to 140 degrees. In males, the nasofrontal angle is typically more acute based on anatomical and arthrometric studies.
The manner in which the desired contour and nasofrontal angle is achieved is dictated by the anatomy in this region. This pertains to the relationship between the thickness of the frontal bone and the size of the underlying frontal sinus. The frontal bone can vary in thickness and ranges from 1 to 10mm. In individuals with thick frontal bone, a type 2 forehead recontouring procedure may be adequate to achieve the desired result.
In individuals where the section of frontal bone that is situated in front of the frontal sinus is very thin, there is very little bone reduction that can be achieved with a shave procedure and a type 3 or 4 forehead reconstruction is required.
This entails repositioning of the prominent section of the frontal bone. CT scan and or cephalogram assessment is undertaken by Dr Reddy to assess the thickness of the bone and determine what procedure is best undertaken for each individual facial feminisation procedure.
Dr Reddy prides himself on careful and rigorous planning in forehead reduction procedures. Not only is a decision made on the type of forehead reconstruction procedure required, but the exact amount of bone to be reduced and repositioned is calculated in millimetres. This helps ensure that your final result matches the preoperative discussion and plan.
The following CT scan depicts a thin frontal bone and large frontal sinus. In this type of setting, a Type 3 forehead reconstruction is undertaken.
In type 3 forehead reconstructions, the prominent section of frontal bone is removed and setback. It is secured back into it’s new position with titanium plates and screws.
It is important to note that the frontal sinus can vary significantly between individuals. In some individuals the sinus is rudimentary. It is also the norm for one side of the sinus to be very different to the other side. This is shown above in the CT scan cross section image.
In Type 3 forehead reconstructions, it is critical that the frontal bone segment is removed with precision and within the confines of the frontal sinus boundaries in order to avoid injury to critical structures. Dr Reddy does this by undertaking careful preoperative CT planning to determine the exact boundaries of the sinus. During the surgery, It is important that the frontal sinus is also managed very carefully in order to minimise the risk of longer term sinus related sequela. The following intra-operative photos highlight the various steps involved in type 3 forehead reconstruction surgery.
Type 3 Forehead Reconstruction Gallery
Following bone setback and fixation, and careful management of the sinus, the forehead tissues are repaired, ensuring good brow position and symmetry.