Michael J. Nuara, MD

Jyda, Thank you for your question.  FFS has great variability in intensity and anticipated healing times.  I have seen patients take 6-12 weeks or more for the initial swelling to settle and a full year before this is matured.  This is particularly true if a lot of bone changes are made.  I highly recommend you talk to your surgeon about what to expect from your specific surgery.  In addition, the photos you have taken might not be representative as they seem to be taken from quite close up.  In order to get a more realistic image, either using a real camera, (rather than a cell phone) with a more zoomed in lens taken from further away, or even with the cell phone from several feet away, rather than a selfie.  Taking selfie photos can give a distorted image that may make your swelling appear worse in the photo than in reality.  

Thank you for your question.  You have nicely detailed the areas of your greatest concerns, as well as what you want to preserve.  Largely, I would agree with what you have suggested for yourself. Not every FFS has to have every component, but it is important to evaluate each component and think about the implications of doing , or not doing each aspect on the balance and harmony in the rest of the face.   You started hormones at a relatively young age, so your hairline has not recessed much, it does however have a more square shape to it.  If you wanted to leave that alone, I think this would be reasonable depending on how you felt about the brow bone.  You could consider a Type 1 brow reduction, which would require an incision in or near the hairline anyway.   Alternatively, the central area of the forehead could be spared and only the outside/orbital portion addressed through an upper eyelid (blepharoplasty) incision.  This is a more limited approach, but I have had good success with this in the past.  I agree with the tip rhinoplasty and would also suggest a lip lift with this.  With the eyes covered, it is not easy to access the cheekbones in your photos, but would also think about augmenting the cheek bones (malar/submalar); particularly if you were wanting to avoid jaw surgery all together.  I would consider reduction of the angle of the jaw to reduce squareness of the face and agree you could leave your chin as is, or only a small contouring around the edges.  The Adam's apple is difficult to evaluate in the photos, but if this concerns you, would certainly include this as well. You appear to be a good candidate. I  recommend finding a surgeon with good experience in facial bone contouring skills and experience of course in all areas of concern.  Also, find a surgeon that really listens to your concerns to make sure expectations are met and well understood.  

You pose a great question that is asked frequently.  I think the most important thing you stated is that you love the results of your surgery.  Enjoy this satisfaction as long as you can.  If the picture you provided is representative, the asymmetry is well within the range of normal and looks natural.  You look fantastic!  Revision surgery may run the risks of giving an unnatural result or other complication and this decision should not be made without serious consideration given you are otherwise pleased.  Sometimes, asymmetries after surgery of this magnitude can be from swelling that settles in an area because of the way you sleep or your preferred posture, etc and may not persist over time.  In general, I would not do anything for at least 1 year after surgery.  After this, depending on the degree of remaining asymmetry, decide if it still bothers you, and whether any procedures can predictably and safely correct it.  It may be correctable with a little filler or botox depending on the location.  In the meantime, if you feel like you want to try something, massage can often help for minor differences. 

Johns, 

Thank you for your question.  The picture you provided does not adequately show your concern about the ear deformity.  However, what I think you might have (again difficult to tell from the photo) is a Stahl's ear.  Yes there are some techniques to fix this and other similar irregular shaped ears.  You want to find a surgeon who has good experience with pediatric facial plastic surgery.  In the US, many of these are taken care of by pediatric otolaryngologists that specialize in microtia.  Because the deformity is in the upper part of the ear, there is much greater potential for error and an "operated on" appearance.  Depending on the degree of the deformity, the operation itself can actually be quite simple and in an adult can be performed under local anesthesia.  

If you are considering otoplasty, but have keloids in other areas, then I would consider discussing with your surgeon the option of incisionless otoplasty.  The risk is small, except in those prone to keloids, where the risk is considerably higher.  A conservative setback can be accomplished without making incisions and would be a great option for someone that is at a known higher risk for keloids.  If you are not otherwise at high risk, then the open approach has a greater chance of giving you more predictable, long lasting results.