Facial Feminization Surgery (FFS)... Forehead Contouring, Chin Reduction with FACIALTEAM in Spain.

Adding pre-OP and post-OP photos to the review.

As part of an ongoing transition, I wanted to take next steps with FFS by seeking forehead feminization surgery aka feminizing forehead reduction/contouring surgery along with chin reduction surgery to achieve correct proportions.

I had wanted FFS for the longest time... my biggest concern was the typical hairline incision that usually exists when hairline lowering is employed as part forehead FFS. There was a very helpful virtual ffs web site that had lots of information and that ultimately led me to run across FACIALTEAM in Spain, where learned about two doctors there who were experts in facial feminization surgery. The doctors are Dr. Luis Capitán and Dr. Daniel Simon and I read about a technique they perfected which approaches forehead contouring by using a hidden coronal incision to access the forehead area for contouring, avoiding all hairline incisions. I had not heard of this before so was excited to learn more.

I initially contacted FACIALTEAM a little over a year prior to my actual surgery date with them, around December 2016. I had my initial consult in January 2016 where they outlined what they could do for me. After that initial consult, I was allowed to ask any desired follow-up questions as needed. I did just that...

I asked them if I could start by getting hair transplants and a lip lift in my local area (in the US) as both a transition-related incremental step—to see how I felt about continuing forward with further FFS with FACIALTEAM after such procedures—and to see how the transplants turned out in order to determine whether I would choose FACIALTEAM's coronal forehead approach with or without "simultaneous transplants."

FACIALTEAM can perform the coronal approach with or without "simultaneous transplants" ... there is a significant cost difference which must be weighed against the benefits achieved by using a particular patient's coronal donor hair and other factors relating to a patient's starting point and all that.

Dr. Capitán was very supportive of my proposed approach and gave me all of the parameters connected with my going that route in terms of eventually going to FACIALTEAM for forehead/chin work.

One thing Dr. Capitán let me know is that he could not perform any forehead surgery upon me until one year post-OP of any hair transplants. That was pretty much the only restriction to doing transplants prior to forehead work. Dr. Capitán also graciously agreed to additional consults at key points throughout the year to monitor my hair transplant recovery progress as well as for their transplant surgeon to assess the outcome of my local transplant work toward determining whether or not FACIALTEAM would recommend transplants at the time of their work.

I went ahead with a lip lift as well as hair transplants locally both here in the US, and I informed my local hair transplant surgeon of my plans to go to FACIALTEAM so he could help me assess whether or not I should receive additional transplants while visiting FACIALTEAM.

Most all of this planning took place in early 2016. By June 2016 the lip lift and hair transplants I got in the US were looking excellent but as incremental steps I was left still wanting to move forward with FACIALTEAM and forehead/chin FFS. That, after all, is what incremental steps are for... take small steps, see, and so forth.

I had another consult with FACIALTEAM around mid-2016. At that time, Dr. Capitán agreed the transplants were looking great so I ended up scheduling surgery with FACIALTEAM and buying airline tickets for my early 2017 surgery.

I was ecstatic to say the least, but I was also climbing the wall waiting for the big date!

In Sept 2016, I had another consult with FACIALTEAM so they could review the progress of my transplants. This allowed us to solidify the final required procedures for the forehead area and whether or not FACIALTEAM would recommend their "simultaneous transplant" option. FACIATEAM's transplant surgeon looked at the progress of my hairline transplants and let me know that getting additional transplants at the time of forehead FFS with FACIALTEAM was not required... so I was booked for surgery with FACIALTEAM for forehead reduction/contouring with potential chin reduction to be determined when I arrived in Spain for pre-OP/surgery in early 2017.

Fast forward to early 2017 and I flew to Marbella, Spain to have FFS surgery with FACIALTEAM. The experience was truly wonderful. The flights both to/from the US/Spain were completely excellent... Thank you Delta! Once in Spain, the whole experience from pre-OP appointment through surgery and recovery was, has been and continues to be unbelievably wonderful. The care by both FACIALTEAM and their partner hospital, High Care International (HC), is so way up there... they do same day cranial scans on your pre-OP day, discuss details, I can make final choices discuss things, then the next day was surgery.

I arrived on day of surgery, moved into my room and got prepared, went into the theater, awoke... did not feel any pain upon waking... most of the pain for me was typical expected recovery pain arriving days after, and continuing as expected as things healed. Frankly, while I was HC going into the theater, waking in the theater, recovering at HC, being treated so well... I was in a very good heavenly place of sorts. Hard to explain but I bet folks who have gone through this know what I mean. I had finally made it here!

The hospital food was that of a truly high-end restaurant... unbelievable. I can be a night owl and like to have a snack at night now and then... I was famished one night and didn't want to bother anybody but my stomach nudged me to push the call button... the staff was like telling me don't hesitate to let us know... if you're hungry we'll bring you something... that night and throughout my stay, HC's staff brought me some awesome sandwiches and fresh fruit, snacks, really excellent stuff. By the next day, I was anxious to walk at least a little bit, and by day two I was strolling outside several times.

It's amazing... I was so daunted by this type of surgery... I don't think it should be treated lightly... I'm not suggesting that, but I'm saying, with all decisions having been thought through and finally made, I was finally there... and I felt waking after that surgery and recovery was comparable to a rhinoplasty, perhaps even easier. I say this for myself... everyone's experience is different. But the point is these guys are really talented... I mean they do this stuff all the time, and it's like artwork, yet it's a very organized process for them too. I mean I can't even tell I've had surgery. All of the incisions are hidden and all that. It's just amazing. My only regret is that I waited so long... but that's my issue, I tend to be overly cautious. However, my wait ultimately led me to FACIALTEAM so all things considered, I wouldn't change a thing about the process.

I'm extremely grateful to both Dr. Capitán and Dr. Simon and all of FACIALTEAM. While Dr. Simon handled my pre-OP consult when I arrived, Dr. Capitán was the one who interacted with me throughout all of the consults throughout the year of 2016. He was tremendously understanding and patient with my overly cautious incremental approach to the transition process. I never felt any pressure, and I always felt welcome, respected. Once I arrived and had a chance to meet Dr. Simon and the other FACIALTEAM staff, I was just filled with so much appreciation that my journey led me to their paradise of talent, expertise, respect, an environment I was so happy to have arrived at for such a big life change.

It was a relief to be there. While I was in early recovery at HC, it was like a vacation in a hotel room... I was actually getting rest and relaxation and not worried at all. I guess, on hindsight, I'd have to say it was the waiting and preparing for travel that was the most stressful aspect of things... once I arrived, life seemed to turn into a technicolor dream. This is in large part because I was surrounded by love, respect, and talent.

When I signed up for surgery, FACIALTEAM informed me of various post-hospital recovery options and I ended up staying a Jenny's Nest because they are staffed with folks who are experienced and trained in FACIALTEAM's post-OP process, including meds and other post-OP care, incision maintenance and all that. Being alone in a hotel, for example, just seemed too unsafe to me... I wanted to be near others who could make calls or whatnot should anything arise.

Well, staying at Jenny's Nest was an excellent choice to say the least. It was nice to have someone there who knows the meds regime and post-care steps and all that. It was also less stressful for me to recover near others ... that was a bonus for a lot of good reasons. I had a chance to meet others and share experiences and all that. Perhaps that's not for everyone but ... actually... it's a flexible environment... some people like to stay tucked away in their room while others like to socialize a bit. I did both... it was great to connect, and great to retreat to take a nap and all that.

I think FACIALTEAM has several options a visiting patient can consider for post-OP recovery accommodations—I don't know them all because I focused on staying at Jenny's Nest given other people's positive experiences—check with FACIALTEAM to find out about all options.

In the past, before meeting FACIALTEAM, I could never see myself traveling internationally for surgery like this. Looking back now, it happened in a blink of an eye and the least stressful aspect of the trip began after I was on the plane to Spain to see FACIALTEAM. Now I get it when people say don't worry about distance with this kind of surgery. I'm guessing things can seem daunting before any travel associated with surgery ... I've traveled twice for surgery and both times I found that to be true... once I had arrived at the destination... actually, once I got on the plane, it both experiences, it was close to a vacation. I became immensely relaxed.

I feel grateful to have visited FACIALTEAM for this surgery. I consider their approach to facial surgery to be sort of like the SRS/GRS of facial surgery, where their goal is not to completely change someone but rather to undo the genetic development which is mismatched to the patient's inner life. I'm still me and their surgery doesn't appear to be surgery... it just tweaks things in a very subtle but important way to undo mismatched development caused by genetics.

The part irony to this kind surgery is that, from my perhaps naive patient's perspective—I can't say this is accurate but it seems so—the key expertise these surgeons provide is not only in the ability to achieve profound aesthetic results, but also in how they do it. They have the rare knowledge on how to accomplish things in a way that is safe for the patient in the long term. These guys are maxillofacial surgeons who understand the extremely delicate nature of the frontal sinus area. Beware of thinking a simple frontal bone burring is the same thing. It's rare that burring can reach the desired aesthetic changes, but even if aesthetically possible, burring can leave a patient with not only limited results but perhaps leave a patient in a less safe condition in cases of typical and untypical trauma to the area and so forth. Simply put, you don't want forehead procedures to leave you with a weaker forehead...

I say this because maxillofacial surgeons like FACIALTEAM know how to go through an extremely arduous process (that for them is likely routine, thankfully... that is part of my point here)... a process which involves advanced frontal/forehead boney work that leaves one's frontal sinus the same condition and strength afterwards. In my case, for example, my frontal forehead is my original forehead, just diminished and contoured. You might ask then... how can they diminish a forehead's protrusion while keeping it the same? Well, exactly my point. This review is not the place to outline it... search the web, see FACAITEAM's web site ... there's also virtual FFS's site which has great info on these nuances. That's what maxillofacial surgeons do... they know how to properly work with the frontal sinus. But beyond that, maxillofacial surgeons who understand feminization surgery (FFS)—not all do—know how to do the right boney work to achieve the desired feminizing outcome.

This is all to say, if you are considering forehead reduction/feminization surgery, regardless of where you go, beware of someone, even if they have a record of phenomenal results with cis-women... beware of anyone offering to do a little burring as if it's easy street. The burring may be easy, but it may lead to a weaker frontal sinus and you do not want that.

I'm not a doctor so obviously can't say what will be right for any other patient... but I can say that in most cases, from the good info I believe I had the fortune to encounter, to scratch and crawl to learn, almost making some wrong turns along the way, that burring the frontal sinus is most always a "no no" for a genetic male seeking forehead feminization surgery.

My suggestion to anyone seeking this surgery is to at the very least seek out several consults with top doctors in this area... hear what they have to say, make sure you see before-and-afters. FACIALTEAM's web site is loaded with galleries of others who have gone to them for this work. They've not only been doing this for ages now, but they've been introducing innovations and related process to the field. If a surgeon can't show you before-and-afters that are to your liking, I suggest you walk. It's easy to use the term "feminization" or "FFS" in literature... but make sure any surgeon you go to has the right experience. I can't claim to be an expert but I personally believe that any forehead/chin FFS work should only be performed by maxillofacial surgeons who specialize in feminization of masculine cranial structures and have a positive track record which includes a good number of successful before/after photos.

Oh, one other thing... there are various approaches to forehead reduction/contouring. I'm not sure what's right in what cases, but I can tell you I considered approaches that involved both a hairline incision with hairline lowering/advancement, as well as the route I went which was FACIALTEAM's hidden coronal incision (hidden incision, avoiding the visible hairline incision). FACIALTEAM is on to something here with their coronal approach innovation.

Coronal approaches are not new to facial surgery by any stretch but from what I know it was not used heavily with maxillofacial FFS until FACIALTEAM introduced it and evolved into a viable approach, including one that can offer simultaneous transplants (pretty amazing if you know this surgical space).

The way I look at it, if one goes to an excellent hair transplant surgeon, these days frontal FFS/feminizing hair transplants seem to produce excellent results. Given this, I see I have two choices... get forehead FFS with a hairline incision and fight a scar using transplants, or get forehead FFS with a hidden coronal incision and use transplants as needed to fill in and lower the hairline.

I opted for the coronal approach but decided to add one extra ingredient by working with both FACIALTEAM and my local hair transplant surgeon. I decided to seek feminizing hairline transplants one year prior to forehead FFS both as an incremental transition step, as well as a way of being in a more optimum condition for the coronal approach (my hairline was lower at the time of surgery as a result of the transplants one year prior).

I can always get additional transplants as desired but if I do I'll be working to lower a hairline and I won't be fighting any frontal scar which is great... I'm getting older so not sure how thick frontal hair will be as time goes on. At least I'm not fighting a frontal incision.

I find that, with this stuff, there is no perfect answer... it's all about finding the right trade-offs that match your journey.

I really appreciate FACIALTEAM supporting me from the initial consult, through the transplants, through the surgery, all with their support in my finding the right trade offs for my journey.

Overall, there were many places along the way where FACIALTEAM suggested routes that could have minimized my need for forehead FFS... or other procedures... they were focused on helping me with my journey regardless of my final decisions. I'm so grateful to them for that selfless care and respect for my journey.

Thank you FACIALTEAM!

Well, that's it for now. For those seeking to have this type of work done... if you're daunted by the travel, the related logistics, all that, just hang in there. I was feeling like I was walking down an endless hall... it all finally led me to the right place at the right time. Have patience and faith in yourself... do your work, research, consults, learn to trust your gut in the right way... you'll find the right path and make it happen.

Well, I've gone another step, hope the above helps someone out there... the journey continues... for now, be well.