Choosing Your Surgeon

Why Choose Us?

Choosing a Plastic Surgeon: Questions to Ask

Years Of Training After Medical SchoolTypical “Cosmetic” SurgeonPlastic SurgeonPlastic Surgeon With Advanced Surgical Training
Year 1Internship In A Surgical Residence ProgramInternship In A Recognized Four-Year General Surgery Residence ProgramInternship In A Recognized Four-Year General Surgery Residence Program
Year 2“Cosmetic” FellowshipResident in Year Two of a Recognized Four Year General Surgery ProgramResident in Year Two of a Recognized Four Year General Surgery Program
Year 3Starts Private Practice As A Cosmetic Surgeon after only 24 months of training since medical school.Resident in Year Three of a Recognized Four Year General Surgery ProgramResident in Year Three of a Recognized Four Year General Surgery Program
Year 4Begins Two Years of Focused Plastic Surgery Training In a Recognized Plastic Surgery ProgramBegins Two Years of Focused Plastic Surgery Training n a Recognized Plastic Surgery Program
Year 5Finishes Second Year of Focused Plastic Surgery Training n a Recognized Plastic Surgery ProgramFinishes Second of Focused Plastic Surgery Training n a Recognized Plastic Surgery Program
Year 6Starts Private Practice as a Plastic SurgeonSurgical Fellowship In Craniofacial & Aesthetic Surgery
Year 7Further Fellowship Training in Orthognathic Surgery
Year 8Starts Private Practice as a Plastic Surgeon

Choosing your FFS Surgeon: Questions to Ask

Facial Feminization Surgery (FFS) is not something to enter into lightly, that’s why it pays to do your research when choosing your FFS surgeon. Here are some critical things to consider and important questions to ask your prospective surgeon:

  • Training: Pay careful attention to the training your FFS surgeon has received. Not all surgeons who claim to be qualified to perform Facial Feminization Surgery (FFS) are adequately trained.
  • Surgical background: A background in plastic surgery, craniofacial surgery and orthognathic/maxillofacial surgery is ideal.
  • Is your surgeon board certified? If your surgeon is not board certified then consider finding a surgeon who is. Your surgeon should be certified by the following boards:
  • False certifications and lack of qualifications: There are several pseudo or even fake board certifications that undertrained doctors claim as “board certification”.
  • False board certification organizations: In an effort to be perceived as bona fide or legitimate, some doctors have created their own captive “board certification” organizations. Only board certifications that trace back to the American Board of Medical Specialties
  • NOTE: the following boards that are NOT recognized by the American Board of Medical Specialties (ABMS):
    • American Board of Cosmetic Surgery
    • American Board of Facial Plastic and Reconstructive Surgery

Dr. Ousterhout’s Background and Training

Twenty years ago, Dr. Douglas K. Ousterhout invented the entire field of Facial Feminization Surgery (FFS).

At the time, he was head of the Craniofacial Anomalies Center at the University of California, San Francisco (UCSF) medical college.

He recognized that some patients were coming to him seeking to have their faces altered to eliminate masculine features. He decided to study the matter like any other scientific problem.

No one had ever done this before.

Dr. Ousterhout was uniquely qualified to do the research and to perform FFS surgeries. From his early training in maxillofacial surgery and by his later training as a craniofacial surgeon in Europe in 1973, he had a fundamental appreciation of the fact that in order to properly perform FFS surgery correctly, one would have to alter the underlying bone structure of the face.

One of the first things he did was to collect data – that’s what any good scientist does to solve a problem. In particular, he needed data about the physical differences in the female and male structures of the skull.

As it turned out, there was an enormous collection of skulls at the dental college in San Francisco. He went there and measured and studied female and male skulls until he understood precisely why and how the appearance and structure of male and female skulls are different.

From that scientific foundation of data, Dr. Ousterhout then began to operate on selected patients. The results have proven themselves to be stunningly successful.

The Gold Standard In Training for Facial Feminization Surgery

Dr. Ousterhout quite literally wrote the book on Facial Feminization Surgery (FFS). It’s titled “Facial Feminization Surgery: A Guide for the Transgendered Womanand you can purchase it from Amazon.

In his book, he rather pointedly states that the surgeon you select must be properly trained with a background in these 3 areas:

  1. Plastic surgery,
  2. CCraniofacial surgery,
  3. And orthognathic/maxillofacial surgery

…as essential aspects of the necessary training for Facial Feminization Surgery.

We all have some general notion as to what plastic surgery is. Craniofacial surgery is related, but is specifically focused on surgical alterations to the skull. Craniofacial surgery started out in the 1960s as a set of procedures invented by Paul Tessier in Paris, to correct facial skeletal defects in children.

But, as it turns out, many of those same surgical skills are useful and necessary to transform masculine facial skeletal features into feminine facial skeletal features.

At the same time Dr. Hugo Obwegeser, in Zurich, was inventing a whole new set of surgical techniques for performing major alterations of the upper and lower jaw structures. Dr. Obwegeser’s procedures make up most of what we now call orthognathic surgery.

Dr. Ousterhout, in his book, is rather blunt in pointing out that a surgeon who does not have all three of those surgical skill sets, is NOT the right surgeon to be attempting to perform most aspects of Facial Feminization Surgery.

Here is the reality:

  • Some plastic surgeons, without craniofacial training try to do FFS surgeries.
  • Some dentists, with maxillofacial training, try to do FFS surgeries.
  • Some head and neck surgeons, without plastic, craniofacial, or orthognathic surgery training, try to do FFS surgeries.
  • Some surgeons with various other specialty backgrounds try to do FFS surgeries.

In many instances, when those surgeries are confined only to limited aspects of the transformation needed for complete FFS, the results are somewhat acceptable.

Stated another way, if performed properly, those surgeries have to only be performed within the scope of the limited set of surgical skills possessed by the surgeon with the limited training background.

Everyone is familiar with the concept that the whole world looks like a nail to a carpenter with only a hammer.

The unfortunate reality is that the same limitation applies to surgeons whose skill set is not sufficiently robust to allow the surgeon to safely and comfortably perform all aspects of the numerous surgical steps needed to accomplish a complete feminization of the face.

Another aspect of that reality is that a surgeon with a limited surgical training background and the corresponding limited surgical skill set can only give limited advice and recommendations to the patient.

The recommendations made to the patient will, inevitably, be limited only to the aspects of FFS surgery for which the surgeon is properly trained and qualified. Those limitations in the surgical training and skill set impose a limitation on the ability of the surgeon to address all of the necessary procedures required for a good overall outcome in facial feminization surgery.

Some of the alterations needed by the patient can and should only be accomplished in combination with other procedures. But if the surgeon cannot comfortably do all of them, then the advice given to the patient is necessarily limited and “skewed” towards only those alterations with which the surgeon is trained and comfortable.

There is no easy way to sugar coat this subject.

The surgeon that is going to do your FFS surgery needs to be properly trained in all three areas described above, otherwise, you may end up with a piece meal series of operations that are not well coordinated and which may then later require modifications – if that is even then still possible.

Here is another matter that is also not easy to sugar coat: The surgeon with the limited surgical skill set is going to charge the patient less than the surgeon with the complete surgical skill set. Sadly, that is inevitable. Otherwise, their patients will inevitably go to those surgeons with the complete surgical skill set required to accomplish aesthetically pleasing final results for the patient. So when it comes to choosing your FFS surgeon, there is a great deal to be said for “buyer beware”.

The Critical Questions

In summary, if you’re looking for a surgeon to do your FFS surgery, make sure that they are:

In the end, it pays to do your research, ask important questions and check that your surgeon’s qualifications are legitimate. After all, it’s your face and your life.

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