Thoughts of an FFS Surgeon - Good title! Now, where should I start?
Should I start from the moment I see them filling in the "precious" paperwork in the waiting area or should I start from the moment I shake hands with them in my room and sit across from them to listen to their concerns, desires and life stories. Or should i simply start from WHY I started doing FFS?
I am Armenian, but I was born and raised in Bulgaria. Simply because I was born and lived the early part of my life in Bulgaria people were telling me that I should identify as Bulgarian. When I was 16 I moved to Italy, I and lived there for 15 years. As a result of living in Italy for a decent duration of time people started telling me I should identify as Italian. During this time I also acquired a Russian citizenship. After the acquisition of this citizenship people started telling me that I should identify as Russian.
Society naturally wants to categorize things, but in this instance we are talking about one's person. To try and label oneself with such singularity does not take into account that we are much more. We are the sum of our life experiences and what we feel we are inside.
My own journey of self has in part created the affinity I feel with the transgender community. It is the courage of transgender people to identify as their true self, and not what is dictated by the circumstances of what society says.
But what are the principles that we follow when evaluating a person who wants to undergo facial feminization surgery? What makes a face beautiful at any age? What distinguishes the male from the female face and what are the features that make them both attractive? Certainly interesting questions!
First of all, the patient can be either a biological man or a biological woman. It is not uncommon for for me to operate on women who are self aware of their heavy forehead or heavy jawline or in general unhappy of their facial contouring.
Facial feminization is all about studying ways to enhance the attractiveness of the face. It takes the brain only a thousandth of a second to decide the gender, the age and the attractiveness of a person based on their facial features. During that period the eyes perform a myriad of involuntary tracking movements scanning the entire face and the neck and submitting the information to the subcortical centers of the brain. And literary “before you know it” you realize what the gender of the person standing in front of you is! This means that the understanding happens without even using the higher centers for consciousness of the brain, like the cortex.
Male and female features are quite different, but the features that are considered attractive are quite similar in both genders. While a woman’s face presents with a smooth forehead, higher cheekbones and smooth oval shaped jawline, just like the shape of an inverted cone, men generally have a protruding forehead, lower eyebrows, larger nose and a more prominent jawline, more like a rectangle.
We know this quite well - the center of the female face are the eyes - there are a constellation of procedures are designated to underline their shape, color and innate beauty. The blepharoplasty or “eyelid lift” is a procedure aimed at removing the excess skin from the upper and lower eyelids to eliminate the so-called “tired look”. At the same time lifting the eyebrows in an aesthetically pleasant position, eliminating the crows` feet and adding more volume to the cheekbones directs more light into the eyes to naturally enhance their beauty.
To underline the oval shape and the attractiveness of the jawline a “classic” facelift and necklift can eliminate the relaxed cheek tissue on the sides of the chin along with tightening the skin and the muscle of the neck. A further step is to soften the contour of the forehead and the jawline if they are too prominent - those are safe and proven procedures of bone contouring that more and more men and women are looking into, to enhance their attractiveness and make their face more feminine looking.
Of course, along with the “golden rations” of aesthetics, each person has unique subtleties and giving balance to the face is a delicate equation that should respect its natural attractive traits.
There really infinite aspects to FFS surgery - few are related to the external appearance, but many more are part of the inner world of the patient. And that is what the real task in front of the FFS surgeon lies: to capture the inner beauty, to transform it in anatomical shapes and contours, to bring a person to a new life and level of confidence, to do the right thing for a patient. And in all this, not to forget that it takes real bravery to travel to and to be your real self - it is an honor for us to be of help and guidance in this journey!