Archive for the ‘Craniofacial Aesthetic’ Category

Considering Facial Feminization? Unsure about V-Line Surgery vs. Feminizing Jaw Surgery?

January 24, 2018

Understanding the Differences Between V-Line Surgery and Feminizing Jaw Surgery is Critical

The Gender-Specific Differences of Male and Female Jaws

Typically, the male jaw is wider and taller than the female jaw. Men tend to have wider, heavier-set jawlines with a flatter base and a sharper angle between the chin and jaw. This gives the male jawline a prominent “square” look. Women’s jawlines typically have rounded edges, are more tapered and pointed.

“Asian” V-Line Jaw Surgery vs. Feminizing Jaw Surgery

Many of our patients who are considering undertaking facial confirmation surgery to feminize the face, often mistakenly think that they need “Asian” V-Line surgery for the jaw when what is actually needed is feminizing jaw surgery — otherwise known as FFS-specific jaw contouring or jaw tapering.

What is the difference between “Asian” V-Line Jaw Surgery and Jaw Tapering?

V-Line jaw surgery typically works to narrow the jawline and bring it forward. This procedure is typically ideal for women who have an overly-square jawline and want a more feminine, streamlined appearance to the jaw and the chin. This tactic, however, doesn’t work to feminize a male’s face because typically a male face is taller or longer, so a V-Line procedure would only make the face appear more elongated. In the case of a male transitioning into a female, what is really needed is jaw contouring surgery to shape the jaw into a more feminine aspect as well as a vertical reduction genioplasty (shortening the height of the chin). In comparison, a V-Line procedure commonly should not reduce the vertical height of the chin as that would run counter to the intended appearance.

If the face to be feminized is overly long, a condition that is known as vertical maxillary excess or “long face syndrome”, we may also recommend surgical correction via a jaw surgery procedure known as the Le Fort Osteotomy I. Read more about Long Face Syndrome and Facial Feminization here.

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The Problem With Chin Implants

October 18, 2017

Chin implants may be a popular choice for chin surgery but removing them is also one of the most popular revision surgeries that we perform.

Chin implants are typically used in chin surgery (genioplasty) to improve a “weak” or nonexistent chin, or within the context of Asian V-Line surgery. The popularity of chin implants has grown over the last few years and has become one of the fastest growing procedures in plastic surgery. Unfortunately, chin revision surgery (revision genioplasty) is also one of the most popular revision surgeries we perform due to the often unsatisfactory results or resultant medical complications of using chin implants.

Chin implants are problematic and often cause complications.

Although chin implants are an option in some cases, and occasionally used, we believe that placing a foreign object (an implant) into your own body is counterintuitive and often problematic when there are much better ways to reshape and augment the chin.

Often chin implants are placed by inexperienced or unskilled surgeons and sold to the patient as an “inexpensive” or simple solution. This, of course, is so often untrue, due to the frequency of need for chin surgery revision procedures! Instead of one operation, the patient needs another one — often at an increased cost because a secondary procedure is always more complex than a primary one — not to mention the suffering, stress and mental anguish over the first, failed procedure.

Chin implants often cause complications, with the most common being:

  • The implant shifting from its original location,
  • The implant eroding into the roots of the anterior teeth,
  • And, most commonly a squaring of the chin which in females, in particular, can have an undesired masculinizing effect that is altogether unsatisfactory.

It is our belief, that a far better option in our experience, is to reshape the underlying skeleton or foundation of the chin by altering or repositioning the bone. In fact, there are several non-implant options for genioplasty surgery: the chin may be moved forward, down, centered, widened, or narrowed — depending on the desired outcome. In these cases, outcomes are improved because there are more “degrees of freedom” for the surgeon to reshape the chin into an aesthetically pleasing shape that is in harmony with other facial features.

The risks, complications and side effects of chin implants.

Apart from the obvious risk of choosing an unskilled or inexperienced surgeon to insert a chin implant – that the aesthetic result will not be a satisfactory one – there are several other serious medical complications and side effects to be aware of:

  • Damage to the marginal mandibular nerve — leading to permanent loss of movement in the lower lip
  • Damage to the mental nerve (a sensory nerve which provides sensation to the front of the chin and lower lip as well as the buccal gingivae of the mandibular anterior teeth and the premolars)
  • Implant is placed in the superficial tissues — not under the periosteum (the dense layer of vascular connective tissue enveloping the bones) leading to implant movement under the skin
  • The wrong sized chin implant is used resulting in a chin looks out of sync or inharmonious with other facial features
  • Injury or damage to the teeth, gums, or surrounding nerves
  • Permanent loss of sensation, and/or scarring.
  • Slow healing, infection, or internal bleeding leading to removal of implant
  • Inadvertent masculinization of the female chin
  • Unsightly deepening of the labiomental crease (the deep groove underneath the lower lip)

It is critical that when you choose a surgeon for your chin surgery, that you choose a U.S. Board Certified surgeon. The risks of choosing an uncertified, unskilled or inexperienced surgeon are too great and must be avoided at all costs.

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African American Facial Feminization Surgery

September 26, 2017

Feminizing the African American Face

If you are of African American heritage and seeking to have facial feminization surgery (FFS) it’s critical to understand that what constitutes a typically female African American face may be vastly different — aesthetically and structurally — than a typical European, Asian, or even Hawaiian (Polynesian) face.

So before you select a plastic and craniofacial surgeon for your facial feminization surgery, it’s imperative to ensure that they have an in-depth understanding of the differences between the facial structures of people of different ethnic backgrounds, and most importantly proven experience with performing FFS on African Americans.

The forehead is the critical to feminizing the African American face.

The shape and size of the forehead and the brow should be the main focus of facial feminization for those of African American heritage. Typically the forehead will project a little further outwards than that of a person of Asian descent, but not as far as that of a person of European descent.

Forehead feminization typically includes forehead reduction and contouring to create a smoother, rounder, and more feminine forehead. Also, a feminizing brow lift and/or brow shaping procedure is recommended to reduce the distinctly ‘heavy’ African American male brow bossing and to “open up” the eyes to create a more feminine and rejuvenated appearance.

The hairline position on the forehead will also be different because African American women tend to have naturally higher hairlines than European women. Therefore, when we perform feminizing hairline lowering we make allowance for the fact that African American women have slightly higher hairlines to begin with, so we may not lower the hairline as significantly as we might in others. Ultimately, it all depends on your newly feminized facial features to ensure aesthetic balance and a natural looking result.

Feminizing the lower half of the African American face.

Typically, feminization of the nose via feminizing rhinoplasty is recommended for those of African American heritage. Often gender transition patients are seeking a narrower, more streamlined female nose. However, we also want to make sure that your nose will maintain a size and shape that is in harmony with your natural African American facial features, so that you still look like you.

Feminizing jaw surgery is also recommended because often the male African American jawline is quite broad and angular – often wider and squarer than what we see in other ethnicities. The jaw will often need to be narrowed and softened via feminizing jaw contouring or reshaping.

Read more about the cluster of surgical and non-surgical procedures that comprise facial feminization.

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Case Study: Adult Cleft Lip & Palate

January 5, 2016

Case Study: Adult Cleft Lip & Palate

These days it is uncommon for problems related to a cleft lip and palate to go untreated into adulthood. However in this case, the 33-year-old male patient known as “Kris” was born with a cleft lip and palate but due to personal circumstances in his teens, he was unable to undergo all the corrective surgeries that would typically be performed on a cleft patient.

The Problem: Cleft Lip and Cleft Palate

When Kris first visited our office he presented with history of left-sided cleft lip and palate. He had a dental malocclusion along with insufficient bone in the jaw for tooth implants, poor nasal shape and lip contour. Also, he still had all his wisdom teeth, which were impacted.

The Solution: Orthognathic and Plastic Surgery

Our initial surgical procedure was to remove his wisdom teeth and take a bone graft from his hip to his upper jaw.

We then recommended orthodontics to align his remaining teeth. One year later we performed a Le Fort I osteotomy, and a Sagittal Split osteotomy, in order to align his jaws.

We then took him into the operating room again for fat grafting to the upper lip and peri nasal region as well as an open Rhinoplasty with extensive cartilage grafting.

The Results: Patient Testimonial

“I don’t know where to begin with writing this review, so I guess I’ll start by saying that Dr Deschamps-Braly and his entire team are remarkable people. From the moment I walked in the door everyone was so friendly and eager to help. Camille, Betty, Jennifer, Caitlin and Dr. D have all gone above their call of duty to make this chapter in my life one of the best.

I was born with a cleft lip and palate, due to personal circumstances that happened in my teens I wasn’t able to finish all of the corrective surgeries that would typically happen with a cleft patient.

Finally, when I was 33 years old, I decided to consult with a plastic surgeon to see about getting my face corrected. Most doctors I spoke with seemed irritated that I had waited so long and weren’t very enthused about working on someone who had been previously treated by other doctors.

When I met Dr. Deschamps-Braly he was enthusiastic and understanding. The fact that he founded an organization especially for kids with facial anomalies made me feel that much better about choosing him as my doctor.

I have had four surgeries so far with Dr. D. The first was to take out synthetic material a previous doctor put in and was causing infection, the second was to perform a bone graft in my upper gum line, the third was my orthognathic surgery where my upper jaw was moved forward, and my lower jaw backward, and the fourth surgery was a rhinoplasty revision. I have one more to go and that will be a fat graft to my lip to make it look normal.

Each operation he’s done I’ve woke up to very minimal pain in the area where the surgery was performed and he was there telling me how great everything went. I really can’t sing this man and his team enough praises, the amount of work and dedication he’s put into me is insurmountable.

My case was complicated and involved coordination with several other doctors that Dr. Deschamps-Braly organized himself and made sure that everyone was on the same page, and that the direction we were headed in was the best for me, and that I would be happy with my results. I can honestly say that I couldn’t be happier. And even though I had to wait as long as I did, I’m glad that things turned out as they did, and Dr. Deschamps-Braly was the one to perform the final operations on me.

In conclusion, there is no one else I would recommend for craniofacial surgery other than Dr. Deschamps-Braly and his team. And judging from the other reviews on this thread he seems to be just as talented in his other areas of expertise.”

Read the original patient review here on

Want to know more information about cleft lip and cleft palate surgery? Contact our office in Downtown San Francisco:

To make an appointment with Dr. Deschamps-Braly, please call our San Francisco office +1.415.624.3992.

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