At the Deschamps-Braly Clinic, we proudly offer the best in nonsurgical treatments with Jennifer Fick, M.S.N., F.N.P-C, C.A.N.S. Jennifer has advanced training in a wide range of cosmetic treatments and holds over 20 years of experience in the field of cosmetic dermatology. This allows her to offer effective, tailored treatment options to meet your unique needs and goals. You may be surprised to learn just how significant your results can be through nonsurgical treatments like laser facials, injectables, and chemical peels.

Refreshing Laser Treatments

Unwanted pigmentation is a common complaint, whether that’s brown sunspots and age spots or redness throughout the face. Jennifer uses advanced laser treatments to rejuvenate the skin and break up unwanted pigmentation.

ResurFX

ResurFX is a fractional, non-ablative laser treatment that utilizes a unique scanner to analyze the skin, protect it from overheating and damage, and precisely target pigmentation. Through ResurFX treatment, microchannels are created to stimulate the natural healing and collagen production response while the surrounding skin is left undamaged to minimize side effects and the healing period.

IPL (Intense Pulse Light)

An IPL Photofacial is a popular laser treatment that can be adjusted according to your Fitzpatrick skin type, making it a highly versatile treatment option safe for many skin types, tones, and concerns. IPL treatments utilize multiple wavelengths of the visible light spectrum to treat a wide range of concerns including sun damage, redness or visible blood vessels, birthmarks, or lines and wrinkles.

Neuromodulators: Not Just for Wrinkles!

Neuromodulators, like Botox, have so many surprising uses in the hands of an expert. Jennifer can use Botox to treat TMJ, migraines, or hyperhidrosis. These treatments can also be used for lip rejuvenation or even non-surgical jaw contouring in addition to softening lines and wrinkles. Neuromodulators work by blocking nerve signals. This means that they can soften facial expressions that result in wrinkles, relax muscles that cause tension headaches, and migraines, or interrupt the nerve signals that trigger sweating.

Hand Rejuvenation

We spend a lot of time focusing on signs of aging in our faces, but don’t ignore your hands! Sun exposure over time, dryness from frequent hand washing, and natural volume loss all contribute to signs of aging in the hands. Jennifer often uses microneedling, laser treatments, and even dermal filler injections to create younger-looking hands.

Nonsurgical Gender Affirmation

Not ready for surgery? Plenty of nonsurgical procedures can still be tailored to create a look that better suits your gender identity, from lip fillers to laser treatments. If you are planning to have surgery, cosmetic treatments are a great option to prepare your skin and ensure it is in good health before your surgery takes place. A consultation with Jennifer will help guide your many options.

Nonsurgical Facelifts

A nonsurgical facelift can be achieved using treatments like injectables, microneedling, or lasers and usually involves a combination of these. Jennifer can make an expert recommendation during your consultation.

Schedule a Consultation

Schedule your consultation with Aesthetic Nurse Specialist Jennifer Fick at the Deschamps-Braly Clinic by calling 415-877-6321.

The ‘Lip Flip” is a simple procedure using a neuromodulator such as Botox® or Dysport® to “lift” and “flip” the upper and lower lips to enhance their appearance and mimic the effect of a filler. The orbicularis oris muscle surrounds the upper and lower lips and works as a sphincter muscle, pulling the lips inward and tightly together as well as allowing the lips to pucker. By relaxing the muscle, the lips naturally appear fuller and plump. The lip flip will soften the fine vertical lines around the mouth and can improve the appearance of a gummy smile.

Am I A Candidate?

Patients may opt for a lip flip if they are not ready to have a filler treatment or to get a preview of what filler may look like. The lip flip will not change the natural shape of the lip so it is perfect for patients desiring a very natural appearance. The procedure is quick with less downtime than filler and can be added on during a typical Botox® or Dysport® treatment visit. It is also less expensive than filler, but the effects will typically last 6 weeks so repeated treatments are necessary to maintain results. Due to the relaxation of the orbicularis oris mucle, some patients may experience some temporary functional change when speaking or eating that is not noticeable to others and resolves spontaneously.

Fillers have long been used to enhance the volume, contour and shape of the lips and perioral area. Typically, fillers placed in the lip are composed of hyaluronic acid, which is a natural hydrator found in the skin and other areas of the body. Because filler attracts and retains water, it creates a soft and natural fullness in the lips, and depending on which filler is used, can last 6-9 months or longer.

How Long Is The Downtime?

There is some social downtime necessary to accommodate any swelling or possible bruising that may result from treatment. Filler treatments also take a bit longer than a lip flip since the provider is shaping and sculpting the lips to augment the appearance and create symmetry. Topical anesthetic and the application of an ice pack reduces discomfort during treatment and can mitigate swelling and bruising. Patients should plan for a few days of social downtime after treatment and  the final lip volume will be realized after about one week.

Schedule A Consultation

Patients may opt to have both a lip flip and filler if they wish to address several concerns simultaneously. In the case of a patient with fine vertical lip lines, have noticed their lips have lost volume with time, combining the two procedures will have a synergistic affect and provide a global aesthetic improvement to the perioral area.

In our last blog, we discussed the impact of laser and intense pulsed light (IPL) treatments to reduce the appearance of aging and photodamaged skin caused by extrinsic factors such as sun exposure and other lifestyle choices. Intrinsic factors such as genetics and the natural aging process also contribute to aging. Are there options for reversing these aging factors?

Combining medical-grade skin care products with laser and IPL treatments provides an additional opportunity to stimulate new collagen production and improve skin texture and tone. In our office we recommend a regimen utilizing Retin-A (tretinoin) and topical Vitamin C serums to maintain and enhance the results of your laser treatments. These two products work in different ways.

Tretinoin is a prescription topical medication that has been used for over 40 years, primarily to treat acne. Tretinoin exfoliates superficial dead skin cells from the skin surface while simultaneously building new collagen deeper in the dermal layer of the skin. As a result, tretinoin can dramatically improve the appearance of fine lines, skin texture and pigmentation. The exfoliation tretinoin provides allows other skin care products to penetrate more deeply into the skin, enhancing their efficacy.

Vitamin C and Vitamin E serums are a valuable addition to any skin care routine, but they also enhance the action of tretinoin to further stimulate collagen and improve skin texture and tone. Vitamin C is an essential component of collagen synthesis, and vitamin C and E work synergistically as potent antioxidants to protect skin cell membranes from oxidative stress. Studies have demonstrated a reduction in fine lines and pigmentation when topical Vitamin C serums are used consistently over time.

A skin care regimen utilizing Tretinoin and Vitamin C topicals is not only very effective at improving and protecting your skin, but can be simple to use. Typically Vitamin C serums are applied daily, often in the morning to provide a photoprotective effect. Tretinoin is applied in the evening, typically 2-3 times weekly. We recommend wearing a mineral-based physical sunblock daily and reapplying as necessary to protect your skin, and prevent further sun damage and aging.

Plastic surgery is an important treatment option for many patients who experience gender dysphoria. The World Professional Association for Transgender Health (WPATH) has identified high standards of care for transgender or gender minority patients, which includes plastic surgery options such as facial masculinization surgery or facial feminization surgery. The goal of these treatments is to achieve “lasting personal comfort with the gendered self, in order to maximize overall health.” At the Deschamps-Braly Clinic, Dr. Deschamps-Braly and certified aesthetic nurse specialist Jennifer Fick offer several gender-affirming treatment options.

Facial Masculinization Surgery

For transmen and transmasculine patients, facial masculinization surgery includes a wide range of options to relieve dysphoria by creating a more traditionally masculine look. As a craniofacial surgeon, Dr. Deschamps-Braly performed the first-ever complete facial masculinization surgery in 2015. Since that first procedure, he has helped countless patients with customized surgeries according to their unique needs. Facial masculinization surgery may include any of the following:

• Forehead lengthening and augmentation
• Chin recontouring
• Jaw augmentation
• Jaw contouring
• Rhinoplasty
• Cheek augmentation
• Adam’s Apple implant

Facial Feminization Surgery

Facial feminization surgery can be tailored to each patient’s goals and unique needs. Guided by Dr. Deschamps-Braly, a transwoman or transfeminine patient may choose a variety of soft tissue, craniofacial, or even non-surgical procedures to create a more feminine look. Some common options for facial feminization surgery include:

• Forehead reduction or contouring surgery
• Brow lift
• Cheek augmentation or reduction
• Chin contouring
• Fat transfer
• Hairline lowering
• Rhinoplasty
• Lip lift or augmentation
• Jaw contouring
• Tracheal shave (Adam’s Apple reduction)
• Feminizing earlobe reduction

Choosing Gender Affirmation Surgery

Surgery isn’t right for everyone, and not all transgender or gender minority patients feel the need to undergo a surgical procedure to affirm their identities. If you are unsure, non-surgical procedures are a great option. Results from options like dermal fillers are not permanent, meaning that you can choose not to continue receiving injections or undergoing treatments if you decide that the procedures are not right for you.

Multidisciplinary Care for Transgender Patients

Coordinated care with multiple health professionals is key for patients who experience gender dysphoria. This includes care in areas including mental health, endocrinology, and more in addition to gender-affirming surgeries. Ideally, your healthcare team will work together to help you reach your best possible health and happiness.

While Dr. Deschamps-Braly offers facial feminization and facial masculinization surgeries, there are several other surgical procedures that patients may choose to undergo as they transition. These include “top surgery” to create a masculine chest or feminine breasts as well as “bottom surgeries” for genital reconstruction. These procedures are not available at the Deschamps-Braly Clinic; however, Dr. Deschamps-Braly can recommend surgeons or practices as needed.

Schedule a Consultation

Each facial feminization or facial masculinization surgery is unique to the patient. As such, Dr. Deschamps-Braly prioritizes a thorough in-person consultation to create a tailored surgical plan to achieve the best possible results. To schedule your consultation at the Deschamps-Braly Clinic in San Francisco, call our office at +1 (415) 877-6321.

Jawline contouring has become much more popular recently, especially in the wake of new non-surgical options and an expansion of our applications for filler and neuromodulators. More and more of our patients are wishing for a more defined jawline, a more prominent chin, or to improve the appearance of laxity or fullness along the jawline.

Most patients are familiar with surgical jaw contouring options, but less familiar with non-surgical treatments that can mimic, but not replace a surgical outcome. Non-surgical options, while not permanent, often give our patients an idea of what a surgical outcome could be for them and helps with a decision to pursue or not pursue surgery.

What are the Treatment Options?

There are several treatment options available depending on the aesthetic goal we discuss. For patients wanting a more contoured and chiseled jawline, adding a filler such as Restylane® Lyft will provide a broader jawline with a more prominent jaw angle. The use of microcannulas to place filler along the jawline and that angle of the jawline ensures a smooth and contoured appearance. Typically 1-2 filler appointments are needed to achieve the final contour desired.

Filler can also be used to improve the appearance of jawline laxity to create a more youthful appearing lower-face by reducing the appearance of marionette lines and improve the loss of volume around the mouth.

Some patients wish their jawline angle was less prominent. Botox® or Dysport® can reduce the bulk of the masseter (chewing muscle) muscle. Over time and several treatments, the muscle mass is reduced over time, creating a slimmer jaw angle. Because the masseter muscle is quite large and other muscles work as a team to facilitate chewing, there is no issue with eating or chewing after treatment. Botox® and Dysport® can also treat the appearance of a “pebble chin” by relaxing the mentalis muscle, causing the skin to remain smooth and undimpled.

How Can I Fix My Double Chin?

If you hate your “double chin,” Kybella® is an FDA-approved treatment to dissolve unwanted submental fat. It takes several treatments spaced 6-8 weeks apart so the downtime is minimal, and patients can return to most activities immediately. Over time, there is a noticeable reduction in submental fat and the appearance of a more toned and defined chin.

Schedule A Consultation

Non-surgical jaw contouring treatments typically require several sessions and sometimes different treatment combinations to achieve optimal correction and the desired aesthetic goal. It is very important to have a thorough consultation with your provider to ensure you both agree on the proposed treatment plan and timeline. It is also critical you have confidence that your provider has the skill and experience to provide a safe and effective treatment with minimal downtime and side effects.

How Computer-Aided Planning in Facial Feminization Surgery isn’t all that it is Touted to be: SHOULD PATIENTS RELY ON VIRTUAL SURGICAL PLANNING FOR FFS SURGERY?

A number of surgeons have begun to utilize virtual surgical planning, exact printed anatomical models, a Sonopet, and ultrasonic bone tools in Facial Feminization Surgery. Is it hype? Does it represent reliable outcomes? Should you trust it? 

During many of my consultations in the office, I am asked about various “new” technologies being used in facial feminization surgery.  Many new technologies are used as marketing tools by surgeons who wish to obtain more business in another niche area of medicine with only a few truly experienced surgeons in this field.  

Virtual Surgical Planning or computer-aided planning in surgery has been a very large advancement in craniofacial surgery.  However, it has very specific areas of efficacy – there are a few areas where it is extremely helpful, and other areas where it is almost a complete waste of the patient’s money. In fact, it can slow the operation down leading to increased cost and poorer outcomes for patients.  

AN EXPLANATION OF VIRTUAL SURGICAL PLANNING – UPSIDE/DOWNSIDE

Virtual Surgical Planning is a tool where you can simulate bone movements or procedures on a three-dimensional planning software.  This software was initially developed within the realm of craniomaxillofacial surgery for the use of orthognathic surgery.  Orthognathic surgery is essentially bite correction surgery.  The planning of these operations when I was initially trained involved taking models of the teeth, and then planning the operation on paper and performing “mock” surgery on models of the teeth.  You would then create surgical jigs out of acrylic or other light-activated curing materials in order to “calibrate” the surgery.  Precision was key.  The old way was quite accurate, however, it was very time-consuming.  Virtual surgical planning allows us to do the exact same thing, however, it occurs much more quickly and the precision is increased slightly.  The cost of materials and equipment is slightly higher because of the need for three-dimensional printers. This was a great use in craniomaxillofacial surgery.

There are other uses for this technology as well.  Virtual surgical planning is well used with patient-specific implants where a patient for instance has an asymmetry and needs an implant that will improve or restore symmetry.  This is something that cannot be done very well any other way.  This is most effective for a generally singular issue with many of the other factors of surgery constant. 

FFS is an extremely intricate surgery that has hundreds of consideration factors – often occurring during the procedure. For instance, many of the outcomes during facial feminization surgery cannot be precisely predicted based on exact bone movements.  What that means is that you may make a very precise change in the bone, but then you need to look at the patient and decide – based on the overall bony/tissue/muscle structure, symmetry, and patient’s goals – do you need to do more or less or make minor changes in the overall plan – and this needs to be done “on the spot”. Knowing that this is our reality – for the surgeon and our patient, it negates the time spent on “precision planning” via computer.  In addition, such planning for facial feminization surgery adds significant cost and expense to the operation without much if enough benefit; we feel we can do this planning with a perfect set of radiographic imaging and perfect measurements. That is one of the many reasons our consultations are so thorough as well as our resulting surgical planning. 

LET’S TALK MODELING 

Exact 3D anatomical models of patients are great props for use in the office while showing a patient their anatomy.  It is possible to create surgical “guides” from these models and these guides in theory tell you where to cut when doing surgery.  However, they are no more helpful to a surgeon in surgery than looking at those images on a computer screen and are not useful if the surgeon who is designing the guides doesn’t understand the skeletal characteristics of a feminine face.  

TOOLS ARE ONLY AS GOOD AS THE SURGEON USING THEM 

As for ultrasonic bone cutting tools, this technology is like all of the others; It has very occasional applications but is not a one size fits all solution for surgery of the facial bones.  Piezoelectric or ultrasound cutting bone tools are essentially similar to a basic surgical saw, only the amplitude of the oscillations are much smaller and the frequency is much higher.  They still create heat and still have the capacity to burn the bone which you are working on.  These tools do tend to be a little safer around the soft tissue, however, they are incredibly slow and dramatically increase the surgical time.  

The sonopet is a great tool for beginning surgeons who are not confident with their tools and or have less than good surgical technique.  One example of this is when I did a direct comparison of two genioplasties.  I did one genioplasty during an OR day with a traditional saw and timed how long it took to “cut the bone”.  I did another with the sonopet for a comparison.  The time it took to cut the bone with the traditional bone saw was about 45 seconds.  The time it took to cut the chin with the sonopet was about 12 minutes.  It was literally 16 times slower than the traditional saw, and there were burned areas of bone where the sonopet had created too much heat.

There are exceptions — the Sonopet is very good at cutting very thin bones in delicate places.   For example, when one is performing a le fort Osteotomy to move the “mid-face”.  There are often interferences of bone at the skull base where there are some very delicate blood vessels which if injured could cause life-threatening bleeding.  I have found great utility in these areas for the sonopet where other tools would be less ideal.  

CONCLUSION – ARE YOU CERTAIN? 

Every tool and technique has its place in the arsenal of a surgeon.  However, these tools should not be used as blanket marketing tools for inexperienced surgeons to draw patients into their practice and try and increase patient’s confidence in their surgery.  Patients do not always have the medical acumen to understand when they are being marketed too and some of these tools can detract from the actual skill of the surgeon. Be sure to ask the right questions, don’t be “dazzled” and ensure that your selected surgeon has the appropriate skills for your desired outcome.  Hopefully, this piece will shed some light on some of these current topics.

Extrinsic (external) and intrinsic (internal) factors contribute to skin aging. Extrinsic aging (photoaging) is caused by exposure to UV radiation, tobacco smoke, air pollutants, digital blue light, and other lifestyle choices. Intrinsic aging (chronologic aging) is influenced primarily by genetic factors. Between the ages of 25-30 years of age, collagen production begins to decrease by approximately 1% to 1.5% annually. Because of this, the skin thins and loses elasticity, leading to the appearance of fine lines, wrinkles, skin laxity, and discoloration.

While we can’t control our genetics, lasers and intense pulsed light (IPL) treatments can reverse the impact of sun exposure and lifestyle choices to boost collagen production, reduce the appearance of capillaries and brown spots, and improve skin texture and tone.

During an IPL treatment, specific parameters are chosen to target redness and pigmentation and stimulate new collagen production.  Multiple wavelengths in the visible light spectrum are emitted simultaneously, allowing a range of targets within the skin to be selectively heated and destroyed. Your body will naturally begin the healing process and results are fully realized in approximately six weeks.

Fractional lasers target a small portion of the skin leaving the untreated skin to rejuvenate and repair the treatment area. Many thousands of fractional microchannels are created in the skin to improve the appearance of fine lines and wrinkles, minimize pore size, and reduce the appearance of scars and stretch marks. Some downtime is to be expected, including mild redness and swelling and some light flaking after a few days. Typically a long weekend will be more than enough time to return to social activities.

Both IPL and fractional laser treatments can be performed alone. However, combining both therapies during the same treatment session compounds the results and provides a more comprehensive approach to improving the effects of extrinsic aging factors. Typically a series of 3-5 treatments spaced 3-4 weeks apart are necessary to achieve the best aesthetic outcome. Once a treatment series is complete, we recommend 1-2 treatments per year to maintain the3 results, as well as a medical grade skin care regimen.

We spend time choosing skin care products and treating lines, wrinkles, and sagging skin for our face to reverse the signs of aging. But what about our hands?

The skin and structures of the hand age in the same manner as the face. Over time, the fatty structures of the hands deflate, and the loss of tone in the intrinsic hand muscles can make veins, bones, and tendons more visible. The microscopic vasculature of the hands diminishes over time, and thinning of the skin over time can cause dryness and reduced elasticity. After the age of 50, bone density in the hands decreases by 0.72% per year (reference). Sun exposure can further damage collagen and connective tissues, further exposing the age of your hands.

I know what you’re thinking. Add it to the list….When you think about it, the hands are the most utilized part of your upper body. We use them during our waking hours for multiple tasks and functions. They deserve some attention too, would you agree?

Dermal fillers to the rescue! Adding volume to the hands can rejuvenate the hands, reversing signs of aging and add lost volume, and make the hands appear more youthful. We use Restylane® Lyft, the first FDA-approved filler to improve volume in the hands. Not only is the treatment quick and painless, but the results can also last for 9 months or more.

Restylane®Lyft is composed of hyaluronic acid, a compound found naturally in the body which holds water in our skin and provides lubrication to our joints. We produce and degrade hyaluronic acid daily in our body. The difference with hyaluronic acid fillers is that the molecules are bound together, or crosslinked, making it more difficult for the body to break down, allowing the filler to provide a longer-lasting result.

References:

https://academic.oup.com/biomedgerontology/article/58/2/M146/593573?login=true

One of the most common points of confusion I hear during consultations is patients trying to decipher between implants or fat grafting. This is especially true when they hear from another surgeon that cheek implants are necessary for feminization and/or that fat grafting “does not last”. 

The truth is: it depends. There is not a right answer that applies to every person’s face. There is not a sexual dimorphism basis for actually increasing the size of one’s cheeks as part of facial feminization surgery –  having larger or smaller cheeks is not inherently feminine or masculine. 

CHEEK IMPLANTS – THE GOOD AND THE BAD

Cheek implants have one main selling point:  they are very reliable in terms of affecting a shape. However, the shape and placement of those implants often is often imperfect and they  also have the drawback of having close to a 3% infection rate, if an implant gets infected then it is necessary to remove the implant.  If one implant is removed, it usually makes sense to remove both so that the patient does not have an awkward appearance.

Cheek implants also do not tend to affect the anterior and medial most portion of the cheek or malar region because of the location of the maxillary branch of the trigeminal nerve prevents practical placement of an implant in this region.  Therefore patients tend to be left with a bulbous or exaggerated appearance in the lateral part of their cheek while their under eyes appear more  hollow and the anterior part of the cheek remains under projected. 

Another issue in particular to trans women is that transfeminine patients have often lost a significant amount of weight as part of their transition, and implants in very thin patients often tend to look exaggerated and visible while lacking the finesse of other techniques.

MY CLINICAL APPROACH

My main application for facial implants on the cheeks in patients is when there is significant asymmetry. In that case I will create a custom made implant for that individual patient based on a 3D CT scan of their skull in order to provide for better symmetry. 

When there is not significant asymmetry, I will generally choose fat grafting. The other main benefit of fat grafting to the face is that you have a very versatile ability to sculpt the entire face in a way that you cannot do with facial implants.  You can easily add fat to areas such as the temple, the zygomatic arch area, the cheek, the under eye areas where people often have depressions or dark circles, and you can add volume to the nasolabial folds therefore adding youth to the face.  This versatility is not present with facial implants and is one of the main adaptive selling points of using fat transfer.

Surgeons who do not offer fat grafts or do not do them well will say that fat grafts do not live.  This is a deceptive statement. The “true” story is that not all of the fat that is injected survives the transfer and usually around ⅓ of the fat that is transferred does not live.  However, the remaining portion of the fat that survives is in fact permanent.  This has been well studied not only in the laboratory but in real world academic research and any statement to the contrary is simply false.

Therefore, my most frequent go to technique is using fat grafting with the exception of a few unusual circumstances. 

To be completely forward, I should say that fat grafts tend to not have quite as predictable an outcome as implants do, however, I feel that our patients have been extremely satisfied, and it provides the opportunity to go back and add some additional fat or touch up certain areas.  That type of finesse is not possible with facial implants.  Fat grafts avoid most of the risk of infection that an implant will often hold, it doesn’t have the same risk of injury to nerves in the face that facial implants do, and of course holds the possibility of improving skin quality. 

THE BEST WAY TO GET AN ANSWER FOR YOUR FACE

A thorough consultation, essential facial imaging, thoughtful planning, and precise measuring is the key to getting a stellar result. We encourage you to have this discussion with us if you have any lingering concerns about which technique is right for you. 

We are often asked to evaluate patients who have previously had orthognathic surgery and are unsatisfied with their results.  One would think that the most common problem after orthognathic surgery is an occlusion issue (the relationship of how the teeth fit).  The reality is that the real issue tends to be more subtle and complex – simply “I liked the way my face looked before”.  

The profile of a masucline vs feminine face is very different.  Not only in terms of vertical height but when viewed on profile in terms of the relationship between the nose, lips, and chin.  This relationship must be taken into account when performing orthognathic surgery in order to maintain a gender appropriate appearance of the face upon which surgery is being performed.

Surgical Techniques Often Solve One Problem – But Create Another Incidental Problem 

After seeing dozens of such patients, one of the most common things we see is that the chin is sometimes elongated, making the face (and especially the lower face) too tall regardless of whether the maxilla was impacted or not. This is often because of the rotation of the two jaws.

Another common issue we often see is that as the occlusal plane has been flattened, the chin has overly rotated and become excessively prominent for femine proportions.  These two surgical techniques may lead to a masculine appearing chin and or lower face. Ultimately, this  may be hard for patients to describe to a surgeon without exceptional clinical knowledge – they just see the result in the mirror. 

Another commonly noted thing among patients: when advancements of the mandible are larger, the corners of the jaw may appear unusually narrow and patients may lose definition of the jaw line.  This often leads to people feeling that they have an aged appearance and that their neck and jaw are not as beautiful as they once were prior to having surgery.

What Are My Options? 

Depending on your exact previous surgical plan, there are a few options to bring back a more feminine appearance. Don’t fret: treatment rarely ever consists of completely redoing the orthognathic procedure.  Although this may be occasionally necessary, it is usually possible to improve the situation with less drastic measures.  

It is often possible to perform a feminization of the chin, by shortening the height of the chin using very precise osteotomies (bone cuts) as well as a reduction to reposition the chin into a shorter space.  In addition, it may be necessary to reposition the chin either forwards or sometimes slightly backwards in order to correct the position of the chin.  

If the issue is loss of definition along the jawline, then a jaw contouring operation along with placing implants along the border and angle of the jaw can restore a more natural and harmonious appearance.  The implants needed in this area often are surprisingly conservative.  We have worked on a number of patients in whom we have placed implants and have learned that there is a very fine balance between placing an implant that is too large in this area and leading to a masculine appearance and of that of a patient having bruxism.  Therefore we usually recommend very conservitive sized implants to correct this situation.  The implants must be placed with finesse and often contoured to make sure that the implant edges sit flush with the bone so that the edges of the implant are not palpable and/or visible.

What Is My Next Step? 

It’s always advisable to schedule a consultation with your surgeon as the possible scope of what may be needed is more complex than can be addressed in a short summary.  Your surgeon should be able to give you suggestions as to what the problem is and what may be done about.  Rarely is redoing the entire orthognathic operation the solution to these problems, because an acute understanding of the differences between masculine and feminine facial morphology and features is critical, be sure to select surgeons who specialize in Craniomaxillofacial surgery, have proven results you can see, as well as understand the minute details of facial proportion and balance.