FPSAM - Roundtable 2022 - 12

forget my touch up of Botox. We all have to accept that
this is the norm of cis women and transwomen alike.
Men of any gender do that as well. It's something that
some don't disclose but it should be less transparent so
that transwomen see it as a norm.
Dr. Spiegel: Dr. Alperovich?
Dr. Alperovich: Iagree with allofthe previous comments.
I do agree that soft tissue for the lower third
should be following any type of jaw work. The thing
that I would just like to add is the power of fat grafting,
just like any facial rejuvenation, whether a cis woman
getting a facelift. I think just the power of redistributing
fat and repositioning fat, if they do not have enough,
benefit from the secondary sexual characteristics from
HRT, I think it has a profound effect. In many ways it
can help kind ofget you over that hurdle ofgetting them
a little bit more of a softer facial appearance.
Dr. Spiegel: Thank you everybody. I will put in my
two cents also. I'll do voice feminization with Adam's
apple reduction, although not with any other
substantial surgeries. I think it's an unfair burden
on a person to expect them to be recovering from
facial surgery with the inability to speak for a
couple of weeks. I think that is too much perioperatively,
even if they think they can do it. We will
do breast augmentation with facial surgery. We
have the breast augmentation done as the very first
thing. We have not had any problems with that.
We'll do hair grafting in the same week, but I'm
not doing it intraoperatively. I think it's not reasonable
to have a person be in the OR that long.
Also, youmust get the hair from the back ifyouwant
the right hair: hair from the top of the head, which
you can access, of course, if there is a hormone
break, it is my opinion that hair is not going to last
enough to be a good idea. Then importantly, what
everyone said about all these other things. My experience
in working with people and thinking about
this is that it appears that it is hard to look feminine.
Looking feminine is a difficult thing and once you
have had facial feminization surgery, or gender
conforming surgery, you do not have some special
pass for the rest of your life. You get the same opportunities
everybody else has to try and maintain
things and look good. It's not a lifelong solution. In
fact, there is such a problem with this belief in the
community that we've used, for the past many
years, a special consent form for facial feminization
surgery that states the patient understands that this
surgery is going to give a baseline improvement,
but it does not guarantee that they are going to be
gendered correctly at all times.
It does not guarantee that they have nothing else
to do for the rest of their life. It does not mean that
they are going to necessarily feel better about how
they look. It just means that they have had these
procedures done and it opens a conversation because
what we are doing can make people look very,
very feminine in two dimensions. As Dr. Schechter
said, when people start speaking, walking, moving,
sitting, and interacting, it can undo everything. So
that has been a helpful addition for us.
Well, thank you to Mary Ann Liebert, Inc., and
Facial Plastic Surgery & Aesthetic Medicine for
putting this together. Thank you to Depuy Synthes
for sponsoring this and giving us a chance to speak
together. Personally, I found this to be both enjoyable
and educational. Thank you to all our
panelists for getting up early and dedicating the
time to this today, and I hope we have a chance to do
this again in another interval of time, and see how
things have all improved and progressed.
Open conversations such as these are critical for
improving patient outcomes, and for helping physicians
to understand that we all share the same
frustrations and challenges as we strive to provide
the best care for our patients.
Author Disclosure Statement
Dr. Loren Schechter receives royalties from books
(Elsevier and Springer) and receives payment for expertise
in federal lawsuits regarding the denial ofgender
affirming medical and surgical services. Dr. Schechter
is also the Treasurer of WPATH. For all other participants,
no competing financial interests exist.
ยช 2022 American Academy of Facial Plastic and Reconstructive Surgery, Inc.

FPSAM - Roundtable 2022

Table of Contents for the Digital Edition of FPSAM - Roundtable 2022

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