Sent: Tuesday, June 06, 2006
Subject: RE: Request for pricing, services

Sophie,

Thank you again for the quick response, sorry to hear the many problems you have had; hope they are worked out now and you are caught up.

After reading and digesting your evaluation of what my needs are, I have come to some decisions as well as some questions and wonder if you might be able to help me in these regards?

First, these surgeries are very important to me for many reasons-body image, self-esteem, to help me be more successful as a woman and so much more but also I am investing every last dollar into this and need to spend very wisely. So in that regard, I have decided to forgo the brow-lift, forehead re-contouring and blepharoplasty from the upper surgical procedures as well as the lip lift from the lower region surgical procedures.

This brings me to my first question. The scalp advance that would be done:

Would that not allow my own hairs to grow in eventually?

Do I need the hair transplant part of the procedure?

My hair grows very fast, even my front. I wore wigs very often and for very long periods while living full –time at first and nearly strangled all my natural hair, especially the front bangs but once I stopped wearing these wigs, my natural hair grew back in full rather rapidly.

Wouldn’t the same thing happen and negate the need for any transplants and all the potential loss, trauma and so on?

What would I look like right away from scars left by the scalp advance procedure if the Dr. knew I was going to grow my own hair, if this were the case?

Again, money is a big issue here, sorry to say. If I have unusual capabilities and blessings, why not take advantage of them, right?

My breasts for example, are real from hormones and are still growing after 3 years on hormones. I just grew another ½ inch in the last couple of weeks and I’m losing weight.

I was already a 36B. I can also still get up and maintain an erection at will as well. My endocrinologist has never seen anyone like me before and he treats 99% of all the Transsexuals in the greater area of a million people!

One other thing you should know is that I am a professional makeup artist and I know how to use makeup up most effectively including highlight and contour. I can do a lot with makeup, making myself very pretty but that can only go so far with bones structure. I also know women very well having done so many of them over the years. I have many features better than many of them, I know. I am not looking for absolute perfection, though I am a perfectionist. I just want to pass better than I do now, more often anyway. My voice is 100% passable. I want my face to come much closer to that.

I don’t want to do much with my eyes, they are fine, and my best feature, as they are. Women and relationships love me as I am but I want to succeed in the world. My brow bone and hairline along w/ my Adams’ Apple are my priority. Anything else within reason is gravy and would be nice but money is a limited commodity.

My problem is that no one will hire, hence these procedures. I live in a very conservative area because my two daughters live here. I hope you can do what you can, money-wise and surgically to help me become all the woman I can be.

Thank you so very much,

Dear Jenelle, 

I apologize for the delay in getting back to you which has been cause by a series of electrical and telecommunications failures at my office, which has delayed my ability to respond in a timely manner, as well as building up a backlog of mail which I am now able to clear. Thank you for your patience in waiting.

Your FFS Assessment 

I am pleased to be able to send you the completed FFS Assessment that you requested.

Your FFS Assessment From Dr Suporn's Clinic

INTRODUCTION

Thank you very much for submitting your photographs for a Feminizing Facial Surgery assessment by Dr Suporn. I am sorry it has taken so long to get back to you. It is quite often difficult to find time to schedule with Dr Suporn outside his surgery, and the assessment itself takes some while to compile on an individual basis. Thank you for your patience. I can assure you that now the assessment has been completed, all other correspondence will be answered in a much more timely fashion. 

Your Photographs 

Your photographs were mostly very good, thank you, and this has made our assessment task easier. 

The Assessment Procedure

Dr Suporn has studied the photographs in detail, and his considered opinion is completely reflected in this assessment. He adopts a very artistic approach to his assessments, preferring to rely on his artistic background to find a good balance and harmony of 'feminine', rather than rely solely on mathematically derived proportions. That said, the objective of FFS is to bring your head and face as closely as possible to normal female proportions as can realistically be achieved through surgery.

Apart from proportion, Dr Suporn's emphasis is on achieving regularity (smoothness) of facial features, and facial symmetry.

He does not offer to achieve "beauty" for any patient; definition of beauty is an individualistic definition, and every person's definition of it will be different. 'Beauty' can also tend to be very much determined by fashion; features sought because they are considered 'beautiful' today, may become unfashionable tomorrow. However, he strives to achieve the most feminine result he can, which - in a great number of cases - have, indeed, been considered to be 'beautiful', irrespective of fashion.

Dr Suporn's assessment looks at 4 basic areas. The first is gained from a first-impression of the overall look, proportions and aesthetics of the face. After that, he considers the face in 3 broadly divided areas - the upper-, mid- and lower-face. Dr Suporn prefers to integrate work in each area as one complete group of procedures, rather than 'picking and mixing' small procedures in individual areas. However, he is always sure to only recommend those procedures he considers necessary or beneficial. Where he has considered a procedure to be unnecessary, he will not have recommended it.

The assessment is done by a small team at the Clinic, headed of course by Dr Suporn. Each member of the team has considerable FFS experience. We take this approach to get the best and most balanced set of opinions we can offer you in terms of aesthetics, while Dr Suporn additionally provides all the essential advice on what can best be achieved surgically. Where in this assessment, the word 'we' is used, it is emphasized that the assessment completely reflects Dr Suporn's considered surgical and aesthetic opinion. Moreover, where you have submitted your own views concerning aesthetic desires, preferences and concerns, those have taken those into account.

Thank you very much for your own comments regarding how you feel about your facial features. Dr Suporn prefers very much to work in close liaison with his patients, and tries at all times to include changes and features that the patient wants, rather than the patient relying  on Dr Suporn's judgment and opinion alone. That way he feels the result is the most likely to be satisfying and pleasing to the patient.

Overall your facial features already present an extremely female appearance, so any recommendations would be based more on a desire to improve femininity, rather than to "be feminized"

UPPER FACE REGION

Scalp Advance

In general your hair appears to be thick and full, and appears to be very much within the norms for a female.

Your hair line is showing some evidence of recession - particularly at the temples.

Your hair line is higher than would normally be found in a natal female, and more in proportion with a typical male hair line. While many natal females enjoy a hair line exposing as much forehead as yourself, we believe you would show a better and more female appearance by bringing the whole hairline forwards.

The need for a scalp advance would be indicated based on the height of your hair line

Based on the evidence in your photographs a scalp advance is indicated to bring forward the hair by some 2-3 cm at the front, and proportionally further forward in the temporal region to define a more typically curved female hair line.

Forehead Recontouring

Your forehead shows only slight evidence of bossing. The amount displayed would not be at all unusual in a natal female though for preference many of our patients prefer to have it removed entirely as far as is possible. This is a matter for personal preference.

Supraorbital Rims

Your supraorbital rims show some slight evidence of bossing, or overhang, which is acceptably within female norms. However, you might wish to have it removed to open up your eyes a little more.

Recommendation

The need for forehead recontouring is indicated to re-profile your forehead and supraorbital rims and remove the evident bossing, resulting in a more pleasingly feminine appearance.

The amount of bossing you display as a characteristic can be almost eliminated to create a flowing profile which will run smoothly into your upper nose area, as is more typically found in a female than in a male. In addition, removal of the bossing around the supraorbital rims will 'open up' the eyes somewhat. 

Dr Suporn uses 3 degrees of surgical procedure to remove this bossing. It is possible in your case that he will be able to remove the bossing by shaving, but it is more likely in your case that he will need to perform either a technique known as 'resetting' which was pioneered by Dr Suporn. It is not likely that Dr Suporn will need to adopt the final technique - a reconstructive forehead surgery - in your case.

He is confident in your case that he can remove all evidence of the bossing you currently display, and leave an extremely female and pleasing shape to your forehead and supraorbital rims.

Your forehead appears to be smooth and free of any vertical frown lines that might need attention.

As far as we can see from your photographs, your forehead shows no sign of any horizontal frown lines.

Brows

The ideal position for the eyebrows is to be positioned a little above the supraorbital rims, and lifted a little higher at the outer third than in the inner two thirds.

Your eye brows appear to be on or below your supraorbital rim, and run in a fairly flat shape following the contour of the supraorbital rims.

Your eyebrows are already well shaped, and angled up a little at the outer edges, opening the eyes somewhat. 

Your eyebrows are nicely symmetrical.

We suggest you undergo a brow lift. This will open up your eyes, and give your mid and upper face a much more pleasingly feminine appearance.

To enhance the typically female 'open eye' appearance that will be created by removal of orbital rim bossing, we would recommend a lift of the eye brows by some 5-8 mm evenly across their length to bring them superior (above) the new supraorbital ridge.

Upper Eye Lid

Removal of the orbital rims tends to increase the effect of 'bagginess' around the upper eye-lids and to considerably open up the eyes to give them a youthful appearance. Dr Suporn normally removes this by performing an upper blepharoplasty (UB) during the same upper face procedure.  In your own case there is already some evidence from the photographs that you would benefit from a UB, and we recommend undertaking the procedure.

Incision Line Hair Transplants

The incision for the upper face procedures will be made just forward of the existing hair line. 

The incision line after surgery will be covered by hair transplants donated from your pre-surgery temporal region, to ensure as much as is surgically possible to give a natural hair line, and to cover any possible visibility of the scar line. Dr Suporn will transplant between 300 and 800 follicular units as necessary. Because the transplants will be deposited in an area having just undergone surgical trauma, you should be aware that the attrition rate of the follicular units is higher than would be experienced during a 'hair transplant only' surgery. The survival rate of the transplanted units is in the order of 70-80%.

MID FACE REGION

Nose (Rhinoplasty)

Overall your nose is already pleasingly shaped , well in proportion to the rest of your face, and is feminine in appearance; it does not appear to be in need of any revision. Naturally that is a matter of personal preference. However, we do not make any specific recommendation to alter the shape of your nose.

You would benefit from an Upper Lip Lift (ULL) to decrease the distance between the nose and your upper lip. This procedure is normally carried out in conjunction with the recommended rhinoplasty, and is effected from a small incision made immediately beneath your nose, which will subjectively disappear a few weeks after surgery.

The lift will expose your upper teeth a little when you smile, giving a more pleasingly feminine and juvenile appearance. Additionally, it will have the effect of slightly opening up the upper lip, and making it appear a little less thin.

Mid Face - Summary 

From the foregoing observations, the following procedures are recommended in the mid-face area:

Upper Lip Lift

LOWER FACE REGION

The lower region of your face (jaw and chin) are already acceptably feminine in appearance and proportion, and we do not recommend surgical alteration at this stage, unless you feel there are any aspects with which you feel particularly unhappy. Dr Suporn would be most happy discuss any points of detail or concern during a personal consultation.

Lips

Your upper lip is a pleasing feminine shape and size, and requires no alteration.

Your lower lip is perfectly proportional, and requires no surgical alteration.

The shape of your lips is acceptably feminine already. The upper lip precedes the lower lip and in profile is angular, relative to the frontal facial plane. The lower lip is fuller than the upper. The upper lip would benefit from a little more fullness, and this will be introduced by the recommended lip-lift (above).

We do not recommend any surgical alteration or enhancement of your lips.

Thyroid Cartilage Reduction

Your "Adam's Apple" or thyroid cartilage is quite prominent, and this is often taken by observers as the most typically noticed of all male facial characteristics.

We recommend a Thyroid Cartilage Reduction (TCR) to remove this almost completely. The exact amount that can be removed cannot be determined until final examination.

PRICE QUOTATION

To perform the surgical procedures recommended, I can offer you the following prices:

Upper Face Region

Upper Face Region Procedures A

Scalp Reduction

Hair transplants to cover the incision line and immediate area behind as necessary

Forehead Lift

Forehead Reconstruction (Procedure III), or

Forehead Contouring/Resetting (Procedure I & II)

Upper Blepharoplasty (UB)

Price - 495,000 Baht or $12,968.30 USD

Upper Lip Lift (ULL)

Upper Lip Lift

Price - 50,000 Baht or $1,309.92 USD

TCR

Thyroid Cartilage Reduction (Procedure I & II) (TCR)

Price - 60,000 Baht or $1,571.91 USD

Total

Our total suggested quotation price is therefore 605, 000 Baht

The above prices include all surgical, medical, hospital and support expenses arising from the surgical operation throughout your stay in Thailand, except for hotel accommodation and food outside hospital. For budgetary consideration, The Mercure hotel room rate is 1320 Baht per night including full breakfast.  In addition, where patients arrive in Thailand with a prior medical condition for which they are taking specific prescribed medication, the cost of continuing treatment of that pre-condition is not included.

For a comprehensive breakdown of what we include in our surgery price, and the service we provide, may I recommend you  visit our web site at http://www.supornclinic.com , and navigate to the page >Support >Commitment . We are confident you will find the overall service we offer for these surgeries to be more comprehensive than is available from any other surgery, anywhere.

IN SUMMARY

Please remember that this assessment is not definitive - it is a suggestion.

If you wish to amplify any of the remarks that have been made, or put more or less emphasis on any of the recommended procedures, be sure to tell us what you would like to be changed.

The more input Dr Suporn has from you, the better the prognosis for an outcome that will satisfy you.

We hope that you find the assessment to be useful, and that it will enable you to choose surgery with Dr Suporn.

Please contact me at ffsassessment@supornclinic.com, or admin@supornclinic.com as soon as you are ready to move to the next stage towards scheduling your FFS surgery with Dr Suporn, and I will help guide you through that process.

I hope you find the assessment to be useful and acceptable, and I look forward to hearing from you again soon.

Best Wishes

Sophie

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From: Jenelle Rose
Sent: 06 June 2006 05:58
Subject: update, followup_jenelle rose

Hi Sophie,

Just thought I’d give you an update of what has transpired since I last heard from you and you said I would be hearing from you in the next “few days”.

I have joined the Dr. S message group, moved up my July 26th appt with my endocrinologist to June 12 and made it a pre-op appointment; I am in process with AAA here to negotiate the best rate fare for my flight to and from the Bangkok airport. --- I am assuming leaving Ohio on August 14th would leave me 2 days stay before the operation?

I then would make the return flight with as short a time as possible with as much room as possible for my legs. I will be arriving with my girlfriend. We have both had to order certified copies of our birth certificates to get our passports which we will obtain from the post office here who inform us that it will take about 6 to 8 weeks to receive but we can expedite that, if need be.

I am wondering if you are waiting for my deposit on the SRS part of the surgery. I was thinking you were going to price my FFS and then we would negotiate that and my deposit would be sent at that time, once a total was determined.

Please advise.

Thank you,

Jenelle Rose  

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From: Jenelle Rose
Sent: 30 May 2006 08:20
Subject: RE: Request for pricing, services

Sophie,

Thank you so much for your quick response to my email in regards to my questions on SRS and FFS. I really appreciate it. I didn’t expect such a quick reply and am so eager the new chapter in my life to begin.

Below you will find the answers to the survey/questionnaire you sent and I will be working on such things as the passport, airline reservations, and documentation from my doctors in the next few days.

I am attaching pictures in JPG format as you requested with this email for the FFS assessment and will be awaiting word from DR. Suporn as to what he thinks is needed for my facial feminization. I believe I am very close, having had work done such as Maylar cheek implants, Blepharoplasty (upper eye), Rhinoplasty and a lower face lift, all at the end of 2004.

Thank you again for your swift response,

Jenelle Rose