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  • How long is the wait for surgery? Why are you not seeing any new patients?
    Waiting times for surgery after consultation vary depending on the procedures being carried out. In general this is 6-12 months. The waiting list for new FFS consultations is temporarily closed due to high levels of demand and limited capacity for surgery. Mr Maini is still seeing patients from the waiting list and committed to continuing to provide facial feminisation surgery in Brighton, UK. It would not be fair to see you for a consultation without being able to offer a date for surgery in a reasonable time.
  • What happens during the initial consultation?
    Mr Maini will discuss your facial features with you, gaining an understanding of what areas cause the greatest dysphoria. You will be asked about your medical history, and about the history of your transition. Mr Maini will assess your face, and discuss procedures, including the benefits and risks of surgery. You will have a chance to ask questions, and you will receive a letter afterwards to summarise the meeting. You will get most out of a face to face consultation but if this is not possible, online video consultations are offered.
  • Do I have to come for a face to face consultation in Brighton?
    No, if you prefer, you can have a video consultation. It is preferable to have a face to face consultation to get the greatest benefit though. Photographs and webcams can be misleading. They can distort the face, and the true three dimensional shape of the face can only really be seen in person. The cost of the consultation is £250
  • Can I see some before and after photographs?
    Yes, you can see some photographs during consultation. Mr Maini does not ask patients' permission to publish photographs online or send them out in emails. He does have permission to show photographs during a consultation.
  • Why do you practise in Nuffield Brighton Hospital?
    Mr Maini only performs private facial feminisation surgery at Nuffield Health Brighton Hospital because of the team and the facilities available. The hospital has a long history of supporting patients with treatment for gender dysphoria. The nursing staff have looked after patients following facial feminisation surgery many times before. The operating theatre staff are familiar with the surgery, and all necessary specialist maxillofacial equipment is available. Nuffield Brighton has three fully equipped operating theatres, 35 patient rooms with en-suite facilities, and 24 hour on site medical and nursing cover. For major facial feminisation surgery, this level of support is essential.
  • Do I need a scan?
    For forehead surgery, 3D imaging is absolutely essential. We often use cone beam CT scanning as this gives excellent quality images with reduced radiation compared to a conventional CT scan. For surgery to the lower jaw, either an x-ray or a cone beam CT scan is needed. If you decide to proceed with surgery, we can organise these scans for you with the team at Medical Imaging Partnership in East Grinstead. The cost of scans and x-rays is not included in the quote for surgery. Please ask the scanning provider for their up to date fee when you book your scan.
  • What is the cost of surgery?
    Until May 2023 there was a fee estimate calculator available. Nuffield Health finance department have informed us that they intend to restructure their fees, so for now, this calculator has been removed to update it. Please bear with us, and hopefully it will be back online soon.
  • I am travelling from a distance, can I come the day before surgery?
    If you have a long journey, you should arrange to come to Brighton the day before your operation and stay locally overnight. After your stay in hospital for nursing care after FFS, it is a good idea to stay in the local area until your first follow up appointment which is around a week after surgery.
  • Do I need to stop my HRT?
    No, stopping hormone replacement therapy is not usually required around the time of facial feminisation surgery.
  • What forehead reconstruction technique do you offer?
    Changes to the forehead are usually among the most important parts of gender confirmation surgery. The aim is to reduce the prominence in the brow bone, above the eyes, and re-contour the edge of the eye socket (orbital shaving). Mr Maini offers both type 1 and type 3 forehead reconstruction, depending on how your forehead is made up, seen on a CT scan. Type 3 reconstruction involves not only shaving bone but also repositioning the plate of bone that lies over the air sinus in most people's foreheads. Type 3 forehead reconstruction was pioneered by Dr Douglas Ousterhout in San Francisco, who like Mr Maini, is a facial surgeon qualified in both medicine and dentistry. In the UK, very few surgeons offer this technique.
  • Where is the incision for forehead surgery made?
    The incision can be made in one of two locations: An irregular tricophytic hairline incision if the hairline needs to be lowered. A coronal incision, behind the hairline if hairline lowering is not needed.
  • What sort of tracheal shave technique do you use?
    The incision is placed higher up in the neck where the lower jaw meets the neck, in a skin crease if possible. The structures overlying the Adam's apple are separated. The cartilage is then carefully shaved or reduced in size to create a flatter and smoother appearance. The procedure is performed under general anesthesia, and stitches are used to close the incision. An incision is not made directly over the prominence because although this makes the surgery easier, this can leave an obvious scar in a prominent place.
  • How do you reshape the lower jaw?
    Mr Maini uses sliding genioplasty to reshape the chin. With this technique, it is possible to reduce the horizontal width and the vertical height of the chin, by removing sections of bone, then using small miniplates to join the pieces together in their new shape. Reducing the angle of the jaw involves refining excessive squareness or angularity by removing prominent areas of bone. For some patients, virtual surgical planning is useful and Mr Maini has access to this technology as well as 3D printing of custom surgical guides. Risks: There is some discomfort, bruising and swelling which temporary. With chin surgery, the nerves supplying the lower lip and chin with feeling are carefully protected, but these areas are commonly temporarily numb after surgery. Permanent altered sensation is very rare indeed. Infection is uncommon, as is the need to remove the miniplates in the future.
  • Do you do rhinoplasty surgery?
    Yes, Mr Maini offers rhinoplasty surgery to reduce a dorsal hump. This is the prominence over the front of the nose. This is done by reshaping the bone and cartilage that makes up the internal structure of the nose to reduce the hump and refine the width of that part of the nose. If other issues need to be addressed, such as difficulty with breathing, or work to make significant changes to the tip of the nose, this is something that Mr Maini does not offer.
  • Do you do skin tightening procedures?
    Mr Maini does not perform face or neck lifts, he focuses on facial feminisation procedures.
  • Do I need to stop smoking? What about vaping?
    Yes, it is absolutely necessary to stop smoking and the use of all nicotine containing products including vapes for 2 months before surgery and for 4 months afterwards. This is to reduce the risk of healing problems and complications.
  • What are the COVID-19 rules?
    Current information can be found here: We're keeping our hospitals safe for you | Nuffield Health
  • Why do you ask for a diagnosis of gender dysphoria?
    Facial feminisation surgery is medically necessary (not cosmetic) surgery to treat gender dysphoria. Cosmetic surgery is subject to VAT, whereas medically necessary surgery is VAT exempt. Nuffield Health require this.
  • Can you make me look like someone else? Can I bring a picture?
    The aim of facial feminisation surgery is to soften and modify masculine features from your face. The aim is not to make you look like someone else, rather a more feminine version of yourself.
  • I have read that FFS surgeons in the UK are not as good as those abroad. Is this true?
    Please do not believe all you read on forums. Mr Maini has made considerable effort to ensure his training in craniomaxillofacial/facial plastic surgery has prepared him for the surgery that he undertakes. He spent years working with his mentor and predecessor and has subsequently adapted as the evidence and techniques for FFS have evolved. He performs FFS using the same techniques as surgeons in Europe and the USA for example type 3 forehead reconstruction. He uses virtual surgical planning and 3D printing technology where this is needed.
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