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Informed Consent and Surgical Risks

Understanding the Risks: A Guide to Aesthetic Craniofacial & Orthognathic Surgery

Aesthetic craniofacial surgery and orthognathic (jaw) surgery are profoundly transformative procedures, offering life-changing structural enhancements and crucial steps in journeys like facial feminization. However, taking the step to alter your facial skeleton is a major medical decision that requires entering the operating room with your eyes wide open.

At the foundation of informed consent is a simple truth: Any type of surgery carries risk. Here is what you need to know about the potential complications of aesthetic craniofacial surgery, and why choosing the right surgeon is the single most important decision you will make.

The Reality of Craniofacial Surgery Risks

Aesthetic craniofacial surgery is highly invasive. Because the surgical field involves the complex structures of the skull, jaw, and intricate nerve networks, a spectrum of complications exists, ranging from minor cosmetic concerns to severe medical emergencies.

While patients often fear catastrophic injuries the most, the most common overall complication is simply an unhappy aesthetic or cosmetic outcome, occurring in approximately 1% of cases in our practice. This may require minor surgical revisions to achieve the desired look. Bleeding issues and localized infections are the next most common concerns.

Beyond general surgical risks, the specific complications vary depending on whether you are undergoing Facial Plastic Surgery, Aesthetic Craniofacial Surgery, Facial Feminization Surgery or Orthognathic Surgery.

Risks Specific to Facelift Surgery

Often performed alongside FFS or as a standalone rejuvenating procedure, a facelift (rhytidectomy) involves lifting and repositioning the skin and underlying facial muscles (SMAS). Because it relies on delicate soft-tissue manipulation over the facial nerve network, it carries its own set of risks:

  • Hematoma: This is the most common complication in facelift surgery. It involves blood pooling under the skin and typically requires prompt surgical drainage to prevent further healing issues.

  • Nerve Injury: There is a risk of injury to the branches of the facial nerve (motor nerves), which can lead to temporary or, in very rare cases, permanent facial asymmetry or muscle weakness. Sensory nerve damage (such as to the great auricular nerve) can cause temporary or permanent numbness around the ears or cheeks.

  • Skin Necrosis & Poor Healing: Poor blood supply can lead to skin loss (necrosis), particularly around the incisions behind the ears. This risk is dramatically higher in patients who smoke.

  • Scarring & Hair Loss: While incisions are carefully hidden, some patients may develop thickened, visible scars or experience localized hair loss (alopecia) along the incision lines in the hairline.

  • Aesthetic Dissatisfaction: As with all cosmetic procedures, there is a risk of asymmetry, over-correction, or under-correction requiring revision.

Risks Specific to Facial Feminization Surgery (FFS)

Facial Feminization Surgery involves a complex array of procedures to soften and feminize masculine facial features. According to a systematic review published in the Plastic and Reconstructive Surgery Global Open journal (PMC8929523), the overall complication rate for FFS is notably low at just 5.4%.

When complications do occur in FFS, the clinical literature notes the following specific risks:

  • Wound Complications: Delayed wound healing or incision dehiscence (separation) is the most common issue, occurring in about 5.1% of cases.

  • Infection: Major wound infections occur in approximately 2.6% of patients.

  • Ophthalmic & Nasal Issues: Because FFS often involves the forehead, brow, and nose, risks include minor ophthalmic (eye) injuries (2.5%) and epistaxis/nosebleeds (2.1%).

  • Bleeding & Clots: Hematomas (blood pooling) occur in 1.3% of cases, while Deep Vein Thrombosis (DVT) or Pulmonary Embolisms (PE) occur in 1.6%.

  • Rare Structural Injuries: In highly complex cases involving forehead cranioplasty, there is a very rare risk (0.2%) of a cerebrospinal fluid (CSF) leak due to the proximity to the brain.

Risks Specific to Orthognathic (Jaw) Surgery

Orthognathic surgery aims to correct conditions of the jaw and lower face. Because it involves cutting and repositioning the jawbones (osteotomies), the complication profile is distinctly functional. According to research published in the Journal of the Korean Association of Oral and Maxillofacial Surgeons (PMC5342970), orthognathic complications heavily involve nerve and joint function.

Known risks of orthognathic surgery include:

  • Nerve Injury & Numbness: Damage or stretching of the inferior alveolar nerve is highly common, leading to temporary or permanent numbness/paresthesia in the lower lip, chin, and jaw. Some studies note nerve injury rates as high as 50%, though most sensory issues are temporary. Motor nerve injury (facial nerve) is much rarer (approx. 0.29%).

  • Bone Splitting Complications: During the division of the jaw bone (such as a sagittal split osteotomy), unpredictable fractures can occur, known as “bad splits” or buccal plate fractures.  This has been reported to range from 2 to 10% of cases in the medical literature.

  • Relapse & Bite Issues: The jaw can sometimes relapse or shift back toward its original position as muscles and tissues heal. This can lead to malocclusion (a misaligned bite) or create a post-surgical open bite.

  • Temporomandibular Disorders (TMD): Jaw joint issues can develop post-operatively in up to 14% of patients.

  • Hemorrhage: Due to the major facial arteries surrounding the jaws, severe intraoperative or post-operative bleeding occurs in up to 9% of cases.

  • Standard Surgical Risks: Adverse reactions to anesthesia, airway obstruction, and, in extreme cases, death can occur, though these catastrophic events are exceedingly rare.

No Guarantees in Surgery

While meticulous surgical planning, advanced imaging, and extensive surgeon experience dramatically increase the likelihood of a successful and beautiful outcome, it is crucial to understand that medicine is an inexact science.

Because every patient’s anatomy, healing process, and biological response are entirely unique, no absolute guarantees can be made regarding surgical or aesthetic outcomes. A reputable, ethical surgeon will always prioritize your safety and aesthetic goals, but cannot promise a “perfect” result. Understanding and accepting this reality is a vital part of your preoperative journey.

The Antidote to Risk: Surgeon Experience

“Complication rates have a direct correlation with surgeon experience, along with how often they perform a specific surgery.”

While the list of risks is serious, there is a vital caveat: when performed by a highly experienced surgeon, major complications are EXTREMELY rare.

Aesthetic craniofacial surgery and Facial Feminization Surgery are not commonly performed procedures in the broader landscape of plastic surgery. In fact, there are very few true experts in the world. The complexity of moving bone and navigating facial nerves requires a hyper-specialized skill set that is only honed through continuous, high-volume practice

Spotlight on Expertise: Dr. Keojampa

As one of the few experts globally in Facial Feminization Surgery and craniomaxillofacial procedures, Dr. Keojampa provides a unique perspective in understanding feminine and masculine facial characteristics.

His extensive training and immense daily experience ensure the highest margins of safety, even with the most complex craniomaxillofacial, plastic, and cosmetic procedures, yielding superior, natural-looking results.

Dr. Keojampa is currently one of the busiest facial feminization and craniomaxillofacial surgeons in the world. His high-volume expertise includes performing an average of three full feminization surgeries weekly, alongside a regular schedule of:

  • Rhinoplasty

  • Sliding Genioplasty

  • Facelifts

  • Aesthetic Orthognathic Surgery (Double Jaw Surgery)

When you are altering the very framework of your face, experience is not just a luxury—it is an absolute necessity for your safety and your results.

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After Surgery Care

Post-Surgical Concierge Care


At Keojampa MD Facial Plastic Surgery, we understand that exceptional surgical outcomes are deeply intertwined with a seamless, comfortable recovery. That’s why we offer an exclusive, concierge-level post-operative care experience tailored to meet the unique needs of each patient. Our curated recovery packages are designed to elevate your healing journey—offering peace of mind, personalized attention, and uncompromising support every step of the way.

From the moment your procedure concludes, our mission is to ensure that you feel cared for, confident, and completely at ease. Whether you’re preparing for aesthetic craniofacial surgery, facial feminization surgery or another advanced facial procedure, our team is here to make your recovery as smooth and luxurious as your transformation.

Please review our elevated care package offerings below. Early booking is highly recommended to ensure availability.

Overnight Concierge Care —

Dedicated Overnight After-Surgery Caregiver

(Required for procedures exceeding six hours)

Your experience begins with a highly trained, dedicated caregiver assigned prior to your surgery. This professional will provide constant overnight bedside support, overseeing your immediate recovery and guiding you through essential post-operative milestones.

Package Includes:

  • Private transportation from the surgical center to a nearby hotel
  • One overnight hotel accommodation
  • 24/7 bedside assistance from your caregiver
  • Expert post-operative monitoring
  • Continuous communication with Dr. Keojampa
  • Vital signs monitoring and complication surveillance
  • Pain and symptom management
  • Support with bathing, dressing, and personal hygiene
  • Prescription pickup and medication administration
  • Professional wound care
  • Assistance in reducing post-surgical anxiety and promoting early independence

Optional Enhancements & Add-Ons – Recommend to schedule several months in advance

In-House Lymphatic Drainage Massage – $100

Our esthetician and massage therapist offers expertly administered lymphatic drainage to reduce swelling, accelerate healing, and promote circulation. Recommended on postoperative days 3 and 7 for optimal results.

We suggest a minimum of one facial lymphatic massage session to help minimize postoperative facial swelling.

Extended Daily Aftercare – Recommend to schedule several months in advance

For those desiring continued support beyond the initial overnight care, we offer personalized daily caregiver visits. Services may be scheduled based on your needs and recovery preferences.

Options include:

  • 1-Hour Wound Care Visit  – $100
  • 2-Hour Recovery Assistance   -$200
  • 4-Hour Aftercare Support  -$400
  • 8-Hour Extended Care  – $800
  • 12-Hour Comprehensive Day Support – $1200

Our extended care packages offer flexibility and luxury to ensure you receive the level of attention that best suits your recovery lifestyle.

Mental Health and Psychological Recovery from Surgery

We understand recovery from surgery is difficult.  Please consider resources with a patient specific navigator and booking a post surgery mental health check with our recommended Psychologist.  Services can be provided remotely by video.   Click here to learn more

Preferred Hotel Partnership

? Holiday Inn® Golden Gateway Hotel
 goldengatewayhotel.com

Ready to Begin Your Recovery Journey?

For bespoke surgical care that extends beyond the operating room, trust Keojampa MD Facial Plastic Surgery to deliver an elevated standard of recovery. To reserve your post-operative package or for further inquiries, please contact our concierge team. We look forward to guiding you through a beautiful, confident transformation—with grace, comfort, and expert care. Let us provide the luxury, support, and medical excellence you deserve.

 

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Choosing the Best Surgeon for You

The best facial feminization and aesthetic craniofacial surgeon should have a combination of technical expertise, artistic skill, and patient-centered care. Here are the key qualities to look for:

1. Surgical Expertise & Technical Skill

  • Craniofacial and Aesthetic Surgery Training – Specialized training in craniofacial and plastic surgery with experience in both reconstructive and cosmetic procedures.

  • High Volume Experience – A surgeon who frequently performs facial feminization procedures, ensuring refined skills and better outcomes.

  • Advanced Surgical Techniques – Mastery of techniques such as forehead reduction, brow contouring, jaw and chin reshaping, rhinoplasty, lip lifts, scarless tracheal shave, and deep plane facelifts.

  • Minimally Invasive & Hidden Incision Techniques – Expertise in reducing visible scarring while maximizing natural-looking results.

2. Artistic Vision & Aesthetic Judgment

  • Understanding of Facial Proportions – Knowledge of how masculine and feminine facial features differ and the ability to create balanced, harmonious results.

  • Customization for Each Patient – Avoids a “one-size-fits-all” approach and tailors procedures based on the individual’s facial structure and goals.

  • Natural Results – Ability to enhance femininity while ensuring the results look natural, not overdone or artificial.

3. Patient-Centered Approach

  • Strong Communication Skills – Listens to patient goals, sets realistic expectations, and ensures informed decision-making.

  • Compassion & Empathy – Understands the emotional and psychological aspects of gender-affirming surgery.

  • Comprehensive Consultation Process – Uses imaging and simulations to help patients visualize potential outcomes.

4. Safety & Ethical Standards

  • State-of-the-Art Facilities – Operates in accredited surgical centers with high safety standards.

  • Commitment to Patient Safety – Uses the latest techniques to minimize complications, ensure optimal healing, and provide thorough aftercare.

5. Reputation & Proven Results

  • Before & After Portfolio – Consistently outstanding patient results that showcase the surgeon’s skills.

  • Patient Testimonials & Reviews – Strong patient feedback and high satisfaction rates.

Dr. Kyle Keojampa is a world renowned facial plastic and reconstructive surgeon specializing in facial feminization surgery (FFS), craniofacial surgery, and aesthetic surgery. He is recognized for his expertise in jaw contouring, forehead reconstruction, rhinoplasty, deep plane facelifts, lip lifts, and tracheal shave procedures.

  • Specialized in Craniofacial & Orthognathic Surgery: His expertise extends beyond traditional facial plastic surgery, incorporating advanced techniques in bone reshaping and soft tissue refinement.

Expertise in Facial Feminization Surgery (FFS)

Dr. Keojampa is known for his highly detailed and natural-looking results in FFS. His procedures often include:

  • Forehead contouring & brow bossing reduction

  • Mandible & chin reduction (V-line surgery)

  • Rhinoplasty for feminization

  • Tracheal shave (Adam’s apple reduction)

  • Lip lifts & deep plane facelifts

Why Patients Choose Him

  • Experience with High-Volume Cases: He has performed numerous FFS procedures with consistently outstanding results.  He is considered one of best and most experienced FFS (facial feminization surgery) surgeons in the world.

  • Customized Approach: Tailors each surgery to the patient’s unique facial structure, ensuring results that are both aesthetic and functional.

  • State-of-the-Art Techniques: Uses hidden incision methods and advanced technology to minimize scarring and optimize healing.

  • International Reputation: Patients travel from around the world for his expertise in complex facial transformations.

Locations & Practice

Dr. Keojampa practices in Los Angeles and San Francisco, operating out of premier surgical centers with a focus on luxury, safety, and advanced technology.

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Hair transplantation and Hairline Lowering in San Francisco and Los Angeles

Unlocking Confidence: A Comprehensive Guide to Hair Transplants and Hairline Lowering

In a world where confidence often goes hand in hand with appearance, hair loss can be a significant blow to one’s self-esteem. Whether it’s due to genetics, hormonal changes, or other factors, the emotional impact of thinning hair or a receding hairline can be profound. There are also significant differences in hairline shape for men and women.  Fortunately,  hair transplants and hairline lowering are options available.  We specialize in hair transplantation for men, women, and transgender patients.

Understanding Hair Transplants:
Hair transplantation is a surgical procedure designed to address hair loss by transferring hair follicles from one part of the body, typically the back or sides of the scalp, to the balding or thinning areas. This process involves two primary techniques: follicular unit transplantation (FUT) and follicular unit extraction (FUE).

FUT involves removing a strip of scalp from the donor area and dissecting it into individual follicular units for transplantation. This method may leave a linear scar but allows for the transplantation of a large number of grafts in a single session.

On the other hand, FUE involves harvesting individual follicular units directly from the donor area using a small punch tool, resulting in tiny, dot-like scars that are less noticeable than those from FUT. FUE is preferred by many patients due to its minimally invasive nature and quicker recovery time.

Both techniques offer natural-looking results when performed by skilled surgeons and can effectively restore hair density and coverage in areas affected by baldness or thinning.

Exploring Hairline Lowering:
Hairline lowering, also known as forehead reduction or scalp advancement, is a cosmetic procedure aimed at lowering the hairline to create a more proportionate and aesthetically pleasing facial appearance. This procedure is particularly beneficial for individuals with a high forehead or a disproportionately large forehead-to-face ratio.

During a hairline lowering procedure, excess forehead skin is removed, and the scalp is advanced forward to lower the hairline. This results in a shorter forehead and a more harmonious balance between the facial features. The incisions are carefully placed along the hairline to minimize scarring, and the procedure can be customized to suit each patient’s unique anatomy and desired outcome.

Benefits and Considerations:
Both hair transplants and hairline lowering offer numerous benefits beyond aesthetic improvement. Restoring a fuller head of hair or achieving a lower, more proportionate hairline can significantly enhance self-confidence and quality of life. Many individuals report feeling more youthful, attractive, and self-assured following these procedures.

However, it’s essential to approach these treatments with realistic expectations and an understanding of the potential risks and considerations involved. While hair transplants are generally safe and well-tolerated, they may require multiple sessions to achieve optimal results, and there is a risk of complications such as infection, bleeding, or scarring.

Similarly, hairline lowering surgery carries risks such as temporary numbness or discomfort, as well as the possibility of visible scarring along the hairline. Patients should carefully weigh these factors and discuss their concerns with a qualified cosmetic surgeon before undergoing treatment.

Hair transplants and hairline lowering procedures  offer effective solutions for individuals experiencing hair loss or dissatisfaction with their natural hairline. Whether you’re seeking to restore thinning hair or achieve a more balanced facial profile, desiring a more feminine hairline, and shape, these treatments can help you unlock newfound confidence and embrace life with renewed vigor.

With the right approach, and an experienced hair restoration team can be a transformative journey toward enhanced self-image and well-being.

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Zygoma cheek bone reduction

Zygoma reduction, also known as zygomatic reduction or zygoma reduction surgery, is a procedure that is used to reduce the size of the cheekbones. This procedure is typically performed for cosmetic reasons, as large or prominent cheekbones can make the face appear unbalanced or disproportionately wide.

The zygomatic bone, or cheekbone, is located at the top of the cheek and is a key feature of the face. It is made up of three parts: the frontal process, the temporal process, and the zygomatic arch. In zygoma reduction surgery, Dr Keojampa will perform osteotomies to in-fracture lateral cheek bone in order to reduce the facial width.

The procedure is typically performed under general anesthesia and takes about two to three hours to complete. Dr. Keojampa will make a small side burn incision and an incision inside the mouth, and then use specialized tools to remove to cut the bone. The incisions will then be closed with sutures and the patient will be placed in a compression dressing to protect the area during the healing process.

Recovery time for zygoma reduction surgery varies depending on the individual, but patients can expect to experience some swelling, bruising, and discomfort for the first few days after the procedure. They will also need to avoid strenuous activity and follow post-operative instructions provided by the surgeon.

Overall, zygoma reduction surgery can provide a more balanced and proportionate appearance to the face. It is important to have realistic expectations and understand the risks and benefits of the procedure before deciding to undergo surgery. It’s also important to find an experienced and reputable surgeon who is trained in craniomaxillofacial surgery to perform the procedure.

It’s important to have a detailed consultation with the surgeon to know the outcome of the surgery and post surgery care. The surgeon would also provide the patient with pre-surgery instructions and post-surgery instructions which must be followed carefully to ensure safe and successful recovery.

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Asian V line Surgery | Jaw Reduction Surgery | Cheekbone Reduction

Asian V line Surgery | Los Angeles | Beverly Hills | San Francisco Bay Area

Dr. Keojampa is one of the few experts in the United States that specializes in Asian V line Surgery which includes extensive jaw reduction surgery and Cheekbone reduction surgery.  Unlike many plastic surgeons, Dr. Keojampa performs jaw reduction surgery on a weekly basis and one of the most experienced in the world.

Why consider Asian V line surgery?

Patients who have a boxy, angular, or a wide chin may benefit from jaw narrowing.   Square faces and jaws can be converted into a more oval and feminine shaped.  Wide faces can be significantly slimmed with these techniques along with cheekbone reduction surgery.

How is the surgery performed?

V line jaw surgery is performed under general anesthesia to ensure your comfort and safety.   Incisions are made inside the mouth and completely hidden.  The cheekbone and jaw bone are accessed while identifying and preserving important nerves such as the infraorbital and mental nerves.  Through those openings, Dr Keojampa will reshape the jaw using advance V line jaw reduction techniques such as a T osteotomy for chin narrowing and resection of the mandibular angle.  The goal is to contour the jaw to a more feminine and soft appearance.  We use the most advanced technology to cut and contour the bone with an Ultrasonic Scalpel for Bone Contouring  the Sonopet  to perform osteotomies with the highest precision and safety.   The Sonopet is the most advanced Ultrasonic scalpel used by craniofacial and neurosurgeons as it selectively targets bone without injuring the surrounding nerves and soft tissue.

During your consultation, we perform 3D CT scans for presurgical planning.

3D Virtual Surgical Planning. We are one of the few practices in the world to use extensive 3D virtual surgery planning along with mapping of critical nerves and important structures.  Shown below is the path and location of the inferior alveolar nerve and mental nerve.  This advanced technology allows us to be maximally aggressive but also maximally safe when performing osteotomies and bone contouring.

V line Surgery – Why Choose Dr Keojampa?

  • Dr Keojampa is one of the few surgeons in the world trained in specifically Facial Feminization Surgery and V line surgery which is highly complex craniofacial surgery.  This experience translates to intricate knowledge in the some of the most advanced surgeries performed anywhere in the world.
  • Dr Keojampa is board certified and specialized in Facial Plastic Surgery.  He is a face specialist and does not dilute his expertise in any other area.  Trust your face to a facial plastic surgeon.
  • Dr Keojampa formerly served as a Clinical Assistant Professor and Clinical Instructor at both Harvard Medical School and Boston University School of Medicine.  He has worked as an educator, teacher and involved with training future surgeons.

V line Jaw Surgery Consultations

Based in both the Greater Los Angeles and San Francisco Bay area, we provide in office consultations and skype consultations for patients interested in facial feminization surgery.  We routinely have patients travel out of state and internationally to our center for advanced jaw reduction surgery. 

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Facial Feminization Surgery FFS Insurance Coverage

Facial Feminization Surgery FFS Insurance Coverage

Yes, we are one the few FFS centers that will accept health insurance if your health insurer provides coverage for FFS and willing to sign a letter of agreement to work with our center. We can work with your insurance to obtain preauthorization for coverage.  FFS insurance coverage is NOT common and often many insurers will place an exclusion from their health plans.  Our practice is considered out-of-network with all insurance providers.

Facial Feminization Surgery Insurance Coverage

We have had success obtaining insurance coverage for Facial Feminization Surgery from health plans of large technology companies such as Facebook/Meta, Amazon, Apple, NVIDIA, AT&T,  T-mobile, Dell, Boeing, Oracle, Google, Microsoft, Starbucks along with select health insurance plans from Massachusetts.  Most other insurance plans do not cover FFS and consider it as cosmetic surgery.  These are usually self-insured employer health  plans.  Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval.

Why should Facial Feminization Surgery be a covered benefit for a transgender patient?

We feel privileged that the #transgender community entrusts us with their gender transition and facial gender confirmation surgery. We feel FFS facial feminization surgery is reconstructive surgery and not cosmetic surgery to align one’s outer appearance to one’s identified gender.

Facial Feminization Surgery is a critical part of a transition timetable for a transgender patient who has decided to live full time as female.  Most patients first begin working with a therapist before and after starting hormones.  After being on hormones for an extended period of time, patients will make the transition to go “full time” and it can be essential to undergo FFS to increase acceptance of their new gender.  The importance of “passing” and the role of facial features play an important part of how the general public and others perceive transgender patients. The therapeutic goal of transgender surgeries is to allow a transgender individual to successfully function socially as a member of their desired gender.

One of the most important components of the gender identification is the face and why we feel Facial Feminization Surgery should be considered a medically necessary procedure. Although it is clearly possible to transition from male to female without facial feminization surgery it can be extremely difficult for many individuals if their facial features are distinctly masculine. Even individuals that develop extremely feminine bodies as a result of hormones often find it extremely difficult to gain acceptance if their facial features are extremely masculine. The degree of acceptance individuals attain is often directly correlated with how “congruent” their gender.

Facial Feminization Surgery can affect the quality of day-to-day life far more than any other therapeutic procedure for a transgendered individual, often more so than Genital reassignment surgery.  Facial features that are distinctly masculine can cause individuals to appear always “male” without surgery.  Facial feminization surgery may have a far more profound effect on the quality of life of a transgender individual than genital reassignment surgery and why most patients elect to undergo FFS first and genital reassignment surgery after.

The process of obtaining all the necessary approvals for insurance coverage for facial feminization surgery can take several months depending on your insurer.

Gender Confirmation Surgery with Related Services – Examples from AT&T Benefits Insurance

Effective January 1, 2017 or as soon as administratively feasible thereafter, benefits provided under the AT&T self-insured medical
programs (currently administered by BCBS or UHC, depending on your program) will include coverage for gender confirmation
services based on the recommendations for medical standards of care issued by the World Professional Association for Transgender
Health (WPATH). The services currently included under this coverage are listed below.

Note: Members who meet the criteria for gender confirmation services may elect to have some or all appropriate services listed.
For example, an individual may choose to just have breast modification, but not the full male to female / female to male surgeries.

Facial Feminization Surgery Coverage
Covered Services

Primary Sexual Characteristic Services
Female to Male Surgeries
Male to Female Surgeries1
Secondary Sexual Characteristic Services
Reduction thyroid chondroplasty or trachea shaving (reduction of Adam’s apple)
Blepharoplasty (rejuvenation of the eyelid)
Brow lift
Calf implants
Cheek implants
Chin or nose implants
External penile prosthesis (vacuum erection devices)
Face lift (rhytidectomy)
Facial bone reconstruction/sculpturing/reduction, includes jaw shortening
Forehead lift or contouring
Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty)
Laryngoplasty
Lip reduction or lip enhancement
Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction
Neck tightening
Pectoral implants
Redundant/excessive skin removal
Rhinoplasty (nose correction)
Skin resurfacing

Voice modification surgery
Voice (speech) therapy or voice lessons
Treatment with hormone therapy or secondary sexual characteristic surgeries for individuals under
the age of majority (18 years old) i.e. puberty-suppressing hormones or masculinizing /feminizing
hormones
Abdominoplasty

Testicular expanders

Commonly used Insurance CPT codes for Facial Feminization Surgery

21139 Reduction Forehead; Contouring & Setback, Anterior Frontal Sinus Wall
67900 Repair, Brow Ptosis, (Supraciliary/Mid-Forehead/Coronal Approach)
61782 Stereotactic computer-assisted (navigational) procedure; cranial, extradural
14041 Scalp advancement
15776 Hair Transplants; > 15 Punch Grafts
15876 Suction Assisted Lipectomy; Head & Neck
20926 Tissue grafts, other (eg, paratenon, fat, dermis)
21122 Genioplasty; Sliding Osteotomies, 2+ Osteotomies
21195 Reconstruction, Mandibular Rami &/or Body, Sagittal Split; w/o Int Rigid Fixation
21209 Osteoplasty, Facial Bones; Reduction
21270 Malar Augmentation, Prosthetic Matl
Modifiers: -50 Bilateral Procedure
31599 Tracheal Shave
40652 Lip Lift
30410 Rhinoplasty; Primary; Complete
30520 Septoplasty
30140 Turbinate Resection w/ Submucosal Approach
Modifiers: -50 Bilateral Procedure

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What to expect during your Facial Feminization Surgery Consultation

Facial Feminization Surgery Consultation with Dr. Keojampa

  • First step of the consultation is reaching out to our office by either completing a consultation form or calling our office.
  • Our experienced office staff will then promptly contact you by email or phone to schedule the desired consult type.  We offer both remote skype consults for our out of town and international patients.  We encourage patients to schedule an in office consultation to see Dr. Keojampa as CT Imaging of the Face and Neck can be performed before the consult  to give the most detailed and accurate recommendations
  • We provide a warm and inviting environment.  Our staff are experienced in treating transgender patients and will not misgender you
  • Costs and Fees are determined after the consultation.  Costs vary with the procedures desired and with estimated operating room and Anesthesia time.
  • In office consultations last 1 hour or more.  During the consultation, CT scans of the Face and Neck are performed and results are reviewed immediately.  Detailed facial measurements are taken.
  • With advanced 3D scanning technology, we can get high-quality 3D images of your entire face and jaw. The images are so accurate that we can use them to create custom surgical guides and for real-time stereotactic image navigation during surgery.
  • Benefits of 3D Scanning
    Our 3D CT scanner offers a variety of benefits over traditional X-rays, including the following:

    • More detailed images
    • Fewer surprises or complications during surgery
    • More accurate treatment planning for face and jaw surgeries
  • We discuss your desired goals in detail and take a complete history and examination
    • Typical questions we ask during your consultation include
      • When and how long have you been on hormonal replacement therapy?
      • Have you had or considering sexual reassignment surgery?
      • What do you expect from FFS surgery?
      • What support systems do you have such as a therapist, family or friends to help after surgery?
  • Dr Keojampa will explain in detail all the procedures recommended along how each procedure is performed.
  • Where do our patients come from and who are our typical patients?
    • Our patients come from Los Angeles, San Francisco, Out of State, and Internationally.
    • Our patients range from middle age to sixties and now more commonly younger patients in their early 20s.  Due to public awareness, transgender patients are transitioning to their true gender earlier.  Our older patients typically have always known their true feminine gender but have suppressed those feelings for years by getting married, having children, and pursuing hyper-masculine careers such as the military and athletics.

Facial Feminization Surgery Office and Surgery Location

  • We have offices located in Los Angeles in the beautiful suburb of Marina del Rey and San Francisco. Our office has panoramic views of the Pacific Ocean to provide a calm and relaxing environment during your Facial Feminization Surgery Consultation
  • Attached to our Los Angeles office is Admiralty Surgery Center, a Joint Commission accredited Ambulatory Surgery Center
  • FFS surgery in Los Angeles are performed at Admiralty Surgery Center
  • FFS surgery in San Francisco are performed at Austin SF Surgery Center
  • After surgery, for forehead only cases, most patients are able to return back to home or hotel room to recover.
  • For longer cases lasting > 5 hours or involving Forehead, Midface, and Jaw surgery., patients are admitted to an Acute Surgical Care facility.  All our nurses have extensive experience caring for transgender patients and will correctly address you by your correct gender.

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Facial Plastic Surgery – Why Choose Dr Keojampa | Los Angeles and Marina del Rey California

Facial Plastic Surgery – Why Choose Dr Keojampa?

  • Dr Keojampa is one of the few surgeons in the world trained in specifically Facial Feminization Surgery which is highly complex craniofacial surgery.  This experience translates to intricate knowledge in the some of the most advanced surgeries performed anywhere in the world.
  • Facial Feminization Surgery techniques work extremely well for both men and women.  These same advanced techniques help to rejuvenate and make your results dramatic and natural.
  • Dr Keojampa is board certified and specialized in Facial Plastic Surgery.  He is a face specialist and does not dilute his expertise in any other area.  Trust your face to a facial plastic surgeon.
  • Dr Keojampa formerly served as a Clinical Assistant Professor and Clinical Instructor at both Harvard Medical School and Boston University School of Medicine.  He has worked as an educator, teacher and involved with training future surgeons.
  • What procedures does Dr. Keojampa offer?
    • Facial Feminization Surgery
    • Nasal surgery such as Rhinoplasty, Septoplasty, and Sinus Surgery
    • Eyelid surgery
    • Facelift
    • Forehead and Browlift
    • Chin Augmentation and Reduction including Asian V-line techniques
    • Ear surgery such as otoplasty “ear pinning”
    • Neck and chin liposuction
    • Botox
    • Fillers such as Juvaderm, Belotero, Radiesse, Voluma
    • Lip Lift
    • Treatment of the Aging Face

 

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Facial Feminization Surgery | Forehead Reduction Cranioplasty Type 3 | Los Angeles | California | Dr Keojampa

How is a Type 3 Feminizing Forehead Cranioplasty performed?

Using either a bicoronal behind the hairline incision or pretrichial hairline incision, the forehead browbone and orbital rims area are exposed. Using CT stereotactic image navigation, the borders of the skull and brain are measured.

The lateral forehead and orbital rims are maximally shaved down to setback the forehead and enlarge the orbital space.

A bone island over the frontal sinus is created with stereotactic image navigation measurements. The central forehead bone is temporarily removed and contoured to fit and setback with the rest of the forehead bone.

If needed, a small titanium microplate was used prior for fixation prior.  We are currently using resorbable Sonicweld fixation plates which disappears after about 12 months leaving no permanent hardware.    This is the only way to safely and maximally reduce forehead prominence and bossing which is a telltale sign of masculinity. We are one of the few centers in the world that perform this procedure routinely for #transgender patients. Surprisingly, this procedure is not painful with quick recovery. #facialfeminizationsurgery #ffs #hairlinelowering #Cranioplasty #craniofacialsurgery #facialplasticsurgery #plasticsurgery #losangeles #california #drkeojampa

We strive to perform Type 3 Forehead contouring and setback on every FFS patient. The only reason to not perform a Type 3 Forehead is because the patient does not desire maximal set back of the frontal forehead bossing or the patient has an absent frontal sinus. About  5%  of the general population never develop a frontal sinus which limits the amount the forehead can be setback because the posterior border is the brain.

We perform pre-surgery CT Imaging of the Face and Skull for every patient during the personal office consultation to determine with the highest accuracy how much the forehead can be set back and reduced.  We are able to clearly see the frontal sinus and thickness of the forehead bone. This CT Imaging is also used during surgery for real time Stereotactic Imaging Navigation to help us plan with pinpoint accuracy the bone cuts.  We then temporarily remove the anterior table of the frontal sinus bone and set back the skull. This stereotactic imaging navigation is the same technology to assist neurosurgeons, craniofacial, and ENT surgeons to pinpoint the exact location of critical areas of the brain and skullbase.

If hairline contouring or lowering is needed, we perform a pretrichial incision at the hairline. For patients who do not need hairline lowering, the incision is placed and hidden in the hair bearing scalp (bicoronal incision).

Dr. Keojampa explains Facial Feminizing Forehead Reduction Cranioplasty Type 3 and Hairline Feminization

Facial Feminization Surgery - Forehead Reduction Cranioplasty Type 3

Facial Feminization Surgery Consultations

Based in the Greater Los Angeles region, we provide in office facial feminization consultations and skype consultations for patients interested in facial feminization surgery who are unable due to location to come to our office for the initial consultation. Requests for in office or skype consultations can be made by calling our office (310) 823-4444, sending an email to frontdesk@delreymd.com or using the consult request form. https://goo.gl/forms/G7gYURAGVkK5g9DA3

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