Transwellness

There are many surgical techniques that can create a more feminine appearance to the face. This may include reducing structures such as the brow bone/forehead, nose, jawline, chin and Adam’s apple (tracheal shave), or moving the hairline forward. This can be performed in one or multiple stages, depending on each person’s anatomy and desires.

This short outpatient procedure shortens the vocal cords to produce a higher vocal pitch. This is most effective when combined with voice therapy to also develop a more feminine cadence and manner of speaking.

This procedure enhances the breast tissue through the use of implants. It is recommended that estrogen and/or progesterone have been utilized for about one to two years (insurance dependent) before the procedure to allow for as much natural growth as possible and provide a breast tissue envelope in which to place the implant.

Surgical procedure to remove the testicles. This is a short, outpatient procedure for those looking to remove testosterone production and the need to take T-blockers.

This is the standard technique for transwomen interested in vaginoplasty. In one operation, the genitalia are reconfigured to create a feminine appearing vulva (external appearance) with a clitoris, labia majora and minora, urethral opening and vaginal opening/canal. The skin from the phallus and scrotum will be used to line the neovaginal canal, the testicles will be removed, the urethra shortened, and a clitoris will be created from some of the tissue of the head of the penis. It will be necessary to dilate the vagina after surgery to prevent the canal from narrowing while it heals. You will need to dilate the vagina continually, but the frequency will decrease over time. You will be given a set of dilatators after your surgery. While this procedure is completed in one operation, healing can be variable, and some people require a second stage “touch-up” to improve aesthetics or function.

Also known as the “zero depth” procedure, this is similar to penile inversion vaginoplasty except it does not include the creation of the vaginal canal. This option is for those who are not interested in receptive sexual intercourse, want to avoid maintaining the vaginal canal with dilation or who may not otherwise be surgical candidates for the creation of a vaginal canal.

There are several surgical techniques that can masculinize the face. This is typically achieved by selectively augmenting certain areas of the face, such as the forehead, jaw, nose and Adam’s apple. This is performed by using special filler material or implants. Procedures include, but are not limited to, jaw implants, chin implants, forehead implants or filler, nasal augmentation and Adam’s apple augmentation.

To create a masculine appearance to the chest, breast tissue is removed. Depending on your presurgical breast tissue volume, the technique and scars will vary, as will the ability to preserve your nipple tissue or the need to remove and replace the nipple. During consultation, you will speak with your surgeon about the best option for you and the scars you can expect.

Removal of the uterus is typically the first step in transmasculine genital gender-affirming surgeries. This surgical procedure can be done laparoscopically (minimally invasive) or through the vagina. You can discuss with your obstetrician-gynecologist (OB/GYN) whether or not you want to remove one or both of your ovaries (salpingo-oophorectomy) at the same time.

This procedure uses the genital tissue you have to create a penis. Typically, after one to two years of testosterone treatment, the clitoris enlarges enough to enable reconstruction into a penis. This is a less invasive procedure than phalloplasty, and can include extending the urethra to the tip of the penis to permit standing to void. There are many variations that can also include removing the vagina (colpectomy) and creating a scrotum (scrotoplasty). If testicular implants are desired, this is performed in a second stage together with a secondary revision of the scrotum.

This procedure creates a penis using skin and fascia from other parts of your body. This procedure is more complex than metoidioplasty and is typically performed in a series of surgeries to reduce complications. The two main tissue donor sites are the forearm and the thigh. You can discuss with the surgical team which is the best approach for you. You will need to have any hair removed via electrolysis from the donor site. Some of the surgical steps include making the penis out of the skin and grafting it to the pubic area, extending the urethra from its natural location to the graft (urethral lengthening), removing the vagina (colpectomy), creating a scrotum (scrotoplasty) and inserting testicular implants as well as a prosthesis for penetration. This is a complicated set of procedures that can have high complication rates, but can also have high patient satisfaction if appropriate expectations are set.

Removal of the mucosal lining of the vagina, with closure of the space. This is typically only performed after a hysterectomy; otherwise, surveillance of the cervix for cervical cancer cannot be performed.