Transgender Services

Facial Feminization

Also known as Chondrolaryngoplasty, is one of the most sought after facial feminization surgery. The “Adam’s Apple” is one of the most telling signs of male secondary sex characteristics. When present in the MTF, it can present a daunting challenge to someone trying to blend into a female society. The Tracheal Shave is a surgical procedure, normally performed under general anesthetic as an outpatient procedure. The goal of the surgery is to reduce the thyroid cartilage to achieve a more feminine neck. Removing too much cartilage can negatively impact the vocal cords and cause your voice to be distorted. The surgeon makes a small incision beneath your chin or right above the Adam’s Apple, in a natural fold on your neck. Through the incision, the bulge of thyroid cartilage is shaved down to create a smoother, feminine surface. This procedure often requires a relatively short amount of time in the operating room.
Chin augmentation using surgical implants can alter the underlying structure of the face, providing better balance to the facial features. Chin augmentation is popular because it is a relatively easy operation for the patient while producing noticeable changes in the silhouette of the face. Silicone chin Implants are one of the most commonly used implants for chin augmentation. They are soft, smooth, flexible and come in different shapes and sizes. They do not incorporate (stick) to the surrounding tissues, so the pocket must be made precisely. An incision is made either under the chin or inside the lower lip, a pocket is made and the implant placed into the pocket. Some chin implants are fixed to the mandible, while others are held in place by the pocket itself.
Cheek augmentation is a cosmetic surgical procedure that is intended to emphasize the cheeks on a person’s face. There are three general shapes to cheek implants: malar, submalar, or combined. Malar implants, the most common shape, are placed directly on the cheekbones. The result is more projection to the cheekbones, providing a “higher” contour to the side of the face. In contrast, submalar implants are not placed on the cheekbones. They are intended to augment the midface, especially if the person has a gaunt or “sunken” appearance to this area. Combined implants or malar/submalar combination, are an extended implant intended to augment both the midface and the cheek bones. The surgeon will usually make an incision in the upper mouth near the top of the gum line and slide the implants into place. Another method is to make an external incision near the eye. Cheek implant surgery is performed under sedation or general anesthesia and takes about one to two hours.
Rhinoplasty is surgery to reshape the nose. It can make the nose larger or smaller; change the angle of the nose in relation to the upper lip; alter the tip of the nose; or correct bumps, indentations, or other defects in the nose. During rhinoplasty, the surgeon makes incisions to access the bones and cartilage that support the nose. The incisions are usually made inside the nose so that they are invisible after the surgery. Depending on the desired result, some bone and cartilage may be removed, or tissue may be added. After the surgeon has rearranged and reshaped the bone and cartilage, the skin and tissue is re-draped over the structure of the nose. A splint is placed outside the nose to support the new shape of the nose as it heals. This surgery is usually an outpatient surgery and performed under sedation.
Brow Shaving is a burring reduction of the outer table of the frontal sinus wall. The thickness of the anterior frontal sinus wall and how much brow bone reduction is needed will determine what is the best technique for the patient. Brow bone reduction surgery is often done either for men with extreme prominences or as part of facial feminization surgery. The typical male forehead has a prominent brow bone that is often flat or even slopes backward to some degree while a female has a rounder smoother and more vertically oriented forehead which is much more desired.
A lip lift is a cosmetic procedure that modifies the cosmetic appearance of the lips by reshaping them to increase the prominence of the vermilion border; and to enhance the facial area above the lips into a more aesthetically pleasing shape. This type of cosmetic facial enhancement does not necessarily augment the lip, but helps to elevate the upper lip area to make it appear larger. The procedure itself involves minor incisions either underneath the nostrils, just above the upper lip line, or at the corner of the mouth, depending on the goals and specifics with surgery.

Breast Procedures (Top Surgery)

Breast Augmentation, or Augmentation Mammoplasty, is the most common cosmetic surgical procedure performed. It is a procedure that will increase the breast or bra size of an individual. Women generally consider breast augmentation for one of the following concerns:

  • Enhancing smaller breasts
  • Restoring breast volume from weight loss or pregnancy
  • Correcting asymmetric, uneven shaped breasts
  • Improving the shape and contour of sagging breast, this is usually combined with a breast lift or mastopexy
  • Reconstruction after breast removal from cancer, trauma, or hereditary defects

To view the Breast Augmentation Procedure Page, Click Here.

Fat grafting helps to achieve your desired facial and body contours. The procedure involves the removal of fat from one area of the body through liposuction. The harvested fat is then injected into other areas to add volume. Transgender fat injections can be useful in helping you reshape your body, giving you the appearance you desire.
Often one of the first surgical steps for individuals transitioning from female to male is the removal of unwanted breast tissue to create a more masculine chest. In the medical community, this is known as mastectomy; in the transgender community, it is commonly referred to as “top surgery”. There are a number of surgical techniques that may be utilized to accomplish the tissue removal.

1. Bilateral Mastectomy with Free Nipple Grafts – This technique allows the removal of essentially all of the breast tissue and excess skin and allows for the proper placement and downsizing of the nipples. This technique is utilized most frequently because the majority of patients present with a combination of excess skin and a naturally low nipple position. This technique leaves a scar on each side of the chest. In order to make the scar less apparent, we place the scar along the lower border of the pectoral muscle fold. The nipple-areolar complex is downsized and placed as a graft in the appropriate location. A special medical dressing stays on the nipple graft for one week.

2. Peri-areolar Subcutaneous Mastectomy / Keyhole Incision – The peri-areolar, or ‘keyhole’, technique consists of breast tissue removal through a small incision around the nipple. This technique carries the advantage of significantly reduced scarring. However, a relatively small number of patients are actually good candidates for this technique. The suitable candidate for this type of mastectomy is typically the young, slim patient with a small amount of breast tissue, no excess skin, and a nipple position that is suitable and does not require repositioning.

3. Mastectomy Combined with Liposuction – The goal for liposuction of the breast is simple. This technique is used to improve the patient’s physical appearance by removing as much fat as possible while avoiding any damage to skin or muscles. With this technique there is minimal postoperative pain, rapid postoperative recovery, quick return to normal activities, and virtually no scaring.

4. Mastectomy with Dermal Pedicle Flap –A dermal pedicle flap is a flap consisting of the full thickness of the skin and the subcutaneous tissue, attached by tissue through which it receives its blood supply. This technique leaves a scar on each side of the chest along the lower border of the pectoral muscle fold. The nipple-areolar complex is downsized and placed through a new opening in the appropriate location and sutured in place.

5. Double Incision Mastectomy – The double incision mastectomy is designed for persons with larger or overhanging breasts. The advantage of this procedure is greater precision in nipple size, nipple position and scar placement. The disadvantage is the scar. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. The techniques for treatment and placement of the nipples with the double incision method vary. Depending on the technique that is the best suited, the original nipples may be completely removed, trimmed to a smaller size, and are then grafted onto the chest in a higher, more aesthetically-male location. Or a “pedicle” technique, wherein the nipples are left partially attached to the body via a stalk of tissue. They are then repositioned in a more aesthetically-male location, while their connection to the body via the pedicle stalk remains intact. They may or may not be trimmed to a smaller size. The pedicle option is sometimes chosen in an attempt to maintain sensation in the nipples.

6. Anchor Incision Mastectomy – This technique is best used with overly large or ptotic breast tissue. The incisions will surround the areola on its outer edge. Then, the incisions continue down the midline of the breast below the nipple and across the inframammary crease. The placement of these incisions allows the reshaping and re-sculpting of the entire breast especially in overly large breasts that will have an increase in excess skin.

Nipple reduction is used to either reshape nipples that are projecting or to reduce the areola. Nipple reduction surgery is done under local anesthesia and usually takes around an hour to complete. A small incision is created in the nipple, and any excess tissue is removed from the area. Stitches are then placed to close the incision, and dressings are applied. Nipple reduction is usually an outpatient procedure done in the office. We typically do not perform this surgery at the same time as a mastectomy to preserve blood supply to the nipple.

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