Transgender Surgery Institute of Southern California

Our Team has a reputation for providing innovative Male to Female (MTF) Gender Reassignment Surgery and Female to Male (FTM) Gender Reassignment Surgery (GRS). Our goal is to make your transition as comfortable and easy as possible. Dr. Youssef and his team, including the office and hospital staff, are committed to serving you during this exciting but anxious stage of your life. Your choice of surgeons and program is determined by many factors including the credentials of the surgeon, the friendliness of the office and hospital staff, the location, and the price. We believe that our total package is the premier choice.

FEMALE TO MALE CHEST SURGERY Female to male transgender patients need reductive surgery to create a male chest. The surgery depends on the size of the breasts, the amount of skin and the size and position of the nipples. For smaller breasts, sometimes a minimally invasive approach can be used. This technique uses a peri-areolar incision and liposuction to remove the breast tissue behind the nipple and to give a more masculine, flatter appearance to the chest. For patients with larger breasts, the technique involves a completion mastectomy. The completion mastectomy involves a larger incision at the inframammary fold: the junction between the pectoralis muscle and abdomen. The nipples are usually reduced and made into a more elliptical pattern. They are then repositioned more superiorly (higher on the chest wall) and laterally (toward the arms) to give the appearance of a more masculine nipple shape and position. Liposuction can be combined to provide optimal chest contour. The third technique is the keyhole pattern. This technique is rarely ever used due to the amount of scarring and lack of contour achieved in the chest. Schedule your FTM top surgery appointment today. Our surgeons make every effort to minimize the size and appearance of the scars to give the most aesthetically pleasing final result. There are many options to assist in the final appearance of the scars including scar gels, scar creams, silicone sheeting, and laser treatments. Our surgeons do everything possible during the primary surgery to avoid the need for a revision, however, sometimes revisions are needed to improve contour, scarring or nipple distortion. + MALE TO FEMALE CHEST SURGERY If you have any questions, please feel free to contact the Transgender Surgery Institute Of Southern California. MALE TO FEMALE CHEST SURGERY MTF top surgery typically requires constructive techniques. These techniques include the use of breast implants, local flaps, or fat grafting. The most common technique typically involves placement of breast implants. The size and shape of the chest determine what type of implant is used in the augmentation. Ancillary techniques involve changing the nipple size or position depending on the desired result. The most common implant used is a silicone breast implant because it tends to give the patient a more natural look and feel. Saline implants can also be used, however risks of rippling and deflation are higher. During the initial consultation with the surgeon, we will discuss the details of the procedure which include the approach, surgical technique and type of implant.

There are many goals in sex reassignment surgery (SRS). In male to female gender reassignment surgery our goal is to create the most functional and cosmetically appealing vagina possible. This includes providing maximal clitoral and vaginal sensation with minimal scarring. To accomplish these goals, sometimes multiple procedures are needed which require time and expertise. We always pay maximum attention to detail to achieve the best possible result. THE PENILE SKIN INVERSION TECHNIQUE: The penile skin inversion technique is an extensive procedure and involves many steps. Part of the head of the penis, with its blood and nerve supply, is moved to become the clitoris. This neo-clitoris allows sensation which can allow patients to have an orgasm. Skin is sometimes used to create a clitoral hood. During the penile skin inversion technique the testicles are also removed. The penile skin is inverted to create a vagina. Typically the amount of skin available from the penile shaft will determine the depth of the vagina. For patients with short penile shafts, the vaginal depth can be increased with skin grafts from extra scrotal skin. This skin should be hairless to prevent growth of hair inside the vagina. To make sure this skin is hairless, the hair is removed first with laser hair removal or by multiple electrolysis treatments. We perform laser hair removal on as much scrotal skin as possible to allow maximal usage for skin grafting. Our goal is to prevent hair growth in the vagina which can cause dysfunction. Other sources of skin graft can include the abdomen and the flank. The scrotum utilized to contour and make the labia majora. The labia minora are created using other specialized techniques. Though our aim is to achieve the best possible result in one procedure, there may be a need for touch up or secondary surgeries. VAGINOPLASTY USING RECTOSIGMOID COLON: The vaginoplasty using the rectosigmoid colon is a specialized technique. This procedure combines penile inversion with the creation of an anstamosis (connection) to a portion of the rectosigmoid colon along with skin grafts to construct the vaginal canal. The benefits of this technique is the neo-vagina has more depth and lubrication as compared to the penile inversion technique. This procedure, however, is more invasive and does require an abdominal entry point to access the colon. The procedure that best suits your specific needs will be discussed with your surgeon during your consultation. SECONDARY GENITAL RECONSTRUCTION: At the Transgender Surgery Institute of Southern California, it is our goal to give our patients the best possible results. However in order to achieve this, sometimes secondary procedures are needed to obtain better appearance and or function. These procedures may include: 1. Labia minora augmentation 2. Clitoral hood augmentation 3. Labia major augmentation 4. Augmentation or recontouring of the mons pubis 5. Urethral set back 6. Removal of scar tissue or excessive urethral tissue 7. Vaginal canal augmentation with skin grafting These procedures can be difficult and have to be performed in a surgery center or in a hospital in order to monitor the patient post-operatively for up to a week (at times) if there is a risk of tissue loss or infection. You will always be closely monitored by your surgeon and cared for by our amazing, dedicated surgical staff. Your safety is our priority.

Our goal is to make your transition as comfortable and easy as possible. Dr. Youssef and his team, including the office and hospital staff, are committed to serving you during this exciting but anxious stage of your life. METAIDOIOPLASTY: I perform a metaidoioplasty (extend, straighten, and release the clitoris) but do not extend the urethra. I will straighten the new penis and insert testicle implants into the labia majora at the same time. I often remove excess pubic by liposuction or excision. I don’t do a urethral extension, which requires a hysterectomy, vaginectomy, etc, because it has a much higher complication rate. I also do not perform microsurgical free flap phalloplasty, such as making a penis from a forearm. Surgery is performed as an outpatient. SECONDARY RECONSTRUCTION I perform a secondary reconstruction of other phalloplasties to improve appearance, correct urinary problems, or insert penile implants. The scrotum is constructed by various techniques including tissue expansion, insertion of testicle implants, muscle flaps, and grafts. Testicle implants made of saline of solid gel are available.

In addition to chest (top) surgery, there are several facial surgeries that can help enhance your transgender surgery results. The Transgender Surgery Institute of Southern California offers Brow Reshaping, Facelifts, Rhinoplasty, Upper Blepharoplasty, Laser Resurfacing, Lip Enlargement, Adam’s Apple Surgery, Facial Implants, Liposuction, Brazilian Butt Lift and more. MALE TO FEMALE BROW RESHAPING In the genetic male, the eyebrows are usually positioned lower and the brow bone is more prominent. An eyebrow lift and contouring of the forehead bone give a more feminine and softer appearance. Our transgender institute specializes in many types of minimally invasive brow lifts. The most common type is the endoscopic brow lift that uses small incisions above the hairline. A small camera is used to reposition the brow with small surgical instruments. The brow bones and forehead bone can also be surgically contoured to soften the look of the upper face. MALE TO FEMALE FACELIFTS There are many types of lower face and neck lifts that can help contour and reshape the neck and jawline to give a more feminine look. These procedures are usually performed through incisions around the ears and a small incision just below the chin. This allows us to elevate the deeper tissue in the lower face, which gives a more “heart” shaped face with a slimmer and more feminine jawline. Recovery time is typically 2-3 weeks. MALE TO FEMALE RHINOPLASTY (NOSE RESHAPING) A feminine nose tends to be slightly smaller with a little curvature along the profile of the nose. This look can be easily achieved with many of our rhinoplasty surgical techniques. We can reshape bones, soften bumps along the bridge of the nose and soften the angles around the tip of the nose to give it that feminine look. Recovery time is typically 1-2 weeks. MALE TO FEMALE UPPER BLEPHAROPLASTY (EYELID SURGERY) Upper blepharoplasty (upper eyelid surgery) can be used to feminize the eye area. A feminine eyelid tends to have less heaviness. We can make an incision along the crease of the upper eyelid to remove a crescent moon shaped section of skin. Through this incision, we can also remove any excess fat and tighten muscles in the eyelid to give a more open and feminine look to the eyelid. This will allow more of the eyelid skin to show above the eyelashes and give room for application of eyeliner or mascara, etc. LASER RESURFACING (SKIN TEXTURE IMPROVEMENT) Fractional laser resurfacing is a newer technology that allows us to dramatically improve the quality and texture of the skin. We use a computer-guided software to deliver small columns of energy into the skin, which forces a new layer of skin to grow with brand new collagen and elastin fibers. This treatment can soften wrinkles, firm the skin, brighten the complexion, diminish pore size and remove sun damage. Downtime is usually 1-2 weeks. MALE TO FEMALE LIP ENLARGEMENT The female lip tends to have more volume and definition than a thinner male lip. We have several dermal fillers that can enhance, augment and reshape the lips to give them a softer look. These fillers have a longevity of approximately 10-12 months. MALE TO FEMALE CHONDROLARYNGOPLASTY OR TRACHEAL CARTILAGE SHAVE (ADAM’S APPLE SURGERY) The male neck tends to have a prominent protrusion of the tracheal cartilage. Chondrolaryngoplasty (commonly called tracheal shave) is a surgical procedure in which the thyroid cartilage is reduced in size by shaving down the cartilage through an incision in the throat, generally to aid those who are uncomfortable with the girth of their Adam’s apple. A small incision along the natural crease lines in the neck can be made to access and reshape this cartilage to give it a more feminine appearance. This is a short outpatient procedure that has about 1-2 weeks recovery time and tends to be one of the most common cosmetic transgender surgeries performed. MALE TO FEMALE FACIAL IMPLANTS The female face tends to have more lateral (outer) cheek prominence verses the central prominence of the male cheek. Cheek implants placed in the outer portion of the cheek through small incisions inside the mouth can give improved feminization. MALE TO FEMALE LIPOSUCTION We can use newer liposuction techniques to reshape and tighten stubborn fat bulges and loose skin. Females tend to have an hourglass shape versus the square masculine waistline. Our liposuction and laser liposuction techniques can bring in the waistline to give that curvy hourglass appearance. The laser liposuction has the added benefit of heating and contracting the skin along the inner surface to improve the skin laxity and give the liposuction results a smoother appearance. Compression garments are worn for 6-8 weeks for best results and the majority of patients can resume work or light physical activity after one week.