Surgical Trans-Formation Hope Sherie, MD, FACS Medical Director Cosmetic Concierge, PLLC IT takes courage to grow up and become who you really are. e.e. cummings The Cosmetic concierge, PLLC About our practice South End Charlotte, NC The Cosmetic concierge, PLLC About Dr. Sherie Over 10 years general surgery practice in military and civilian hospitals Board certified by American College of Surgeons 2005-present Dedicated cosmetic surgery fellowship 2012 Began performing top surgeries & advanced body 2012 Private practice opened February 2015 Currently performing 4-5 top surgeries / week Member of WPATH and Charlotte Transgender Healthcare Group. The Cosmetic concierge, PLLC About our practice Private Surgical Center with full Operating Rooms Licensed Anesthesia Providers in every case 85-90% Transgender Procedures Only Regional Practice Certified in VASER Hi-Definition Liposculpture Only practice offering “buttonhole” nipple technique Amazing Trans-Friendly Staff We support multiple LGBT organizations & events The Cosmetic concierge, PLLC The Cosmetic concierge, PLLC About our practice Informed consent practice: do not require therapist’s letters for most surgeries (one letter for orchiectomy) Top surgery for 16-17 year olds with prior therapy and parental/guardian consent We offer three types of financing: descriptions and applications available at www.cosmeticconciergemd.com No specific waiting time for surgery – we are adding O.R. days as needed Phone & skype consultations available Many out of state, and International, patients The Cosmetic concierge, PLLC About our practice Proud to stand with the community and allies in North carolina ! Despite modern taboos, Long history of body modifications, trans-genderism, and intersexuality Biblical Recognition of 3rd Gender: • Matthew 19:12 – “For there are eunuchs who have been so from birth, and there are eunuchs who have been made eunuchs by men, and there are eunuchs who have made themselves eunuchs for the sake of the kingdom of heaven. Let the one who is able to receive this receive it.” Billy tipton: 1914 - 1989 Let’s start from the top… Top surgeries FTM Chest Reconstruction MTF Breast Augmentation Androgynous Chest FTM Chest Reconstruction Anatomical Considerations Natural Male Chest…not just flat ! Preserve Upper Pole Remove Lower Pole & Fold Accentuate Pectoralis Muscles Nipple Placement More Lateral - At Edge Of Pectoralis Symmetry Important FTM Chest reconstruction: Nipple placement FTM Chest Reconstruction Types of Surgeries Being Performed Today: Double Incision With Free Nipple Grafts Inverted T Keyhole / Peri-Areolar Free Nipple Pedicle – “Buttonhole” Ftm chest reconstruction double incision with free nipple grafts curved incision, muscular patient Ftm chest reconstruction double incision with free nipple grafts curved incision, muscular patient after weight loss Ftm chest reconstruction DouBle Incision with free nipple grafts curved incision, average weight patient Ftm chest reconstruction DouBle Incision with free nipple grafts Curved incisions, heavy patient Ftm chest reconstruction DouBle Incision with free nipple grafts Curved incisions, heavy patient Ftm chest reconstruction DouBle Incision with free nipple grafts Curved incisions, thin patient Ftm chest reconstruction DouBle Incision with free nipple grafts thin patient Ftm chest reconstruction Double incision with free nipple grafts straight incision, average weight patient Ftm chest reconstruction DouBle Incision with free nipple grafts Straight incisions, thin patient FTM Chest Reconstruction Keyhole / peri-areolar FTM Chest Reconstruction Keyhole / peri-areolar Note: nipple position cannot be moved FTM Chest Reconstruction Keyhole / peri-areolar FTM Chest Reconstruction ButtonHole Technique (free nipple pedicle technique) FTM Chest Reconstruction ButtonHole Technique FTM Chest Reconstruction ButtonHole Technique WARNING: GRAPHIC IMAGES IN NEXT SLIDES FTM Chest Reconstruction ButtonHole Technique DE-EPITHELIZATION FTM Chest Reconstruction ButtonHole Technique SKIN FLAP AND DERMAL PEDICLE FTM Chest Reconstruction ButtonHole Technique FLAP CLOSURE AND NIPPLE THROUGH “BUTTONHOLE” FTM Chest Reconstruction ButtonHole Technique FINAL Ftm chest reconstruction “buttonhole” technique Curved incisions, thin patient FTM Chest Reconstruction ButtonHole Technique thin patient FTM Chest Reconstruction ButtonHole Technique average patient FTM Chest Reconstruction ButtonHole Technique average patient FTM Chest Reconstruction ButtonHole Technique hEAvy patient FTM Chest Reconstruction ButtonHole Technique hEAvy patient FTM Chest Reconstruction ButtonHole Technique heavy patient FTM Chest Reconstruction ButtonHole Technique heavy patient Buttonhole technique Information: Primary advantage is preservation of nipple sensation – intensity is variable Avoidance of scar distortion of grafts in patients with hypertrophic or keloid scarring Increased operating time Current Contraindications due to risk of nipplie loss: nicotine use, diabetes (microvascular disease) Caution in older patients, larger breasts with long pedicle distance from nipple to breast fols The androgynous chest A little more or a little less nipples optional Mtf breast augmentation Anatomical Considerations Chest Width Skin Amount and Elasticity Surgery Types Implants Silicone Gel vs. Saline Above or Below Muscle Incision Site Fat Grafting Mtf breast augmentation implant placement Mtf breast augmentation insertion sites MTF breast augmentation trans-axillary submuscular gel MTF breast augmentation trans-axillary submuscular gel MTF breast augmentation trans-axillary submuscular gel MTF breast augmentation trans-axillary submuscular gel MTF breast augmentation trans-axillary submuscular gel MTF breast augmentation trans-axillary submuscular gel MTF breast augmentation trans-axillary submuscular gel Body contouring Characteristics Masculine Feminine Torso Shape V from chest to waist Hourglass Waist Straight Line or Taper Exaggerated Indentation Abdomen Smooth or Muscular “6-pack” Curved or Vertical Lines Outer Thighs/ Hips Straight or Concave Curved, Convex Thighs Overall Smaller, Straighter Overall Larger, Gentle Slope Buttocks Smaller, Central Fat Pad Larger, Blends into Hips Torso & abdominal shape Male vaser liposuction Male vaser liposuction Male vaser liposuction Male vaser liposuction Male vaser liposuction Male vaser liposuction Male vaser liposuction Male vaser liposuction + Fat Grafting Male vaser liposuction + Fat Grafting Female vaser liposuction + fat grafting Female vaser liposuction + fat grafting Female vaser liposuction + fat grafting Other Procedures offered For Trans Men For Trans Women Pectoralis Implants Orchiectomy Top Surgery Revision Top Surgery Revision & Breast Lifts Buttock Reduction Buttock Augmentation Botox for Forehead Lengthening & Forehead Reduction/Scalp Advancement Brow Lowering Botox & Facial Fillers Botox & Facial Fillers Electrolyss under sedation or numbing injections Lip Fillers & Lip Implants Multiple Minor Procedures: Multiple Minor Procedures Scar revisions, Mole/Wart Removal, Skin Tag Scar revisions, Mole/Wart Removal, Skin Tag Removal, Hemorrhoid Removal, Hernia Removal, Hemorrhoid Removal, Hernia Repairs Repairs Bilateral orchiectomy + scrotal excision Surgery preoperative requirements 18 years old or 17 with parent or guardian consent Medical Clearance if older than 55 or significant medical problems Do not require a mental health letter for most surgeries One letter for orchiectomy Do not require hormonal therapy prior to surgery If taking, skip one dose before surgery Do not require weight loss unless BMI > 45 BMI > 35 need airway exam Avoid Blood Thinners (aspirin, NSAIDS, herbals) Ride home & caregiver for night of surgery General Postoperative recommendations & Expectations Draining for first 48 hours (up to 10 days with large volume liposuction) Stiffness & soreness, not sharp pain, for first week Moderate swelling for 1-2 weeks-often asymmetrical ! Mild swelling, firmness for up to 3 months Aerobic activities, light work within 1-2 weeks Heavy lifting, push-ups at 4 weeks Scar remodeling and fading for 1-2 years .