Surgical Trans-Formation. Hope Sherie, MD, FACS Medical Director Cosmetic Concierge, PLLC

Transcription

1 Surgical Trans-Formation Hope Sherie, MD, FACS Medical Director Cosmetic Concierge, PLLC

2 IT takes courage to grow up and become who you really are. e.e. cummings

3 The Cosmetic concierge, PLLC About our practice South End Charlotte, NC

4 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.

5 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

6 The Cosmetic concierge, PLLC

7 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 year olds with prior therapy and parental/guardian consent We offer three types of financing: descriptions and applications available at 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

8 The Cosmetic concierge, PLLC About our practice

9 Proud to stand with the community and allies in North carolina!

10 Despite modern taboos, Long history of body modifications, trans-genderism, and intersexuality

11 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.

12 Billy tipton:

13 Let s start from the top

14 Top surgeries FTM Chest Reconstruction MTF Breast Augmentation Androgynous Chest

15 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

16 FTM Chest reconstruction: Nipple placement

17 FTM Chest Reconstruction Types of Surgeries Being Performed Today: Double Incision With Free Nipple Grafts Inverted T Keyhole / Peri-Areolar Free Nipple Pedicle Buttonhole

18 Ftm chest reconstruction double incision with free nipple grafts curved incision, muscular patient

19 Ftm chest reconstruction double incision with free nipple grafts curved incision, muscular patient after weight loss

20 Ftm chest reconstruction DouBle Incision with free nipple grafts curved incision, average weight patient

21 Ftm chest reconstruction DouBle Incision with free nipple grafts Curved incisions, heavy patient

22 Ftm chest reconstruction DouBle Incision with free nipple grafts Curved incisions, heavy patient

23 Ftm chest reconstruction DouBle Incision with free nipple grafts Curved incisions, thin patient

24 Ftm chest reconstruction DouBle Incision with free nipple grafts thin patient

25 Ftm chest reconstruction Double incision with free nipple grafts straight incision, average weight patient

26 Ftm chest reconstruction DouBle Incision with free nipple grafts Straight incisions, thin patient

27 FTM Chest Reconstruction Keyhole / peri-areolar

28 FTM Chest Reconstruction Keyhole / peri-areolar Note: nipple position cannot be moved

29 FTM Chest Reconstruction Keyhole / peri-areolar

30 FTM Chest Reconstruction ButtonHole Technique (free nipple pedicle technique)

31 FTM Chest Reconstruction ButtonHole Technique

32 FTM Chest Reconstruction ButtonHole Technique WARNING: GRAPHIC IMAGES IN NEXT SLIDES

33 FTM Chest Reconstruction ButtonHole Technique DE-EPITHELIZATION

34 FTM Chest Reconstruction ButtonHole Technique SKIN FLAP AND DERMAL PEDICLE

35 FTM Chest Reconstruction ButtonHole Technique FLAP CLOSURE AND NIPPLE THROUGH BUTTONHOLE

36 FTM Chest Reconstruction ButtonHole Technique FINAL

37 Ftm chest reconstruction buttonhole technique Curved incisions, thin patient

38 FTM Chest Reconstruction ButtonHole Technique thin patient

39 FTM Chest Reconstruction ButtonHole Technique average patient

40 FTM Chest Reconstruction ButtonHole Technique average patient

41 FTM Chest Reconstruction ButtonHole Technique heavy patient

42 FTM Chest Reconstruction ButtonHole Technique heavy patient

43 FTM Chest Reconstruction ButtonHole Technique heavy patient

44 FTM Chest Reconstruction ButtonHole Technique heavy patient

45 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

46 The androgynous chest A little more or a little less nipples optional

47 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

48 Mtf breast augmentation implant placement

49 Mtf breast augmentation insertion sites

50 MTF breast augmentation trans-axillary submuscular gel

51 MTF breast augmentation trans-axillary submuscular gel

52 MTF breast augmentation trans-axillary submuscular gel

53 MTF breast augmentation trans-axillary submuscular gel

54 MTF breast augmentation trans-axillary submuscular gel

55 MTF breast augmentation trans-axillary submuscular gel

56 MTF breast augmentation trans-axillary submuscular gel

57 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

58 Torso & abdominal shape

59 Male vaser liposuction

60 Male vaser liposuction

61 Male vaser liposuction

62 Male vaser liposuction

63 Male vaser liposuction

64 Male vaser liposuction

65 Male vaser liposuction

66 Male vaser liposuction + Fat Grafting

67 Male vaser liposuction + Fat Grafting

68 Female vaser liposuction + fat grafting

69 Female vaser liposuction + fat grafting

70 Female vaser liposuction + fat grafting

71 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 & Brow Lowering Forehead Reduction/Scalp Advancement Botox & Facial Fillers Botox & Facial Fillers Electrolyss under sedation or numbing injections Lip Fillers & Lip Implants Multiple Minor Procedures: Scar revisions, Mole/Wart Removal, Skin Tag Removal, Hemorrhoid Removal, Hernia Repairs Multiple Minor Procedures Scar revisions, Mole/Wart Removal, Skin Tag Removal, Hemorrhoid Removal, Hernia Repairs

72 Bilateral orchiectomy + scrotal excision

73 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

74 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

75