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What Is Gender Reassignment Surgery?

Gender Reassignment Surgery also known as Gender Confirmation surgery or Sex Reassignment Surgery (SRS) is performed on a person with Gender Dysphoria and who wish to change their existing sex to the opposite gender. Gender Reassignment surgery is a life-changing decision and thus, cannot be taken lightly. As a doctor, I always advise the patients and their loved ones to undergo counselling before they conclude on whether or not they want to undergo this surgery.

Questions to ask your Cosmetic Surgeon:

  • Am I a fit candidate for this surgery?
  • What should I expect from this surgery?

  • What precautions should I take in the days leading up to the surgery?

  • What will be my average recovery time?

  • What care should I take to get optimum results from this surgery?

  • What steps will I need to take to maintain my health after the surgery?

  • Are there any risks and safety concerns that I need to be aware of?

  • What is the cost of Gender Reassignment Surgery?

What Happens Before The Surgery?

Once you have finished all the legal formalities and have been granted permission from the court to undergo the surgery, the doctor will begin hormone therapy for you.

The duration of hormone therapy is generally 6 months before Gender Reassignment Surgery. Hormone therapies for males involve testosterone-blocking agents, which assist the person in feeling and appearing more like a female. Apart from this, the doctor may ask you to stop certain medications before the surgery or start you on some new ones depending on your case. You may have to get blood tests done to check your fitness for general anaesthesia.

Who Is An Ideal Candidate For Gender Reassignment Surgery – Male to Female?

Following are the criteria for the ideal candidate:

1. A person who has realistic expectations about the result.

2. An adult male or a transgender woman who has been diagnosed with Gender Dysphoria or Gender Incongruence by two mental health professionals (psychiatrists)

3. Physically fit

4. Non-smoker, non-diabetic and have no cardiac issues

Gender Dysphoria is a psychological condition where the person feels a mismatch with the gender of their birth. It is also called as gender incongruence.

If a person wishes to undergo this surgery in India, then he needs to complete all legal formalities including certificate from 2 psychiatrists and permission from the Court. This will acknowledge the fact that the person understands all aspects of the surgery and is making an informed decision regarding his life.

What Are The Different Surgical Procedures In Gender Reassignment Surgery?

As we have mentioned earlier, Sex Reassignment Surgery is not a single procedure. It is a set of procedures that will eventually result in the gender change of the patient. In this blog, since we are discussing only Male to Female transitioning, we will refer to only those surgeries in our list:

  • Vaginoplasty

  • Laser Hair Removal
  • Breast Enhancement Surgery

  • Facial Feminization Procedures
  • Voice Feminization Procedure
  • Butt Enhancement Surgery

The sequence and inclusion of different procedures will be guided by individual concerns and the Cosmetic Surgeon.

Undergoing all of the above surgeries will eventually transform the person’s gender from male to female.

What Is The Cost Of Gender Reassignment Surgery (M To F)?

The cost of this surgery depends on various factors such as:

  • The procedures included and the methods used.

  • The location of the clinic.

  • The experience of the doctor.

Therefore, we cannot write down a ballpark figure for this surgery. The actual cost estimate will be given to you by your Cosmetic Surgeon after your consultation.

Details Of Surgical Procedures Involved

I. Vaginoplasty

Vaginoplasty is the first major surgical procedure under Gender Reassignment. It is a surgery where the doctor creates a vagina out of the penile tissue. This is a complex procedure which takes 4-5 hours. It is performed under anaesthesia.

The Plastic surgeon will first make an incision in the scrotum and remove the testicles. Then the skin from the scrotum and penis will be used to create the labia majora. A new urethra will be made (for urination).

In case the skin from the penis and scrotum is not enough for the vagina, then healthy skin from other parts of the body such as the abdomen or hips will be grafted for the vaginal lining. Some of the excess skin will be used to make a clitoris in the vagina.

The doctor will insert soft cotton or silicone mould to prevent the cavity from collapsing.

II. Laser Hair Removal

Laser Hair Removal is a simple procedure which aids in removing all the hair from the patient’s body permanently. This procedure is important when transitioning from male to female since men are biologically more hairy than women.

A plastic surgeon uses a laser for hair removal. The laser involves the use of electric current to attack and destroy the roots of the hair follicles. On an average, it takes multiple sessions of one hour each to undergo complete Laser Hair Removal.

III. Breast Enhancement Surgery

Breast Enhancement or Breast Augmentation Surgery is carried out in person undergoing Gender Reassignment to help them increase their breast size in proportion to the rest of their body. Under an Augmentation Mammoplasty or Breast Enhancement Surgery, the plastic surgeon will increase the size of the breasts by inserting saline/silicone implants inside a patient’s breasts.

The doctor starts the patient on estrogen supplements as part of the SRS process.

The hormone estrogen is important in the growth of breasts, widening of hips and achieving a voice which is more feminine.

Breast Augmentation is not performed immediately on patients who have undergone a Vaginoplasty. The doctor waits for the patient to recover and for the body to accept the change.

IV. Facial Feminization Procedures

There are multiple procedures that fall under the Facial Feminization surgical procedures. When a person transitions from male to female, the face needs to become softer, the cheeks higher and the hairline thicker. All of these can be achieved by undergoing some minor procedures. The impact of these procedures is to make the appearance more ladylike and natural.

Hair Transplant:

The male hairline is different from a female hairline. Therefore it is important for a transitioning patient to have a hairline that is more in-sync with their desired gender.

Males usually have to combat against male pattern baldness and hair fall. So, hair transplant is an important step in the Gender Reassignment Surgery.

The hair transplant procedure involves reconstructing a new hairline and restoring hair for the patient. There are two options with Hair Transplant – FUT (Follicular Unit Transplant) and FUE (Follicular Unit Extraction). Your course of treatment will be decided by the Cosmetic Surgeon according to your needs.

The doctor administers local anaesthesia on the patient before the procedure. The doctor then begins the procedure called FUE/FUT. The result of FUT/FUE will become visible slowly over a period of months.

Feminization Rhinoplasty:

Feminization Rhinoplasty is a surgical procedure which involves reconstructing the nose of a patient to make it appear more suitable to their new female avatar.

Rhinoplasty is important for achieving a more feminine profile for a person undergoing Gender Reassignment Surgery. The surgeon will reduce the size of the nose and change the nasal angle to make it more feminine and delicate.

During the surgery, the doctor will make incisions inside the nose and change the nasal cartilages to aesthetically improve the appearance of the nose.

Cheek Implants:

Women have softer cheeks and slightly higher cheekbones as compared to men. A cheek implant can change the patient’s cheeks into more feminine and aesthetically pleasing ones.

Cheek Implants are inserted into the cheeks by creating a curvilinear incision. The implants used are made of silicone. The other method which may be used is called Fat Grafting. In this method, fat from other parts of the body can be harvested and injected inside the cheeks to make them appear fuller and feminine.

This is a minimally invasive procedure with good results

Chin Recontouring:

Chin Recontouring or Genioplasty/Mentoplasty is a cosmetic surgical procedure that changes the shape and the size of the patient’s chin. A male’s chin is more wide-set and protruding, with square angles. Whereas a woman’s chin is smaller, with a short angle and more curved.

Through Genioplasty, a surgeon shaves off the excess bone from the patient’s jawline to make it more aesthetically pleasing for the new woman’s body of the patient. Sometimes it is also necessary to reduce the chewing muscles to make the jaw narrow.

Jaw Reduction and Genioplasty go hand in hand for a Gender Reassignment (M to F) patient.

Adam’s Apple Correction:

Men have a prominent Adam’s apple in their throat. When a patient transitions from male to female in a Gender Reassignment Surgery, it is important to change the existing masculine 90-degree angle of the Laryngeal Prominence (Adam’s Apple) to a feminine 120-degree angle.

This is achieved by a small surgery called Chondrolaryngoplasty or Tracheal Shave. In this procedure, the doctor makes a small incision at the juncture of the chin and the neck and then shaves off the extra cartilage. Lastly, the incision is closed with sutures and then a surgical tape is applied

Lip Shaping:

Another aspect of the Facial Feminization Surgeries is lip augmentation or lip shaping. Women have fuller lips and thus, for a patient who is transitioning from male to female needs to undergo lip augmentation to make the face appear more feminine. The Plastic Surgeon will use a filler injection for Lip Shaping.

Eyebrow Lift:

Male eyebrows are thicker in size and are placed a little lower on the forehead. Female eyebrows are thinner and are located slightly higher on the forehead. Therefore, Facial Feminization Surgeries also include eyebrow lift surgical procedure.

As a Plastic Surgeon in Surat, I have performed this surgery on many patients with great results. There are various options for getting the perfect eyebrows such as:

1. Laser hair reduction – a quick session of laser hair reduction can make the eyebrows thinner. This is a minimally invasive procedure.

2. Botox – Botulinum toxin can be injected near the eyebrows to lift them higher with immediate effect. This is a minimally invasive procedure.

Eyelid Correction:

Eyelid correction can be performed with a surgery called Blepharoplasty. When a surgeon performs Blepharoplasty he makes incisions along the natural creases of the eyes. He then removes the excess fat and skin and tightens the shape of the eyes. Once this is completed, the surgeon will close the incision with sutures.

Forehead Feminization Procedure:

The forehead is an important part of the face. It is a distinguishing feature in a male face and a female face. Females have softer, less angular foreheads, with a longerhairline. Whereas males have large and angular foreheads.

The Forehead Feminization Procedure helps persons who are transitioning from Male to Female to achieve a beautiful, feminine forehead.

In the Forehead Feminization Surgery, the Cosmetic Surgeon shaves off the hard angles of the forehead and contours it according to the female face. He also reduces the brow bone to give the forehead a soft, feminine look.

The procedure is simple and effective.

V. Voice Feminization Procedure

There is a grave difference in male voices and female voices. Men tend to have a more baritone and heavy voice texture, whereas women have a softer voice with a higher pitch.

When a person undergoes SRS from Male to Female, it is important that their voice is appropriate to their new female gender. Cosmetic Surgeons perform a surgery called Voice Feminization Surgery.

In this surgical procedure, the patient’s vocal cords are shortened to heighten their pitch and make their voice feminine. The process is called as Laser-Assisted Vocal Fold Webbing Anterior Commissure Retrodisplacement. This is a minimally invasive procedure and patients recover quickly after this procedure.

But the patient needs to continue Speech Therapy to adjust their speech patterns and pronunciations to have a full effect of the surgery.

VI. Butt Enhancement Surgery

Butt Enhancement Surgery or Buttocks Enlargement Surgery is also a part of the SRS. Biologically a male’s hips are narrow and firm, while a female’s hips are soft and wide. When a male undergoes a Sex Reassignment Procedure, it becomes necessary to enhance the patient’s hips to be more appropriate to the new gender.

There are two ways to achieve the right size of buttocks for an in-transition patient.

1. Gluteal Implants

2. Fat Grafting

In the Gluteal Implants Procedure, the Plastic Surgeon inserts the silicone implants inside the butt. Once the implants are placed, the tissue around the buttocks is tightened and shaped appropriately and the incision is closed.

The patient is given a support garment to wear for the next 2-3 weeks.

In the Fat Grafting Procedure or Brazilian Butt Lift procedure, the doctor uses fat from other parts of the body such as the abdomen, flank or lower back to enhance the butt of the patient. This procedure is considered to be a better alternative to the Gluteal implants.

Procedures You Might Be Interested In

Breast Augmentation

Laser Hair Removal

Veginoplasty