What you can expect
Facial feminization surgery
Facial feminization surgery includes a broad range of procedures to change masculine facial features into feminine features. You might have your hairline moved to create a smaller forehead, have your lips and cheekbones augmented with implants, or have your jaw and chin reshaped and resized. If you have bone reduced, you might need skin-tightening surgery.
These surgeries are typically outpatient, requiring no hospital stay. Recovery time for most of these procedures is about two weeks, though recovering from jaw procedures will take longer.
A tracheal shave is a procedure to minimize your thyroid cartilage or Adam's apple. During the procedure, a small incision will be made under your chin, in the shadow of your neck or in a skin fold to conceal the scar. Your surgeon will then reduce and reshape the cartilage. This is typically an outpatient procedure, requiring no hospital stay.
Top surgery for transgender women
While the use of estrogen will stimulate breast growth, many people aren't satisfied with this growth alone. Top surgery for transgender women is a surgical procedure to increase your breast size that might involve implants, fat grafting or both.
Your surgeon will make incisions around the areola, near the armpit or in the crease under the breast. Next, your surgeon will place the silicone or saline implants under breast tissue. Alternatively, you could have fat, muscles or tissue from other parts of your body transplanted into your breasts.
If feminizing hormones haven't made your breasts large enough, you might need an initial surgery to have devices called tissue expanders placed in front of your chest muscles. You'll visit your doctor every few weeks to have a small amount of saline injected into the tissue expanders. This will slowly stretch your chest skin and other tissues to make room for the implants. When your skin has been sufficiently stretched, you'll have another surgery to remove the expanders and place your implants.
Orchiectomy is a surgery to remove your testicles. Because testicles produce sperm and the hormone testosterone, an orchiectomy might eliminate the need to use testosterone blockers, such as spironolactone (Aldactone), and reduce the amount of estrogen needed to achieve and maintain your desired appearance.
This type of surgery is typically done on an outpatient basis. You will be given a local anesthetic, in which you're awake and only your testicular area is numbed, or you will be placed under general anesthesia, in which you're asleep for the surgery. To remove your testicles, your surgeon will make an incision in your scrotum and extract the testicles through the opening. Orchiectomy is typically done as part of the surgery for vaginoplasty, though some prefer to have orchiectomy alone without further genital surgery.
Vaginoplasty is the surgical creation of a vagina. During vaginoplasty, skin from the shaft of the penis and the scrotum is used to create a vaginal canal. In some techniques these are also used to create the labia (labiaplasty). To surgically create a clitoris (clitoroplasty), the tip (glans) of the penis and the nerves that supply it are used. Alternatively, skin can be taken from another area of the body or tissue from the colon to create the vagina. The testicles also are removed during the course of the surgery.
Some surgeons use a technique requiring electrolysis or laser hair removal in your penile and scrotal areas to provide hair-free tissue for the procedure. The process can take several months. Other techniques don't require hair removal prior to surgery because the hair follicles are destroyed during the procedure.
After vaginoplasty, you'll have a tube (catheter) placed in your urethra to collect urine. You will need to be closely monitored either in the hospital or an associated care center for about a week after surgery. Recovery can take up to two months. Your doctor will provide instructions about when it's OK to begin sexual activity with your new vagina. You'll be given a set of vaginal dilators of increasing sizes that you'll insert in your vagina at time intervals to maintain, lengthen and stretch the size of your vagina. You will need to dilate on a regular basis indefinitely.
Keep in mind that because the prostate gland isn't removed during surgery, you will need to follow age-appropriate recommendations for prostate cancer screening. You might also develop urinary obstructive symptoms from benign enlargement of the prostate.