surgical trans-formation hope sherie, md, facs medical ... · the cosmetic concierge, pllc about...
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Hope Sherie, MD, FACSMedical DirectorCosmetic Concierge, PLLC
Surgical Trans-Formation
IT takes courage to grow up and become who you really are.
e.e. cummings
The Cosmetic concierge, PLLCAbout our practice
South End Charlotte, NC
The Cosmetic concierge, PLLCAbout 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, PLLCAbout 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, PLLCAbout 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, PLLCAbout 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 MusclesNipple 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 reconstructiondouble incision with free nipple grafts
curved incision, muscular patient
Ftm chest reconstructiondouble incision with free nipple grafts
curved incision, muscular patient after weight loss
Ftm chest reconstructionDouBle Incision with free nipple grafts
curved incision, average weight patient
Ftm chest reconstructionDouBle Incision with free nipple grafts
Curved incisions, heavy patient
Ftm chest reconstructionDouBle Incision with free nipple grafts
Curved incisions, heavy patient
Ftm chest reconstructionDouBle Incision with free nipple grafts
Curved incisions, thin patient
Ftm chest reconstructionDouBle Incision with free nipple grafts
thin patient
Ftm chest reconstructionDouble incision with free nipple grafts
straight incision, average weight patient
Ftm chest reconstructionDouBle Incision with free nipple grafts
Straight incisions, thin patient
FTM Chest ReconstructionKeyhole / peri-areolar
FTM Chest ReconstructionKeyhole / peri-areolar
Note: nipple position cannot be moved
FTM Chest ReconstructionKeyhole / peri-areolar
FTM Chest ReconstructionButtonHole Technique
(free nipple pedicle technique)
FTM Chest ReconstructionButtonHole Technique
FTM Chest ReconstructionButtonHole Technique
WARNING: GRAPHIC IMAGES IN
NEXT SLIDES
FTM Chest ReconstructionButtonHole Technique
DE-EPITHELIZATION
FTM Chest ReconstructionButtonHole Technique
SKIN FLAP AND DERMAL PEDICLE
FTM Chest ReconstructionButtonHole Technique
FLAP CLOSURE AND NIPPLE THROUGH “BUTTONHOLE”
FTM Chest ReconstructionButtonHole Technique
FINAL
Ftm chest reconstruction“buttonhole” techniqueCurved incisions, thin patient
FTM Chest ReconstructionButtonHole Technique
thin patient
FTM Chest ReconstructionButtonHole Technique
average patient
FTM Chest ReconstructionButtonHole Technique
average patient
FTM Chest ReconstructionButtonHole Technique
hEAvy patient
FTM Chest ReconstructionButtonHole Technique
hEAvy patient
FTM Chest ReconstructionButtonHole Technique
heavy patient
FTM Chest ReconstructionButtonHole 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 chestA 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 augmentationimplant placement
Mtf breast augmentationinsertion sites
MTF breast augmentationtrans-axillary submuscular gel
MTF breast augmentationtrans-axillary submuscular gel
MTF breast augmentationtrans-axillary submuscular gel
MTF breast augmentationtrans-axillary submuscular gel
MTF breast augmentationtrans-axillary submuscular gel
MTF breast augmentationtrans-axillary submuscular gel
MTF breast augmentationtrans-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 & 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 ProceduresScar revisions, Mole/Wart Removal, Skin Tag Removal, Hemorrhoid Removal, Hernia 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 problemsDo 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 Postoperativerecommendations & 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