The pure penile inversion technique perfected by Dr. Stanley Biber and his understudy Dr. Marci Bowers in Trinidad, CO could be completed in two hours or less. I will acknowledge that some US and European GRS surgeons are starting to use modified penile inversion methods to produce better outcomes. These modifications do require more time in the operating room (anesthesiologist, hospital charges, etc) which increases the prices they have to charge to cover their increased costs. The reason you don't see the full Thai scrotal skin graft technique used in the US is because the cost would become prohibitive to most patients who, up until recently, have had to cover the full cost out of pocket. With the increasing availability of health insurance policies which cover transsexual surgical expenses, I bet we will start to see more sophisticated surgical methods take root in the western world. GRS in the US is typically $20K - $25K. I paid $7.5K to have my GRS in Thailand in 2015 (Chettawut). He keeps his prices low by minimizing his overhead costs. (Suporn is nearly twice that, but still much less than US surgeons.) Hotel costs for a 25 day stay in Bangkok (Vertical Suite) was $1300 which included an all-you-can eat breakfast buffet. Airfare varies depending on many factors, but even flying business class round trip from Chicago with Qatar Airways resulted in a total cost less than $15K. You can see how important keeping prices down in the US is for every surgeon facing such competition, and that means keeping the surgical method simple and quick.
