Susan's Place Transgender Resources

So can anyone explain to me what are the determining factors are for the maximum attainable depth with non-penile inversion technique with Chett/Suporn?

I don't know the answer, but that's an interesting question.

Suporn did a paper where he reported depth, but not the why of it

THE EFFECTIVENESS OF FULL-THICKNESS SCROTAL AND GROIN SKIN GRAFT VAGINOPLASTY IN MTF SEX REASSIGNMENT SURGERY
http://www.supornclinic.com/restricted/SRS/srspapers.aspx#depth

He is well known for getting good depth though. I've heard of 8.5" and 9.0".

I don't know much about Dr Chettawut.

As always AnonyMs... you're wonderful!

Quote from: Ella_bella on June 20, 2016, 08:55:58 AM
As always AnonyMs... you're wonderful!

I don't get that very often. Now if only my wife would say it...

I always heard if u have a 12 inch ding dong you will get a 12 inch vagina ... Don't know how truth that is tho ... I know a sex change that have the colon one who said she took a 13 inch all the way Trinidad guy. I don't buy it tho [emoji23][emoji23][emoji23]


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Achievable depth is always limited by anatomy... first and foremost by size and shape of pelvis, secondary by available skin tissue. Another thing is dissection. If surgeon isnt able to create enough space, due to complicated dissection for reasons like inner scar tissue - adhesions, nothing else matters. What Thai surgeons do differently (with non-penile-inversion), is different arrangement of skin flaps, which are used on the outside. And use of skin graft(s) for neovaginal wall. 

Dr. Suporn, in majority of patients, only uses scrotal skin graft for vaginal wall. He uses micro-fenestration in skin graft preparation, which increases the surface area. Even if a patient had small scrotum, it is likely enough for 6 inch vaginal depth. In cases where patients were 10, 20 or more years on HRT, or previously had orchiectomy, or skin damage by electrolysis, it might not be enough, and additional skin graft might be needed.

Dr. Chettawut and other Thai surgeons use normal full-thickness skin graft, which is sometimes enough for 7 or more inch (imagine sagging scrotum), and sometimes isnt. It comes down to your anatomy. If patient wants extra depth, but they only have scrotum skin available for 4-5 inch depth, additional graft (usually from groin area) can be used for additional depth. 

Quote from: Ella_bella on June 20, 2016, 08:47:05 AM
So can anyone explain to me what are the determining factors are for the maximum attainable depth with non-penile inversion technique with Chett/Suporn?

Here ya go. https://en.wikipedia.org/wiki/Human_vaginal_size

"The depth of the typical neovagina created by male-to-female sex reassignment surgery is generally limited by the length of Denonvilliers' fascia,[citation needed] and is reported to be between 11 and 12 cm (4.3-4.7 in), within the range of the natural female vagina.[2]"

Hugs, Devlyn

Quote from: Devlyn Marie on June 20, 2016, 02:38:28 PM
"The depth of the typical neovagina created by male-to-female sex reassignment surgery is generally limited by the length of Denonvilliers' fascia,[citation needed] and is reported to be between 11 and 12 cm (4.3-4.7 in), within the range of the natural female vagina.[2]"

Something wrong with that 11 to 12 cm, I've not often heard that shallow.

I generally find facts to be pretty factual. People's claims, not so much.  ;)

Hugs, Devlyn

I was feeling a bit down because I got 5 inches depth from my surgery, especially after hearing all this talk about 9 inch deep vaginas. With more thought though, it's not much to feel bad about.

Even if we were to argue about the average depth of a cis-vagina (my human sexuality professor says it's 4-6 inches), the debate is itself wrong-headed, in my opinion. It's akin to guys arguing over whose penis is bigger. There are far more important factors to happiness in regards to one's sex life. I guess it depends on whether it's really that important to a post-op woman to have sex with a 10 incher haha :P besides, the average for a guy is like 5.5 inches, isn't it? I'd be more than happy to give an average guy an ego boost by his having half an extra inch on me (I like females more anyways!).

There's always anal too  >:-)

- Ruby

Hi Ruby,

I just posted something similar up and then saw your thread ;) https://www.susans.org/forums/index.php/topic,211246.0.html

Mmmm explains well how Suporn gets his depth: he basically pushes the scrotal skin through a pasta machine (  ;D ). Although this creates small holes, they subsequently heal: hopefully (some people report bleeding a long time after).

In practice and despite what a few people (e.g. Mona) might try and tell you, all the Thai surgeons now use scrotal tissue not just penile inversion. The differences are minor in that regard.

There's a fair bit of criticism that Suporn's results don't look like cis-vaginas. Whilst the latter have a lot of variety I guess it comes down to whether depth matters more than aesthetics? Personally I want it to look like a female vagina and for that reason I'm going to PAI.

I'm also really glad you mentioned anal because if I ever encounter someone with a penis that isn't satisfied with 5.5-6.0" insertion I will steer the thing elsewhere :D

Chen x

Quote from: Devlyn Marie on June 20, 2016, 02:53:51 PM
I generally find facts to be pretty factual. People's claims, not so much.  ;)

Well yes, but which are the facts?

Suporn did a paper where he said the average depth was 6.47". You'd think a physical limit would be a limit no matter who the surgeon was. I've no opinion as to whats correct, only pointing out it doesn't seem quite right.

http://www.supornclinic.com/restricted/SRS/srspapers.aspx#depth

Has anybody ever seen this pasta machine suporn uses ? [emoji102][emoji102][emoji102][emoji102]


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Quote from: Richenda on June 20, 2016, 10:16:34 PM
In practice and despite what a few people (e.g. Mona) might try and tell you, all the Thai surgeons now use scrotal tissue not just penile inversion. The differences are minor in that regard.

Enlighten and educate us! We are dying to know, and please dont hold yourself back, we appreciate each and every detail about that minor differences.

Quote from: AnonyMs on June 20, 2016, 10:35:12 PM
Well yes, but which are the facts?

Suporn did a paper where he said the average depth was 6.47". You'd think a physical limit would be a limit no matter who the surgeon was. I've no opinion as to whats correct, only pointing out it doesn't seem quite right.

http://www.supornclinic.com/restricted/SRS/srspapers.aspx#depth

Yes and in that paper he claims that without his super-duper technique 40% of them would have had depths averaging 3.7 inches. Two things about that. First, those 40% must have had small penises and/or circumcision and second, the paper is now 15 years old. Other surgeons all over the world, including in Thailand, have moved on from then and most now combine penile inversion with use of scrotal tissue. Even if they don't run it through the pasta machine (no sorry Tina haha) they're still achieving better than 3.7 inch depths. See here for a discussion about alleged differences: https://www.susans.org/forums/index.php?topic=203552.new;topicseen#new
(Edit: mmmmm ^^^^)

For me the benefits of an extra inch are far outweighed by the negatives, but others may feel differently.

Quote from: TinaVane on June 20, 2016, 10:35:26 PM
Has anybody ever seen this pasta machine suporn uses ? [emoji102][emoji102][emoji102][emoji102]


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http://cdn.thomasnet.com/ccp/30720834/221214.pdf

http://biomed.brown.edu/Courses/BI108/BI108_2007_Groups/group11/surgery.html

https://www.aesculapusa.com/assets/base/doc/doc107_rev-skin_mesher.pdf

Quote from: Richenda on June 20, 2016, 10:16:34 PM
There's a fair bit of criticism that Suporn's results don't look like cis-vaginas. Whilst the latter have a lot of variety I guess it comes down to whether depth matters more than aesthetics? Personally I want it to look like a female vagina and for that reason I'm going to PAI.

I don't think I've seen that criticism often at all. I think you can tell the difference, but its still better than any other surgeon I've seen results for. I've little opinion on PAI as I've not seen their results (the photos they publish are not good enough to work it out and I've seen no others).

I think Suporns results do look very good, and are generally well within natal variation, but there's various giveaways that its SRS. I think if you weren't aware of those you'd never realize.

Quote from: AnonyMs on June 20, 2016, 10:45:27 PM
I don't think I've seen that criticism often at all.

There are stacks of threads on here about it. If you search for Suporn you'll see.

But, hey, I'm not here to champion one place over another, especially about aesthetics. Safety's a different issue and there I have concerns about one place in particular.

Quote from: Richenda on June 20, 2016, 10:42:49 PM
Yes and in that paper he claims that without his super-duper technique 40% of them would have had depths averaging 3.7 inches.

My point is only that the Wikipedia article said that there's a physical limit around 11 to 12 cm, and its apparently not correct. Much as I like Suporn I don't think he can work around the laws of nature.

Quote from: mmmmm on June 20, 2016, 10:43:04 PM
http://cdn.thomasnet.com/ccp/30720834/221214.pdf

http://biomed.brown.edu/Courses/BI108/BI108_2007_Groups/group11/surgery.html

https://www.aesculapusa.com/assets/base/doc/doc107_rev-skin_mesher.pdf

Faints [emoji33][emoji33][emoji33][emoji33][emoji33][emoji33]
Oh my lawdy jebus
Off topic I heard this is what some Doctor do in Cali with hairline advancement to bring the hairline further up in hairline advancement surgery ... But eeeeekkkk


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Quote from: AnonyMs on June 20, 2016, 10:45:27 PM

I think Suporns results do look very good, and are generally well within natal variation, but there's various giveaways that its SRS. I think if you weren't aware of those you'd never realize.

The thing that worries me about that is that despite sometimes liking penises I'm basically a lesbian. (Men don't turn me on at all.) So the scary bit is that a cis-female tends to be a bit more savvy and observant about down there, as others on here have commented previously.

Anyway I must get back to my writing.

I seen suporns vaginas and cis vaginas and well every vagina is not made equal. I know I want mines to always look small and pretty like a virgin vagina. I don't want hanging sitely hanging beef curtains


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Sorry I should have mentioned Tina that although I haven't seen Suporn's specific pasta machine I have seen other skin meshing being performed a lot using exactly those kinds of machines just linked by mmmmm. It does thin out the skin quite amazingly like, well, like pasta! I spent 3 months in a unit using skin meshing. It's pretty amazing. Although the even more amazing thing (to me) is that we're not far from artificial skin. That will revolutionise care of burns and other patients and, who knows, might become a technique in MtF GRS.

Quote from: TinaVane on June 20, 2016, 10:50:05 PM
Faints [emoji33][emoji33][emoji33][emoji33][emoji33][emoji33]
Oh my lawdy jebus
I heard this is what some Doctor do in Cali with hairline advancement to bring the hairline further in one surgery ... But eeeeekkkk


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For hairline advancement?? Dear, you probably must have confused some words... I know this technique is used for scalp reconstruction, but that has nothing to do with hairline or advancement.

Quote from: mmmmm on June 20, 2016, 10:37:53 PM
Enlighten and educate us! We are dying to know, and please dont hold yourself back, we appreciate each and every detail about that minor differences.

Assuming that wasn't facetious ;) I'll post a link here and on the other thread I referenced about the PAI technique. As you can see it's now called peno-scrotal which I think seems to give a fair description:

<Link Removed>

WARNING: There are thumbnail links to some pretty graphic op and post-op pictures. Underneath each thumbnail is a lengthy explanation of the current PAI technique

Notice: 'Since the first sex reassignment surgery for biological males performed in Thailand in 1975, Dr Preecha and his team developed the surgical technique for vaginoplasty; many refinements have been introduced during the past 40 years, with nearly 3000 patients operated on. The scope of this paper is to present the surgical technique currently in use for vaginoplasty and clitoro-labioplasty and the refinements introduced at the Chulalongkorn University and at the Preecha Aesthetic Institute, Bangkok, Thailand.'

You can click on a link for the full paper in .pdf. WARNING the full paper has graphic images of the operation with descriptions of the techniques.

There are less academic links to PAI's work here:
http://travel.cnn.com/bangkok/play/everything-youve-ever-wanted-know-about-sex-changes-379486/
http://mycosmeticsurgerythailand.com/home3/2014/11/03/how-annie-david-can-help-to-make-your-beautiful-transformation-a-reality/

But the .pdf is good for going into detail, with pictures, on latest PAI techniques and it is a properly academic peer-reviewed article published in a reputable journal.

Mod Edit:TOS 5

I am familiar with this article from last year. Thank you for sharing nontheless, its helpful for others!

I didnt ask for that though, I personally am very familiar with technique of Dr. Preecha, as I was considering PAI for my surgery, along with Suporn and a local european surgeon. I asked for your explanation and clarification on that "minor" differences that you were mentioning.

Errr, isn't it obvious from that? Both PAI and Suporn use scrotal graft (or in the case of PAI sometimes colon graft). In PAI's example that's a case-by-case approach depending on penis length and circumcisions. Suporn uses mesh grafting i.e. he thins out the scrotal tissue. The differences in practice are relatively minor. I think sometimes people analyse a place like PAI on 40 year old data. All Thai surgeons revise their techniques. I'm sure Suporn has had an impact on the others just as PAI has for so many years.

 :police: Tread unlocked. Ladies, remember TOS 5 forbids nudity.  :police:

Quote from: Richenda on June 21, 2016, 06:22:34 PM
Errr, isn't it obvious from that?

Apparently not! If you take time to actually look at it, and compare the both techniques, you will actually find out that these are very different techniques. There are some obvious common aspects that basically every SRS technique shares (like using penile skin and using scrotal skin and using glans for clitoris). But apart from most basic common aspects, these two techniques are about as different as they get. PAI technique is very similar to North American and European techniques, from flap arrangement for labia minora and majora, for scrotal flap for lower vaginal introitus, to prepuce M incision (check some european surgeons who do exactly the same incision for prepuce flap), to urethral flap use in clitoral and inner labial area, to scrotal flap excision for actual vaginal lining graft, etc... You could almost say that Dr. Bowers and Brassard and Mcginn, and about at least 20 european surgeons, are doing the same technique as PAI, but they are in fact each doing their own techniques, with not just minor differences, but quite many major differences, although it might seem as they all arrange flaps in similar way. Quite different to all that modern penile-inversion techniques, are non-penile inversion. You could say that Dr. Chettawut and ten other Thai surgeons are doing exactly the same technique as Dr. Suporn. Even though they adopted some main ideas after Dr. Suporns technique, they each developed their own technique, and differences even between Chettawut and Suporn who are probably doing most similar thing, are far from minor. The devil is in the detail. And thats where they are very different.
Not that it has to matter to you. You believe whatever you like to believe! :) Im just saying it for the people who actually care about how their pussy will look like, and which "minor" differences make most sense for what their anatomy in relation to their expectations and preferences.

I'm not allowed to link to the PAI academic peer-reviewed article because the article itself describes, with pictures, the MtF GRS surgical technique used by PAI ...

If anyone wants a copy of the .pdf which is called 'Male-to-female vaginoplasty: Preecha's surgical
technique' in the Journal of Plastic Surgery and Hand Surgery · October 2014

then pm with your email address and I'll send you it.

p.s.mmmm they aren't very different at all in practice, neither here in Thailand nor nowadays in the west, but you have your view to which you're welcome. The devil is NOT in the detail because no two patients are alike: no two penises are alike and nor are any two cis vaginas. I will discuss it no further. I can't see much point going round and round in circles with the same six people who ever post on here.