Does anyone know how updated they are and what they can do for people who want bottom surgery
like does it look good now or is there work to be done?
Just wondering, iv'e been thinking about things but i normally keep this kind of conversation limited and to myself i don't like talking about things that personal for some reason to me it seems more personal then a lot of my other thoughts but i don't know why.

A lot of surgeons are posting their results online. You could have a look at Dr. Miro or Dr. Crane's websites. They both have a pretty good gallery of different results. I would say the outcomes now are very good in terms of aesthetics, sensation, and function; especially when you compare them to how things were a decade or more ago.

There are still areas for improvement, such as erectile implants for phalloplasty which have a high complication rate currently. But as far as the basics go, things have improved a lot.

If I had to estimate or hypothesize how much more advancement there could be, I would say that metoidioplasty is probably about as advanced as it will get. Phalloplasty as it exists now in its most popular forms (RFF, ALT, MLD) will probably not change as a procedure. I do foresee continued improvements in erectile implants, as companies continue to offer new models with improvements regularly.

There are a lot of different kinds of surgery and every surgeon does them a little differently. But yes, the methods have improved a lot! Things like nerve-hookup improve the sensation in phalloplasties. They can also make them look more realistic than they did in the past. Metoidioplasties have also gotten better over time. Erectile implants have come a long way, but they still have high rates of complication.

Check out places like transbucket and yahoo surgery groups. Surgeon websites are also a great place to check. If you're seriously considering surgery, research surgeons in your area and get a consultation.