Those interested in the latest peno-scrotal technique used at PAI can see them here:

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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 contains graphic images of the operative 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.


Mode Edit:TOS 5

Kind of hard reading the middle pages of that paper. I think I'll have to print it out in black and white.

Because it's so graphic you mean?

It is a bit!

I had a look at that paper and had some observations. Medicine's not my thing, so perhaps someone else could go further.

On page 6, Table I, there's some statistics on the 395 SRS's they did from 2009 to 2013. You don't often see that, so its quite interesting if you want to know what might go wrong. I don't if its good or bad - presumably good or he wouldn't publish it. There's no fistula's but then it not a large number either.

The average surgical time is 3 hours. Suporn's is I believe 5.5 hours. I'd assume less time under general anesthetic is safer and has less side effects, so you have to wonder what benefit you might get with that extra time. Hopefully something.

Also on page 6 is a section on Skin Grafts

"Many Thai patients are presenting with a short penis; many patients from Arabic countries are circumcised; many patients from western countries demand a deep vagina (deeper than 14 cm): as a consequence, the use of skin graft has become very common at our centre. Still, when there is abundant penile skin, the vagina is solely lined with penile skin. The preferred skin graft used is a full thickness from the scrotum."

Whats up with these Westerners?

I notice there's appears to be no actual statistics for depth in the paper, which is a curious omission seeing as westerners are asking for it. In Suporn's 2004 presentation the average depth was 6.4", and

During the period 2010 - 2013 the average vaginal depth has been in the region of 7 inches (17.8 cm)
http://www.supornclinic.com/restricted/SRS/SRSTechnique.aspx

There's discussion of what they use the scrotal graft for but I didn't really understand it. I have the impression, especially from the above, that they try to use penile skin for the vagina, whereas Suporn uses scrotal skin for that. So they both use it, just differing amounts in different places.

Suporn discusses this on the image 110.jpg in the presentation you can download here. It's a bit unclear to me as they both appear to use penile and scrotal skin for both purposes, presumably its a matter of what their first priorities are.

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I've no real idea if that's correct.

On page 5 there's a 1+ year post-op result. Given the limitations of photo its a bit hard to be sure, but I think I much prefer Suporn for aesthetics.

Mod Edit:TOS 5

Quote from: AnonyMs on June 21, 2016, 10:55:38 AM
Suporn discusses this on the image 110.jpg in the presentation you can download here. It's a bit unclear to me as they both appear to use penile and scrotal skin for both purposes, presumably its a matter of what their first priorities are.

There is no penile-inversion is Suporns technique, logically -> this is why it is called non-penile inversion (scrotal skin graft inversion). All penile skin is used on the outside: inner labia minora (prepuce), outer labia minora and inner side of labia majora (penile shaft), and introitus (penile shaft).
If a patient had a lot of penile skin available, a result is similar to Danielle Foxxx, resulting in generous labia minora. Some may or may not like that. Its a personal preference, and if someone dont like that appearance, they probably should consider surgeons who perform penile inversion. If a patient had smaller penis, they wont have that kind of problem, as they will have result with smaller, tidier labia minora.

  Topic unlocked. Ladies, please remember this is a family friendly site and nudity isn't permitted even if it's a surgical picture 

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.

Does anyone know about the fat transfer they offer there? In particular with respect to BA. I'm kind of interested.

So am I. Try Warlockmaker maybe?

I've got a solution to the fact the link I posted showed 'nudity' (it's actually the MtF GRS operation). The abstract shows no nudity at all:
http://www.ncbi.nlm.nih.gov/pubmed/25356769

Those who wish to go ahead to the full article can presumably do so or google 'Male to female vaginoplasty: Preecha's Surgical technique' and it should be the first thing which shows up on your search.

Chen x

Hi Chen. Yesterday I went to Yanhee hospital as they are the only ones that do electrolysis. It's an older hospital but used to be the best in Bangkok for cosmetic surgery. So on the elevator,in a big poster, in Thai, I see they offer srs for thai baht of 140,000...which is usd 3,800 and includes 13 days in the hospital. My thai tgs told me about this.  I'm going to check on the method and reputation.

Hi beautiful, sorry to be off the board for a bit. A few discussions were getting a bit too much for me! That's brilliant about Yanhee. I'd love to hear more when you can.

I heard a fabulous story about Dr Preecha yesterday. I'll tread carefully here as it's a real story and I'm not going to reveal any actual details. A MtF girl who had just had her GRS subsequently suffered a major post-op problem. The GRS surgery was performed outside Bangkok. It wasn't the fault of the initial surgeon. Basically the person had an accident which caused a dangerous rupture to the GRS she had received a few days before. She tried to get emergency surgery from the original place but they refused to help.

Someone I know made phone calls and she was flown to Bangkok where Dr Preecha stepped in. His team at PAI performed the emergency surgery in hospital, she was hospitalised and then put up in hotel accommodation close by and monitored until she was better. And do you know what?

Dr Preecha didn't charge her one single dime.

This was told to me by the professional western doctor who made those phone calls.

That's would be Dr Preecha... he gives generously to charity both in his time and monetary.  I understand he is also setting up a charity service to help tgs in Asia.  Today we have no united organization here.

Is you have not met him yet ...you will see he has the warmth and kindness in his soul.

I love this thread. It contains so much useful info for those of us trying to pick a surgeon. Dr Preecha was very high on my list just because he uses an actual hospital. Hearing all of this info raises him in my choices. Now if I could only find some examples of his GRS work to settle my mind.

Hi Lauren...just pm me and I will give you Jessie, his assistants e mail and he will provide you with the required information.

A really important reason is that he is a one stop service and has excellent surgeons for ffs and ba.  Having them in the same clinic allows them to do the surgeries together at one GA..thus your time under GA is significantly reduced .

Sorry I can't PM yet. Still too much of a newbie here.

I had my consultation at PAI today and so I thought a few reflections might be helpful. As I've chosen PAI I may fall into that trap of only talking-up my chosen clinic. I will try to be objective and not be too evangelical about it.

The clinic is on Sukhumvit 55 and the area is a relatively wealthy and stylish one with hair salons and expensive houses. The clinic is quite glitzy and smart and bigger than I expected.

Clinic staff are extremely attentive and friendly: it's one of my most striking impressions. The reception foyer is bustling and I suppose I rather foolishly forgot that it's also a cosmetic and aesthetic institute so there are lots of people there for all sorts of procedures. There were a number of young cis-female westerners having face or breast surgery. Personally I really liked that. There's nothing 'back street' about this place haha. This is a thriving institute.

I did have some issues with needing to chivvy them along for my appointment as I had a flight to catch. Basically the appointment slot was a block hour with a handful of others. However, when I very politely explained my predicament they reacted excellently and I was seen at once by Dr Sutin.

I am scheduled for my surgery at the end of July. This will take place at their affiliated hospital. One thing I was very happy about was that he said I have lots of lovely loose skin on both penis and scrotum ready for my SRS. There will be no need for other grafts, even having had the orchiectomy.

Overall? What can I say really: I think it comes back to that central question about what you are looking for. Personally I do place safety high on my list of priorities. Anyone can have an unforeseen problem but PAI is a super professional outfit well equipped to deal with such things.

Richenda, did you get a chance to look at any after surgery results photographs? I'm looking for a result that looks as close to cis as possible, with a posterior fourchette etc.

Hi Lauren,

Because I was focused on the orchiectomy I didn't. However, I'm committed to having my SRS there so I will ask them. I'm popping in next week to pay my deposit and then will be there much of 28th / 29th in preparation for my surgery so I will make a point of doing so. They're good questions.

I do actually have the impression they tailor ops to individual requirements rather than using a one-size-fits-all approach. That's why, for instance, they offer different skin graft options and how they can operate both a penile inversion and a peno-scrotal non-inversion in the same place. The fourchette question is a very good one that I will pursue.

I've already decided that I'm going to tell my SRS surgeon there: 'make it beautiful'

Chen x

Thankyou, its so hard to do this through websites. Makes it very difficult to choose a decent surgeon. And of course you only get one crack at this sort of surgery.

Quote from: Lauren O on June 27, 2016, 03:45:10 AM
... as close to cis as possible, with a posterior fourchette etc.

Most surgeons can only try to imitate posterior fourchette, as with penile-inversion based techniques this simply isnt possible, as there isnt extra skin available for that. With most penile inversion techniques, labia minora ends above vaginal entrance. For posterior fourchette, there needs to be labia minora all the way down, and both labias closed together around vaginal entrance. With penile inversion, lower part of vaginal entrance is simply scrotal flap, except if a patient had XXL penis, there might be enough extra skin tissue that would allow a surgeon to fold penile skin flap all the way around introitus and make uniform labia minora with fourchette. Usually, this is not a case, as most of penile flap is needed for adequate depth.
Most realistic fourchette can be therefore done with techniques which use all penile skin for vulva. One option is sigmoid colon vaginoplasty, and non-penile-inversion like Chettawut and Suporn do it. Simply because there is extra penile skin that allows long labia minora with extra skin. Im not sure about Sigmoid colon technique, various surgeons do such details very differently, but Chettawut and Suporn dont do fourchette during initial surgery, as fourchette wouldnt survive the dilation stage. This can be done later with revision surgery, when a patient is able to skip dilation for few weeks or a month without concern for losing depth. After fourchette revision, special dilation technique is introduced which is focused on softly stretching fourchette and vaginal entrance...