Quote from: Clara Kay on December 21, 2016, 10:11:30 AM
I received a response from Dr. Chettawut concerning my complaint about the looseness of my labia majora.  He has agreed to doing a revision under local anesthetic.  I'd be required to stay in Bangkok for 12 days.  He wants 2 months advance notice of my intention to have the surgery.  I have some thinking to do.

Received the same response. Agreed to revise the looseness of labia majora under local anesthetic and 2 months notice required. However he has denied my requests for more defined labia minora, labia minora extension and fourchett construction, stating that there's a limitation due to insufficient skin. I sent another email bargaining for more defined folds between the labia majora/minora. If he agrees to my request then I will most likely return for the revision.

Vaginoplasty aesthetics are so subjective.  I'm convinced that few trans women are completely satisfied with the results they achieve on the first pass.  Revisions and even a full labiaplasty are often pursued to correct flaws of one kind or another.  Those who elect the penile inversion method are typically on the operating table for 2 hours.  It's hard to imagine a surgeon being able to create a vulva with all the definition that a natal woman's vulva exhibits (clitoral hood, labia minora, fourchette) in that amount of time, not to mention the scars that you end up with.  Even the results of reputable Thai surgeons (Suporn, Chettawut, Kamol, etc.) who spend 6 to 7 hours doing the scrotal skin graft method rarely achieve completely natural looking results.  There are so many variables that limit what can be accomplished.  The biggest variables I would think are the patient's own genital characteristics and healing capacity.  Look at the wide variety of outcomes that appear on Marci Bower's vaginoplasty surgical results gallery.  I'm sure these are among her best outcomes.  Which one do you think is the best aesthetically (1 to 23)?  I doubt many of us could agree on just one.

PI results in a functional bottom but not a visually correct bottom. It is locker room passable but not bedroom passable.  The reason is the front must be left open until the blood flow is establish in the new location. After sufficient time has passed, the front can be closed and a clitoris hood constructed. If required, the labia can be touched up at the same time. I was not aware of this when I had my surgery and for that matter, I didn't know what a proper bottom look like. I had no interest in playboy or hustler magazine so my education was greatly lacking. Only after my surgery I learned that a revision was available.

Quote from: Clara Kay on December 28, 2016, 08:43:57 PM
Vaginoplasty aesthetics are so subjective.  I'm convinced that few trans women are completely satisfied with the results they achieve on the first pass.  Revisions and even a full labiaplasty are often pursued to correct flaws of one kind or another.  Those who elect the penile inversion method are typically on the operating table for 2 hours.  It's hard to imagine a surgeon being able to create a vulva with all the definition that a natal woman's vulva exhibits (clitoral hood, labia minora, fourchette) in that amount of time, not to mention the scars that you end up with.  Even the results of reputable Thai surgeons (Suporn, Chettawut, Kamol, etc.) who spend 6 to 7 hours doing the scrotal skin graft method rarely achieve completely natural looking results.  There are so many variables that limit what can be accomplished.  The biggest variables I would think are the patient's own genital characteristics and healing capacity.  Look at the wide variety of outcomes that appear on Marci Bower's vaginoplasty surgical results gallery.  I'm sure these are among her best outcomes.  Which one do you think is the best aesthetically (1 to 23)?  I doubt many of us could agree on just one.

I agree with most of this although the PI techniques vary so much amongst different doctors. Dr. Brassard is very different from Dr. Bowers who is different from Dr. Satterwhite (just some examples). The shortest time I've heard is 2 1/2 hours. Dr. Satterwhite, whom I went to, is 5 to 5 1/2 hours and he does a pretty good job of constructing a clitoral hood, labia minora, and especially the forchette. But like you said, everyone heals differently and even if you leave the operating room with a perfect looking vagina, the end result after healing can be quite different. I'm going in for a labiaplasty and revision tomorrow because, as you mention, it's difficult to get completely the first time through, particularly when attempting to create labia minora and the clitoral hood. And like Dena mentioned, blood supply is an issue as well. My labia minora ended up shrinking, my clitoral hood had some necrosis and then partially fused to my clit, and my forchette partially fused as well. Despite that, it looks pretty good. However, the optimal result for many us will require a second surgery. Luckily I didn't even have to ask my surgeon - he actually said he wanted to do it and got my insurance to pay for it! I hope more surgeons opt to do the same and not make their patients ask or worse yet, complain in order to get a revision.

- Ruby

My doctor said she would do a clitoral hood 6 months after my GCS. She said she would stitch the skin together and create the hood. Does that sound correct?

How is labia minora created after GCS? My scrotum was used for the vaginal graph and I do not have labia minora.

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.

Quote from: Rachel Lynn on December 29, 2016, 07:28:53 PM
My doctor said she would do a clitoral hood 6 months after my GCS. She said she would stitch the skin together and create the hood. Does that sound correct?

How is labia minora created after GCS? My scrotum was used for the vaginal graph and I do not have labia minora.

Dr. Chettawut created a very nice clitoris and clitoral hood for me.  It is fully sensate and I'm very happy with the appearance.  However, he did not create well-defined labia minora.  They are almost non-existent.  He did leave excess skin in the labia majora which he has agreed to remove in a revision at my request.  It seems to me that the excess skin in the labia majora could be used to create larger labia minora, but he has not agreed to do that for free.  Maybe he would do so for an additional charge.  I'll be asking about that.  I would be willing to pay for it given that I'm paying to go back to Bangkok anyway.  I was curious as to why an experienced GRS surgeon like Dr. Chett would leave excess skin in the labia majora as a matter of course (others have complained about this as well).  Is it to provide the tissue that will be needed for revision surgery?  I don't know.  One of my biggest complaints about all GRS surgeons is how opaque they are about revealing their surgical methods. 

Quote from: Clara Kay on December 29, 2016, 07:55:54 PM
I was curious as to why an experienced GRS surgeon like Dr. Chett would leave excess skin in the labia majora as a matter of course (others have complained about this as well).  Is it to provide the tissue that will be needed for revision surgery?

I don't know about Dr Chettawut, but Suporn does leave material so he can revise it later.

I am a Chet baby too..... First of all I would say that I am very happy with my results.... Early on I too was critique-ing my vagina ....why is it like this ....it should be like that etc.....sure it cld have been better or prettier and yes it can still be improved.... After having "used" it and compared it to many vaginas of real people and not porn actresses or playboy models...i can say I dnt think I need to fix it just yet, maybe when I am older. I live stealth and so far non of my ex bfs commented abt my vagina being weird or different and I've dated a bunch of Medical Doctors including OB Gynecologists who didn't know until the end....I compared it to my cis female sis and I am a medical professional who have seen tons of vagina and I can assure u they all look different and Your vaginas will pass unless u out urself or in combination with other telling signs of your past betrays u. So be easy on yourselves and don't overanalyze and start living. If I learned anything with my many surgeries it is - The enemy of good is perfection.

I'll second that penile inversion results vary widely (even from the same surgeon). I've also been confronted with disbelief that I was done in 2 hours, so I don't think that's *typical.* 🙂 Even Brassard can only manage it because he works with a partner. I am, however, fully satisfied with my one-stage PI results. (I have a clitoral hood, pink mucosal labia minora, and a rudimentary vaginal fourchette, as well as no visible scars at 4+ years post-op. I've also had issues with medical professionals insisting that I was cis, even with a speculum in there.) Are there things that aren't perfect? Sure. But my wife says the same thing about the vulva she was born with. Honestly, there are cis women who get "revisions," too; some trans women who do so may be perfectionists because they know what's possible with further surgery, rather than because there are obvious non-cis aspects of their vulva. In other words, I agree with Miss Lux that sometimes perfect is the enemy of the good.

I'm sure that many trans women are happy with the results they have without achieving 'perfection', whatever that means.  Some vulvas are considered prettier than others among natal women, and many natal women go in for labiaplasty and even vaginoplasty surgery for aesthetic as well as functional reasons.  It's a personal matter that cannot be explained away.  If you are uncomfortable with your body and can do something about it, what's the problem?  Do it. 

I heard the same talk from friends and family prior to my FFS.  You're fine as you are.  I like your nose.  You already pass as a woman, etc.   They couldn't understand what gender body dysphoria was like for me.  I just ignored what I heard and did what I knew I had to do to see my true self when I looked in the mirror.  I view the results of my GRS the same way.  I didn't do it for someone else, and I'm not seeking perfection. But for once in my life I want to like what's between my legs.   🙂

I don't know why it didn't occur to me before, but I wonder if it would be feasible to have labiaplasty surgery by a local surgeon whose patients are normally natal women.  The procedure is typically performed as an outpatient under local anesthesia and costs less than $4K.  All I could expect is the removal of the excess labia majora skin, no construction of more well-defined labia minora and fourchette.  The cost is less than traveling round trip to Bangkok and staying for 2 weeks.  I haven't heard back from Dr. Chettawut yet about his willingness to do a more complete revision (for an additional fee if need be).  Has anyone taken this approach for a minor revision post-GRS?  If so, how did it work out? 

Still, no word from Dr. Chet, but it may not matter.  I contacted the surgeon who did my BA about doing the labiaplasty, and he agreed to do it.  What I'm seeking is not complex.  It's similar to the labia reduction surgery that many natal women undergo.  I haven't received a quote yet, though.  He wants to see pictures to better assess what needs to be done.  Two other surgeons I contacted didn't respond, so I assume they were not interested.  I'll make a final decision once I hear from Dr. Chet.

I got a response from Dr. Chettawut (through Ms. Som his business manager).  He will not do a revision that includes creating more well-defined labia minora. 

"Dr. Chettawut have read your email and he commented that the excess skin on the labia majora cannot be used to create a more defined labia minora. This part was created in one step construction and Dr. Chettawut have done his best to make it more defined utilizing your original tissue."

Why the excess skin was left there to begin with, I have no idea.  I did not experience much swelling in the labia, and I asked him during his checkup prior to returning home if the skin would tighten on its own.  He replied that it wouldn't.  I can only conclude that his sense of aesthetics includes larger, baggy labia majora. 

With that response, I've decided that it makes no sense to return to Bangkok for minor surgery to remove excess tissue from my large labia.  I will have it done here in the US.

The odd thing is that a lot of Chett's results that I've seen show a preference for larger, more defined labia minora. I'm sorry that in your case, he went in the other direction, and that he now will not refine the inner labia; I hope you can find a plastic surgeon in the US who can help.

Just in my opinion... The hard part is the reassembly of the parts the the creation of the entire thing but I think most US doctors who routinely perform vaginoplasty on cis women here n the US can easily tweak the aesthetics of you labia... I've thought about it years ago and went for consultations here in Beverly Hills and a bunch of surgeon are capable and willing to do it. Goodluck!

The doctor that did my BA locally here in Chicago has agreed to do a labiaplasty to remove the excess skin in my labia majora.  Almost all of his patients are natal women, but I don't see that as a disadvantage.  He's expressed an interest in working with trans women also.  The total cost including anesthesia and facility fees comes to nearly $5k.  That's a lot, but I'd avoid having to travel literally halfway around the world to have Dr. Chettawut do it and stay in Bangkok for 12 days of recovery and spend nearly as much.  I also feel that my local surgeon will do a better job.  I can elect to have either local or general anesthesia.   I'll probably go with the local plus sedation.  When all is said and done, my total outlay for GRS (original and revision) will be $23K including travel and living expenses. 

 

Quote from: Clara Kay on January 31, 2017, 05:01:18 PM
The doctor that did my BA locally here in Chicago has agreed to do a labiaplasty to remove the excess skin in my labia majora.  Almost all of his patients are natal women, but I don't see that as a disadvantage.  He's expressed an interest in working with trans women also.  The total cost including anesthesia and facility fees comes to nearly $5k.  That's a lot, but I'd avoid having to travel literally halfway around the world to have Dr. Chettawut do it and stay in Bangkok for 12 days of recovery and spend nearly as much.  I also feel that my local surgeon will do a better job.  I can elect to have either local or general anesthesia.   I'll probably go with the local plus sedation.  When all is said and done, my total outlay for GRS (original and revision) will be $23K including travel and living expenses. 

Doing you revision locally sounds reasonable. If you can afford the price asked by this surgeon it seems to me the right solution for you.

Quote from: Lucie on February 01, 2017, 02:29:04 AM
Doing you revision locally sounds reasonable. If you can afford the price asked by this surgeon it seems to me the right solution for you.

I've gone back and forth on my decision.  If I travel to Thailand alone and economy class, I'd save a bundle.  Still, there are real and potential downsides to going back that I'd rather not flirt with.  I'm very glad I traveled business class for the original surgery.  Being able to recline my seat into a bed is heaven on the longest (20 hr.) leg of the flight back home.  Business class costs 5X as much as economy, though, which would erase any savings by having Dr. Chet do the revision.

I know from someone who went to Suporn that the flight back 2 weeks after a revision is nothing like after SRS. It was very easy.