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Written By: Erin Storm, PA-C
Published: March 19, 2021
Last updated: October 21, 2021
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The Skinny
Gender confirmation surgery or gender reassignment surgery can be a major component of a transgender individual’s transition. There are numerous surgical procedures from head to toe for male to female (MTF) transgender patients. Plastic surgery procedures are typically used in conjunction with medical and hormone therapies being administered under the care of a medical provider. You can also consult our female to male (FTM) gender confirmation guide.
All individuals undergoing a gender confirmation or gender reassignment transition are evaluated for mental health, emotional health, and physical health. This is to provide whole patient consideration and maintain standards of care for transgender health and gender dysphoria. Numerous international and national organizations exist to advocate, educate, and create a transgender community. The World Professional Association for Transgender Health (WPATH), American society offshoot USPATH, and GLAAD are some of these institutions.
The Specifics
Who is a candidate for male to female (MTF) gender confirmation surgeries?
Candidates for gender confirmation surgery are individuals identified as male at birth who are seeking to fully embody their authentic female gender identity. The decision to pursue medical and/or surgical treatments as part of the transition journey is entirely unique to every individual transgender person. Anyone considering a gender confirmation surgery should consider their overall health, expectations of the procedure, and ability to commit to recovery times prior to pursuing treatments.What can you expect from male to female gender confirmation surgeries?
MTF gender confirmation surgeries vary significantly depending on an individual transgender candidate’s needs. There are both surgical and non-surgical procedures for gender reassignment.- Facial Feminization: These procedures address the hair, face, and neck. There are surgical options to alter bony and soft tissue structures. There are also non-surgical options like fillers, thread lifts, and Botox.
- Transfeminine Top Surgery: Typically a surgical breast construction involving implants or fat transfer. The nipples and areola are also usually addressed to create a female breast.
- Transfeminine Bottom Surgery: These are usually surgical procedures to alter the hips, buttocks, legs, and genitals.
- Body Contouring: Liposuction is a minor surgical procedure, although other body contouring procedures may be less invasive and involve phototherapy or freezing techniques.
Surgical options are more involved, but also more permanent, and will involve weeks to months of recovery. Non-surgical procedures typically provide less permanent results, but are also less invasive, and possibly changeable. Certain hair procedures may take years to achieve full, lasting results. Medical and hormone therapies may affect surgical procedures and so should be discussed with your providers.
When should you consider male to female gender confirmation surgeries?
The decision to pursue gender confirmation surgeries is unique to every individual transgender patient. Considerations for mental health and physical health are highly important components of the appropriate time to pursue procedures. Additionally, candidates undergoing medical and hormone therapies will need to discuss the possibility of surgical procedures with their plastic surgeon and medical provider.What is the youngest age someone can have male to female gender confirmation surgeries?
Guidelines for pediatric individuals (those under age 18) pursuing gender affirming surgeries recommend that transgender candidates do not undergo genital reconstruction procedures including phalloplasty (penile construction), scrotoplasty (scrotum construction), vaginoplasty (labia, clitoris, and vaginal construction), oophorectomy (ovary removal), or hysterectomy (uterus removal) until they are 18.Certain top procedures can be considered around age 16. A discussion with a certified medical provider is important in determining the most appropriate timing of all gender affirming procedures and therapies. Additionally, parental consent and complete physical and mental health evaluations will be necessary.
Facial Feminization Procedures
A combination of surgical and non-surgical procedures that address the forehead, hairline, nose, lips, cheeks, chin, neck, and more may be employed for facial feminization.Forehead Contouring & Hairline Advancement
- Forehead Reduction
- Overview: A surgical procedure under general anesthesia for hairline lowering to create a shorter, more feminine forehead.
- Cost: $7,000 - $14,000
- Recovery & Results: Swelling, pain, and bruising for a few weeks. Numbness and hair shedding will continue for months. The results are permanent.
- Surgical Hair Restoration
- Overview: To preserve and augment scalp, eyebrow, and eyelash hair procedures like Follicular Unit Transplantation (Strip Harvesting), Follicular Unit Extraction (FUE), Neograft, and ARTAS Robotic Hair Transplantation are available.
- Cost: $4,000 - $18,000
- Recovery & Results: Pain, swelling, and bruising will resolve within a week or two. The results are permanent and hair growth will begin after several months.
Eyelash & Eyebrow
- Non-surgical Eyebrow/Eyelash Augmentation
- Overview: Eyelash Extensions, an Eyelash Lift, and Latisse can be used to enhance volume and definition.
- Cost: $75 - $450
- Recovery & Results: Possible skin irritation with some procedures. The results are temporary.
Hair Removal
- Non-surgical Hair Removal Solutions
- Overview: Electrolysis, IPL for Unwanted Hair, and Laser Hair Removal can remove hair from numerous areas of the body.
- Cost: $350 - $2,000
- Recovery & Results: Some irritation is possible. Avoid direct prolonged sun for six weeks. Results are temporary and multiple treatments are usually needed.
Rhinoplasty
- Surgical Rhinoplasty
- Overview: There are numerous approaches including Open Rhinoplasty, Closed Rhinoplasty, Endoscopic Rhinoplasty, Ultrasonic Rhinoplasty, and Alarplasty.
- Cost: $3,000 - $15,000
- Recovery & Results: The results are permanent and may continue to heal for up to 18 months, but most activities can be resumed within six weeks.
- Non-surgical Rhinoplasty
- Overview: Liquid Rhinoplasty with dermal fillers or Muscle Paralysis Rhinoplasty with Botox are less invasive options.
- Cost: $500 to $2,000
- Recovery & Results: Results last six months to a year and are immediate. Activity can generally be resumed the same day.
Cheek Augmentation
- Surgical Cheek Augmentation
- Overview: Cheek augmentation with fillers, Cheek augmentation with implants, and Cheek augmentation with fat transfer can be used to soften and refine the cheek area.
- Cost: $500 - $6,000
- Recovery & Results: Tenderness, swelling, and bruising will resolve within a week or two. Results may be temporary or permanent depending on the procedure.
Lip Augmentation
- Surgical Lip Augmentation
- Overview: V-Y Mucosal Advancement of the Lip, Lip Implants, Lip Augmentation with SMAS Implant, and Lip Augmentation with Autologen can provide permanent solutions to lip shape and size.
- Cost: $1,000 - $5,000
- Recovery & Results: Tenderness, swelling, and bruising will resolve within a few weeks. The results are usually permanent.
- Non-surgical Lip Augmentation
- Overview: Cosmetic Lip Tattoo, Temporary Lip Fillers, Semi-Permanent Lip Fillers, and Permanent Lip Fillers are less invasive, but still provide dramatic improvements to lip shape and size.
- Cost: $500 - $4,000
- Recovery & Results: Tenderness, swelling, and bruising will resolve within a few weeks. The results are usually temporary and require maintenance.
Chin Surgery
- Surgical Chin Augmentation
- Overview: Osseous Genioplasty for Chin Deformity, Chin Reduction, and Surgical Correction of Chin Ptosis can help to define the chin area.
- Cost: $5,000 - $15,000
- Recovery & Results: Some procedures will require a liquid diet for one week with activity limitations for multiple weeks. The results are permanent and usually finalize within one year.
Neck & Jaw Procedures
- Adam's Apple Reduction
- Overview: Also known as a tracheal shave or chondrolaryngoplasty reduces the protuberance and size of the Adam’s apple.
- Cost: $3,500 - $6,000
- Recovery & Results: The average patient recovers within two weeks, and the results are permanent.
- Neck and Jaw Definition Augmentation
- Overview: Thread lifts are commonly used to enhance neck and jaw definition through a minimally invasive surgical procedure. Available thread lifts include Silhouette Instalift, Silhouette Soft Thread Lift, and PDO Thread Lift.
- Cost: $1,500 - $10,000
- Recovery & Results: Most candidates recover within a few days. The results will finalize over six months and then continue to evolve with aging and use.
Transfeminine Top Procedures
Breast augmentation via implants, fat transfer, or some combination of the two is the goal of transfeminine top procedures.- Breast Augmentation
- Overview: Breast augmentation with implants and breast augmentation with fat transfer can be used to create female appearing breast tissue. Alterations to the nipple and areola are often made as well.
- Cost: $3,000 - $12,000
- Recovery & Results: The average patient recovers within a few weeks, and the results are permanent.
Transfeminine Bottom Procedures
Transfeminine bottom procedures can be used to remove male sex organs and create a vagina, clitoris, and labia.- Vaginoplasty
- Overview: Also known as a vaginal construction involves creating female genitalia including a vagina, clitoris, and labia. This procedure can also involve an orchiectomy and other procedures to remove male genitalia and shorten the urethra.
- Cost: $3,000 - $10,000
- Recovery & Results: The average patient recovers within a few weeks to months, and the results are permanent.
Body Contouring
There are both surgical and non-surgical treatment options to shape and contour the body.- Non-Surgical Body Contouring
- Overview: An alternative approach to classic liposuction that may also have skin tightening benefits. Procedures include truSculpt®, Emsculpt®, and BodyTite™.
- Cost: $1,000 - $10,000
- Recovery & Results: The average patient recovers within a few days to weeks, and the results are permanent, but will evolve with aging and weight gain.
- Liposuction
- Overview: Lipodissolve, Laser-Assisted Liposuction, Power Assisted Liposuction, Radiofrequency-Assisted Lipolysis (RFAL), SmartLipo, SlimLipo, Tumescent Liposuction, Ultrasound Assisted Liposuction, Water Jet Assisted Liposuction, SculpSure, and PrecisionTX can be used to alter and redistribute fatty tissue deposits.
- Cost: $1,000 - $8,000
- Recovery & Results: The average patient recovers within a few days to one week, and the results are permanent, but will evolve with aging and weight gain.
- Hip & Buttock Augmentation
- Overview: Butt Augmentation with implants and hip implants can be used to create a more female hourglass figure with additional volume.
- Cost: $3,000 - $10,000
- Recovery & Results: The average patient recovers within a few weeks, and the results are permanent.
- Calf Reduction
- Overview: Calf Reduction by Muscle Resection, Calf Reduction by Selective Nerve Blocking, Calf Reduction by Radiofrequency Nerve and Muscle Ablation, and Calf Reduction by Botox Injections can lessen the appearance of muscular calves.
- Cost: $1,000 - $4,000
- Recovery & Results: The average patient recovers within a few weeks, and the results are permanent. There will be significant limitations on mobility for a few weeks.
The Takeaway
For transgender individuals considering incorporating gender confirmation surgeries into their transition, there are a myriad of available procedures to further refine, define, and idealize their desired aesthetic. A plastic surgeon can assist with both sex reassignment surgeries and cosmetic transgender surgeries in conjunction with medical and hormone therapies from a healthcare provider. Candidates should also consider discussing with their insurance companies possible coverages for some of these procedures in the treatment of gender dysphoria.
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Source List
- American Society of Plastic Surgeons Gender Confirmation Surgeries plasticsurgery.org
- Karel E Y Claes Chest Surgery for Transgender and Gender Nonconforming Individuals PubMed.gov; 2018-07-02
- American Society of Plastic Surgeons 2018 Plastic Surgery Statistics Report plasticsurgery.org; 2019-01-01
- Otto J Placik Female Genital and Vaginal Plastic Surgery: An Overview pubmed.gov; 2019-08-01
