Gender Reassignment Surgery in Thailand

MTF |SRS Surgery – Male to Female Surgery Gender Reassignment Dr. Sanguan

Doctor Sanguans expertise in Gender Reassignment, has been heavily documented over the past decade with extensive media coverage, including documentaries on the National Geographic Channel (internationally), MDR (Germany), ABC (Australia), Star TV (Hong Kong) and 20/20 (New Zealand). These programs have given transgendered clients the opportunity to pass on their personal experiences and their decision-making process in undertaking Gender Reassignment Surgery in Phuket.

Extensive training in urology, reconstructive urology, and plastic surgery allows Dr. Sanguan Kunaporn to understand the complex transformation of a male to female transition.

Dr. Sanguan firmly believes in a personalised approach to assisting patients to achieve their unique surgical goals.  They have detailed one-on-one discussions, addressing all questions and concerns their patients have about Gender Reassignment Surgery.

Male to female genital surgery is easier, less expensive and more successful than female to male surgery. That’s one reason why fewer women choose to have surgery on their genitals.

In male to female Gender Reassignment surgery, the testicles and most of the penis are removed, and the urethra is cut shorter. Some of the skin is used to fashion a largely functional vagina. A “neoclitoris” that allows sensation can be created from parts of the penis. Men retain their prostates.

Men transitioning to women can have plastic surgery to “feminize” their appearance, including work on their eyes, noses, brows, chins and hairlines. They also can have their Adam’s apple shaved down, so it is less prominent.

FTM |SRS Surgery –  Female to Male Surgery Gender Reassignment

In female to male Gender Reassignment surgery, the breasts, uterus, and ovaries are removed (in two separate procedures). A “neophallus” can be constructed using tissue from the forearm or other parts of the body that allow sexual sensation, an expensive process.

Extending the urethra to allow standing urination has proved to be perhaps the most difficult part of the process.

Penile inversion vaginoplasty is a MTF surgical procedure in which the male genitalia is reconstructed into that of a female’s.

In the penile inversion vaginoplasty the testicles are removed (orchiectomy) and the scrotal skin is used to make labia majora (labiaplasty). The nerves to the the sensitive glans penis and the corresponding skin is preserved and used to make a clitoris. The skin of the penis and, in most cases, skin grafts from the scrotum are used to make a vaginal vault. The urethra is shortened and placed in the female position.  Sensitive urethral mucosa is placed in between the labia minora.

Penile inversion vaginoplasty is typically a one stage procedure, however, occasionally secondary procedures are preferred to maximize the aesthetic appearance of the vulva.

Permanent hair removal is required on the genital area prior to surgery although Dr. Sanguan doesn’t require electrolysis because he removes the hairs during surgery. Removing hair before SRS ensures the best results and a faster surgery though.

Many transsexuals that don’t want to go through the embarrassment of getting electrolysis use the Tria Laser hair removal system for home use. If you try this, make sure to buy it from their website (www.triabeauty.com) so that you get the warranty and the battery lasts. Silk’n (www.silkn.com) is also another option for hair reduction.

Trachea Shave

A trachea shave is one of the most common surgical procedures for transsexuals. The surgeon reduces the cartilage in the throat to make the shape more feminine.

Common names:

  • Adam’s apple reduction
  • tracheal shave
  • thyroid cartilage reduction (TCR)
  • chondrolaryngoplasty

The procedure

Many  do it in conjunction with other procedures.

If you feel your throat, you will feel several horizontal ridges of cartilage on your trachea. If you feel the prominent part, you’ll feel a V-shaped protrusion of cartilage. That’s what they reduce.

The surgeon makes a horizontal incision in a crease of skin on the throat. Then the vertical muscles in the throat are separated to expose the cartilage. Then the surgeon shaves off the most prominent part of the notch and the top of the V.

Recovery

Bruising and swelling are common and vary greatly by individual. Swelling usually subsides fairly quickly over 2 to 14 days. Bruising is generally heaviest on the throat, but drainage from the site can cause bruising to show on the lower neck and chest. Usually this resolves in one to three weeks.

Most procedures leave you with a prominent red scar that lightens over the next 1 to 3 months. This can usually be concealed with makeup once any stitches or staples are removed. Depending on the procedure, this scar can be a raised ropy scar that will settle without the indentation common to healed incisions. How noticeable it is depends on the surgeon’s skill, and your body’s formation of scar tissue. Severe cases might require surgical scar revision or flesh colored tattooing.

You may be told to rest your voice following surgery.

Some have a temporary change in vocal quality. This can include weakness, lowering of pitch, raspiness, hoarseness, raising of pitch.The more cartilage removed, the greater the risk.

Some have reported pain and difficulty swallowing, but this is often caused by intubation during general anesthesia instead of the surgery itself.

Most patients experience temporary numbness and tightness in the soft tissue, lasting a day to a week.

You will have stitches at the incision, often supplemented by surgical tape or butterfly bandages for a few days. Rarely, they use staples. These usually come out in a week. Stitches and tape must be kept dry, or there is a risk of worsening any scar.

You may have temporary dimpling of the skin along the incision.

If being accepted as female is your goal, one of the most important things to consider is facial feminization surgery. It can have a major impact in the quality of your day-to-day life, far more so than other aspects of transition.

It’s not enough by itself to make you be accepted as female, but for some, it’s a necessity. It has often been said  the key to being accepted as female is from the neck up. That means hair removal, voice, and face are vital. If you’re serious about having a smooth transition and the option of stealth, you should consider some feminisation surgeries and treatments.

First, since each case is completely different, a  free personalised evaluation is always required initially, which should mark the beginning of in-depth conversations about what your ideas are and adjusting these to realistic expectations given your “base” features and the anatomical limits placed for safety.

Facial Feminization is a collection of different procedures that primarily aims to eliminate a person’s masculine facial features to become that of a woman’s visage.
Although biological women may opt to have these kind of procedures, it is undeniably widely known and beneficial to the transgendered community.
The most common mark of male gender are the brow bone bossing, straight, large convex nose profile with overly projected nasal tips, visible Adam’s apple, prominent mandibles- a very chiseled face.

Men have longer faces than women. Male foreheads tend to have a prominent ridge running across the forehead above the eyes (brow bone bossing) while female foreheads tend to be smoother and flatter and have little or no bossing. Male chins are usually square while the female one are round and pointy.
In general, facial feminization works by bone reduction and manipulation of the skeletal framework.

Suggested Areas of feminisation with most impact :

It’s not about creating a whole new different person but helping someone in becoming her own true self- which is a “woman”.

Facial feminization is neither a whim nor an expensive lavishness. It is indeed vital and a needed medical intervention for a person transitioning from male to female in order to create harmony and comfort between her outer and inner self.

 

Breast implants, or augmentation mammaplasty, is a procedure some trans women undergo in order to supplement development they had with hormones. Some women never feel they need them, while others wanted them very much.

The surgeon inserts the gel-filled bag into a pocket created under the skin. This can be done in several different ways. To  understand the proceedure and options please look at our Breast Augmentation Page

As with any medical procedure, there are advantages and disadvantages which must be considered when deciding if breast implants are right for you.

Some advantages:

  • they might help you pass better
  • they might help make your body more proportionate
  • they might make you look or feel more sexually desirable
  • they might make clothes fit better
  • they might help avoid embarrassment in public dressing areas

Male to Female Gender Reassignment Surgery (also know as Sex Reassignment Surgery, or SRS) is a complex and irreversible sex change operation and therefore prospective patients must demonstrate a firm commitment to the decision to proceed.

The World Professional Association for Transgender Health (formerly the Harry Benjamin Association) recommends that six objectives must be met before a sex change operation is undertaken.

  • The patient must demonstrate a desire for sexual reassignment for at least 2 years prior to surgery
  • A clinical behavioral scientist trained to deal specifically with transexualism must make the diagnosis of Gender Identity Disorder.
  • The patient must live and work exclusively in his or her chosen gender for not less than 12 months.
  • The patient must be under psychological or psychiatric care for not less than 6 months prior to surgery.
  • The patient must have commenced hormonal sex reassignment treatment for not less than 6 months prior to surgery.
  • Throughout the evaluation process, peer reviews must be evaluated and the patient discussed by the appropriate clinicians.

In order to preserve the integrity and ethics of Transgender Reassignment Surgery, the Medical Council of Thailand now insists that all prospective patients are approved by a Thai psychiatrist. To facilitate this process, Doctor Sanguan requires, one month before intended surgery, a letter of referral from a psychiatrist, a physician, an endocrinologist or a psychotherapist. This needs to demonstrate the person’s suitability for GRS and will help ensure that the examination by the local psychiatrist (which will take place on the day prior to scheduled surgery) does not cause a delay to the surgery schedule.

Gender Reassignment Surgery aims to create a functional vagina with an external appearance as close as possible to that of a genetic female, together with the associated sensations and feelings

Doctor Sanguan achieves this via a two stage procedure, to ensure that the necessary skin grafts for the vaginal tunnel are carried out after an initial healing process of approximately 7 days. During this time newly formed granulation tissue provides an abundant blood supply, thus reducing the possibility of the skin graft failing.

STAGE 1

The creation of a vaginal tunnel (Vaginoplasty)
The removal of the penis (Penectomy)
The removal of the testes (Orchidectomy)
The construction of clitoris, clitoris hood, and labia minora (Labiaplasty).
The construction of a new urethra opening (Urethroplasty)

Since 2005 Doctor Sanguan has improved GRS techniques by using all of the sensitive skin from the penile head and prepuce skin cuff, with blood supply and nerves intact, to fashion the clitoris, clitoris hood and labia minora. By this process, the top of the glans becomes the neo-clitoris, and the underside forms the inner section of the labia minora – all preserved as one piece of skin. The color of the new labia minora will match that of the former prepuce skin. This new procedure significantly improves the external appearance of the new genitalia, as well as enhancing sensitivity.

STAGE 2 (after approx. 7 days)

Skin graft using, whenever possible, scrotal skin to line the new vaginal tunnel.

Although many GRS surgeons discard excess scrotal skin, Dr. Sanguan has found it to graft successfully in the majority of cases, thus making additional skin grafts unnecessary. After the scrotal skin is removed during the first stage of surgery, it is safely refrigerated at 4 degrees Celsius (approximately 39 degrees Fahrenheit), where it will remain healthy for up to 3 weeks, far longer than necessary. Before grafting, Dr. Sanguan carefully scrapes the scrotal tissue to remove hair follicles, thus preventing hair growth inside the vagina. This technique means patients do not require expensive and sometimes painful scrotal electrolysis prior to GRS.

The average vaginal depth will be 4-5 inches when grafted from the available penile and scrotal skin.

If, however, Dr. Sanguan concludes that the penile and scrotal skin is not sufficient to construct a functional or sufficiently deep vagina, he will recommend one of the following three skin graft options:

1. Full Thickness Skin Graft.
Excess or loose skin from the tummy, hip area or groin is added to the penile and scrotal skin. The donor site for the graft will leave a linear or horizontal scar. This is the best, and least invasive, choice.

2. Split Thickness Skin Graft.
Skin is removed from the thighs or buttocks and is added to the penile and scrotum skin. The donor site for the graft will leave a scar of approximately 50-100 square centimeters (8-16 square inches), similar to a deep abrasion or burn injury. The bandage covering the donor site will dry out and detach approximately two weeks after surgery. In most cases its initial poor appearance improves over time. However in some cases, the donor site may end up with a hypertrophic or keloid scar with little or no visual improvement.

3. Secondary Colon Vaginoplasty.
After a minimum of six months the patient may return for a colon vaginoplasty. This involves removing a section of the colon and constructing a self-lubricating vagina. The abdominal incision for the graft will leave a scar similar to that for women who have given birth by Cesarean Section.
However, this is an invasive and complicated procedure, and complications such as infection, and leakage of anastomoses or fistulas, though not common, may occur. The treatment for these complications is re-operation and on rare occasions, temporary colostomy cannot be avoided.

 

SURGERY SCHEDULE DETAILS

Full MTF Surgery Schedule is available, please contact one of our consult who will provide further details and any requirement

We understand that you will not always be sure about what surgery will be needed and that you will need to know that you are, in fact, a candidate for your Gender reassignment surgery with Dr Sanguan. To address this, you have the opportunity to have Dr Sanguan provide you with their personal recommendations at no cost or commitment to you to proceed with surgery.

Step 1: Take photos as required

Step 2: Complete the Patient Registration and upload images taken

Step 3: Receive personalised  Recommendations, exact cost and duration required to stay in Phuket for recovery, from Dr Sanguan your Transgender surgery specialist Thailand.

Switching from male to female might cost in the $60,000 to $70,000 range  in Australia. This is precisely why many Transgenders travel to Dr Sanguan in Thailand for surgery .

Our advice to get a clear picture of what is going to work to achieve your results is to submit your images and patient information so Dr Sanguan  can provide you with recommendations. These recommendations will  include what surgery will achieve your results, confirmation of price and duration you require for recovery in Phuket.

The pricing below is  for standard MTF nad Female Feminization surgery costs in Phuket and should be used a  guide only without having surgical recommendations provided.

Surgery THB AUD
Tracheal Shave (under LA) 40,000 $1500
Tracheal Shave (under GA) 90,000 $3300
SRS (GRS) 400,000 $15,500
SRS + Breast Augmentation (round Implant) 515,000 $19,900
Female Feminization Surgery (FFS)
Forehead Brow ridge Contouring 220,000 $8,500
Scalp advancement 200,000 $7,700
Cheek Implant Surgery 120,000 $4,600
Cheek Bone Reduction 230,000 $8,900
Chin Contouring/Shaving 180,000 $6,900
Jaw Contouring/ Jaw Reduction/Shaving 230,000 $8,900
Lip Lifting (Reduction between upper lip and nose) 70,000 $2,700

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