Surgical Trans-Formation
Hope Sherie, MD, FACS
Medical Director
Cosmetic Concierge, PLLC
IT takes courage to grow up and become who you
really are.
e.e. cummings
The Cosmetic concierge, PLLC
About our practice
South End Charlotte, NC
The Cosmetic concierge, PLLC
About Dr. Sherie
Over 10 years general surgery practice in military and civilian
hospitals
Board certified by American College of Surgeons 2005-present
Dedicated cosmetic surgery fellowship 2012
Began performing top surgeries & advanced body 2012
Private practice opened February 2015
Currently performing 4-5 top surgeries / week
Member of WPATH and Charlotte Transgender Healthcare
Group.
The Cosmetic concierge, PLLC
About our practice
Private Surgical Center with full Operating Rooms
Licensed Anesthesia Providers in every case
85-90% Transgender Procedures
Only Regional Practice Certified in VASER Hi-Definition
Liposculpture
Only practice offering “buttonhole” nipple technique
Amazing Trans-Friendly Staff
We support multiple LGBT organizations & events
The Cosmetic concierge, PLLC
The Cosmetic concierge, PLLC
About our practice
Informed consent practice: do not require therapist’s letters for
most surgeries (one letter for orchiectomy)
Top surgery for 16-17 year olds with prior therapy and
parental/guardian consent
We offer three types of financing: descriptions and
applications available at www.cosmeticconciergemd.com
No specific waiting time for surgery – we are adding O.R.
days as needed
Phone & skype consultations available
Many out of state, and International, patients
The Cosmetic concierge, PLLC
About our practice
Proud to stand with the community and allies in North
carolina !
Despite modern taboos, Long history of body
modifications, trans-genderism, and intersexuality
Biblical Recognition of 3rd Gender:
•
Matthew 19:12 – “For there are eunuchs who have been
so from birth, and there are eunuchs who have been
made eunuchs by men, and there are eunuchs who have
made themselves eunuchs for the sake of the kingdom of
heaven. Let the one who is able to receive this receive
it.”
Billy tipton: 1914 - 1989
Let’s start from the top…
Top surgeries
FTM Chest Reconstruction
MTF Breast Augmentation
Androgynous Chest
FTM Chest Reconstruction
Anatomical Considerations
Natural Male Chest…not just flat !
Preserve Upper Pole
Remove Lower Pole & Fold
Accentuate Pectoralis Muscles
Nipple Placement
More Lateral - At Edge Of Pectoralis
Symmetry Important
FTM Chest reconstruction:
Nipple placement
FTM Chest Reconstruction
Types of Surgeries Being Performed Today:
Double Incision With Free Nipple Grafts
Inverted T
Keyhole / Peri-Areolar
Free Nipple Pedicle – “Buttonhole”
Ftm chest reconstruction
double incision with free nipple grafts
curved incision, muscular patient
Ftm chest reconstruction
double incision with free nipple grafts
curved incision, muscular patient after weight loss
Ftm chest reconstruction
DouBle Incision with free nipple grafts
curved incision, average weight patient
Ftm chest reconstruction
DouBle Incision with free nipple grafts
Curved incisions, heavy patient
Ftm chest reconstruction
DouBle Incision with free nipple grafts
Curved incisions, heavy patient
Ftm chest reconstruction
DouBle Incision with free nipple grafts
Curved incisions, thin patient
Ftm chest reconstruction
DouBle Incision with free nipple grafts
thin patient
Ftm chest reconstruction
Double incision with free nipple grafts
straight incision, average weight patient
Ftm chest reconstruction
DouBle Incision with free nipple grafts
Straight incisions, thin patient
FTM Chest Reconstruction
Keyhole / peri-areolar
FTM Chest Reconstruction
Keyhole / peri-areolar
Note: nipple position cannot be moved
FTM Chest Reconstruction
Keyhole / peri-areolar
FTM Chest Reconstruction
ButtonHole Technique
(free nipple pedicle technique)
FTM Chest Reconstruction
ButtonHole Technique
FTM Chest Reconstruction
ButtonHole Technique
WARNING:
GRAPHIC IMAGES IN
NEXT SLIDES
FTM Chest Reconstruction
ButtonHole Technique
DE-EPITHELIZATION
FTM Chest Reconstruction
ButtonHole Technique
SKIN FLAP AND DERMAL PEDICLE
FTM Chest Reconstruction
ButtonHole Technique
FLAP CLOSURE AND NIPPLE THROUGH “BUTTONHOLE”
FTM Chest Reconstruction
ButtonHole Technique
FINAL
Ftm chest reconstruction
“buttonhole” technique
Curved incisions, thin patient
FTM Chest Reconstruction
ButtonHole Technique
thin patient
FTM Chest Reconstruction
ButtonHole Technique
average patient
FTM Chest Reconstruction
ButtonHole Technique
average patient
FTM Chest Reconstruction
ButtonHole Technique
hEAvy patient
FTM Chest Reconstruction
ButtonHole Technique
hEAvy patient
FTM Chest Reconstruction
ButtonHole Technique
heavy patient
FTM Chest Reconstruction
ButtonHole Technique
heavy patient
Buttonhole technique Information:
Primary advantage is preservation of nipple sensation –
intensity is variable
Avoidance of scar distortion of grafts in patients with
hypertrophic or keloid scarring
Increased operating time
Current Contraindications due to risk of nipplie loss:
nicotine use, diabetes (microvascular disease)
Caution in older patients, larger breasts with long pedicle
distance from nipple to breast fols
The androgynous chest
A little more or a little less
nipples optional
Mtf breast augmentation
Anatomical Considerations
Chest Width
Skin Amount and Elasticity
Surgery Types
Implants
Silicone Gel vs. Saline
Above or Below Muscle
Incision Site
Fat Grafting
Mtf breast augmentation
implant placement
Mtf breast augmentation
insertion sites
MTF breast augmentation
trans-axillary submuscular gel
MTF breast augmentation
trans-axillary submuscular gel
MTF breast augmentation
trans-axillary submuscular gel
MTF breast augmentation
trans-axillary submuscular gel
MTF breast augmentation
trans-axillary submuscular gel
MTF breast augmentation
trans-axillary submuscular gel
MTF breast augmentation
trans-axillary submuscular gel
Body contouring
Characteristics
Masculine
Feminine
Torso Shape
V from chest to waist
Hourglass
Waist
Straight Line or Taper
Exaggerated Indentation
Abdomen
Smooth or Muscular “6-pack” Curved or Vertical Lines
Outer Thighs/ Hips
Straight or Concave
Curved, Convex
Thighs
Overall Smaller, Straighter
Overall Larger, Gentle Slope
Buttocks
Smaller, Central Fat Pad
Larger, Blends into Hips
Torso & abdominal shape
Male vaser liposuction
Male vaser liposuction
Male vaser liposuction
Male vaser liposuction
Male vaser liposuction
Male vaser liposuction
Male vaser liposuction
Male vaser liposuction + Fat Grafting
Male vaser liposuction + Fat Grafting
Female vaser liposuction + fat grafting
Female vaser liposuction + fat grafting
Female vaser liposuction + fat grafting
Other Procedures offered
For Trans Men
For Trans Women
Pectoralis Implants
Orchiectomy
Top Surgery Revision
Top Surgery Revision & Breast Lifts
Buttock Reduction
Buttock Augmentation
Botox for Forehead Lengthening &
Brow Lowering
Forehead Reduction/Scalp Advancement
Botox & Facial Fillers
Botox & Facial Fillers
Electrolyss under sedation
or numbing injections
Lip Fillers & Lip Implants
Multiple Minor Procedures:
Scar revisions, Mole/Wart Removal, Skin Tag
Removal, Hemorrhoid Removal, Hernia
Repairs
Multiple Minor Procedures
Scar revisions, Mole/Wart Removal, Skin Tag
Removal, Hemorrhoid Removal, Hernia
Repairs
Bilateral orchiectomy + scrotal excision
Surgery
preoperative requirements
18 years old or 17 with parent or guardian consent
Medical Clearance if older than 55 or significant medical
problems
Do not require a mental health letter for most surgeries
One letter for orchiectomy
Do not require hormonal therapy prior to surgery
If taking, skip one dose before surgery
Do not require weight loss unless BMI > 45
BMI > 35 need airway exam
Avoid Blood Thinners (aspirin, NSAIDS, herbals)
Ride home & caregiver for night of surgery
General Postoperative
recommendations & Expectations
Draining for first 48 hours (up to 10 days with large
volume liposuction)
Stiffness & soreness, not sharp pain, for first week
Moderate swelling for 1-2 weeks-often asymmetrical !
Mild swelling, firmness for up to 3 months
Aerobic activities, light work within 1-2 weeks
Heavy lifting, push-ups at 4 weeks
Scar remodeling and fading for 1-2 years