Let’s talk about aesthetics of GRS.

54
u/whitebasket22
Wed Nov 13 06:12:51 2019 UTC
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(36 comments)

Now far as I seen, including the wiki here,I have yet to come across anyway results that mirror afab vaginas. Which is 100% fine. Like there is obviously differences that is to be expected in most cases. some do look 100% real because not all vaginas are the same. However, the one characteristic that I notice is that the vaginal opening isn’t in the vulva and labia minora. It’s like, directly beneath, In its own separate thing?

but I am just wondering if there are any surgeons that really take in and listen to your vision as long as it’s realistic? Like would it be possible to ask for the opening to constructed inside the vulva, in the labia?

The big whole beneath everything is really the only thing holding me back at this point.

all 36 comments


29
u/ymmvmia
Wed Nov 13 07:20:43 2019 UTC
(6 children)

I was just thinking and worrying about this, pretty close to scheduling with my surgeon when I realized this. WHY DOES NO ONE TALK ABOUT THIS? Everyone talks about how most SRS results are indistinguishable generally except for the scars and obviously the internals. But even the "great" surgeons don't follow a basic diagram of what female genitalia look like. Why is the vaginal opening "outside" and below the freaking labia? Can someone explain with more knowledge on this explain "why" they can't have the vagina within the labia without a revision?

20
Wed Nov 13 08:04:34 2019 UTC
(2 children)

It has to do with dilation and tissue fragility.

You can get a minor revision later that fixes this.

That being said, there are some surgeons that get within AFAB aesthetics on a first pass. The labia minora are usually supposed to extend below and enclose the vaginal canal...but there are some cis women where thats not the case, granted its not common.

9
Thu Nov 14 01:29:48 2019 UTC
(1 child)

Mcginn nails this, if only I could afford her.

https://www.drchristinemcginn.com/services/srs/vaginoplasty.php

2
Sat Nov 16 15:52:31 2019 UTC
(0 children)

Can confirm

9
Wed Nov 13 12:53:24 2019 UTC
(1 child)

I will not post pics. But mine is not outside. Nor is it below. Thank you , Dr. McGinn.

5
Wed Nov 13 18:51:59 2019 UTC
(0 children)

I had a different surgeon, but otherwise the same. I know exactly what OP is talking about, but mine doesn't look like that either. I'm not even really considering any cosmetic revisions because I'm happy with how things turned out.

28
u/HashnaFennec
Wed Nov 13 19:40:43 2019 UTC
(0 children)

I actually know the answer to this one! If they were to stitch up the labia minora beneath the vaginal opening it wouldn’t get the chance to heal before being ripped open while dilating. Because of that there’s three main techniques that I’ve seen, the first is where they leave the labia minora open at the bottom and the second one is where they close the labia minora above the vaginal entrance and just hope no one notices. The third and by far the best technique is a two stage surgery where they leave the labia minora open at the bottom and once fully healed (typically about a year depending on the surgeon) they finish the vulva and have you not dilate for a couple weeks so it can heal.

19
u/GothicElectric
Wed Nov 13 20:15:02 2019 UTC
(1 child)

Here’s the bottom line—any neovagina you get from any surgeon is never going to be picture perfect porno pussy. Aesthetics do matter to some extent but having the best aesthetics in the world and having a non-functional piece of equipment is much worse. If you can accept that you’re never going to be perfect and you’re being truly honest with yourself that you have an authentic need to go through with GCS then maybe, just maybe you might be happy with your results.

There’s lot of risk that goes with having GCS which is why you need to be absolutely sure that you’re 100% on board with doing it. And what I’m about to say may be an unpopular opinion but I do think that the therapists/psychiatrists writing many of the letters for their patients need to take more responsibility of working through every emotional and psychological eccentricity before giving the go ahead.

It took me ten years from the point of starting my transition to finally get FFS. It took me another four to get GCS done. All of it has been hard. My results haven’t been perfect, but my quality of life has become better. I’m happier. It took me fourteen years to get here and I’m glad that it did. Had gotten surgery of any kind too early, I might have reacted differently after everything was said and done.

Take your time. Research, research, research. And most of all enjoy the damn journey.

6
Thu Nov 14 10:36:18 2019 UTC
(0 children)

And what I’m about to say may be an unpopular opinion but I do think that the therapists/psychiatrists writing many of the letters for their patients need to take more responsibility of working through every emotional and psychological eccentricity before giving the go ahead.

I am totally up there with you on that. And I think that (depending on the medical system) they should stay involved for at least a couple of months after the surgery, since it is mentally tough and post-surgical depression is a thing.

u/[deleted]
Wed Nov 13 06:16:52 2019 UTC
(23 children)

[deleted]

7
Wed Nov 13 06:24:33 2019 UTC
(18 children)

I've seen it in a Suporn result.

Wed Nov 13 06:30:17 2019 UTC
(17 children)

[deleted]

5
Wed Nov 13 06:38:16 2019 UTC
(10 children)

I've seen it in real life, post revision. He does do labia all the way down, but I don't know the sucess rate. And I've seen so many photos now I can't remember which one is which.

He published a paper on aesthetics recently. It's very interesting.

2
u/slitza
Wed Nov 13 09:20:39 2019 UTC
(4 children)

Do you perhaps have a link to the paper you mentioned please?

3
Wed Nov 13 09:30:15 2019 UTC
(3 children)

It's this paper, but I can't help you getting hold of it

Vaginoplasty Modifications to Improve Vulvar Aesthetics. https://www.ncbi.nlm.nih.gov/pubmed/31582028

1
u/slitza
Wed Nov 13 10:05:53 2019 UTC
(2 children)

That's great, thank you very much! :)

2
Wed Nov 13 10:07:26 2019 UTC
(1 child)

I'm sure it will turn up on scihub eventually.

2
Wed Feb 12 01:32:01 2020 UTC
(0 children)

It is now

Wed Nov 13 06:40:01 2019 UTC
(4 children)

[deleted]

1
Wed Nov 13 06:47:46 2019 UTC
(3 children)

Have a look at this new post

https://www.reddit.com/r/Transgender_Surgeries/comments/dvm6z3/5_months_post_op_with_dr_keelee_macphee/

I'm not sure what you can do in a revision. Suporn leaves extra tissue so he can fix things up later. I don't know what options there are if it's missing, or who would do it. There's very little information about revisions and very few photos.

Wed Nov 13 11:29:24 2019 UTC
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(2 children)

[deleted]

2
Wed Nov 13 12:20:17 2019 UTC
(0 children)

I commented on the other post, but just want to repeat it is a really good result. As far as external appearances got you've got all the right bits so it looks easy to revise if you want to improve it anymore. Look at Suporn's paper if you're interested in that kind of thing. Maybe Dr. MacPhee might be interested too.

I saw your labia don't quite reach the bottom, but it is close. Some asymmetry too.

1
Wed Nov 13 06:48:41 2019 UTC
(5 children)

I think the thing he tries to talk people out if is the posterior commissure, but that's different.

Wed Nov 13 13:17:06 2019 UTC
(4 children)

[deleted]

1
Wed Nov 13 14:54:44 2019 UTC
(3 children)

I'm not sure what you're describing. In the other post here I referenced Suporn's paper. If you can get hold of that there's some good photos.

https://www.reddit.com/r/Transgender_Surgeries/comments/dvnhc6/lets_talk_about_aesthetics_of_grs/f7dzutt/

There's a good photo here also.

https://en.wikipedia.org/wiki/Vulval_vestibule

Wed Nov 13 15:09:57 2019 UTC
(2 children)

[deleted]

1
Wed Nov 13 15:38:50 2019 UTC
(1 child)

I think going past the vaginal canal is not by itself the what the posterior commissure revision achieves. I've only seen it a couple of times so I'm not entirely sure how often the revision is necessary. I heard a Suporn sometimes says it's not necessary so perhaps it's adequate without it in some cases. I don't know enough.

1
Wed Nov 13 17:51:35 2019 UTC
(0 children)

In theory it is not necessary, as in cis-women it has plenty of variation and it can be barely visible, pretty minimal, it can suffer damage and so on.

3
OP
Wed Nov 13 06:19:50 2019 UTC
(3 children)

Congratulations! If I can’t find any resourceful answers. I may just proceed anyway. I actually saw your post about your experience at Mt Sinai. They are actually the top three locations im looking at right now. My insurance covers them thankfully.

Wed Nov 13 06:26:21 2019 UTC
(2 children)

[deleted]

1
OP
Wed Nov 13 06:29:39 2019 UTC
(1 child)

Was it easy finding lodging for your stay in the city? That really is the only obstacle. Which I’m sure I can find a solution. But also how much did your entire stay, excluding surgery fees, cost you? Just to get an idea.

7
u/carbonara3
Wed Nov 13 17:12:48 2019 UTC
(0 children)

I found that Dr. Theerapong at Interplast clinic in Thailand brings the labia minora down in the first pass. His results are on the website thesexchange.com

13
u/cybelechild
Wed Nov 13 17:45:37 2019 UTC
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(0 children)

However, the one characteristic that I notice is that the vaginal opening isn’t in the vulva and labia minora

This depends on the surgeon. Suporn results for example don't have this problem. McGinn doesn't either from what I've seen online. Also this is in general something that can be fixed in a revision. Do note that most photos out there tend to be pre-revision, which often improves looks considerably.

IMO the biggest giveaway tends to be the lack of proper clitoral hood and the way the labia connect with the clitoral area. The labia also tends to be thicker than it's cis equivalent, but IMO that is easily within variation, depending on the surgeon. A more problematic, and less discussed and visible thing seems to be that some surgeons apparently put the urethra in the vaginal canal which is downright idiotic, especially coming from someone who should know the ins and outs of female anatomy.

In general I wouldn't call even Suporn vuvlas cis-passing (Hell, I have one) or they rarely are on the first try, but after revision easily could easily pass.

u/[deleted]
Wed Nov 13 06:18:56 2019 UTC
(4 children)

[deleted]

Wed Nov 13 06:26:21 2019 UTC
(1 child)

[deleted]

6
Wed Nov 13 08:01:18 2019 UTC
(0 children)

US surgeons seem occasionally to be able to do it (I saw a Wittenberg result that did recently) but it seems like a dice roll. Suporn unfortunately seems to be the only one doing it consistently. There's almost no information on revisions to address it either. You might be able to ask at a consult about options, it would be very helpful for others to know if it's a possibility. I'm surprised this doesn't seem to be a top aesthetic concern for more patients, as it's not really a natural variation, whereas nearly everything else is.

2
Wed Nov 13 19:58:24 2019 UTC
(1 child)

Do you feel that Chets results are similar to Suporns?

21
u/bellatricked
Wed Nov 13 10:49:35 2019 UTC
(0 children)

I think the words you're looking for are "cis-passing" not "real"

Every neovagina is real. The alternative is calling them "fake" or "imaginary"

"Real" is not a good term to use of you're trying not to offend anyone.

Either way, the Suporn Clinic does what you're asking for. Check out the wiki on r/transgender_surgeries

8
u/taylort2019
Wed Nov 13 13:42:16 2019 UTC
(2 children)

I wonder how many cis vaginas you've actually seen and what expectations you might have because of that.

3
Thu Nov 14 07:51:35 2019 UTC
(1 child)

What do you mean?

9
Thu Nov 14 11:13:37 2019 UTC
(0 children)

I mean that many people, and I'm not saying it's your case, only know cis vaginas because of porn. Those bodies are not a realistic representation of cis vaginas and sometimes we have expectations because of that kind of exposure that are not real. Even for cis women.

1
u/HiddenStill
Wed Nov 13 06:40:03 2019 UTC
(3 children)

It's not something you'll get on request. They can either do it or not depending on their technique/skill.

7
Wed Nov 13 08:07:21 2019 UTC
(2 children)

Wrong. Its relatively simple (if they can handle everything else they can do this part decently well enough). The problem is that it will just get screwed up by the initial frequency of dilation.

You can get it on request via many surgeons as a revision. No reputable surgeon would do this on an initial pass at this point as it will just lead to an inferior aesthetic and healing/recovery process.

Edit: for the record all but 1 of the surgeons i had consults with offered this as a possible revision

7
Wed Nov 13 09:57:10 2019 UTC
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(0 children)

I think we're talking about two different things here. I'll reference Suporn as I know his work best and he's recently published a paper on it.

I believe the problem the OP described is when the labia don't extend all the way down to the posterior, instead stopping half way down or so. Suporn typically manages to extend it all the way down, or close to it, in the primary surgery. He can't to the posterior commissure revision until a year later due to dilation. Extending the labia down is not the posterior commissure revision as I understand it.

I believe there's plenty of surgeons that can't get the labia all the way down in the primary surgery. I've not seen enough revision photos to have any opinion on what they can do there.

In Suporn's paper there's a couple of good photos. Figure 6F before and Figure 7D after. I don't know if this is the same person, but I think it shows the difference in posterior and its what I have in mind by the posterior commissure revision. Note how figure 6 has the labia all the way down already.

And at the bottom of page 548

SECONDARY AESTHETIC IMPROVEMENT SURGERY

One hundred and sixty-two patients (27.9%) subsequently requested further minor aesthetic vulvar improvement surgery later than a year postoperative. Typical aesthetic improvement surgery requested were as follows:

Posterior commissure reconstruction in 33 cases (5.7%) to narrow the exposure of the vaginal entrance. If the labia minora are long and have adequate tissue, the lower part of both labia minora are mobilized and joined together to form the posterior fourchette.

1
Thu Dec 26 13:48:38 2019 UTC
(0 children)

You can get it on request via many surgeons as a revision. No reputable surgeon would do this on an initial pass at this point as it will just lead to an inferior aesthetic and healing/recovery process.

Edit: for the record all but 1 of the surgeons i had consults with offered this as a possible revision

I heard of a number of surgeons declining a revision later and who said it would not be possible.

Do you know if this needs to be talked through in advance and if there needs to be material positioned so it is possible later ? Or if there needs to be sufficient material present, if necessary from a skin graft for example ?