After my consultation with Dr. Kamol I had a consultation with Dr. Theerapong too. He works from several clinics, it doesn't really matter which one you go to, but if you schedule surgery with one clinic you have to stick with them, so that's important. On reddit it sounds like a lot of foreigners schedule with a separate company and get extra services like pick up from airport, nurses after the hospital and stuff like that. I think that's a good idea unless you have somebody who will come with you. In Thailand we normally always have a close relative stay with sick people to help at the hospital (or sometimes hire somebody if no-one is free and your family has the money), I think you need that help, surgery was very hard. I don't know how anyone does it alone, but sometimes it happens.

I went to the Interplast clinic for a consult. I arrived and somehow I wasn't on the list which added an hour wait to see Dr. Teerapong. Dr. T was totally different personality wise from Dr. Kamol - he was asking me all sorts of questions about my life, including questioning why I didn't come out sooner, if I had a boyfriend, details about my work, schooling, etc. None of that was really relevant, and I honestly was worried he was going to spend the whole time playing getting to know me instead of answering my questions about surgery. I'm glad he was friendly. I wasn't able to ask him a lot of questions because he really went off on the answers. Here's some of what we talked about:

* He only does one surgery a day, and on days he has surgery scheduled, he does not go into the clinic for consults. That made sense of why the options for scheduling a consult were so limited - if he's operating, he puts his entire effort into that for the day. Major plus in my book. I don't want to be handed off to a unknown team for surgery.

* He's got his surgical team down to where he wants it to make everything go smooth. He likes performing the operations himself and is obviously very proud of his work.

* Looking at the calendar they had, it seems like he's booked most days of the week, but the waitlist isn't long. They are happy to take reservations for many months in advance, but they seemed to expect that I'd want to book within a month or two.

* He's not really interested in opening his own clinic or facilities - he has the money to do so, but he doesn't want to have to spend the time build the organization, so he works from Interplast and Bangkok Cosmetic Surgery clinics for consults, and hospitals in Bangkok for the operating theaters and rooms for patients. This is common for Thai surgeons. What hospital he uses depends on the technique as the equipment needs are different.

* I was curious about how he works with pelvic floor muscles - he said there has to be a big enough opening made to allow for dilation (I don't love the idea of what making an opening might consist of, surgery is scary), and not making that would mean things are too tight to dilate or have sex. However, voluntary contraction with pelvic muscles is a thing you can practice, and spasms when orgasming are normal which is really cool. I want to have that for my partners.

The rest of this is PPV specific discussion.

* For PPV it's 6 nights in the hospital, then go home or to a hotel to continue recovering. On day 14 he cuts the stitches, and then after that it's sending follow up pictures and texts, with appointments whenever needed.

* He's been doing PPV for over a year (now two years), but didn't know exactly how many he's done - I'd guess many dozens, but that's just my guess. I saw a lot of PPV on the schedule, so he's obviously doing a lot.

* His strategy is to use penile skin for labia (and boy does he give girls big labia!). He thinks that many surgeons skimp on inner labia and don't extend them down far enough to cover the entrance. He definitely gets them down there far enough.

* He uses scrotal flap (yes, a flap! he says it's much less risky than a graft, and preserves more sensation and allows for better recovery and doesn't risk the graft dying) for the entrance, with peritoneal flap being the rest. He can do the scrotal tissue as a graft to allow for hair scraping, but he recommends getting removal instead. If there are any remaining hairs, they will only be in the first couple inches where removal is still possible, albeit more difficult than pre-op.

* He also uses the extra urethra in the entrance area as it's a useful source of mucosal tissue.

* The funny lump below the vaginal entrance is not my cup of tea aesthetically, but the extra skin is there to allow the entrance to expand a bit more to make insertion easier. It also insures that he doesn't have to discard useful tissue, and can keep it for revisions. He said it's easy to remove it in a revision if I'd prefer to not have it, but it's harmless and it's rare for a patient to ask for it to be removed. Post-op I agree with him, it makes insertion way easy even if it looks slightly different than cis.

* He thinks that excess lube does happen for some of his patients, but it's usually in the Goldilocks zone for most of his patients. Long term it's anyone's guess - there's no studies. I have seen studies for cis women that say they have good sex from PPC though, so I think it's fine.

* For PPV, frequent and early dilation is extremely important. The join between scrotal and peritoneal tissue can contract and cause you to lose most of your depth unless you make sure it stays expanded. That being said, early in his mind is the day of removing packing, and frequent is just twice a day - so not really different than what most surgeons suggest. One of his earlier PPV patients said that she started dilation when the stitches were cut, and it went fine for her - I'm not sure why he moved that up.

* His dilators are made out of wax. They are literally candles shaved down on a lathe or something. Really, really odd, but hey, I've heard of plastic, glass, silicone, metal, and even foam dilators. He likes them because he can shape the tip how he wants it for easy insertion, and the patient can just put a condom over them to keep them clean and to make clean up easier. I'm not convinced that wax is really a great material - one accident and you are out a dilator. Definitely will need to buy some additional ones made of more durable materials as a backup, for travel, etc. That being said, I searched around and I guess some people find wax to be more comfortable, plus you can DIY replace them X-) The clinic also sells plastic/glass sort.

* He only give two sizes for PPV (I think he gives 3 for colon) - he doesn't think that a bunch of intermediate sizes are needed, at least at first. I'm not sure about that either, but he seems confident that two is enough. Again, I think a backup set is a good idea. I measured the small one is 1 inch diameter and the large one is 1.25 inches. The clinic has lots of bigger ones you can buy separately.

Overall, he was very talkative, happy to answer questions, and seems like he's very into what he does. We talked for somewhere between 30-60 minutes before he had to move on to his next appointment. Looking through older pictures and reviews he's obviously gotten better over time and it sounds like he's proactive in finding new ways to make sure things go well. He's not stuck in a rut.

I ended up deciding to have surgery with Dr. Thee, but went to BCS clinic instead of interplast because they had a promotional price which was better. They made me do another consult with him, which was also free. He did the whole getting to know me thing again and we talked about even more details until really late since I was his last appointment. When left the door was locked and they had turned off the lights. Dr. Thee is a night owl for sure, he only starts working in the afternoon and works late into the night. He says the hospital is quieter and it's easier for him to focus at night.

He's tried a lot of things over the many years he has done surgery, like using the tunica vaginalis, which he said he only did about ten times because it didn't work and that's why no surgeons do it anymore. I was very impressed with his knowledge and experience of surgery. He has been doing SRS for a very long time and has lots of happy daughters here.

I think interplast is more marketed for foreigners, but BCS had foreigners there too, so I'm not sure. BCS is closer to Mali hospital where he does PPV, and I think his house is nearby too. Doesn't matter much though, same surgeon at both places.