I had my consult and booked surgery with Dr. Horesh and wanted to share since I know there is not a lot of information out there about him yet. There is a lot of jargon because I want everyone to have the most accurate information possible!

Background: Elan Horesh is the newest addition to the CTMS Plastic Surgery team, working alongside Doctors Ting and Avanessian. He did both his residency and fellowship in Plastic Surgery at Mount Sinai and has worked with the team from it's inception.

Consult: From initial contact, I was able to book my consult 2 weeks out.

Booking: Dr. Horesh is currently booking for late February-early March. I decided to book for May because of personal circumstances.

Operation: (beware: lots of jargon!) Dr. Horesh performs the normal penile inversion with scrotal grafting that has become standard. In addition, he uses tunica vaginalis grafting (which is the same as peritoneal grafting) to line the deep vagina so that it is smooth, pink, and secretory. He still recommends patients use lubrication with intercourse after surgery, but it does mean that the vagina will be naturally moist and pink. He is also able to customize for patients who have a lot of tissue and want good aesthetics so he would use almost all of the penile skin for the labia minora and exclusively line the vaginal canal with scrotal/tunica graft so that you have a cis-like labia. This is what I requested. He also uses the entire corona of the glans penis in the construction of the vulva so that the labia are sensate and have a frenulum, similar to a cis vagina. The clitoris itself comes from a w-shape he makes in the corona, similar to the Thai/Suporn technique. More to that point, he uses a perineum flap just like the Thai/Suporn technique so that the entrance of the vagina does not look warped and the labia fully frame the vulva to the posterior introitus. He also flaps the urethra so that the urethra and the vagina are basically one unit, similar to a cis vulva, and uses the remainder of the urethral skin to line the vulvar vestibule so that it is pink, secretory, and sensate.

Pre-op: Before surgery, patients must shower with antiseptic soap 3 times (3 days before, 2 days before, and 1 day before). You are not allowed to shave your legs or genitals the day before surgery, but shaving your face is fine. The day before surgery, breakfast will be your last solid meal of the day. After that you have to start drinking a laxative solution (Golytely bowel cleansing solution) at Noon. For the rest of the day you can only have clear fluids, so gatorade, apple juice, water, broth... After 12, you cannot eat or drink anything. You cannot drink alcohol for 1 week before and 3 weeks after surgery, and no smoking is allowed for as long as possible before surgery. Importantly, he does not require you to stop taking HRT before surgery! This was one of my biggest worries going into this.

Recovery: After surgery, you will have a wound vac to minimize swelling which will be removed along with the packing at your follow-up appointment, about 1 week after surgery. He asks that you limit yourself to 150 steps per day for the first 4 weeks, and advises that you will probably have to avoid strenuous activity for the first 3 months. It is variable for everyone.

Dilation: Everyone's favorite thing! His schedule is 3 times a day, 30 minutes each, for the first year. It's a lot, I know. They say it's because they really want to avoid stenosis and vaginal failure, so just be prepared for dilation consuming your life. The packet I received doesn't say what happens after a year, but they mentioned that they recommend girls still dilate at least once or twice a week for the rest of their life, since there is a growing body of literature to suggest sex is not an adequate replacement for dilation (variable penis girth, depth, frequency, etc).

I think that's everything! If you have any questions please feel free to comment. I will try to make some posts when I'm on the other side to show off the results. I am so excited; the results of his I've seen are comparable to the best on this subreddit.