Hope Sherie, MD, FACSMedical DirectorCosmetic Concierge, PLLC

Surgical Trans-Formation

IT takes courage to grow up and become who you really are.

e.e. cummings

The Cosmetic concierge, PLLCAbout our practice

South End Charlotte, NC

The Cosmetic concierge, PLLCAbout 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, PLLCAbout 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, PLLCAbout 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, PLLCAbout 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 MusclesNipple 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 reconstructiondouble incision with free nipple grafts

curved incision, muscular patient

Ftm chest reconstructiondouble incision with free nipple grafts

curved incision, muscular patient after weight loss

Ftm chest reconstructionDouBle Incision with free nipple grafts

curved incision, average weight patient

Ftm chest reconstructionDouBle Incision with free nipple grafts

Curved incisions, heavy patient

Ftm chest reconstructionDouBle Incision with free nipple grafts

Curved incisions, heavy patient

Ftm chest reconstructionDouBle Incision with free nipple grafts

Curved incisions, thin patient

Ftm chest reconstructionDouBle Incision with free nipple grafts

thin patient

Ftm chest reconstructionDouble incision with free nipple grafts

straight incision, average weight patient

Ftm chest reconstructionDouBle Incision with free nipple grafts

Straight incisions, thin patient

FTM Chest ReconstructionKeyhole / peri-areolar

FTM Chest ReconstructionKeyhole / peri-areolar

Note: nipple position cannot be moved

FTM Chest ReconstructionKeyhole / peri-areolar

FTM Chest ReconstructionButtonHole Technique

(free nipple pedicle technique)

FTM Chest ReconstructionButtonHole Technique

FTM Chest ReconstructionButtonHole Technique

WARNING: GRAPHIC IMAGES IN

NEXT SLIDES

FTM Chest ReconstructionButtonHole Technique

DE-EPITHELIZATION

FTM Chest ReconstructionButtonHole Technique

SKIN FLAP AND DERMAL PEDICLE

FTM Chest ReconstructionButtonHole Technique

FLAP CLOSURE AND NIPPLE THROUGH “BUTTONHOLE”

FTM Chest ReconstructionButtonHole Technique

FINAL

Ftm chest reconstruction“buttonhole” techniqueCurved incisions, thin patient

FTM Chest ReconstructionButtonHole Technique

thin patient

FTM Chest ReconstructionButtonHole Technique

average patient

FTM Chest ReconstructionButtonHole Technique

average patient

FTM Chest ReconstructionButtonHole Technique

hEAvy patient

FTM Chest ReconstructionButtonHole Technique

hEAvy patient

FTM Chest ReconstructionButtonHole Technique

heavy patient

FTM Chest ReconstructionButtonHole 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 chestA 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 augmentationimplant placement

Mtf breast augmentationinsertion sites

MTF breast augmentationtrans-axillary submuscular gel

MTF breast augmentationtrans-axillary submuscular gel

MTF breast augmentationtrans-axillary submuscular gel

MTF breast augmentationtrans-axillary submuscular gel

MTF breast augmentationtrans-axillary submuscular gel

MTF breast augmentationtrans-axillary submuscular gel

MTF breast augmentationtrans-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 ProceduresScar 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 problemsDo 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 Postoperativerecommendations & 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