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MTF / Transfeminine Procedures

Conveniently located to serve Hoboken, Ridgewood, Livingston, Pompton Plains, Manhattan/NYC, and Nyack
 

Your MTF Consultation

Deciding to undergo an MTF procedure is a major decision in life. Potential candidates will have reservations, concerns, and a desire to learn more. During the consultation, the surgeon and the patient will discuss transition goals and how they can be accomplished through MTF techniques.

Based on the patient’s goals, along with their medical history and overall health, the surgeon will create a treatment plan that will best suit the patient. All questions and concerns regarding transfeminine procedures will be answered. The surgeon may also show the patient photos of possible results so they can gain a clear picture of what to expect for each type of MTF procedure.

 

MTF Top Surgery

MTF top surgery or chest feminization is a commonly performed surgical procedure for transfeminine patients in our practice. Dr. Keith is a world-recognized pioneer in the techniques and concepts of feminizing chest surgery for transgender patients. Chest feminization refers to a range of procedures aimed at feminizing the chest. This is done through augmentation of breast tissue through the use of implants and/or autologous (your own) fat. In some cases, repositioning the nipple to a more female anatomic position is necessary.

Implant-based Chest Feminization

For some transwomen, feminization of the chest is achieved through addition of volume with the use of a silicone implant. Typically, an incision is made in the inframammary fold (the area underneath the breast tissue) in order to nicely hide the incision. It is important to note that feminizing the chest entails much more than simply placing silicone implants, and it is important to pick a surgeon who specializes in these chest feminizing techniques. During your initial consultation, Dr. Keith will go over a surgical plan specific for you, depending on your unique anatomy and goals. You will also be given the opportunity to try on implants in the office to help decide on what size works best for you.

Autologous Chest Feminization and Hybrid Feminization

In some circumstances, we add autologous (your own) fat to the constructed female breast to further feminize the breast. This can be achieved by harvesting fat via liposuction from distant sites such as the abdomen, flanks and thighs, processing the fat and transferring it as a graft to the chest. The benefit of this approach is a natural-appearing and natural-feeling feminized chest without the use of a foreign body such as a breast implant. There is a limit to how much volume can be achieved when only using autologous fat. In a hybrid chest feminization, an implant is utilized in addition to grafted fat in order to achieve the most natural and feminine look and feel.

Patients under Age 18

The team at ECAPS will consider candidacy for younger patients under age 18 who provide referral letters from a mental health professional and have parental consent.

MTF Top Surgery Recovery

MTF top surgery recovery requires you to restrict your activities for several weeks to support the healing process and avoid compromising your results. The length of your recovery will depend on the extent of your procedure, your body’s natural rate of healing, and how closely you follow the aftercare instructions provided by your surgeon.

 
Chest Feminization:

Chest Feminization

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MTF Bottom Surgery

Dr. Keith has assembled a highly skilled team of health professionals to perform gender affirming genital feminizing surgery.

Robotic Penile-Inversion Vaginoplasty

Dr. Keith pioneered the use of the da Vinci® robot in the penile-inversion vaginoplasty. He partners with a board-certified urologic surgeon to safely perform this cutting-edge procedure. This technique involves the removal of the testicles and erectile portions of the penis. A sensate clitoris is created from the glans penis with the goal of achieving female aesthetic and functional erogenous sensation. The urethra is shortened and the entire external genitalia is configured to a natural-appearing female form. In addition, a neo-vaginal canal is created between the bladder and the rectum. The lining of this canal is created with the use of skin from the penis and scrotum, as well as a graft from the peritoneum. The goal of this procedure is to create a natural appearing, sensate and fully functional vagina. This surgery is typically performed in one stage.

What is Peritoneum?

Peritoneum is a smooth, mucosa-like tissue lining the inner wall of the abdominal cavity. It secretes a natural lubricant and has the appearance and feel of natural vaginal mucosa once healed. Dr. Keith has pioneered the technique to utilize a strip of peritoneum as a graft in construction of the canal of the neo-vagina. This is harvested with the use of the robot. Peritoneum is a smooth, mucosa-like tissue lining the inner wall of the abdominal cavity. It secretes a natural lubricant and has the appearance and feel of natural vaginal mucosa once healed. Dr. Keith has pioneered the technique to utilize a strip of peritoneum as a graft in construction of the canal of the neo-vagina. This is harvested with the use of the robot. Peritoneum is a smooth, mucosa-like tissue lining the inner wall of the abdominal cavity. It secretes a natural lubricant and has the appearance and feel of natural vaginal mucosa once healed. Dr. Keith has pioneered the technique to utilize a strip of peritoneum as a graft in construction of the canal of the neo-vagina. This is harvested with the use of the robot.

Hair Removal

Hair removal is NOT mandatory prior to vaginoplasty. The hair follicles are removed surgically during the vaginoplasty procedure.

Dilation

Dilation of the vaginal canal is a critical part of the postoperative recovery process of penile-inversion vaginoplasty. Failure to dilate will result in collapse of the vaginal vault and loss of vaginal depth. You will visit the office each week, for at least four weeks following surgery, in order to learn how to properly dilate. We know that dilation can be time-consuming and difficult at first, however, it will become much easier with time.

Zero-Depth Vaginoplasty

In some circumstances, patients may request a zero-depth vaginoplasty. Simply put, this gender-affirming genital surgery configures the external male genitalia to a female form. The goal is to create a natural appearing vulva complete with a sensate neo-clitoris and a female-positioned urethra. However, no vaginal canal is created and therefore no grafts are required from the skin of the penis, scrotum or peritoneum. Being that no vaginal canal is created, the patient will not be able to receive a partner through penetrative intercourse.

Revision Vaginoplasty and Labiaplasty

Dr. Keith routinely performs revision surgery for patients who underwent gender-affirming genital surgery in other countries or with other surgeons. These are often covered by insurance and may require collaboration with board-certified urologists or gynecologists. These procedures may help to improve overall function and aesthetics of the female genitalia.

Review from D.| Source: Healthgrades | Apr 12, 2020

“I had top surgery with Dr. Keith February 2020. His wait time for surgery was super fast, I had my consult and then a month later had my surgery. He is very thorough and wants the best results he can give you. At the consult he explains everything to the T and showed multiple results which look phenomenal. Contacting the office was super easy and his staff is very nice towards lgbtq. Dr. Keith also makes sure his hospital staff uses the correct pronouns. This was the best experience I could’ve wished for and I’m very happy with my results. 10/10 recommended”
 

Other

Facial Feminization

There are a myriad of options in feminizing the face for our transfeminine patients. There are both surgical and non-surgical options available. Dr. Keith and his team will be happy to discuss the spectrum of options available at your consultation.

  • Hairline Advancement and Forehead Contouring
    A male pattern receding hairline and prominent orbital ridge are common concerns for our transfemale patients. Dr. Keith uses cutting edge, 3D printed modeling techniques to deliver natural, soft-appearing and symmetric forehead reduction. This can be combined with hairline advancement to restore feminine balance to the face.
  • Rhinoplasty
    Nose contouring and feminizing surgery is available. In some instances, collaboration with our Ear, Nose and Throat (ENT) colleagues will be required. This can often be combined with other facial feminization procedures.
  • Botox and Fillers
    Injectables are a safe and effective way to help feminize the facial structure and anatomy. Botox and fillers are often used prior to, or in addition to, surgical facial feminizing procedures.
Tracheal Shave (Chondrolaryngoplasty)

The tracheal shave, commonly known as an Adam’s apple reduction surgery, involves a small incision over the cartilaginous prominence of the voice box. The cartilage is then shaved down to create a more flat or convex shape to the profile of the neck. This softens and feminizes the appearance of the neck.

Male to Female (MTF) Body Contouring

MTF body contouring is comprised of multiple procedures and/or surgeries to help accentuate the hips and buttock areas. Consisting of liposuction and fat grafting, body contouring procedures may help augment the buttocks and hips to give a more “hourglass” body type. The procedure is performed by harvesting fat from areas where excess fat is of concern, commonly the “love handles,” abdomen and thighs. In addition to these typical areas for liposuction we focus on the lower back and thigh areas to accentuate the buttocks and hips as much as possible.

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