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Our Locations / TEL: 201.449.1000 / FAX: 201.399.2433

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

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 and gender non-conforming patients. He is widely published on the topic and has been an invited speaker at national and international surgical conferences. 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 fat. In some cases, repositioning the nipple to a more female anatomic position is necessary. Dr. Keith is an expert in these procedures. Call us at 201.449.1000 or use our online form to schedule an appointment right now.

Implant-based Chest Feminization

For some transwomen, feminization of the chest is achieved through addition of volume through the use of a silicone or saline implant. There are a myriad of options and choices during this procedure and Dr. Keith will help guide you through this process.

Autologous Chest Feminization and Hybrid Feminization

In some circumstances, it is important to add autologous fat to the constructed female breast to further feminize the breast. This will 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 feeling feminized chest without the use of a foreign body such as a breast implant. Additionally, in hybrid chest feminization, a small implant is utilized in addition to grafted fat in order to achieve the most natural and feminine look and feel to the feminized chest.

Chest Feminization:

Chest Feminization

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MTF Bottom Surgery

Dr. Keith has assembled a world-class team of health professionals to perform gender affirming genital feminizing surgery. In addition to the surgeons of ECAPS, Dr. Keith routinely works with board-certified experts from urology to safely perform these procedures.

Gender Affirmation Vaginoplasty

Many transgender patients see Gender Affirmation surgery as a final step in their transition from living as one gender to living as another. In a one stage vaginoplasty, a vaginal vault is created between the rectum and the urethra, in the same location as a non-transgender female between the pelvic floor, below the urethra, and the vaginal lining is created from penile skin. An orchiectomy is performed, the labia majora are created using scrotal skin, and the clitoris is created from a portion of the glans penis. The prostate is left in place to avoid complications such as incontinence and urethral strictures. Furthermore, the prostate has erogenous sensation and is the anatomic equivalent to the “g-spot.”

Robotic Vaginoplasty

Dr. Keith pioneered the use of the da Vinci robot in penile-inversion vaginoplasty. He partners with board-certified urologic surgeons to safely perform this cutting-edge technique. 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 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 prostate 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.


Peritoneum is a smooth, mucosa like tissue lining the inner wall of the abdominal cavity. It secretes a natural lubricant and appears like natural vaginal mucosa when 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.

Zero Depth Vaginoplasty

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

Revision Vaginoplasty and Labiaplasty

Dr. Keith routinely performs revision surgery from patients who underwent gender affirmation in other countries or with other surgeons. These are often covered by insurance and may require collaboration with board-certified urologists or gynecologists.

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”


Facial Feminization

There are a myriad of options in feminizing the male face for our transgender patients. There are surgical and non-surgical options and Dr. Keith and his team would be happy to discuss the spectrum of options available.

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 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.

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.


Nose contouring and feminizing surgery is available. In some instances, collaboration with our colleagues from ENT will be required. Your surgeon will evaluate and educate regarding your options.


MTF Procedures Recovery

The recovery period for MTF surgery depends on the exact procedures that were performed. Transfeminine top surgeries require one to two weeks of healing and a month before rigorous activities are allowed. Transfeminine bottom surgeries have a six-week healing period, and weekly follow-up appointments are often necessary to monitor the recovery process and ensure the safety of the patient.

Patients may be advised to hire the services of a healthcare provider to take care of their needs during the initial recovery period. Any prescription medications must be taken as prescribed for a comfortable recovery. Patients need plenty of rest to help with their recovery.


How Much Do Transfeminine Procedures Cost?

The cost of transfeminine procedures varies based on several factors. The surgeries performed impact the cost, as do anesthesia and hospital facility fees. The price of medication and the services of healthcare providers also contribute to the cost of the procedure. Health insurance companies do not cover certain MTF procedures, so it is vital to get in contact with your provider when considering transfeminine surgery.

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