Sculpting the transgender body

Caitlyn Jenner in the US has helped to transform attitudes to transgender people and we are seeing the results in our surgery. Many more people are willing to be open about their transgender identity and are seeking plastic surgery to make their physical appearance match their inner sense of self. My job is not sex reassignment surgery. Instead, as a cosmetic surgeon, I am helping to resculpt faces and bodies, usually from male to female characteristics.

This is a really important work. Psychologically, transgender people need to fit in with their gender identity. Hormone replacement therapy which can limit the growth of facial hair and encourage breast budding, can only do so much. You can’t get rid of a prominent Adam’s apple by taking oestrogen. The feminine waist to hip ratio isn’t going to happen unless fat is removed from the waist and repositioned on the hips.

My clients have all undergone extensive psychological evaluation before they are even considered for surgery, but once this assessment is complete, I am happy to proceed. The whole process can take one to two years and can cost tens of thousands of pounds. Usually, the transgender client who was born a male wants to start work on the body first. This is understandable. It is possible to feminise the face with makeup but a male body can be very hard to disguise. They are highly motivated and keen to get on with surgery as soon as possible.

One of the earliest procedures in any transformation is liposuction from the abdomen to achieve a more feminine waist to hip ratio. At the same time, I will usually perform a fat transfer from the waist to the hips. The fat is transferred within 20 minutes so it is still living tissue. I estimate that about 20-30 per cent of the transferred fat will dissolve and not ‘take’ but the rest will stay in situ and develop its own blood supply. Women are also very keen to have this procedure done to achieve a ‘hyper feminine’ hour glass look. Breast enlargement is also an early procedure.

I will usually work on various aspects of the face to create a more feminine look. Men tend to have a more protuberant forehead and this can be shaved down until it is smoother and flatter. I trained as a cranial facial surgeon and use specialist tools to do this when a patient is anaesthetised.

The Adam’s apple can also be shaved down with special drills. If someone has a prominent chin, we can reduce this. A rhinoplasty procedure is often appropriate too, particularly if a patient has a very nnprominent nose. I normally make a feminine nose which is smaller and slightly less wide.

I have never had any female to male patient decide that they want to reverse these feminisation procedures, but if they did, it wouldn’t be possible to change back. I think this is very low risk however, bearing in mind the many years that it takes to even get to the point where surgery is an option. I always have realistic and in-depth conversations with my patients who undergo these types of procedures as it’s important for them to understand that there is no going back and if they decide to opt for facial feminisation, for example, this is irreversible.

I always consult with my patients carefully and give them time to consider their options and weigh up their final decision before going ahead with the operations. I always see my patients for as many pre and follow up appointments as is required to ensure they respond positively after the procedure. I will offer them bespoke, direct and honest advice, without judgment at all times, while listening to their issues and desires to understand fully and take into consideration their requirements. I want to ensure that they are confident with their new body and feel more comfortable in society. Transitioning is a long process and it brings me great satisfaction to know that I have played a role in helping my patients feel as though they have found themselves and are happy, often for the first time in their lives.