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Surgical Concept

There is no strict definition on transgender surgery in the field of plastic surgery, but generally it refers to facial or body plastic surgeries before transgender patients decide to undergo the final change of genitals to achieve real male-to-female or female-to-male conversion, which does not retain organ functions. During this stage, patients still preserve concurrent partial male or female body features and genitals, but identify with the opposite gender, and their original gender cannot be told from their appearance and clothing; therefore, they are also called the “third gender.” In other words, generalized transgender surgery does include not only genital organ conversion but also body feature transformation, which should be undergone in the first step by a patient who wishes to become a transgender. However, because policies on sex identification have not been liberated in Taiwan, genital conversion surgery can only be conducted after long-term and strict physical and psychological evaluations and under the support of assessment reports of more than two physicians at the Department of Psychosomatics. Such a surgery generally cannot be performed in clinics other than teaching hospitals. Therefore, transgender surgeries at WiSH Clinic primarily target the converting of secondary sex characteristics on body and facial appearance of males and females but do not include genital organ changes.

Transgender plastic surgeries performed by Dr. Chuang are all-encompassing and mainly comprise the enhancement of male and female facial skeletal features, application of facial implants, hairline and forehead plastic surgeries, and male and female mammoplasties. Apart from genital organ conversions, almost all changes of female and male sex features can be completed by Dr. Chuang at WiSH clinic. However, despite being able to meet the expectations of the third gender, transgender surgery is an arduous road with no return. Dr. Chuang recommends that patients ascertain their gender identification before making their decision and bravely face social pressure to embrace their future life with confidence. The following aspects are critical to evaluate the success of transgender surgeries.

Surgical characteristics

Meets patients’ requirements

Almost all transgender patients have an unknown and hard story, so they mostly have higher expectations and requirements of surgical results than common patients and are more obsessed with perfection. Nevertheless, some parts of male and female structures cannot be completely changed by plastic surgeries, and the prolonged oral administration or injection of hormones also increases the incidence of surgical complications or malignancy. Therefore, under the precondition of ensuring surgical safety and results, Dr. Chuang usually recommends patients to honestly express their expectations and requirements of appearance change in the preoperative consultation or prepare some photos of their expected face and organ features for discussion to strike a reasonable balance between personal pursuit and surgical limits. Thus, Dr. Chuang can understand patients’ requirements in the shortest time and makes the most appropriate surgical plan in light of their original conditions to help them accomplish their dream of gender change.

Formulate a complete conversion plan

Gender change is a long process full of hardships, and psychosomatic and financial costs usually exceed patients’ expectations. How to complete the numerous surgeries as scheduled within affordable budgets and entail the formulation of a complete transformation plan at the early stage of plastic surgeries? General speaking, facial feature conversion principally comprises plastic surgeries regarding skeletal (bone, nose, and chin) and soft (eyes, skin, and lips) tissues. As changes in skeletal structures affect the proportion of facial organs, facial bone surgeries should be the priority, and the nose, chin, eyes, and skin are adjusted after changing the facial contour. Dr. Chuang advises that patients undergoing gender change should first know about the probable expenses and recovery period of various surgeries and then decide on a one-time or staged conversion process. Besides, patients should let the physician who knows them take full charge of the overall transformation surgeries and should avoid undergoing separate surgeries by different doctors, which not only heightens the risks and uncertainties of the surgery but also increases the probabilities of secondary surgery due to differences in the aesthetic concepts and expertise of physicians.

Feasibility of one-time facial conversion

Transgender surgery mainly concerns highlighting the difference between male and female facial structures and proportions, which, despite being diversified in contents, can be classified into two categories of skeletal and soft tissues. If the surgeon has adequate expertise and experience to integrate the esthetics and characteristics of various parts, one-time facial conversion is the fastest way to fulfill patients’ expectations. The costs and recovery period of combined surgeries are lesser and effective than those of separate surgeries. With abundant experience in facial and breast plastic surgeries and unique esthetics and proportion concepts, Dr. Chuang, using sophisticated medical facilities at WiSH Clinic, provides comprehensive face plastic surgeries, such as facial bone reduction combined with surgeries of the eyelids, nose, and chin, to make patients fulfill their expectations in one session so that they do not suffer from repeated procedures, which lowers the risks and complications arising from separate surgeries.

Reversibility of the surgery

Not all transgender patients persist in undergoing the final genital organ conversion, and few patients may consider recovering their original sex characteristics, so Dr. Chuang takes into account reversibility in the formulation of a surgical plan and method to maximally guarantee patients’ physical rights and benefits. Taking the most common breast surgery as an example, if male-to-female patients want to remove their female chests, they only need to take out breast implants to restore male chests, while if female-to-male patients undergoing reduction mammoplasty need to revert female breast features, breast implant emplacement or breast reconstruction will be performed to restore the appearance of a female breast. As for facial bones, various implants will be utilized to offset contour defects due to bone reduction or surgeries of the nose or other facial organs will be conducted to regain the appearance of the original gender. Generally speaking, the reversibility of non-genital transgender surgeries amounts to approximately 60–70% or more, and it is relatively easy to revert the original appearance due to a change in idea, so patients can pursuit their dream with great ease and no stress.