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Transfemale:Gender Affirming Surgeries
September 22, 2018
Toby R Meltzer, MD
Scottsdale, Arizona
Toby R Meltzer, MD BS Louisiana State University Baton Rouge MD Louisiana State University Medical School General Surgery Residency, Charity Hospital of New Orleans Plastic and Reconstructive Surgery, University of Michigan Medical
School Fellowship in Burn Surgery, Wayne State University Board Certified in Plastic Surgery and General Surgery Assistant Professor of Surgery, Oregon Health Sciences University (1990-
1996) Chief of Plastic Surgery at Veterans Administration Hospital of Portland
(1990-1995) President, Oregon Society of Plastic Surgeons (1995-1997)
Private Practice, Eastmoreland Hospital 1996-2003
Private Practice, Honor Health (formerly Scottsdale Healthcare) 2003-Present
Reviewer for Journal of Plastic and Reconstructive Surgery, Journal of Sexual Medicine and Aesthetic Surgery Journal.
Ellie Zara Ley, MD Board Certified by The American Board of Plastic Surgery
Universidad of Guadalajara/New York Medical College
General Surgery Residency – University of Arizona
Fellowships:
Craniofacial/Pediatric Surgery – Primary Children’s Medical Center Salt Lake, Utah
Hand and Microsurgery – University of Southern California
Plastic and Reconstructive Surgery – University of Utah
Licensed and in good standing – Arizona, California and Utah
Tri-lingual – Spanish, English, Cantonese (conversational)
Published in Multiple Journals – Co-Author Book Chapter on Abdominal Flaps
Private Practice until 2016 – Tucson, AZ
Joined Practice of Toby R Meltzer, MD, PC – 12/15
Management
Linda Takata, Practice Administrator
Miki Takata, Practice Manager
Debbie Gill, Business Manager/Insurance
Kelly DeMoe, Assistant to Debbie Gill – Insurance Coordinator
Medical
Meg Bergeson Irvin, DNP, FNP-BC, ACNP-BC
Michelle Iagulli, RN
Sara Fassbinder, RN
Lindsay Torralba, LPN
Monica Aniol, ST, CFA
Jeremy Ballard,
Patient Coordinators and Support Staff
Rachael Gold, Web Mistress, Transportation, Tech Support
Sarah Guzek, PCC, Scheduler, Graphic Artist
Paxton Thornton, PCC
Hannah Bergeson, PCC
Andrea Brown, PCC
Audrey Price, PCC
Debbie Storey-Stillion, Patient Liaison and Provider of TLC
Special mention and thank you to The Post Surgical Recovery Team, LLC. This team is not employed by The
Meltzer Clinic, PC. They are available for post recovery needs both daily and hourly.
Lori Getzwiller, CNA, Owner of Post Surgical Recovery Team, LLC
Jaimi Getzwiller and CAN Jennifer Horwath, CNA
The Meltzer Clinic, PC
Toby R Meltzer, MD | Ellie Zara Ley, MD
Biography
BS Louisiana State University Baton Rouge MD Louisiana State University Medical School General Surgery Residency, Charity Hospital of New Orleans Plastic and Reconstructive Surgery, University of Michigan Medical
School Fellowship in Burn Surgery, Wayne State University Board Certification in Plastic Surgery and General Surgery Assistant Professor of Surgery, Oregon Health Sciences University
(1990-1996) Chief of Plastic Surgery at Veterans Administration Hospital of
Portland (1990-1995) President, Oregon Society of Plastic Surgeons (1995-1997) Private Practice, Eastmoreland Hospital Portland Oregon 1996-2003 Private Practice, Honor Health 2003-Present
Pre-operative Requirements
World Professional Association for Transgender Health (WPATH)
Psychotherapy
Hormone Therapy
Real Life Experience
Hospitalization
Why? Major surgery with life
threatening risks
Regular after-care
Rapid treatment of complications
Why not? Reduced costs?
Self-insured
Insurers
Hospital acquired complications
Greenbaum Surgical Specialty HospitalHonor Health System
Gender Confirming Surgery for Trans Females
Modern Vaginoplasty Technique
Penile Inversion
Clitoroplasty
Sensate Flap from Glans of Penis
Modern Penile Inversion Vaginoplasty
Penile Skin Vaginal Lining
Scrotum Labia Minora/Major
Glans Penis Clitoris
Embryologic Equivelents
Goals of Vaginoplasty
Safe Operation with Minimal Morbidity
Adequate Depth and Width for Intercourse
Cosmetically pleasing and Close as Possible Anatomically
Vaginoplasty
Vaginoplasty
Vaginoplasty
Vaginoplasty
Clitoroplasty
Vaginoplasty
Single Stage Vaginoplasty
Labiaplasty
Labiaplasty
Vaginoplasty with Labiaplasty
Patient E Patient F
Vaginoplasty with Labiaplasty
Patient G Patient H
Vaginoplasty and Labiaplasty
Vaginoplasty and Labiaplasty
Labiaplasty
Why?
Labia Majora too far apart
No labia minora
Minimal or deficient clitoral hood
Everyone doesn’t heal perfectly
Why not?
“Not necessary”
Viewer discretion
High revision rate
Labiaplasty or “revision optional”
Another operation
Minor procedure
One night hospital
Short recovery period
Added cost?
Labiaplasty
28
Vaginal Dilators
Skin Graft Donor Site
Electrolysis
Preoperative Electrolysis
Why? Very unlikely to eliminate all
follicles at surgery
Why not? Painful
Another “procedure”
Delays surgery
Hair doesn’t cause physical problems
Vaginal Hair
Sigmoid Colon Vaginoplasty
Sigmoid Colon Vaginoplasty
Dr. Meltzer did not perform these procedures
BREAST RECONSTRUCTION
Breast Reconstruction
Breast Reconstruction
BODY FEMINIZATION
Liposuction
Liposuction
Mini Abdominoplasty
Mini Abdominoplasty
Abdominoplasty
Abdominoplasty
Lipoinfiltration of Buttocks
Lipoinfiltration of Buttocks
Lipoinfiltration of Buttocks
Sub-Fascial Gluteal Implants
Sub-Fascial Gluteal Implants
FACIAL FEMINIZATION
Feminization of the Neck
Thyroid Cartilage Reduction
Thyroid Cartilage Reduction
Pre-Op Post-Op
Thyroid Cartilage Reduction
Post-Op
Thyroid Cartilage Reduction
Voice Modification Surgery
Open neck incision
Cricothryoid Approximation
Laryngofissure and direct shortening
Laryngoscopic technique
Excise mucosa of anterior vocal cord and approximation
Cephalometrograms
Forehead Feminization
Forehead Feminization
Forehead Feminization
Forehead Feminization
Feminization of the Jaw(Mandibular Reduction & Genioplasty)
Surgery of the Jaw
Mandibular Reduction and Genioplasty (Li et al, PRS 2011)
Mandibular Reduction
Vertical Reduction and Narrowing Genioplasty
Vertical Reduction and Narrowing Genioplasty
Facial Feminization
Facial Feminization
Facial Feminization
Facial Feminization
Facial Feminization
Facial Feminization
Thank [email protected]