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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 you!tmeltzer@themeltzerclinic.com