CRITERIA FOR ELIGIBILITY FOR SRS

If you consider having a surgical procedure for gender reassignment, you must meet the following criteria.

To be eligible for G.R.S., one must, first of all, answer to the criteria of the « Standards of Care of the Harry Benjamin International Gender Dysphoria Associations, Inc. ».

That is :

« Hormonal sex reassignment recommended by a clinical behavioral scientist.

Full-time living in the social role of the chosen gender at least 12 months.

Two letters are required for surgery :

A . Two separate letters of recommendation from mental health professionals who work alone without colleagues experienced with gender identity disorders are required for surgery and :

1. If the first letter is from a person with a master’s degree, the second letter should be from a psychiatrist or a clinical psychologist. Those who can be expected to adequately evaluate co-morbid psychiatric conditions.

2. If the first letter is from the patient’s psychotherapist, the second letter should be from a person who has only played an evaluative role for the patient.  Each letter writer, however, is expected to cover the same seven elements.

B. One letter with two signatures is acceptable if the mental health professionals conduct their tasks and periodically report on these processes to a team of other mental health professionnals and nonpsychiatric  physicians.

The patient has the responsibility to see that the behavioral scientists have the necessary qualifications mentioned above and that they are clearly stated in the recommendation.  Also most important is the fact that one of these recommendations has been made by a scientist who has followed the patient for at least six months.

FACE AND BODY FEMINIZATION

Here is a list of other surgeries that we perform. You may want to know more about a specific one and if it applies to you. When you contact us, feel free to ask information on your desired topic and we will answer your inquiry as soon as possible. Some of the topics are linked to an education brochure you can download.

Facial features

One or a combination fo the following procedures can be done to feminize the face:

1- Rhinoplasty :  modification of size and shape of the nose.

2-   Blepharoplasty: baggy eyelid surgery.

3-   Face-lift, neck-lift: reduce signs of face aging.

4-   Malar implants: to increase cheek definition.

5-   Forehead shaving: diminution of prominent bones in the eyebrow region.

6-   Chin implants: achieve further balance of your profile if your chin is small or

recessed.

7-   Restilane injection: used to add fullness to your lips or reduce face crease or

wrinkles.

Body contourning

Depending on your needs the contourning of your body (breast, thigh, limbs) can be done in different ways.

8-   Breasts: cosmetic breast surgery by lifting, augmentation or reduction .

9-   Abdominoplasty: tummy tuck surgery.

10- Liposuccion: removal of localized excess fat (chin,arms, hip rolls, thighs…)

11- Otoplasty: correction of prominent or deformed ears.

12- Pectoral and calf implants: to increase either chest or calf volume and contour.

BREAST AUGMENTATION

Breast augmentation is often requested to enforce one’s perception of feminine gender and give a well proportioned figure. It is performed, most of the time, in combination with another procedure. For example, breast augmentation can be combined to vaginoplasty and/or Adam’s apple shaving and/or rhinoplasty. It adds approximatively 60 minutes to the operating time and, needless to say, it can be done as a separate procedure.

To achieve chest fullness, saline filled implants are inserted under your existing breast. Being used since the 70′s, they have a long history of safety and their reliability has increased to a very acceptable level. Other implants could be available in a near future, but we are waiting for strong scientific data before offering them.

2. Insertion of the breast implant increases breast volume.

The location of incisions, volume of augmentation, location of implants (either subglandular or submuscular) are some of the important points that have to be discussed with your surgeon. He will take into account your particular needs and goals, individual features and anatomy.

If you consider breast augmentation, you should ask for more information (Contact us). Also consult the ASPS Patient Education Brochure

VOICE SURGERY

The fundamental frequency or pitch is the quality of voice that can be modified with surgery. Vocal register, intensity and vocal tract resonance (e.g. vowel production) also can be changed but only with speech therapy. The mechanical properties of the vocal cords have to be altered to modify pitch. This can be done directly by scarring procedures on the cords (laser and cautherization) but they are unpredictable, irreversible and often need revisions. On the other hand, it can be done safely by indirect cricothyroid approximation.

SCHEMA VOICE

Cricothyroid approximation increases the tension in the vocal cords and consequentlyraises frequency from a male pattern (100-150 Hz) to a female one (200-300 Hz). Preferably, the procedure is done under local anesthesia through a short neck incision and can be combined with Adam’s apple shaving if desired. It requires a short operation time (1 hour) during which you will notice an immediate change. Voice rest is recommended after surgery for a short period and the final result comes gradually within the first 6 to 12 months. Speech therapy is advised before and after surgery.

Quality of voice change can vary from one person to the other.  The predictability of this procedure is fair.  The patient who consider this procedure has to talk with her surgeon before scheduling.

ADAM’S APPLE SHAVING

Adam’s apple shaving or chondrolaryngoplasty is aimed at correcting an unpleasing bulge at the anterior neck. This minor procedure can be done under local anesthesia through a convenient skin crease and leaves a short horizontal and conciliable scar at the anterior neck. If desired, it can be combined with vaginoplasty and/or breast augmentation under general anesthesia.

Schema adam’s

In the long term, it will not modify adversely your voice tonality and the unwanted «apple» will not grow back. In a short operative time, between 30 and 45 minutes, you can get rid of a constant embarrassment and your neck will fit your individual gender. For specific information on chondrolaryngoplasty, do not hesitate to contact us.

Male to Female Sex Reassignment Surgery

We perform a one step skin inversion technique coupled with a neurovascular island flap of the glans for clitoris construction.  Dr Ménard and Dr Brassard refinements of the skin inversion technique have redefined the Standards of vaginoplasty who is responsible for the most enviable reputation of Montreal as one of the world’s best centers for M to F SRS.

Cosmetic and functional results are outstanding and state-of-the-art :

• Skin hooding (prepuce) over the clitoris.

• Clitoris formed with sensitive skin from the glans.

• Good vaginal depth obtained with a skin graft from the scrotal sac at the end on the penis skin tube.

• Vaginal opening with labia minora and without late contracture (posterior band).

• Erogenous sensation and sexual satisfaction.

• No donor site scars on abdomen, thighs or buttocks.

• Tension free technique which allows no distorsion of the vulva and also leaves more loose tissue to construct the fine details of the vulva (labia minora, clitoris, hood).

The highlights of the technique are as follows :

• Skin markings and infiltration of vasoconstricting solution.

• Scrotal skin harvesting and thinning and hair bulbs removal of that skin which will be grafted to the penis skin tube.

• Testicule removal (castration).

• Penis skin degloving and preservation of an island of skin of the glans.
• Dissection of the neurovascular island flap of the glans.  This flap contains the nerves and vessels of the glans with the small « tailor made » island of skin to make the clitoris.  The size of the clitoris can be adjusted at that time to the patient demand.

SEEKING IMPROVEMENT AFTER GRS

You may already be confirmed in your new gender, however your result may not be functionally and cosmetically as pleasing as you expected or as it could be. We have helped quite a lot of people with disappointing results after GRS done elsewhere (Europe, Asia and USA).

For the male to female a wide vulva or separated labia majora can be corrected by W-labioplasty done under local anesthesia. Excess of spongious tissue (bulging in your genitals when sexually aroused), wrong direction of your urinary stream, wrong location of your urinary meatus, absence of clitoris, and shallow vagina are deficiencies that we also correct.

If you consider having an improvement, we can analyze your problem if you provide us a well detailed description (a photograph is sometimes necessary).

Contact us in order to solve your problem.