Gender Affirmation

Gender Affirmation Surgery

At West End Plastic Surgery, Dr. Ruff and our team are happy to offer the most advanced, personal care in your transition process. Dr. Ruff is a member of the World Professional Association for Transgender Health (WPATH).

portrait half woman half man, androgyny concept

At West End Plastic Surgery, our surgeons and team are well versed in making your experience as comfortable and informative as possible. Our AAAASF accredited Class C Operating Suite affords our patients one on one care with maximum discretion.

How Effective is Gender Affirmation Surgeries for Transitioning?

There is no one-size-fits-all approach for the gender affirmation process. An experienced, patient-centered surgeon can intuit the best way to move forward after meeting with the individual interested in transitioning. Surgical procedures are performed using precision and a depth of respect for masculine and feminine anatomy. As a result, the efficacy of gender affirmation surgeries most often results in significant patient satisfaction. According to a systematic review of several databases of gender affirmation surgeries, more than 99% of patients who choose to include surgical techniques in their transition process are happy with their decision.

Who is a Candidate for Gender Affirmation Surgery?

Patients who undergo gender affirmation surgery do so because they want to feel like their physical body reflects who they truly are. The vast majority of people who seek to transition have lived with incongruence between assigned sex at birth and gender for many years, if not decades. This incongruence is referred to as gender dysphoria, a term developed by the American Psychiatric Association. While there are people who live as their most authentic gender utilizing nonsurgical modalities like hormone therapy, social transitioning, and vocal training, there remains a solid place for gender affirmation surgeries in the efficacy and success of the transition process.

Gender affirmation surgery may be the best next step for the person diagnosed with persistent gender dysphoria. Patients need to have been under the care of a qualified mental health professional for some period of time. This care provider writes a letter of recommendation in support of the procedures that are necessary for a full physical transition. Often, patients who undergo gender affirmation have been living as their true gender to some extent and have a clear understanding of what it may feel like to complete their transition.

In addition to observing the emotional and psychological preparedness for gender affirmation surgery, your plastic surgeon also needs to assess your general health and wellness. Patients who smoke or use certain medications or supplements may need to make a few lifestyle changes for a brief period to ensure that surgery can be conducted safely and that the risks of intra- and post-operative complications are low. During your consultation with Dr. Ruff, be prepared to discuss your medical history, lifestyle habits, and expectations. The more thorough we are in this initial step of treatment, the better our outcome can be.

Is Gender Affirmation Considered an Elective Surgery?

The medical necessity of gender affirmation surgery has been a contentious subject of discussion for several years. It seems that "medical necessity" is somewhat determined by the country's largest insurance provider, Medicare. While this insurance company does provide some coverage for gender affirmation procedures, it has refrained from setting a national mandate. What this means is that it comes down to each patient's insurance company to determine what may receive coverage and what may not. We are seeing an expansion of coverage for gender affirmation procedures in recent years that acknowledges the medical necessity of various procedures based on specific criteria. It is necessary for each patient interested in gender affirmation to consult with their insurance provider for direct details as outlined in their insurance package. Generally, for gender affirmation surgeries to be deemed medically necessary, the patient must have a written recommendation from at least one qualified mental health provider, a documented history of gender dysphoria, and engagement in designated hormone therapy.

We are here to help you. If you have questions about gender affirmation procedures and how insurance may be involved, contact us. Our experienced team will do their best to provide guidance and answer questions to help you obtain the care that you deserve.

How can I Prepare for Gender Affirmation Surgery?

All plastic surgery procedures require consideration of physical and emotional outcomes. These are magnified amongst patients who seek gender affirmation procedures. The mental preparation that is necessary before surgery may come in part from an ongoing conversation with a qualified therapist or psychiatrist. However beneficial this may be, though, there is also significant value in hearing from patients themselves. Gender affirmation is still a relatively uncommon path. As such, it may be difficult to find people within one's local community who can offer relevant insights. In such situations, resources like I Am: Trans People Speak can be beneficial.

On the physical level of preparation, patients will receive clear, detailed pre-operative instructions from the doctor. Suggestions may range from lifestyle changes like avoiding tobacco and alcohol to planning for recovery. It's never too soon to begin planning for that. Patients must consider which friends and family members may be available and willing to help them on a daily basis while they heal. A strong support system is vital to the recovery process. Patients will rely on help for meals, medications, child or pet care, domestic duties like cooking or laundry, and, equally as important, good company on a day-to-day basis.

If you are moving closer to your gender affirmation date, please know that we are here to help. Contact our office with questions as needed. We're here for you!

How Many Procedures can be Done?

Like traditional plastic surgery procedures, those that are done to complete gender affirmation may be combined. There are a number of techniques that one may consider based on their unique situation, including breast removal or augmentation, liposuction with skin tightening, and facial feminization procedures. Dr. Ruff can discuss the ideal combination of procedures with each patient on a case-by-case basis. Several factors may determine the procedures that are performed together, including risk and the anticipated recovery from each.

What is Recovery Like?

Recovery from many of our gender affirmation procedures involves at least a few days of rest and support from loved ones. It is difficult to pinpoint recovery because the transition process can look different for every patient. The amount of downtime that is needed, the activities that may be restricted, and the side effects that may occur are unique to each procedure. As an example, patients who undergo top surgery, either for masculinization or feminization, may need about two weeks to recover enough to return to work. Additional recovery will continue beyond that point. Usually, patients can resume most normal activities and exercise after six weeks. Expectations for recovery are discussed at length during the consultation and planning stages of gender affirmation. This way, doctor and patient can collaborate in a way that best meets the patient's needs.

Female to Male Top Surgery

We offer all types of procedures for the reduction of breast tissue to allow you to lead life without having to bind anymore. Most patients are well versed in the more common techniques of mastectomy including a standard incision with free nipple grafting and keyhole technique. We also offer liposuction with J-Plasma skin tightening to provide a virtually scarless technique for select patients.

Mastectomy with Free Nipple Grafting

This is the most common technique we use at West End Plastic Surgery. The surgeon makes an incision in the inframammary fold and carries it to the side (usually along the border of the “pec” muscle shadow) for the best contour. Your surgeon removes and resizes the nipple to create a typical cis-male position, shape, and size (2X2.5 cm oval).

The pros of this technique is that it creates a great contour, excellent areolar shape/position and removes excess skin. With this technique, there is loss of nipple sensation and loss of pigment. The loss of pigment can be tattooed back on. This technique also leaves a larger scar and sometimes “dog ears” that may need revision under local anesthesia.

Keyhole Incision

For this technique, your surgeon removes the breast through an incision in the areolar border. The nipple can be resized and moved. This technique is best for patients with minimal excess skin.

The keyhole incision involves smaller incisions and faster healing. There is a possibility to retain some nipple sensation and patients are less likely to lose pigment. Unfortunately, this procedure is not possible in all patients. There is still a chance of some excess skin that may need to be removed in the future. Areolar spread is also a possibility.

Liposuction + Renuvion (J-Plasma)

In the past, we have successfully used tiny incisions with VASER liposuction to remove breast tissue and obtain some tightening of the skin. This has worked well in patients with minimal breast tissue and excellent skin tone. The issue was that most patients did not fit into this category.

Renuvion (J-Plasma) is the newest cutting-edge technology that uses radiofrequency and plasma energy to contract skin much more effectively than any other device used in the past. This allows us to combine VASER liposuction with the Renuvion (J-Plasma) to tighten skin and remove breast tissue on patients with even larger breasts and whose skin tone is not perfect.

With this technique there is virtually no scarring, no nipple loss, Patients are likely to keep nipple sensation and results are permanent. For patients choosing this technique, insurance will not cover this procedure. They may also need touch-up surgery to shrink and reposition the nipple/areola.

Male To Female Top Surgery

At West End Plastic Surgery, we strive to give patients the perfect breasts. At your consultation, we have an extensive discussion about your goals and how you want your breast to look. We offer small incision augmentation with silicone implants and can give you the breasts you've always wanted in about an hour. We modify the techniques to make the breasts as feminine as possible and frequently perform revisions for surgery performed elsewhere in the United States or internationally.

Facial Feminization

Facial feminization is a particular focus of expertise for the surgeons at West End Plastic Surgery.  We perform both facial feminization and masculinization procedures to have your face match your identity. We offer the full range of procedures including:

  • Rhinoplasty – In the center of your face, your nose is likely one of the first things that people see when you are in public. Whether it’s a more delicate nasal tip, a large hump that needs to be reduced, or a nose that’s too wide for your face, we can help you achieve your ideal aesthetic with rhinoplasty. We also have Vectra 3D imaging that can help you visualize what your nose will look like after surgery.
  • Jaw Surgery – Whether it’s a chin augmentation with an implant, filler or fat, a chin reduction, mandibular angle implants for a square jaw, or fat grafting and angle shaving for a smooth contour, we at West End Plastic Surgery can work with you to define how you want your lower face to appear. We perform bone remodeling, implants, and fat and filler injections.
  • Cheek Surgery – We can perform cheek augmentation with deep fillers, cheek implants placed through the mouth, or facial fat grafting. This can give you the prominent/high cheekbones that you’ve always wanted.
  • Forehead Reduction – Through small incisions in the hairline, we can reduce your brow bone. We can do this with burring/shaving or in some cases a bone setback to reduce the prominent brow ridge. Your hairline can also be advanced to round out and feminize your hairline and shorten your forehead.
  • Other Procedures – Facial aging procedures, Botox, fillers, J-Plasma, and eyelid surgery are for everyone.

Body Contouring

Your general body shape, muscle structure, and fat distribution can certainly masculinize or feminize your body. The use of liposuction, fat grafting and body implants can help achieve your goals of transitioning. We offer “manscaping” liposuction to masculinize your body by removing fat deposits from areas that are typically feminine areas – inner and outer thighs, lateral chest, etc. Similarly, fat grafting to the buttock area (Brazilian butt lift), hips and thighs can feminize your figure. Body implants such as pec implants, buttock implants, bicep/tricep, and calf implants can also be used to contour your figure.

Schedule a Consultation

To learn more about any of these gender affirmation procedures, contact West End Plastic Surgery. Call us at 202-785-4187 to schedule a consultation with Dr. Ruff. Our practice serves Washington D.C. and surrounding areas.

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Located in Washington, D.C.

Monday: 7am-5pm
Tuesday: 7am-9pm
Wednesday: 7am-8pm
Thursday: 7am-9pm
Friday: 7am-8pm
Saturday: 9am-5pm
Sunday: Closed

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