Permanent and irreversible
by Courtney Caplin MD, DMD
Trans Surgical Columnist
To many people these two words may seem like simple descriptive words, but to the transgender community, these words determine their future ability to match their legal identification with their gender identification.
In order to change one's gender on a driver's license, Oklahoma state law mandates that the physician who performs the sex change operation provide a letter stating that the change is “irreversible and permanent.”
What surgeries are truly permanent and irreversible? Essentially any of the various “bottom surgeries” would qualify, but many of my patients either refuse or are not able to have these surgeries, as they are expensive, often require travel to find a competent surgeon to perform them, and invasive with serious risks, side effects and possible complications.
What less invasive alternatives are available for our transgender population? Although we would like to say that breast implants are permanent, one could contest that the implants could be removed and thus reversible. Therefore, instead of looking at any surgery that augments the body, which could then later be removed, we should look for surgeries that remove tissue. Once a tissue is removed from the body and discarded, no one could argue that it could be reversed. Sure, artificial means of replacement exist, but once that surgery is complete, it is permanent and irreversible.
To simplify the subject, I would like to separate and specify what surgery could be used without question for legal documentation of a "sex change". For trans-female patients, a "tracheal shave" (or in medical terms a chondrolaryngoplasty) is a simple, outpatient procedure performed in under an hour. Although the Adam’s apple is a tiny part of the body, it is uniquely masculine. Additionally, it frames the face so it is readily noticed.
Removing the Adam’s apple helps feminize the body, but also permanently removes tissue from the body and is therefore irreversible. The surgery itself involves making a small incision, approximately 2-3 cm in length in a natural crease hidden high in the neck. While the patient is asleep, the angular and prominent portions of the thyroid cartilage are cut and removed leaving a smooth and feminine neck contour.
All of the surgery is performed on the outside of the vocal cords; therefore, the voice is not affected. The recovery process is simple and post-operative pain is often controlled with over-the-counter medication (although narcotics are generally prescribed). If a patient elected to have this procedure on a Thursday or Friday, she could reasonably expect to return to work the following Monday.
For trans-male patients, "top surgery" is the answer. Depending on the patient's goals, amount of glandular tissue, skin laxity, and nipple-areolar size and position, several different surgical techniques exist. All techniques involve removing glandular tissue while masculinizing the chest, and are unquestionably permanent and irreversible.
"Top" surgery is also safely performed as an outpatient procedure in under two hours. Aside from specific wound care for the nipples, the recovery process is typically uneventful, and patients are generally able to wean off of narcotics in three to five days. Although patients are advised to avoid high impact activity for approximately one month, most patients can return to normal life activities in about a week.
Cosmetic Surgery Affiliates (CSA) offers free online consultations atcsaok.comand clients can upload photos from the privacy of their own home. Consultations are also available in person in our office, which is a safe and supportive environment. The staff at Cosmetic Surgery Affiliates focuses on the individual patient and what his, her or their needs may be and work together to achieve their aesthetic goals.
Copyright 2017 The Gayly – February 24, 2017 @ 4:30 p.m.