Caitlyn Jenner's Transgender Transformation: A Doctor's Point of View
I’m not going to lie - when I saw Caitlyn Jenner’s Vanity Fair cover I was mesmerized by her beauty. Her flawless feminine features were a 180 degree transformation from the former Olympic athlete's masculinity and the unveiling in and of itself was powerful on many levels. In fact, her quite public transformation has essentially put her on the map as a beacon of strength and resilience for those individuals who are currently in the trenches dealing with their own personal transgender journeys.
Bruce Jenner’s transition to Caitlyn has created a wave of worldwide interest for the arduous physical and emotional struggles transgender people must face when choosing to physically alter their bodies to match their gender. For those of us who haven’t grappled with this, or have never had a relationship with a transgender individual – it raises a lot of questions. For instance-- what went into this transition medically and surgically, and what are some of the procedures one needs to undergo to make this transition? I was lucky enough to have Sheldon Lincenberg, MD shed some light on the physical journey one must undertake to make the transition from a male to female.
Regarding male transitioning to female what is the most challenging task for a plastic surgeon?
SL: There are many steps in the transition process which have emotional, psychological, physical, and functional components. It is very important to ascertain that the transitioning patient has had good counseling and that the timing for any surgical intervention is optimal and supported by a qualified therapist. Surgical procedures that feminize the features of the face, the body and the genitalia have been performed for years and they continue to be refined. By far, the most challenging tasks for a plastic surgeon are the gender-altering procedures of the genitalia. These should be referred to a board-certified plastic surgeon who specializes in penis and scrotal conversion and vaginal construction.
How is an Adam’s apple shaving performed and can it be a dangerous procedure?
SL: The Adam’s apple is the front portion of the tracheal cartilage, which is shaped like the keel of a boat. It contains the vocal cords and surrounding structures. A tracheal shave is a relatively minor procedure with the potential for serious consequences including alteration of the character of the voice.
Are breast implants commonly placed in males and how is it different than placing implants in a female?
SL: Males request breast augmentation to create cleavage and larger breasts that hormone therapy alone would achieve. The male chest differs from the female breast in that it is frequently wider, the pectoral muscles are bulkier, and the nipples are further away from the middle of the breastbone. These proportions should be considered when discussing this procedure with a transitioning male-to-female patient.
What is the plastic surgeon’s role in changing the facial features of a man to become more feminine?
SL: Facial feminization procedures include; lowering the hairline, reducing the ridge of bone beneath the eyebrows, refining the nasal aesthetics, enhancing cheekbones, reducing the squareness of the jawbone, reducing the projection of the chin, eliminating facial hair, and restoring a softer, lighter, healthier facial skin. Adam’s apple reduction and neck liposuction as well as facial rejuvenation procedures including facelifts, brow lifts and eyelid tucks may also be useful.
Is buttock enhancement common and how is it usually performed?
SL: The male has hips that are narrower and buttocks that are flatter than their female counterparts. Enhancement of these structures is primarily performed with either gluteal implants, fat grafting techniques, or a combination of these. The selection of which surgery is best for you depends upon many factors including the patient’s desires and goals, available fat donor areas, and general patient health.
What is the plastic surgeon’s role in the vaginoplasty surgery?
SL: Formation of a vagina or vaginoplasty is a complex procedure that has urological, gynecological and plastic surgical concepts at its core. A team of these specialists often work together to obtain the best possible outcome. Briefly, the penis is converted into a clitoris, the testicles are removed, and the scrotum is turned outside-in to create the vaginal pouch. There are several variations in surgical techniques that each have their proponents, because complication rates are still quite high for any of the procedures.
Is there anything prospective transgender male-to-female patients should know or ask their plastic surgeon prior to undergoing their procedures?
SL: My recommendation is that the prospective patients ask the plastic surgeon to speak with several of his/her patients who have undergone the proposed surgery.
MC: Personally I am grateful for Caitlyn’s bravery and the fact that her public persona is shining a much-needed light on the transgender community. Dr. Lincenberg's first answer was also critical in underscoring the fact that this is a multi-step process that involves emotional, psychological, physical and functional components and is not to be undertaken lightly.