Office: 480.657.7006

Toll-free: 866.876.6329

E-mail: info@tmeltzer.com

office ext pix

7025 N.Scottsdale Road
Suite # 302
Scottsdale, AZ.
85253

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Surgeries & Procedures-MtF
Vaginoplasty (Stage One)

The surgery for male-to-female sex reassignment is done by Dr. Meltzer.
For unusual or complicated cases, he may involve an urologist.

PENILE INVERSION TECHNIQUE FOR VAGINOPLASTY

This surgery is done under general or spinal anesthesia.
The testicles and the erectile tissue of the penis are removed.
A vaginal space is created below the urethra (urinary tube).
The penile skin is used to line the vaginal vault, which eliminates the need for skin grafts in most cases. In patients with a shorter penis (less than 5 inches erect when measuring from the underside), distant grafts may still be avoided if the scrotum is cleared of hair preoperatively.
The clitoris is formed from the glans of the penis, keeping the nerves that supply it intact. By doing this, Dr. Meltzer can create a sensate clitoris.
A small portion of scrotum is used to fashion the labia (the lips of the vagina).
A cotton stent is placed in the vagina. The stent stays in place for five to six days.

WHO IS A CANIDATE?


Individuals who are in good health and have fulfilled the prerequisites of the
WPATH
Standards of Care -The World Professional Association of Transgendered Health -
(formerly known as HBIGDA -The Harry Benjamin International Gender Dysphoria Association).
This includes pre-operative psychological counseling, hormonal therapy and
generally a one year real life test.



REFERRAL LETTERS


Referral letters from two different therapists must be received at least two months prior to your surgery date. One of these therapists must be an M.D. or Ph.D. The second letter may be from a licensed clinical social worker or a master's level therapist. Both letter writers must have specialized training in the treatment of Gender Dysphoria. We do confirm all letters received.

In addition, we require a letter of introduction from one of your therapists stating that you are in the process of transitioning before we can schedule your surgery.


INTENDED RESULTS

The intended results are a natural appearing vagina with normal sensation adequate for sexual intercourse.


PROCEDURE DESCRIPTION


Dr. Meltzer performs this procedure under general or spinal anesthesia and takes approximately three and a half to four hours. The testicles and the erectile tissue of the penis are removed. The clitoris is formed from the glans of the penis, keeping the nerves that supply it intact, thereby creating a sensate clitoris and labia. A small portion of scrotum is used to fashion the labia (the lips of the vagina). Cotton packing or bolsters are placed in the vagina at the end of the procedure.
Patients stay at the recovery care center in the hospital for a total of nine nights.


SECOND STAGE LABIAPLASTY


A secondary procedure, labiaplasty, is recommended, although not required. If the patient desires further definition of the labia and hooding of the clitoris, this can be done at a second stage known as a labiaplasty. This is a separate procedure with a separate fee. One must wait a minimum of three months (to allow for an appropriate blood supply) before this procedure can be performed. Not all patients will find this stage necessary or desired. It is mostly based on personal preference.

HOW LONG DO I STAY IN SCOTTSDALE?

You will have a pre-operative visit with Dr. Meltzer at least one day prior to your procedure. Following the procedure you will stay in the Recovery Care Center of the hospital for nine nights. In total you need to plan on being in town at least 10 nights. You will need to stay in a hotel near the office the night before surgery and may leave to return home upon being released from the hospital. It is our suggestion that you do not book a return flight home before 7pm as you may not be released till the late afternoon. It is important to allow ample time to speak with Dr. Meltzer, or medical staff upon release from the hospital as well as ample travel time to the airport.


RECUPERATION AND HEALING

Depending on your surgery date, you will need to arrive in town one to three days prior to surgery. Please refer to our hotel list for hotels near the hospital or office. Patients will stay in the hospital for nine nights after surgery. Patients may return to sedentary work as early as two weeks after surgery and may require up to eight weeks off after surgery for less sedentary jobs.

Patients will get out of bed on the second day after surgery, and should gradually increase their activity level over the next two weeks. See the Schedule of Events for a description of expected daily activities.

There are few restrictions after two weeks; however, most patients will not have their usual energy level back for four to eight weeks.

Please refer to the Specific Post-operative Instructions for restricted activities and duration.

OTHER OPTIONS

Breast augmentation (silicone or saline), tracheal shave or other aesthetic procedures of reasonable duration can be done at the same time as vaginoplasty; however, these procedures must be scheduled in advance and are subject to available Operating Room time.


SCHEDULING REQUIREMENTS AND PAYMENT INFORMATION

Before surgery can be scheduled, the following information must be received in our office:

1) Completed Patient Information Form
2) Completed Health History Form
3) Completed Smoking Form
4) Letter of Introduction from Your Therapist
5) Signed Financial/Cancellation Policy
6) Signed Financial/Surgery Schedule
7) Deposit of $1000.00

(The deposit will not be accepted until items 1-6 have been received).

NOTE: Patient MUST be at least 18 years of age.

Your deposit will hold your approximate surgery date and Dr. Meltzer's portion of the current
surgery fee for a period of 12 months from the time the deposit is received. However, Dr.
Meltzer cannot guarantee that hospital and anesthesia charges will remain the same. Any
hospital or anesthesia fee increase will be the patient's responsibility.


PAYMENT SCHEDULE


A non-refundable deposit is required to schedule surgery. A payment of 50% of the balance is due six weeks prior to surgery. The remaining 50% is due four weeks before surgery
. We do not accept personal checks. We do accept most major credit cards, cash, cashier's check, money order or you may wire the funds.

The following are some of the more common additional fees. It is not an inclusive list.

Medication - Routine medications are provided during your hospital stay. However, if you have special health conditions that require specific medications you will be responsible for those charges. In addition, you are responsible for medications required upon discharge.

You will also be responsible for non-routine services such as monitoring of blood sugar levels if you are diabetic. While not required by Dr. Meltzer, some patients prefer to donate a unit or two of their own blood; you are responsible for any charges associated with blood donation.

Remote skin grafts - If required for additional length of the neovagina, you will be responsible for the additional charges for Operating Room and anesthesia.

REVISIONS

Dr. Meltzer will do all he can to keep any necessary revision costs to a minimum.
However, you will be responsible for any hospital, anesthesia, medications, meals,
accommodations, supply charges, travel fees and any other expenses.



YOUR CONSULTATION, PRE-OPERATIVE APPOINTMENT AND SURGERY DATES



CONSULTATION / PRE-OPERATIVE VISIT


Dr. Meltzer will spend as much time with you as you need at your consultation. Due to each individual's unique needs and list of questions, it is difficult to determine how much time a patient may need for their consultation. As a result, you may find that you appointment time is delayed. We recommend that you bring something to read or work on for this reason. We do keep the lobby stocked with current magazines. If you wish to discuss additional procedures at the time of your vaginoplasty consultation (i.e.: facial feminization), please contact our scheduler well in advance so additional time can be allotted for your consultation.


SURGERY DATE


Dr. Meltzer will do all he can to keep your surgery date as originally scheduled. However, surgery dates can change for reasons beyond his control. Please allow extra time when making travel plans in the event of airline cancellations or delays. We do not advise scheduling your arrival time too close to your appointment time or departure time. Please allow plenty of time for delays, baggage and traffic. The airport is about 30 minutes from the office if there is no traffic. You will be responsible for any travel change fees should your date change.


RETURNING TO SCOTTSDALE


It is always Dr. Meltzer's preference that you return to him for any necessary revisions. If for some reason you find it necessary to see another physician/practitioner, it is advisable to have him/her contact our office at 866-876-6329 or local 480-657-7006. Please note, while most issues can be covered by phone, certain issues will require a return to Scottsdale.

NOTE

The specific risks and suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications occur rarely.


Please e-mail us at info@tmeltzer.com for more information,
or call our office at 1-480-657-7006 or toll-free at 1-866-876-6329.

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