A Vaginoplasty, also called MTF Bottom Surgery or Gender Affirmation surgery, is a surgical procedure where the male genitalia is reconstructed into aesthetically beautiful female genitalia including a clitoris, labia, urethra and possible vaginal vault. As an innovative cosmetic surgeon, Dr. Stiller continues to evolve his techniques, focusing on giving the most natural looking outcomes. The emotional benefits our patients feel after bottom surgery is truly amazing and inspiring as we see the newfound comfort they have with their bodies.
Dr. Stiller has trained extensively in multiple vaginoplasty techniques and is the only surgeon in Washington state devoted solely to MTF Bottom surgery. He has been performing vaginoplasties for the past 5 years and is trained in Zero Depth Vaginoplasties, Penile Inversion Vaginoplasties, and Colovaginoplasties. He has performed over 1,000 vaginoplasties, averaging 5 procedures a week, making him extremely sought after for MTF bottom surgery. Not only does Dr. Stiller have an immense amount of technical expertise and attention to detail, his bedside manner is unmatched. You will feel calm the moment you sit down for your consultation with his warm and compassionate nature. You will leave your consultation full of confidence knowing you are supported and in excellent hands.
The Zero Depth Vaginoplasty procedure consists of creating a vulva that includes a clitoral hood, clitoris, urethra, labia minora and labia majora that is both functional and beautifully feminine. There is no vaginal canal created which patients may want if they do not desire penetrative vaginal intercourse. A small pocket of skin is left where the vaginal canal would be, still giving the appearance of a vagina. This is done in a one-stage approach by reconstructing the male genitalia to give physical sensation, pleasure and urinary functionality that is consistent with that of female genitals. Full functionality regarding urinating and sexual pleasure involving the clitoris can be expected when transfeminine surgeries are performed by experienced board-certified surgeons such as Dr. Stiller. He has spent years perfecting his craft with the utmost goal of giving his patients the most natural looking outcome. If MTF bottom surgery is a part of your transition and you do not desire a vaginal canal, a Zero Depth Vaginoplasty may be right for you.
The Zero Depth Vaginoplasty is a one-stage procedure and takes up to 3 hours. The procedure itself incorporates an orchiectomy, penectomy, labiaplasty and cliteroplasty. If not done already, an orchiectomy will be performed and the spermatic cord will be tied off to the inguinal canal. The penis is deconstructed and removed however, sensation is preserved through a portion of the glans of the penis and the neurovascular bundle that runs along the shaft of the penis, which remain attached at all times. The neurovascular bundle is placed in the correct anatomical position, on top of the pubic bone, to create the clitoris and clitoral hood.
The urethra is shortened and a functioning urethral opening is created as well as relocated to an appropriate female position below the clitoris. The remaining part of the scrotal skin and fat pads are used to construct both labia majora and minora. A small portion of penile skin is constructed to the anatomical location of the vagina to give a vaginal canal appearance. The final result is an anatomically congruent, aesthetically appealing, and functionally intact vagina. The prostate gland is left intact.
The zero depth vaginoplasty is an outpatient procedure. Most commonly our patients go home, to your Airbnb or hotel if traveling out of town, the same day of surgery. After surgery, you will have 2 drains, a catheter, a sutured compression dressing and a tape dressing. You will stay in Spokane for 2 weeks so Dr. Stiller and Riley can monitor your progress. At 1 week your drains, catheter and dressings are removed. Your anatomy will also be reviewed to make sure you are comfortable and confident going home.
The next follow up will be in another week to monitor your progress and you may return home after this appointment (if traveling out of town). The recovery process can look very different for every patient and you can find most of your recovery questions under our FAQs. However, the most common questions patients have are regarding exercise, work and sex. Patients usually return to light exercise when they feel comfortable however no heavy lifting, greater than 20 pounds, for 4 weeks after surgery. You may return to work once cleared by medical staff, most commonly around 4 weeks. No submerging in water (most commonly by 3 months) or anal intercourse (most commonly 4 weeks) until cleared by medical staff.
Since you did not receive a vaginal canal, there will be no dilating for you!
If your goal is to receive the Colovaginoplasty eventually, you will start dilating after that procedure once your vaginal canal is created from your colon.