"BE THE BEST VERSION OF YOU" - Buddha
Physical and emotional transition, done with great care and research, aligns your outer appearance with your inner identity. There are no hard and fast rules concerning the procedures and timeline you choose when transitioning. Any path you choose on your journey is appropriate. What's important is that you feel comfortable, secure and healthy along the way. This area of Just Another Girl consists of important resources and information collected from the experience of our fearless leader, Lauren. In addition to her journey as a trans-woman and international model, Lauren spent over a decade as Public Relations Manager and Marketing Director of the prestigious Miami Institute for Age Management and Intervention, at the Four Seasons Hotel in Miami, consulting with some of the most elite medical and mental health providers in the United States.
- Always do your research on the providers you choose. Stay away from black market options.
- Thinking that one provider can do all your procedures is probably not wise. There are a few exceptions but mostly Just Another Girl suggests finding experts who specialize in particular fields and do the same procedures daily.
SPIRITUALITY – MENTAL HEALTH
"THE SPIRIT IS GENDERLESS" - Marianne Williamson
YOU - When embarking on this journey, seek out a qualified therapist who is knowledgeable about gender transition and get provider recommendations from women that have successfully transitioned. Seeing a therapist is required before you can begin with hormone therapy. Your therapist will write you a referral letter for an endocrinologist. If your goal is gender confirmation surgery, bear in mind that most surgeons require two letters of recommendation before they will perform surgery on you. One of these letters must be from an experienced mental health professional, who you have worked with for over a year. Letters must state that gender confirming surgery is the correct course of treatment for the patient. Therapists can also help with all issues, legal and otherwise. Social and moral support, particularly from loved ones, is a crucial aspect of a healthy and happy transition.
YOUR LOVED ONES – This is the time to be surrounded with love and support from family members (if your are lucky enough to have their support), friends and/or your significant other. Be patient and understanding. They may make mistakes during this time, such as a poor reaction or unsupportive comments. Feelings will be hurt. Emotions are fragile. People who transition are fearful emotionally. What we fear the most is loss of love. The best way for your loved ones to be supportive is to arm themselves with knowledge on stigma and the basics of gender expression.
GLAAD offers thorough explanations on gender identity and is an excellent resource for transgender individuals and their loved ones.
Hormone therapy will profoundly impact your quality of life and appearance. Seek out a reputable endocrinologist who specializes in gender therapies so that you are adequately informed and understand the benefits and potential risks. Studies as recent as February 2015, conducted at the Boston University School of Medicine, found that there is no evidence of a significant increase in cancer risk from transgender hormone treatment despite that being a common fear.
- Estrogen Therapy
Estradiol is the main form of estrogen responsible for promoting feminine physical traits during feminizing hormone treatment. It works directly on the tissues in your body and also indirectly suppresses your testosterone. Estradiol can be administered orally (tablet), trans-dermally (skin patch or gel), intramuscular application (implant/pellet inserted under skin) and sub-muscular injection.
- Progesterone Therapy
Although not used frequently in the United States, this therapy is gaining popularity. Progesterone can supplement estrogen if estrogen isn't working efficaciously or there are concerns about estrogen's side effects or health risks on some patients. Some providers believe that progesterone helps with nipple development and sensitivity. Progesterone can be administered orally, sublingual (under the tongue) suppository, gel, and sub-muscular injection.
- Anti-Androgen Therapy
Androgen blockers may slow male-pattern baldness and reduce facial hair growth. Androgen blockers are unnecessary if you have undergone orchiectomy surgery. Anti-androgen therapy is often prescribed in addition to estrogen, as the two have effects that complement each another. By blocking androgen, the amount of estrogen you need to produce the same desired effects is reduced.
Facial hair removal is an important step in any trans woman’s cosmetic journey. Estrogen therapy will not get rid of existing facial hair but anti-androgens can help retard future hair growth, especially body hair. There are non-hormonal remedies such as waxing and topical hair remover but Just Another Girl recommends an initial visit to your dermatologist to discuss your specific needs. Androgen-driven facial hair can be permanently removed with either electrolysis or laser hair removal. It’s important to follow a healthy skin care regime during treatment.
Electrolysis is the most efficacious treatment. An electric current is used to destroy each hair follicle individually. The procedure must be repeated on a weekly basis and the process could take a few years for complete permanent hair removal. Choosing an experienced certified electrologist is important.
- Laser Hair Removal
Office based LHR used to be best only for fair skin and dark, thick hair, but there are new lasers specifically designed for darker skin, so laser hair removal is another option. Six to eight treatments can get an 80 percent improvement in permanent hair reduction.
FACIAL FEMINIZATION SURGERY
The most feminizing procedures favored by surgeons and patients alike is to advance the hairline forward, lift the brows and flatten the supraorbital rims. Many patients also choose rhinoplasty to re-sculpt the nose, straighten the bridge and refine the tip. If necessary, a tracheal shave and jaw contouring will soften the facial appearance. Cheek and lip enhancements can give both a rounder and smoother appearance. Subtle cheek augmentation could entail either inserting implants underneath the skin or volumizing the area with dermal fillers. Lip work could include either a lip lift, which shortens the upper lip, and the use of fillers or fat transfer injections for plumping the lip.
Some patients will undergo a myriad of cosmetic and reconstructive facial procedures to modify or revise their existing, often masculinized features. Just Another Girl understands that if you have features like a square jaw, pronounced forehead, or a receding hairline, then FFS can be an attractive option. Often FFS is more powerful than vaginoplasty and can sometimes be the most important decision in your transition. Beverly Hills based FFS surgeon, Dr. Harrison Lee says, “Oftentimes, my patients tell me that they feel trapped in a face they cannot identify with in the mirror. My job is to create a reflection they can identify with.' Feminine facial features make you feel comfortable in your new self and present confidently as the woman you are.
Popular FFS procedures include:
- Tracheal Shave – Adam’s Apple Reduction/Removal
- Forehead Reduction/Contouring – Scalp Advancement, Hairline Correction. Women tend to have flatter foreheads than men.
- Brow Lift – A brow lift will result in a fresher, rejuvenated appearance.
- Jawline/Chin Contouring – Also known as a Mentoplasty. Subtle contouring can soften and narrow the jaw, resulting in a more feminine silhouette.
- Rhinoplasty – Nose reshaping. Often performed in tandem with a Mentoplasty.
- Lip Lift/Reduction – This procedure shortens the distance between the upper lip and the nasal base, improving the visibility of the smile and the upper teeth, which is a more feminine appearance.
Dr. Douglas Ousterhout & Dr. Jordan Deschamps-Braly
450 Sutter Street
San Francisco, CA 94108
Recognized internationally as a pioneer in Female Feminization Surgery, “Dr. O” is one of the premier FFS surgeons in the United States. He recently joined Dr. Deschamps-Braly’s practice. Dr. Deschamps-Braly’s new ideas, combined with Dr. O’s aesthetic and decades of knowledge, is beneficial to all seeking subtle, yet profound, feminization surgeries with excellent results. In an interview with ALLURE magazine, Dr. Deschamps-Braly says, “The operation is something they have longed for. In no time at all, they forget what they looked like [before],” he says. “Looking believably female is important. There’s a sense of relief. You can’t hide your face. There is less discrimination. Facial feminization surgery gives them a foundation.”
Just Another Girl recommends both these surgeons for their excellent cranio-facial work; especially jaw contouring and forehead enhancement.
Dr. Joel Beck
1241 E. Hilldale Blvd.
Foster City, CA 94404
An excellent FFS surgeon, Dr. Beck offers a comprehensive range of rejuvenating and beautifying surgical procedures and non-surgical treatments, including lipo-sculpting and breast augmentation.
Dr. Suporn Watanyusakai
938 Sukhumvit Road
Bangplasoi, Muang District
T: 66 38 780569
Thailand is probably one of the more popular surgical destinations for many trans women. It is the country that performs the most gender confirming procedures, followed closely by the USA and Iran. The high quality of medical services offered in the best hospitals in Thailand, makes this one of the preferred hospitals.
Dr. Harrison Lee
9735 Wilshire Blvd., Suite 220
Beverly Hills, CA 90212
113 E. 39th Street
New York, NY 10016
AKA Caitlyn Jenner’s surgeon. Dr. Lee focuses initially on understanding the patient's concept of beauty. He believes that beauty is subjective. Everyone is unique and has a unique concept of beauty. Dr. Lee also works with Dr. Gary Alter on some of the same patients. This synergistic partnership, that offers a myriad of procedures, proves to be an excellent choice.
Dr. Jeffrey Spiegel
1200 Boylston Street
Chestnut Hill, MA 02467
Dr. Jeffrey Spiegel is a world-renowned facial plastic surgeon specializing in advanced facial plastic surgery. Dr. Spiegel’s offices are located in Boston and he sees patients from around the world who seek expert facial cosmetic surgery with subtle, refined results.
Dr. Mark Zukowski
3612 West Lake Avenue
Wilmette, IL 60091
Dr. Zukowski is a Diplomate of The American Board of Plastic Surgery. Very few surgeons performing feminization surgery carry this distinction. Want to be a “Z Girl”? His office staff is happy to answer your questions and will refer you to some of his patients for their testimonials. They are happy to talk about their surgical experiences. The expert hand of Dr. Zukowski has enhanced many beautiful faces in the Chicago area.
An overall natural, soft look is always flattering. Now, more than ever, your beauty game is important. You will notice improvements in your skin after a few months of hormone therapy. Just Another Girl believes that the role of an experienced dermatologist is paramount in helping reestablish facial contours in a safer, noninvasive, and semi-permanent fashion. Cosmetic dermatology procedures could serve to bridge the gap while awaiting confirming surgery and as an adjunct following surgery. Your facial features can be manipulated with dermal fillers, lasers and neurotoxins to create a more feminine appearance. Neurotoxins like Botox and Dysport can help flatten your forehead, open up your eye area and arch your brow, while dermal fillers like Restylane, Perlane, Juvederm and Sculptra could be used to accentuate lips, cheekbones and augment your jaw line. Just Another Girl strongly recommends seeing licensed dermatologists and steering clear of any unlicensed providers such as those found in salons/spas, “pumping parties” and low-grade silicone injections. Maintaining a fresh, feminine look is attainable with clear, bright skin, perfect brows and lashes and a healthy head of hair.
Rand Rusher, RN
9735 Wilshire Blvd
Beverly Hills, CA 90212
HAIR & SCALP – BEAUTY & RESTORATION
Beautiful, healthy hair plays a pivotal role in your transition. Bring your natural beauty into focus with a thick, luscious head of hair.
Deep temple recession or long foreheads can be reduced with a short surgical procedure to advance the hairline. A fine incision is made along the hairline from temple to temple. The incision is done in front of the hairline to preserve the hair you have while advancing the scalp and positioning the hairline to a more attractive position. The incision mimics that of a natural hairline so that it will fade after surgery. Your surgeon can shape the hairline by advancing the scalp in areas where it has receded. A natural result is obtained, which typically eliminates the need for any fat grafting in the temporal area. Often the eyebrows are adjusted to a natural, but more youthful position in relation to the new forehead. The look is subtle, giving patients a beautiful result highlighting their eyes and new, smooth forehead with a lower, natural looking hairline.
HAIR TRANSPLANT – FUG
The most common technique in hair transplant surgery today is known as follicular unit micro grafting (FUM/FUG), sometimes referred to as strip harvesting or the strip technique. With FUG, a single donor site strip, ranging in length from 5 to 25 cm, of hair-bearing scalp is removed from the back or sides of the head. From this strip are dissected hundreds/thousands of tiny grafts containing anywhere from one to three, sometimes four hairs each. These grafts are then implanted into tiny slit incisions in the receded area where they can then grow after several months.
NeoGraft is the first FDA cleared follicular unit harvesting and implantation system. The NeoGraft system delivers automation of the FUE technique, the most advanced technique in the hair transplant industry. This game changing, less invasive technology uses the Follicular Unit Extraction (FUE) method perfected by the NeoGraft Automated Hair Transplantation System. The FUE method removes individual hair follicles from the scalp in their naturally occurring groupings of about 1-4 hairs and are then placed in the areas of the scalp where recession or thinning has occurred.
Platelet-rich plasma, PRP, is finding a permanent place as an anti-hair loss treatment and sometimes, if hair loss is not extreme, as an alternative to hair transplants. PRP is different from other treatments in that there are no messy creams to apply, nor surgical grafts that need to be transplanted. Instead, the power lies in your own blood. Performed in just one treatment, your blood is drawn and spun in a centrifuge, which separates out the platelets (which help with healing), before injecting the serum into the hair follicle. Platelets are rich in growth factors and stem cells, which can improve the health of both the hair and scalp. PRP is a nice alternative to more traditional hair restoration methods without having to undergo surgery. It may serve as an intermediate therapy for those who have failed with oral and topical treatments but still want a nonsurgical approach to hair restoration.
HAIR RESTORATION SPECIALISTS
Dr. Jeffrey Epstein
Sunset Professional Building
6280 Sunset Drive
Suite 504, Miami, FL 33143
Dr. Jeffrey Spiegel
1200 Boylston Street
Chestnut Hill, MA 02467
Dr. Gary Alter
416 North Bedford Drive
Beverly Hills, California 90210
See a beautiful head of hair on TV or your favorite fashion magazine? 90% of the time, the actor or model you saw has hair extensions. Thick, voluminous hair is readily available with extensions. Using a high-grade product, such as HairDreams, your own hair is supplemented and filled in with hand-selected 100% real human hair. This hair matches yours in color, length and structure, creating an absolutely natural-looking result. The integration process is gentle and non-damaging. The additional hair feels like the your own and has no lifestyle limitations. The additional hair volume is indistinguishable from your natural hair. Step out your door with a beautiful head of hair!
INSIDER SECRETS TO GORGEOUS HAIR
- A PERFECT CUT - If you’re in the beginning of your transition, your hair is probably in that awkward growing-out stage. Just Another Girl suggests long layers that skim the bottom of your cut, combined with longer layers in the front, which will give you the illusion of length. If you already have the length, it's sexiest when the back falls into a soft V shape that starts with face-framing layers at your cheekbones or chin, with blended layers down to the ends. Your ends should come to a gradual point in the middle of your back.
- MONTHLY TRIMS – “The ends of long hair have been styled and colored so often that they get frizzy and dry fast," says celebrity hairstylist Steven Dillon. Have your stylist snip less than a half-inch every other month. Your hair grows faster than that, so you won't lose any length.
- VOLUMINOUS, BEACHY HAIR – A beachy wave is natural and sexy. Without a volumizer, the roots will fall flat. Before drying, massage an apricot-size dollop of lightweight mousse into your hair or spray a product like Bumble & Bumble Surf Spray at the root. After shampooing, blow-dry your volumizer-coated roots and mist the ends with a texturizing spray.
- SUPPLEMEMENTS – In addition to your estrogen therapy, Biotin and Viviscal supplements are your new BFFs! Biotin elongates the hair follicle, which makes hair grow faster. It also stimulates the cells that cause your hair to grow. Viviscal contains amino acids and marine extracts.
EYELASH & EYEBROW ENHANCEMENT
The importance of beautifully shaped brows cannot be stressed enough. A perfectly arched brow can lift the face and open up the eye area, resulting in a youthful, feminine appearance. To achieve appropriate symmetry and balance, Just Another Girl suggests an initial visit with an eyebrow pro to add definition to your eyes and accentuate your facial features. Once you have the perfect shape we suggest an eyebrow kit to help you create and maintain perfectly shaped, beautiful brows at home or between salon appointments. Just Another Girl crushes on the Brow Kit by Anastasia of Beverly Hills. Remember to keep it “natural”. For best results we suggest a few strokes of a brow gel along your arches to give them a gentle hold. Voila! Your brows are polished and in place throughout the day.
YOUR LASH GAME
Brows may be big right now, but long and full lashes are one look that will never be a fleeting fad. Who doesn’t want to wake up in the morning with beautiful lashes? Here are some ideas for lashes that wow!
Get lush, beautiful, longer lashes with eyelash extensions. Single strands of lashes that are weightless and comfortable are applied with a quick drying, medical grade, non-toxic glue, creating a custom designed, natural look for the shape of your eyes. They stay flexible, bouncy and water resistant.
EYELASH PERMING & DYEING
Enhance your lashes by perming them into a beautiful lift and curl. An instant “eye lift”, a lash perm is an innovative way to keep lashes curled. A custom fit mini perm roller is secured onto the upper lashes. Mild and gentle solutions are applied to set and then neutralize the lashes, creating beautiful curled lashes. After perming, a dark dye is applied. This safe and gentle procedure can last up to 6 weeks. A great solution for allergy sufferers or contact wearers. Wake up with fresh, beautiful lashes every morning.
As you transition, you may find that your current smile no longer fits with your overall appearance, or you may feel that now is the perfect time to correct imperfections. You’re becoming the person you’ve always wanted to be; don't forget about the most important feature and the focal point of your face -- your smile! A Smile Makeover can include dental implants, porcelain crowns, and veneers. The finishing touch may then include teeth whitening and/or veneers for a dazzling smile. If you have chosen to undergo facial feminization procedures, your FFS provider will be able to recommend a cosmetic dentist or prosthodontists that they work with on a regular basis. They understand the contours of the mouth, teeth and jaw area and will recommend any dental work to complement your facial feminization procedures.
THE BREAST EXPERIENCE
After 3 to 6 months of estrogen therapy, breast growth is evident. It is similar to the breast growth evident in a young girl’s stage of puberty. Some patients are happy with this “natural” development. Most will seek augmentation. The key to natural-looking breast implants not only lies in the kind of implant used, but also where they're placed. A sub muscular, dual plane placement of a silicone gel implant gives the most natural result. Placing the implant underneath the muscle assures that there is less rippling of the implant and provides a more natural slope to the upper part of the breast. Just Another Girl favors the new “tear drop” silicone gel implants (“Gummy Bears”). This implant is surrounded by a thick, strong, multi-layered outer silicone shell, and is similar in texture to Gummy Bear gelatinous candies. There are reputable cosmetic surgeons in every major city in the US, who perform excellent breast augmentation surgeries. Many of the surgeons you choose to perform your gender confirming surgery will also offer breast enhancement.
Orchiectomy, a bilateral castration, is sometimes the first surgical procedure that a patient will seek, if they are financially unable to undergo complete GCS and/or they are looking to halt the production of testosterone before GCS. This procedure will negate the need for testosterone blockers (anti androgens) and permit a lower estrogen dosage. Some patients will choose to have this procedure without a vaginoplasty or penectomy. This is an outpatient surgery. Just Another Girl is aware that, often, if an orchiectomy is performed too far in advance of vaginoplasty, the scrotal tissue will shrink leaving less than a desirable amount to mold the labia majora.
Just Another Girl recommends the following orchiectomy surgeons:
Dr. Marc Arnkoff
26400 Twelve Mile Rd
Southfield, MI 48034
Dr. Marc Arnkoff, MD is a board certified urologist in Southfield, Michigan, offering excellent orchiectomy results. He is affiliated with Providence Hospital, Botsford Hospital, and Garden City Hospital.
Dr. Jenelle Foote
Midtown Urology & Midtown Urology Surgical Center
128 North Avenue, NE, Suite 100
Atlanta, GA 30308
Dr. Foote is a practicing urologist, specializing in orchiectomies, and is the vice-president at Midtown Urology, P.C and Midtown Urology Surgical Center.
Dr. Tuan A. Nguyen
15820 Quarry Road, Lake Oswego, Oregon, 97035 USA
Dr. Nguyen offers orchiectomy surgery, as well as additional, adjunctive gender therapies and surgeries.
GENDER CONFIRMATION SURGERY
THE EXQUISITE CONGRUENCY
Gender Confirmation Surgery (GCS) is the modern term used to describe surgical procedure(s) by which a transgender person's physical appearance and their existing sexual characteristics/genitalia are surgically altered to align with their true gender.
Gender Confirmation Surgery has had multiple titles/monikers in the past which have included:
- Sex Reassignment Surgery (SRS)
- Gender Reassignment Surgery (GRS)
- Gender Affirmation Surgery
THE PERSONAL PROCEDURE
The most common vaginoplasty technique performed uses the existing penile and scrotal tissue. This is commonly referred to as the "penile inversion technique" and involves the creation and reshaping of the neo-vagina. In some cases the lack of tissue may require additional skin grafts taken from the buttocks or inner thigh. Post-operative sexual intercourse is permitted, usually after 12 (twelve) weeks. Sensation (vaginal & clitoral) is generally successful. Outside of the US, some surgeons will perform a colovaginoplasty, using a segment of the colon, if there is very little existing tissue to use. The complexity of this surgery and its higher complication rates make it a less preferable option. Just Another Girl does not favor this procedure.
The best GCS surgeons all follow the Harry Benjamin guidelines for medical care. This set of clinical guidelines were created by Dr. Benjamin, one of the pioneers of GCS surgery, for the express purpose of ensuring "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment." These standards are still considered to be paramount in the care for the transgender patient. Outside of the United States there are different sets of protocols and guidelines. Just Another Girl recommends the surgeons below only because we have first hand knowledge of their surgical skills and aftercare and we have witnessed the stellar results their patients enjoy. Just Another Girl feels that vaginoplasty is the most intimate and important surgical decision you can make. We want you to enjoy your body and embrace your new journey with the utmost confidence.
Collectively, these surgeons perform thousands of gender confirming surgeries annually and are the elite leaders in this very specialized field.
Dr. Brassard is the leader in his field. His clinic in Montreal performs more than 200 gender-confirming surgeries annually, with unmatched results and excellent after care facilities. He is presently director of the Centre Metropolitain de Chirurgie. Dr. Brassard’s medical team has some of the most extensive GCS experience in the world. His greatest referral is word of mouth.
Dr. Toby R. Meltzer
7025 N. Scottsdale Road,
Suite # 302 Scottsdale, AZ 85253
F: 480 657-7020
Dr. Meltzer’s clinic is located in Scottsdale, Arizona. An elegant physician in his prime, Dr. Meltzer performs hundreds of gender confirming surgeries annually, achieving outstanding results in appearance, function and sensitivity.
Dr. Gary Alter
416 North Bedford Drive
Beverly Hills, California 90210
Dr. Alter, AKA the “Vagina Whisperer”, is a Board Certified Plastic Surgeon and urologist in private practice in Beverly Hills, California, subspecializing in genital reconstruction. He often works, in tandem, with Dr. Lee (a maxillo-facial surgeon) and it's been widely reported that , together, they performed Caitlyn Jenner's facial transformation, breast augmentation, and other unspecified body procedures. Dr. Alter also has a practice in Manhattan, New York.
Dr. Marci Bowers
345 Lorton Avenue
Burlingame, CA 94010
Dr. Bowers is a Pelvic and Gynecologic Surgeon with over 25 years experience. In 2003, Dr. Bowers relocated to Trinidad, Colorado, following in the footsteps of legendary SRS surgeon Stanley Biber, MD. Dr. Bowers relocated to the Bay Area of San Francisco in October 2010, where she practices general gynecology and surgery, performing hundreds of gender confirming surgeries annually. Excellent results and patient care have made Dr. Bowers a favorite of many. Dr. Bowers also serves on the GLAAD Board of Directors in her philanthropic time.
Dr. Suporn Watanyusakai
938 Sukhumvit Road
Bangplasoi, Muang District
T: 66 38 780569
Dr. Suporn is an aesthetic plastic and reconstructive craniofacial surgeon specializing in the fields of GCS, FFS and Breast Augmentation surgeries, and whose clinic is in Thailand. With almost 18 years experience of gender confirming surgery and related operations, Dr. Suporn has carried more than 1800 cases of primary GCS on patients from some 40 countries. His GCS results are well touted and often come at a cheaper cost, depending on your country's exchange rate. His proprietary non-penile inversion technique for GCS differs substantially from the more traditional penile inversion technique. Dr. Suporn believes that his single stage vaginoplasty, labiaplasty and clitoroplasty gives generally superior results overall in terms of depth, cosmetic appearance and sensation. This being said, as this is one of the most important procedures you will ever undertake, Just Another Girl favors undergoing any major surgery in the country where you reside. It is more convenient for follow up appointments and overall peace of mind.