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Transgender surgery: From male to female

The ultimate goal of gender reassignment surgery (i.e., gender confirming surgery or sex reassignment surgery) is to change the patient’s body so that their identity lines up with their appearance. Patients typically begin to consider gender reassignment surgery when they suffer from social dysphoria (strong discomfort in how others see them), physical dysphoria (strong discomfort in the mismatch between their physical body and their identity), or both. Whether you suffer from one or both of these conditions, we’re here to help. We can ensure that what you feel inside matches how you look outside.

Male to female vaginoplasty

The Maercks Institute’s sexual reassignment vaginoplasty involves a state-of-the-art, sensation-preserving creation of a self-lubricating neo-vagina with maximal depth and a fully sensate neo-clitoris with extended mucosal flaps and MACIE (Maercks Color-Corrected Intimate Enhancement) labiaplasty style labia majora and minora sculpting with structural fat grafting to ensure the most beautiful, feminine form for MTF transformation. This technique was developed by top transgender surgeon Dr. Rian Maercks. 

The FAVE procedure

Unlike conventional penile inversion techniques, the FAVE male to female surgery procedure allows customized tailoring to create the most feminine and natural-looking genital anatomy for each unique patient. Top transgender surgeon Dr. Maercks developed the FAVE procedure after his disappointment with the open and scarred appearance of conventional vaginoplasty techniques. After gaining experience with multiple techniques and combining his knowledge and experience with genital reconstruction, he devised the FAVE procedure to provide optimal aesthetic and functional results for trans women.

What are the FAVE enhancements?

The “E” in FAVE represents important enhancements that aren’t typically (or simply not ever) found in conventional vaginoplasty techniques. These enhancements include:

  • Natural-looking clitoral hood origination. The FAVE male to female surgery procedure developed by top transgender surgeon Dr. Maercks achieves a natural-looking hood that has subtle folds on either side and originates from a subtle suprapubic mound — just like natural female anatomy.
  • Optional urethral flap for enhanced natural vaginal lubrication. In the FAVE procedure, the long segment of the urethra that is usually thrown out can be integrated into the vagina. This helps with spontaneous lubrication.
  • A scarless appearance. Conventional vaginoplasty techniques often result in significant, unattractive scars in the crease of the groin, but the freestyle flap design of the FAVE procedure allows either a completely hidden, “scarless” appearance or greatly minimized scarring.
  • Internally oriented labia majora. Conventional vaginoplasty techniques pull the tissues in a “down and out” vector, which flattens the labia majora and spreads it apart. The FAVE procedure, however, allows a “closed” appearance of ideal aesthetics, which looks more natural. 
  • 100% flap-derived vaginal vault. In conventional vaginoplasty techniques, surgeons often use skin grafts to augment the lining of the neo-vagina to allow for adequate vaginal depth. This can result in pain and the need for a revision procedure. In the FAVE procedure, novel flaps and novel arrangements are used to provide a redundantly large surface area to line the vaginal vault, eliminating the need for a graft. 
  • Full-length true labia minora. The labia minora are largely neglected in conventional techniques, but in the FAVE procedure, the labia minora begins from the clitoral hood and travels with constant dimension all the way to the posterior of the vaginal opening, reflecting ideal feminine aesthetics. 
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Breast augmentation and MTF surgery

This male to female surgery is designed to create breasts that deliver a more feminine physique. Hormone therapy may first be used to enlarge the breasts, but if this treatment option fails, many turn to breast augmentation to achieve the full, round breasts that project from the chest.

Because female breast tissue is very similar to male breast tissue, the process used is very similar to a typical breast augmentation MTF surgery. The procedure is usually performed under anesthesia on an outpatient basis and can be done in just under an hour.

The breast augmentation procedure

The procedure starts with an incision that is used to place the implant inside the chest. Implants are placed through incisions that can be made in several different areas of the body. The exact placement of your incisions will be determined during your consultation, but most patients prefer an incision site around the nipple (on the areola) because the scarring is less visible. However, there are other options available. Once the incision is made, the saline or silicone implant is placed through the incision site — typically underneath the muscle for reduced risk of rippling, and a more natural look. Once the implants are properly placed, the incision site is closed with sutures

Types of breast implants

Breast implant types vary in textures, shapes, materials, and sizes. Choosing the right one is a matter of deciding what’s right for your individual preferences. At The Maercks Institute in Miami, we offer both silicone and saline implants for our transgender patients.

  • Silicone: A cohesive silicone gel is used to fill an outer silicone shell. These are often referred to as “gummy bear implants” and they offer decreased risks and better safety.
  • Saline: A silicone shell is filled with a saltwater solution, and implants are filled after they are placed inside the body.

Patients may also choose between textured or smooth implants, as well as anatomically shaped or round implants. Getting the appearance you want is the most important outcome, and we can help you choose the right implants for what you hope to achieve.


After breast augmentation surgery, some discomfort and swelling is normal. This is easily controlled with pain medication.

While you may notice a change in breast sensation right after surgery, this issue is typically resolved within a few weeks. Most patients resume normal activities about a week after the procedure.

Did you receive loose silicone? We can help. 

Unfortunately, there are dangerous and illegal plastic surgery techniques out there — and many individuals fall prey to “medical professionals” offering to inject loose silicone in the body. These are known as “pumpers”, and they often do not have credentials to perform this service. This is very dangerous, as the loose silicone (if it even is silicone) can migrate to the rest of the body and cause scarring, infection, disfigurement, or even possible death. At The Maercks Institute, we work hard to keep the plastic surgery industry professional, classy, safe, and satisfying. If you’re dealing with loose silicone in your body, top transgender surgeon Dr. Maercks can remove it and perform a breast augmentation surgery just a few months later to ensure that you get the breasts you want without the risks that come from less-than-ideal providers.

Brazilian butt lift and MTF surgery

During a Brazilian butt lift, extra fat is removed from a part of the body where it’s not wanted (typically the abdomen or thighs), purified, and then injected into the buttocks to add feminine curves to your figure. This gives MTF patients a slimmer appearance while also enhancing curves that create a female appeal.

Rhinoplasty feminized

We use specialized techniques to feminize the face for MTF patients. One of the most effective procedures is rhinoplasty (a nose job). Dr. Maercks narrows the nasal bone, decreases the entire nose size and nostrils, refines the nasal tip, and improves the entire profile during surgery. This results in a more feminine, delicate appearance. 

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Your MTF surgery consultation

There are many questions and concerns that our patients have before they undergo male to female surgery, and we are here to educate and help in any way that we can. We want you to feel good about the changes you’re making with your body, and our initial consultation can put any fears you have to rest. At The Maercks Institute in Miami, we offer only the best in care and services. No matter where you are in your journey to transitioning, we’re with you every step of the way from the moment you decide to work with us. While risks are inherent with all surgeries, we do our part to minimize your risks and keep you safe.

Why choose Dr. Maercks for MTF surgery in Miami? 

The Maercks Institute offers transgender patients access to state-of-the-art technology, the expertise of an experienced top transgender surgeon, and the absolute best in patient care. Board-certified president and medical director Dr. Rian Maercks is a cosmetic, plastic, and reconstructive surgery specialist who is double-fellowship trained and has a unique combination of specialized expertise in cosmetic breast and body procedures. His innovative approaches to both surgical and non-surgical procedures of the face and body have garnered him international recognition by surgeons and patients alike, and his undergraduate training in fine arts and philosophy created the framework through which he explores the world of medicine and plastic surgery. In addition, Dr. Maercks elevates the standard of patient care and safety through his work as medical director. If you’re interested in male to female surgery in the Miami area, come discover why Dr. Maercks has changed the lives of thousands of patients over the years. Schedule a consultation with us today. 

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