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What is the FAVE vaginoplasty?

Dr. Rian Maercks developed this technique after being disappointed with the open and scarred appearance of conventional vaginoplasty methods. After gaining experience with multiple techniques and combining his knowledge and experience with genital reconstruction, he devised the FAVE vaginoplasty to give optimal aesthetic and functional results to trans women.

About the FAVE vaginoplasty

The “E” in FAVE stands for important enhancements that are not typically or simply not ever found in conventional techniques. These enhancements include:

  • Natural-looking clitoral hood origination. Instead of a short and flat clitoral hood that originates abruptly from the midline, the FAVE creates a natural-looking hood that is gently caressed by subtle folds on each side, and originates from a subtle suprapubic mound — just like natural female anatomy.
  • Full-length true labia minora. The labia minora are a very important part of feminine aesthetics and function. They are, for the most part, neglected in conventional techniques, only appearing as a short extension from the clitoral hood. Because of the unique flap developed to create the FAVE labia minora, they start seamlessly from the clitoral hood and travel with constant dimension all the way to the posterior of the vaginal opening, reflecting ideal feminine aesthetics. 
  • Internally oriented labia majora. In conventional vaginoplasty techniques, the tissues are pulled in a “down and out” vector, creating a tendency to flatten and spread apart the anatomy especially the labia majora. The FAVE procedure manages vectors in a completely different manner, allowing a “closed” or “kissing” appearance of ideal aesthetics that Dr. Maercks originally developed for the MACIE cis gender labiaplasty.
  • A scarless appearance. Conventional vaginoplasty creates large, unsightly scars in the groin crease. It also tends to create the appearance of redundant skin, which draws attention to these scars. The freestyle flap design of the FAVE procedure allows accommodation of the variable anatomy of each individual patient to provide either a completely hidden, “scarless” appearance or greatly minimized visible scarring.
  • 100% flap-derived vaginal vault. It is very common for surgeons to use skin grafts to augment the lining of the neo-vagina to allow for adequate vaginal depth. This is especially true when the penile length is limited. Grafts always exhibit extensive retraction, making painful dilatation and sometimes revisions necessary. The FAVE procedure is designed with novel flaps and novel arrangements to provide a redundantly large surface area to line the vaginal vault without using any graft whatsoever. Comparably minimal post-operative care is required because all of the tissue used to create the vagina is vascularized flap tissue.
  • Optional urethral flap for enhanced natural vaginal lubrication. Based on patient preference, the long segment of the urethra that is usually discarded can be integrated into the FAVE vagina, helping with spontaneous lubrication.

Male to Female Vaginoplasty: Image One

Male to Female Vaginoplasty: Image Two

Male to Female Vaginoplasty: Image Three

Image One: Pre-operative view of patient undergoing MTF transgender FAVE vaginoplasty.

Image Two: Immediate on-the-table result after completion of FAVE vaginoplasty. There is some obvious swelling. The labia majora is demonstrated extending to posterior fourchette and showing clitoris covered by hood and pink urethral tissue and well-lined natural appearing entry and vaginal vault. The vaginal vault is 8.5 inches deep and lined with excess to accept a full-sized dilator/dildo. Instead of dilation, the patient does daily depth checks with an 8 to 9-inch dildo for ten minutes.

Image Three: Once swelling resolves, full-length labia minora are evident, starting at the clitoral hood and continuing to the posterior fourchette. There is a “closed” or “kissing” appearance.

On examination, there is a stable 8 to 9 inches of depths and adequate width consistent with a native vagina. There is no dilatation necessary; only nightly rather than weekly depth checks in the shower with a large dildo. At this stage, the patient was very satisfied and declined further revision. There are options to further refine the clitoral hood and labia.

The Maercks Institute

FAVE post-procedure results

Patient shown below is six months post-op with 8 inches of depth, discreet labia minora, and orgasmic potential (both internally and externally). Patient never required dilation and performs weekly depth checks.

Vaginoplasty in Miami at The Maercks Institute

Dr. Rian Maercks’s expertise in natural aesthetics is not limited by gender or body part. He has developed aesthetic and augmentative techniques for both male and female genitalia, including the advanced FAVE procedure. At The Maercks Institute, genital surgery is one of our main services, and each and every patient is considered in a manner that is anything but cookie-cutter. Dr. Maercks’s attention to detail, vision, and experienced judgement are used to achieve optimal results in the safest and most effective manner possible. As a board-certified, internationally recognized cosmetic, plastic, and reconstructive surgery specialist, Dr. Maercks elevates the standard of patient care and has changed the lives of thousands of patients over the years. Individuals come to him with an issue, and he determines the best way to go about solving it. He is the expert who will formulate the right treatment for your goals, with the most natural-looking outcome possible. 

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