A Primer on Skin-Graft Vaginoplasty
Vaginoplasty is vaginoplasty, right? Not entirely. There are actually a few different methodologies involved within the grouping of procedures that we would call “vaginoplasty.” Without going into which is better and under what circumstances, let’s discuss skin-graft vaginoplasty.
Skin-graft vaginoplasty is normally considered the most common form of reconstructive procedure. This is usually done after cancer resection, or severe scarring due to trauma. Under this procedure, the woman’s neo-vagina is created via a split-thickness skin graft. In the case of vaginal agenesis, the necessary donor skin is normally taken from the abdomen, the buttocks or from the top of a thigh. If it’s an MTF SRS patient, then skin from the person’s penis is mostly used and is normally combined with skin from the person’s testicle sack (or “scrotum”). However, in a few MTF cases, there’s not enough scrotal or penile skin for producing an adequate neo-vagina (for instance, if a castration or circumscision has been carried out in the past). In these cases, the surgeon will also take a skin graft. We should mention that the place from which a graft originates is sometimes prone to scarring, which can be a bit painful and unsightly in the future. Therefore, the therapist is obligated to take extreme care, especially during the post-op care, to make sure that this scarring is kept to a minimum.
No matter what kind of skin-graft vaginoplasty is employed, it’s important that a skin donor site (and the genital area, in the event of an MTF SRS) is either hairless area or permanently and completely cleared of all hair prior to the commencement of the operation. To be honest, this is not an especially pleasant process, however, it must be done—and it must be done comprehensively. This is essential, and plastic surgeons must cauterize stray hair follicles off the back-side of the skin-graft prior to implanting it.
If anyone is skeptical about the need of taking this initiative, they should think about the repercussions of an incomplete hair removal—i.e., having hair within the patient’s neo-vagina, which can probably never be removed later. Please note: Laser hair removal is not suggested by most reputable surgeons to remove this hair, even though some have started suggesting it in recent times. One reason that surgeons don’t recommend the laser option is because it must be repeated 6-7 times as one time removal is not permanent. Therefore, even though electrolysis is a bit slower and a bit more painful, it is by far the preferred technique—because it is permanent.
The hair-removal process needs to be started far in advance of surgery so that there is no re-growth ever likely. You can expect that genital electrolysis will typically take from 25 to 45 hours; it’s also a bit more expensive than facial hair removal.
As with any form of plastic surgery, there are certain steps that should be taken by the patient before the procedure to improve the results of the operation. Likewise, there are measures the patient should take following the procedure to make sure she recovers correctly. All of these will be discussed with the patient at her first pre-operation meeting with the plastic surgeon.
