1st Generation

OVERVIEW

First generation SRS (vaginoplasty) existed mainly in the 1960's and 1970's. While initial attempts were made in the 1950's, the so-called barbie-doll beginnings of the surgery. Results were very crude with disfiguring skin grafts.

When penile inversion became understood, appearance improved, but the neo-vagina created during this period offered minimal appearance and vaginal depth.

Many of the early USA surgeries were performed in Trinidad, Colorado by Stanley Biber, MD. Along with SRS sugeries, Dr. Biber brought a good deal of notoriety to the small town and a modest income base to the local hospital.

2nd Generation

OVERVIEW

Second generation vaginoplasty developed in the 1980's and into the early 1990's. A few excellent technicians, such as Eugene Schrang, MD, took great care to assure aesthetics were more pleasing. Techniques that added a neo-clitoris were introduced in Asia, and eventually become incorporated in US practice. Use of scrotal skin also became popular for donor tissue, which is used to increase vaginal depth. During this period, some surgeons instead used a split thickness skin graft taken from the lower abdomen. But this latter technique has been largely abandoned due to poor results.

These second generation techniques are largely still practiced in North America and Europe, because of the limitation of a single surgeon who performs the entire procedure.

Second generation technique requires the patient first undergo painful and lengthy genital electrolysis, or instead, later suffer with numerous hairs growing inside the neo-vagina. While some removal of hair follicles usually does occur, the single surgeon operator does not have enough time and resources to usually do an effective job of hair removal.

3rd Generation

OVERVIEW

Greater attention to detail becomes possible due to a team approach in third generation vaginoplasty.

A second surgeon is responsible for preparing donor tissue such as removing hair follicles. With 3rd generation techniques, there is no need for genital electrolysis. The hair follicles are removed from the underside of the scrotal skin during the operation.

Also, secondary surgeries, such as breast augmentation, are able to be completed during the vaginoplasty operation.

Detail becomes the major focus of 3rd generation procedures, and later surgical revisions are less often requested by patients.

As the community of Thai SRS surgeons has grown over the years, there is a greater opportunity for surgeons to learn and observe from their local colleagues.