Post phalloplasty aesthetic treatments

Radial forearm flap phalloplasty is the most sought-after gender-affirming surgery among trans men after bilateral subcutaneous mastectomy. However, in many cases, it requires aesthetic treatments after phalloplasty. (To learn more about phalloplasty, read the post Phalloplasty or Metoidioplasty? That Is the Question).

There are various techniques to enhance the aesthetic outcomes of phalloplasty. Some are aimed at achieving a phallus with more natural coloration and anatomical structures, while others focus on improving skin quality and the appearance of scars left on the arm by this technique.

Among the most common aesthetic treatments after phalloplasty are micropigmentation of the neophallus, fat grafting in the arm, and laser treatment to improve the appearance of scars on the arm.

Radial forearm phalloplasty involves creating a phallus and urethra (the channel through which urine exits the body) using skin and fat from the forearm. The phallus is then transplanted to the genital area through complex microsurgical techniques, connecting the blood vessels (veins and arteries) and nerves from the forearm to those in the genital region.

Creating the phallus is often the first step in the surgery. In a later stage, many patients opt to have testicular implants placed in a cavity previously formed within the scrotum (where the labia majora were located prior to surgery). Various sizes of testicular prostheses are available, and the choice typically depends on the individual’s body type and the scrotum’s capacity.

Commonly, one prosthesis is placed first, and after it has “settled” naturally, the second implant is added to achieve better results.

To design and create the phallus, the entire thickness of the forearm skin is used, leaving a noticeable defect in the area. This is typically covered with a skin graft, usually taken from the non-dominant thigh, for example, the left thigh if the person is right-handed, and the right thigh if left-handed.

As a result, the scar on the arm left by the phalloplasty technique is significant. Various treatments can help improve its aesthetic appearance:

Lipofilling, also known as fat transfer, is a surgical procedure involving a free fat graft. Adipose tissue is harvested via liposuction from different parts of the body, typically the abdomen. Once extracted, the fat is purified and enriched before being injected into the donor arm area beneath the skin. This allows the fat to nourish the vessels in the area and improve the appearance of the scar.

Laser treatment improves the appearance of scars left on the donor arm by phalloplasty. A medical specialist will evaluate the scar to determine the most suitable type of laser and the expected results. This treatment can smooth irregularities in the skin and promote the renewal of the skin’s superficial layers.

Once the phallus has fully healed, its coloration can be adjusted to match the surrounding genital area. Typically, the scrotum has a darker coloration than the rest of the genital area, which is achieved naturally when the labia majora skin is used to create it. For this reason, additional treatment is often unnecessary.

In contrast, the forearm skin used for the phallus is usually much lighter and lacks the natural structures of a penis. Micropigmentation, or dermopigmentation, can be used to darken the skin and recreate anatomical features such as the dorsal vein of the penis. This significantly enhances the natural appearance of the phallus.