Transcription:

Bill Klaproth (Host): So what is facial gender affirmation surgery? When should this surgery be considered? And what is the first step for patients seeking facial surgery? Well, let's find out with Dr. Angela Rodriguez, a Gender Affirmation Surgeon at MarinHealth Medical Center.

This is the Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Dr. Rodriguez, thank you so much for your time. So can you start out by giving us a bit of your background and credentials?

Angela Rodriguez, MD (Guest): My name is Angela Rodriguez. I am a Gender Affirmation Surgeon at MarinHealth. I'm a trained Plastic Surgeon, craniofacial surgeon and have been in practice for about 15 years.

Host: Okay. Very good. So, you're the perfect person to talk to about this. So, Dr. Rodriguez, what is facial gender affirmation surgery?

Dr. Rodriguez: Gender affirmation surgery, in general, is a set of procedures that are directed towards aligning somebody's gender with their appearance. So facial gender affirmation surgery are a set of facial procedures performed to align somebody's face with the gender that they identify with.

Host: Okay. So then what is the difference between gender affirmation surgery and cosmetic surgery?

Dr. Rodriguez: That is a great question, Bill. Cosmetic surgery is when you have a normal structure and you want to make it a little bit better. When we do gender affirmation surgery, even though it might be the same procedure as a cosmetic procedure; what we're trying to do is alleviate the individual's gender dysphoria, which is a misalignment between their body and their gender identification. So one procedure is reconstructive gender affirmation surgery, and the other one is completely cosmetic.

Host: So then gender affirmation surgery is more reconstructive in nature. Does that mean that you have to have different qualifications than a regular cosmetic surgeon would have to have?

Dr. Rodriguez: Yes. You have different branches of training in surgery. I think in plastics or you are trained both in cosmetic and reconstructive and some of those procedures overlap. You can have surgery on your nose that takes care of the function and also the shape of the nose. Basically, your breathing and the shape of a given feature that you want to change. So to answer your question, a surgeon should be board certified, trained in either plastic surgery, ear, nose, and throat surgery and be trained in also facial surgery or craniofacial surgery or maxillofacial surgery to have a little bit more subspecialization in that regard. And also, in my mind there is a human qualification and needs to be involved with the community.

Host: Right. And you are certified as a facial gender affirmation surgeon. I hear you have patients coming from all over the country. Is that right?

Dr. Rodriguez: Well, it has been a very, very exciting career. I started my career, doing children with congenital malformation or disfigurement as a result of trauma. But, we have so few surgeons that, people come from all over the place and it's a little bit like word of mouth. So I'm very, very, glad that, to be able to serve the community, full-time so yeah, people come from all over the place.

Host: Yeah, that is, exciting. And we're glad that you're right here at MarinHealth. So let me ask you this. When should this surgery be considered in the overall journey of gender affirmation and transition?

Dr. Rodriguez: Every patient is an entire different world. Some people, feel dysphoric about their face or any other part of the body. So it's a very personal decision. It's a decision that obviously as a practitioner, we can help the patient make. So everybody feels different way. For some people, they want genitalia surgery first or chest surgery. For other people that face is the priority.

Host: And then Dr. Rodriguez, when it comes to gender affirmation surgery, are there any risks or complications to consider?

Dr. Rodriguez: Like in any other surgery, you can have bleeding. You may have a trip back to the operating room to take care of the bleeding or infection or wounds opening. Very rarely on the face, thankfully things heal really well on that area. I think the important thing is that the patient is well-informed and I would say that occasionally when people are not completely happy it has to do more with education, with setting realistic expectations for the patient.

Host: And then for someone considering this, what are the requirements for gender facial affirmation surgery, for example are hormones necessary before surgery.

Dr. Rodriguez: I think hormones are not definitive requirement, but I believe, for example, in the case of feminizing a face, hormones are going to decrease the facial hair. Hormones are going to give the skin a different glow and redistribute the fat of the face. So it is beneficial to start after hormones. I think one of the important requirements has to do with mental health, because I need a mental health provider to make a diagnosis of gender dysphoria. So I will ask for a letter from a mental health provider in every one of my patients.

Host: So I'm sure you get this question a lot. Does insurance cover gender affirmation surgery?

Dr. Rodriguez: Insurance covers the majority of the times. You have to realize there is a giant pool of insurances and policies. So the patients should check their benefits and our office helps doing that. And that's a large part of what our administrative office does. But for the most part, insurance covers, if they deem the procedure reconstructive and therefore medically necessary.

Host: Right. Yeah. As I'm thinking about this, I imagine facial surgery must be so important in contributing to the wellbeing and self-confidence of your patients. I know this has gotta be really important for them to change the look of their face, to match their gender identity. Do you have any stories from a patient to share?

Dr. Rodriguez: Yes. One comes to mind. There was a patient that showed up to the office for a consultation unrelated to facial surgery. She was looking for a different procedure. You have to understand this is prior to the pandemic. She came with a mask on her face and after we did the consultation. I asked her, you know is are you sick? Is there any reason why you are wearing a mask and she said, I just fear for my safety. I don't feel safe when I take a cab. When I go to the train station when I walk outside, because my face gives me away, but I was denied by insurance. So, I said, well, let's give it a try. And she said, I don't know if I can bear the pain of having to be, not authorized again. I just it's too much for me. We tried actually, and we got her surgery and she has a mask now because of the pandemic, but obviously, her self esteem and life is completely different. She's looking to go somewhere else and start a new life. So it really fills my heart with joy to be able to help patients in this manner.

Host: I bet. What you do is life-changing to your patients and that should not be overlooked. And I imagine each case must be so individualized, right? And needs to be personalized too. So for someone thinking about gender affirmation surgery, what is the first step for a patient seeking facial surgery?

Dr. Rodriguez: The first step is, you know, it comes from usually a lot of the patients come referred from a mental health provider because of the diagnosis of gender dysphoria. That needs to be established. But I think it's a good idea to always, even if the patient is early in the process, consult with a surgeon.

You know, see with their primary care physician or their endocrinologist, if they want to pursue hormone treatment because as we discussed before, the patient doesn't have to wait to see the surgeon to do these and they can also for example, start laser hair removal treatment, which takes time. So, I think those are some important initial steps in the process.

Host: And then, what would be helpful for a patient to bring to their appointment? Should they bring photos of how they would like their nose or their forehead to look like as an example, would that be good to bring those things to their appointment?

Dr. Rodriguez: If the patient has a specific look, I think it's important that the patient share this information with the surgeon. Because that's going to give me an idea of what type of outcome they want. And set expectation on whether they are realistic or unrealistic, I want to make sure that I can communicate that with the patient and in areas like the face, pictures are really, really important. I think they should bring a lot of questions and if they want pictures. We usually, analyze pictures in the office, pictures of the patient. But yeah, lot's of questions and, ideal outcome. It's always good.

Host: Yeah, well, that's really good to know. And then can patients customize the procedures they want to have, for example, for a facial feminization surgery, can someone choose to keep their jaw line as it is, and only have their forehead lifted?

Dr. Rodriguez: Yes, of course, to a certain degree, this is not a cookie cutter operation. This is an operation that the surgeon and the patient design for the patient's needs. So it takes a lot of ,planning. It takesa CAT scan some radiological images and the patient can choose, and the surgeon is responsible to make sure that they can guide the patient through the process.

Host: Okay. And then lastly, is there anything else you'd like patients to know ahead of time so they can prepare for the best outcomes?

Dr. Rodriguez: Facial surgery is nonetheless surgery. So the patients need to understand that. It's a surgical procedure with risk and benefits and be prepared and have everything in place for their operation. Planning is important.

Host: Absolutely planning is important. Well, Dr. Rodriguez, this has really been informative. What you do is amazing. And I know as we talked about earlier, this is a life transforming for your patients. So thank you for all you do, and thank you for sharing your time with us today. We really appreciate it. Thanks again.

Dr. Rodriguez: Thank you so much Bill.

Host: And once again, that's Dr. Angela Rodriguez. And if you'd like to know more, please visit myMarinhealth.org/gender-affirmation. And if you found this podcast helpful, please share it on your social channels. And check out the full podcast library for topics of interest to you. This is the Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks for listening.