Love the Skin You're In: Plastic Surgery in the Trans Community

Episode · 3 years ago

Love the Skin You're In: Plastic Surgery in the Trans Community


Dr. Elliot Hirsch is a board certified plastic surgeon in Sherman Oaks, CA. If you're starting to think about your journey through gender confirmation, he might be your guy. Learn the importance of building relationships with doctors you trust who are going to care for you and your well being. And don't ask your Dentist for breast implants. (Seriously, that happened.) Find Dr. Hirsch at Your host is Levi Chambers, co-founder of Gayety. Follow the show and keep up with the conversation @LGBT, @LGBTQ, and @Pride. Want more great shows from Straw Hut Media? Check out or website at Your producers are Will Sterling and Ryan Tillotson. Have an interesting LGBTQ+ story to share? We might feature U! Email us at Learn more about your ad choices. Visit

Straw media. What does it mean to be comfortable in your own skin? For many of us, it's not as simple as waking up and being who everyone else expects us to be or who everyone tells us we're supposed to be. And at a time in which the current administration seems to be finding new ways to strip people of their identities, the Trans community has seen some of the most painful setbacks. But, as always, we're here to celebrate and, despite the challenges we might face today, it's always comforting knowing that in the world around us, there are both people and professionals who have our best interest at heart, who want to help. For those in the Trans Community who wish to live in the skin of the gender they identify as. It's no surprise that transitioning can be a challenging process, but today's guests got involved in his line of work to do exactly what we so desperately need, help those in the Trans Community live as their authentic selves, both inside and out. I'M LEA by chambers and from Straw hut media. This is lgbtq plus. You. Hi, I'm leave. I'm here to talk to Dr Hirsch. Hi, I'm Dr Elliot Hirsche. I'm a board certified plastic and reconstructive surgeon practicing out of Sherman Oaks, California. Dr Hirsch lives in La in the valley, not too far from Hollywood or Beverly Hills, but just for are enough not to get wine accidentally thrown on you by a housewife. I think my parents never pushed me as funny I was just talking my dad about this a couple days ago, but I never they never push me. They said. I always this is just what I wanted to do and they kind of helped me kind of get to that point, just guide me in the right direction. But it's important to have a good, supportive family. You know, I've my wife is at my office manager and she's very supportive. We have two kids and a lot of a lot of what we do is is just try to keep a good balance between work and family life and not get caught up too much. If you know, if my kids not doing a good job with baseball is having a hard time, you don't bring that into work. Or if if I'm having a tough day at work, don't bring that home. So just maintaining balance is really important for me. Some might turn their noses up at cosmetic surgery. There can certainly be a stigma against it, but often that's when it seems to go wrong and when the obsession with it takes over the sense of self. But for those in the Trans Community it's one of the ways in which you can live in the skin. You feel beautiful and well. It's interesting field, you know, because we work both with patients who have like reconstructive problems, where they have breast cancer or skin cancer, they have something that's fundamentally a medical problem and we help them become whole again after surgery, after cancer surgery, and there's also the recon the cosmetic patients who oftentimes they have low self esteem or they want to look a certain way. A lot of that is education, understanding. You know what's possible it's not possible, but it's a very a filling field, and so when you're in what I was in med school, I spent a lot of time looking at all the different surgical specialties and seeing what different people are doing, and what everybody said was that all the goodlooking, funny people go into plastic surgery, and so I thought, well, I've got one of those. Maybe you kind of pick which one, I don't know, but it it just kind of fit me because it wasn't it wasn't just a simple thing like you take out an appendix and the patients better. It's you really kind of using a set of principles instead of tools to change people, and that's what really appealed to me about it. Right, so instead of just, you know, fixing someone's appendix, you're helping make their life better. You're changing them. Right, that's plastic surgery that were plastic is. It's a Greek word from plastic coast. That means to change, and that's that's what the specialty is. It's a transformative specialty. How do you feel about knowing? When you do you do a breast documentation on assist gender woman, you're helping her look more like she wants to look. When you're doing it on a trans woman, you're affecting more than just that. You're helping them live in this gender that they identify with, beyond just you know,...

I already have them, I want them huge. You're really really changing someone's life beyond just cosmetic. Does that? Howes that make you feel to know like that person now feels like they're more themselves because of that small thing, because it is small. You do forty. I mean for you, you do a ton of them. It's a small thing, but, dree, it has a massive effect on Trans People. Well, that's that's why I mean, that's why we do it. You know, were to. I went into medicine to help people, and so it's the being able to do this is very gratifying, where you have oftentimes, some of these who has not felt right about them selves their entire life and they're in they're like thirty years old. I can't make can imagine what that's like for thirty years not feel like you're the right person, and so if I can help them take a small step in that direction, it's a very Grad Finny thing to do. Not Everyone in the Trans community undergoes hormone therapy or gender confirmation surgery, but for those interested in taking the steps, there's a lot of vital things to know as you prepare. When someone approaches you and says like I want to transition, these are all the things I want. What do you what are those first conversations like? For me, it's about getting to know the patient, because we've had patients come in before who have wanted specific procedures, and not always the the the the gender changing type procedures. But you got to get to know the patient, understand what their motivations are, understand where they're coming from. Surgery is not going to fix all your problems. If it's, if it's something like that, but a specifically with with this patient population, it's important to know the number one, they've been under the care of mental health professional for over a year. And then number two, make sure they're stable. And it's not just stable like physically and emotionally, but they're living space needs to be stable and they have to have somebody to take care of after surgery and you know there's that. We've seen a lot of patients in this community who have drug problems or alcohol problems and that all has to be stable because sometimes surgery can it can kind of kick off a relapse. And make sure they've got good support and you know, they have to understand what they're getting into and and the surgeries that we do they're not always reversible. Right. So, like as a SIS gender person, it's I mean I can see how a transperson would want one of those procedures or the therapies because they see it as like, if I get this, I will finally be happy. Is that kind of a conversation that you have with your you know, your patients, like I can do this. Is it going to make you happy? For sure. Yeah, we always have that conversation. It's you never know the answer. The to to know it. Are you going to be happy? I mean you're going to be different, you're going to have breasts or you're going to look your faces a look a certain way. It's not going to be the same therapy and having that stable therapist to talk to to make sure that mentally, you are prepared to understand what's about to happen to you. That's critical. Do you find that? You know when you're having those conversations about these are the changes that are going to happen, you have to kind of like set expectations or be reasonable, because I can see, you know, a lot of people will want to look like a playmate or a playboy bone, you know what I mean, and have really big breasts or really high cheek bones and are really tiny nose. Do you have to kind of curve those and like that's really great. These are the things I think I can achieve in it will help, it will be what you want and that may not be something I can do for you. Well, that's that's number one. You know, it's once you actually go down the road of okay, we're cool, you seem reasonable, I can help you with this. There's a whole informed consent process and we look at pictures, we you know, we kind of talked about things. There's informed documents have to sign. But yeah, you're absolutely right. You've got to make sure that their expectations are realistic and are something that I can accomplish, because if it's not, then, like you said before, they're not going to be happy with me or with the procedure that they did. Right as we talked about stability going into surgery, we're now starting to see that a lot of people from all communities are shockingly starting to do is refer to as diy procedures. You know, you talked about things changing. That's one thing that I think all board certified plastic surger would like to see go away. I remember one day I had I had three patients come in together...

...because somebody they had gone to a garage and Van eys and somebody had ejected something into them. This is like six months ago and now they all had infections and I mean they're but felt like cement. It was just just really a bad situation. You know that. And Medical Tourism people going to to Mexico or other other countries where it's you know this. There's not the same safety standards, same training standards. So the do it yourself stuff. It's never a good idea to inject anything into yourself. I wish people wouldn't do that. Going away for surgery another thing I wish we could just kind of put the Kibosh on that. Sometimes it's a desire to save money, but then the more insidious side of it is. Well, maybe because it's become so commonplace with reality shows and people doing undergoing procedures, are undergoing injections, and all the social mediacy, snapchat, facebook, all these different things, people think it's a simple stuff and what could go wrong? I can just do this. I bought this off the Internet. But when you do that, you know you really take it a big risk. You don't know what you're buying off the Internet could be counterfeit, it might not be sterile, might be secondhand, and then you know the other things too, like it's not that simple to just inject filler into yourself. There's a lot of blood vessels in your face and if you inject into a blood vessel you can go blind. Your skin couldn't just die and make it be a big deal. Both ox is a little different because both tox it goes away after three months. But some of the changes, though, that you can have with Filler, they could be permanent and it's it's always better. It's always better to go see a doctor, qualified doctor get that done. And even more terrifying is the notion that if you have a medical license, despite not being trained in a specific field, you can perform literally any surgery on a patient. Imagine your dentist giving you breast implants. More on this, after the brain. So one thing to always keep in mind is that there's no there's no such thing as scope of practice legislation in Calfaria, really in anywhere in the US. What that means is technically anybody with a license and medical license can do anything they want. So if I wanted to do, let's say, a heart transplant, I wouldn't know how to do it, but I could probably do it as long as I got privileges at a facility to do that, and if I have my own surgery center, and that's probably not a good example because it's have a big surgery, but like a Bunion, for example, on the foot, if I have my own surgery center and I decided I wanted to start doing bunions, I could do it. So in California people who are not qualified to be doing cosmetic surgery are doing cosmic surgery. I've seen patients who have had breast augmentations from their dentist before Tummy Tucks from there from their family practice doctor. You know, this is very common stuff and the there's no such thing, like I said, as legislation preventing this. What is important that what's the American society plastic surgeons has been trying to push for a long time is education understanding that the American board of plastic surgery is the highest level of board certification that there is, and we talked about how long it took me to get to that level. Whereas board certified, that's what patients to look for. Look for that level certification. Then you know you're more likely than not in the hands of somebody who's competent and you'll be well taken care of. So it's important to remember that was something like cosmetic surgery. You're not only taking care to make the right choices and decide on the right professional, but that there really are no shortcuts. You know, it's I'm kind of past the point where, I mean every so often I get surprised, but it's very rare. Most of the time, even when it's something really bizarre, it's I mean it's kind of like you that show botched. Yeah, that's every day for me, you know, I see the stuff every day and sometimes it's patients did to themselves, sometimes other doctors did it and I do a ton of revision surgery and so's I'm never really surprised by it. But but it you can't always fix it,... the problem. And especially when you've got a situation where if somebody injected some hard substance that's infected now and it's deep in the tissue of their butt, I mean you can cut it out sometimes, but if involves the skin, you got to cut skin. It looks like somebody had a shark bite in there. But so you can't always fix it. It can really be something catastrophe. Oh Yeah, you can make better, hopefully. Sometimes, yeah, sometimes you can help the symptoms, but it's not going to look good. When we walked into Doctor Hirsch's office, there were a lot of certifications on his wall. If you think it's as simple as a few injections here there were traveling to another country for a simple procedure. Consider that for Dr Hirsh his time in Med school equates to the amount of time spent going from first grade through high school graduation. Well, it starts out, you know, the whole med medical process really starts from most people in College, where in college you do some kind of shadowing or some experience, usually voluntary shadow just anything clinical. I did research just with with stroke patients, and that's when you become exposed to it and you when you sign up for medicine, it's a life, it's a lifetime. It's not like any other job. It's it takes a really long time to finish your training and then setting it a practice and it's really a commitment, and so getting that early exposure is important. So, you know, is this for me? Is this something I want to do? And so I had a pretty good idea. More or less where I want to go with it. I went to college and John Hopkins and Bolt more and then towards end of college, you you apply for Grad School. You got to take a bunch of tests and things like that. So I apply for MED school. Ended up back here at USC and that's four years and, you know, about two hundred thousand dollars. Yeah, and then you have a real commitment, yes, a down payment commitment, and then you have after that, seven years of residency. So we moved to Chicago for seven years and that's you know, that's like eighty, eighty plus hours a week of work, six days a week. He got one day off. It's a really, really big change in your life and for me it was Chicago's cold weather. I had two kids there, you know, didn't see them a ton during that time, but that's that's the sacrifice. So it's funny you think about I started met for a time, I started med school to I finish residencies eleven years. The time you start grade school, from first grade you Graduate High School is twelve years. So I spent almost the same amount of time training as I did doing, you know, first grade to twelve grade. Yeah, you think about all the change in your life in first grade twelve grade. Yeah, I spent all that time in the hospital. Right, that's crazy. How long have you been doing this? But a while, you know, at the whole process for me started I graduated med school in two thousand and seven and there was residency and we've been out here in this office for about five years now. That's great. That's great. And when did you start helping transgender patients? Back around, I would say, back around maybe two Tho and and six. In Med schools, my first I saw my first one. So what was it like for him getting started helping someone in the Trans Community? You know, when one of the First Trans Patients I saw here, as by I can, I can picture this in my head, was somebody who had silicone injected into her breast. is a transgender male, a female patient, and she been living like that for like twenty years, twenty thirty years, and her breast felt, I mean not to it was like a sack of potatoes. That's what they look like, that's what they felt like. That was from all the silicone injections. And so I talked. We why did you do this? How did you get to this point? And not just to be accusatory but just to find out like what happened, and she said that when she had that done, that's all they had. You know, it wasn't an option to do the things that we do now. And so I think as time has passed and this has become more accepted and more commonplace, it's I don't really see a lot of a lot of patients...

...who say, well, I delay going to a doctor, I was scared to go to a doctor. The diy stuff now is almost always people who have seen something on instagram or social media or their friend did it and they were great for their friend, but when they did they got an infection or just kind of looked weird, and that's more what I'm seeing that. But it's pretty rare to have, especially transgender patients. I was scared to go to doctor for a long time. I think you're right. Probably just tolerance and acceptances help them, you know, feel more confident. yeaking in here absolutely something as opposed to feeling ashamed or something. Well, of course, it's just always good to be able to help people and so we're always happy when people make it in. What is the talk to a little bit about therapy and making sure that, like a trans patient or a person who is pursuing certain gender related procedures, what is part of that, like the component of working with them that's that's more about like their emotional state. Do you make sure you're working with their mental health provider to understand, like how they've been for the last year, or is that something that's in their records? Like how does that work well either? For from our standpoint, by the time they come to us, we are more of almost like a technician, where I don't see patients typically early in their in their process. It's very rare for me to have a patient that has not been in therapy for at least a year. Most of the time they're in therapy for several years before I see them, and and it's now with insurance covering a lot of the the surgeries. It's usually their primary doctor, whoever's making the referral doesn't even refer them until everybody knows the criterias. They don't refer them until it's been over a year. Have you had any experiences with those patients where you find yourself kind of having to like put down the stethoscope and be listening more to their you know what I mean, almost in like a not like a friend, but sort of like I'm hearing the things you want and I also have to be your your care physic, you know, your physician, and make sure that we go down the right path. Yeah, is that a hard line to walk to where you're not like yes, I understand what you want. You want to look like Angeline, a letter, you know. Well, it's most of the time. So we do mostly transgender breast surgeries and this exact conversation that you just mentioned. You. I've had this conversation probably twenty times in the past six months and it's almost always about breast implant size and my idea of what a sea cup or a decup size breast is totally different than that from somebody who is has gendered identities for you or even a as female. You know. So so we see different ideas was sea cup or decup sized breast is. And I've had many of our transgender patients say I want to be a full see and they come up with a picture of somebody who's got like seven hundreds se see ginormous implants and I say I can't, there's no way. I could even get that into you. You know, like this is a sea. Yeah, this like the my one hand. This is a sea for me is one hand. You know, I have to stretch my hand. That's a deep and now you got to hands. That's a double d. So what you're showing me, that's like an EH, there's just not going to happen. But oftentimes, when dealing with a specialized professional like Doctor Hirsch, a cosmetic surgeon's office isn't a onestop shop for everything you're looking to have done. They might offer additional services. But a person's journey and gender confirmation can also mean finding one's own network of doctors. So would you say that different doctors than you talk about doing mostly breast agumentation? Are there doctors who specialize in other elements of it, like facial feminization surgery or yeah, yeah, for Gender Confirmation Surgery? Yeah, you kind of mean you kind of specialize in my general practice. Like I said, doing, you know, forty plus procedures a month and about sixty seven percent of them our breast. And so so for me, just kind of incorporating the transgender breast cases into a part of my practice. It was an easy step. You know, I don't do any of the bottom surgery and if I did, have to get trained to have to learn it right. And each every surgery you do has it has its own issues, you know, the nuances and it's play. I was I was just talking to a buddy of mine couple days ago about some of the things that we do and he...

...says, you know, as I get older, I feel like I'm betting slower. I said, yeah, you know, I've know the same thing, but it's because you've seen more complications, more problems, and so you're doing more things during surgery to kind of prevent those things and try to optimize your results. And so that's what happens with with our practices. Like, you know, the breast stuff. The more breast cases I do, the more I see and the better it gets. Sometimes takes long or sometimes it doesn't, but you end up specializing right. So that's like you said it technically you can do any surgery you want. Yeah, but between being able to, and I'm I mean from what I know about the like bottom surgery, either on a transman or a trains woman, it is super complicate, very complicate. So you definitely want to go to the right person now that, because that's unlike breast implants. Like you said, you can remove them and, you know, do reconstructive surgery if they don't want them, and do the best you can to put it back. But some things you can't, fun things you can't. Yeah, right, and there's of course to that. You know, half of the surgery is what happens in the ore, but the other half is what happens out of the or and managing complications, managing problems. You know, some times things don't heal properly sometimes. You know, sometimes just takes a little while for things to settle but all that stuff is part of the process, and so it's not just you show up, you get surgeon, you're done. It's I mean this is like three six months writing. Settle Out. Taking the time and care to build that network is going to ensure that whatever procedure you might be thinking of undergoing is done by exactly the professional who should be performing it. We repeat, do not let your dentist give you breast implants. And of course, like all things, the body ages as you change throughout life and as your body needs different upkeep and care. So too do the procedures you've undergone. And you asked me before about where the patients come from. That we see with the revisions. A lot of times they may come from really well qualified surgeons, but nothing last forever. And so even if my own patients, you see them, over time things change and you see like the skins not as tight as it was ten years ago, or the rest implants. They breast in plants need to be replaced every ten or so years. I've seen patients who had forty year old implants. They looked fine but they're ruptured, you know, and you got to take them out and put it in, put the new ones, and so things need maintenance. It's not like you do surgery one time and then the rest of your life it's perfect. Just needs needs to upkeep and and and care. So what are some of the most important things to him when having conversations with his trans patients? It starts with happiness and comfort, but also practicality and safety. I think a lot of it is just eddication for the patient, making them understand what's possible what's not possible, and for me it's it's not it's not like a very emotional thing where it's almost like I know, more or less, based on your anatomy, what you look like, what we can and can't do, and I want you to be happy, I want you to be comfortable with with this procedure. But if you if you're asking me to do things that are unsafe or you're not going to be happy with and I know you're not going to be happy with them because I've seen this so many times. You know, the beginning of my career, I probably did it and realize that it never worked. So it's just education and you got to have that relationship with a patient where they trust you and they say, well, yeah, I know you, I want these eight hundred CC IM plants, but you're telling me it's just not going to fit. So okay. Well, I trust you and and you know, we'll go with something that's going to work for me. So let's recaunt. Are you part of the Trans Community and are you considering beginning the process of gender confirmation? Remember, a doctor, licensed and exactly the field needed, is the only person you can trust if you're thinking about doing something to yourself or to or having somebody else who is not a doctor do something to you, or a PA or nurse or medical professional. Don't do it. It's just not going to be worth it. You know, you might be okay at first or for a little while, but you'll regret, I promise, at some point. You know, you go, you go to a doctor and some of whose qualify, who you know, they're certifications. It's it means, a very thoughtful process and like, for...

...example, we're starting our own surgery, post surgery skin care line and and things to help patients recrd from surgery, because I've done this for a long time and I want to know. You know, there's no product out there that really kind of fit our needs. So we're launching our own skin care line to kind of help our patients. You know, we formulated the products we wanted and we kind of set the websites almost ready and you know, we're gonna have instagram and social media. But it's called Aura Ra, which is it's kind of a long story how we how we got that name, but it's it's a good it's a good line. We're really excited about it. It's all going to be medical grade. So patients we've tested on a lot of our patients. People really like the products and we're excited to be able to offer that to everybody. If you're in the area and looking for a doctor you can trust, you know where to find him. Our website is wwwhers plastic surgerycom, hi R sech plastic surgerycom. Our instagram handle is hirsh plastics. As with a lot of things in life, gender confirmation can seem scary, but remember that there are doctors out there who got started specifically to help you. You are their primary focus and care. Maybe you're not ready, maybe you're happy just the way you are. Regardless, no, there's always a space for you here with us and in the world. LGBTQ PUSU is brought to you by Straw hut media. If you like the show, don't forget to rate US ON APPLE PODCASTS and be sure to leave us a review. The show can be found all across social media at LGBT, at LGBTQ and at pride. Yes, those handles are us. If you'd like to check out more of our great shows, give us a look at Straw Hut Mediacom and you can find me on social at Lea by chambers or at Gayety. Our producers are will sterling and Ryan Tillitson, copy written and engineered by will sterling. Those fellows can be found at will sterling underscore and at Ryan Tillitson. We'll see you next week.

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