Choosing a Surgeon

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 12 October 2026· How this site is researched

Your surgeon shapes your result more than the technique, the hospital or the country. Choose well and the rest of the plan falls into place. I have spent over ten years coordinating patients through Bangkok hospitals, and I know how heavy this decision feels when it is your body on the table. The women who come home happiest are almost always the ones who chose carefully and then trusted their choice.

Where to start your shortlist

If you are going through the NHS or a US insurer's network, your options may come down to two or three surgeons. Every question below still applies.

If you are paying yourself, the field opens up. Thailand, and Bangkok in particular, has been a centre for this surgery for decades. Its leading surgeons do these operations every week, in hospitals built for international patients. My best MTF surgery clinics in Thailand is the strongest place to begin. It sets out who operates at each clinic, the hospital behind them and what each does best. For facial work, go straight to the best facial feminization clinics in Bangkok. Every clinic on those lists has a full profile under clinics, with the surgeons, the procedures and the sources.

Beyond that, talk to the people already in the system. Your prescriber, gender clinic or letter writer will know where their patients go. Peer groups tell you who people are choosing this year. A friend's recommendation is a good lead. Just remember it tells you how her surgery went, not how yours will.

Check the basics first

Before you look at a single photo, confirm the surgeon trained in the right field. That usually means plastic surgery, with urology or gynaecology also common for genital work, and ear, nose and throat surgery for voice. In Thailand, the Medical Council keeps a register of licensed doctors. In the US, look for board certification. In the UK, the GMC's specialist register is public. Look the name up yourself rather than taking a title on trust.

Then check where the operation happens. For anything under general anaesthetic, you want a hospital or an accredited surgical centre, with a qualified anaesthetist. Ask who does which part. In a teaching hospital a trainee may close the wound. That is normal and fine, as long as you are told.

How often they do your operation

Ask how many of your exact procedure they did last year. Not "gender surgery" in general, but the operation you want. You want to hear that it is routine, and you want the answer to come easily.

• Vaginoplasty. The top Bangkok surgeons do these every week. Ask how many are penile inversion and how many peritoneal pull-through. Ask how they handle depth loss, fistula and narrowing, and whether they treat their own complications.
• Facial feminization. Bone work on the forehead, jaw and chin is specialist. Ask how many brow reshapings they do, and whether one surgeon does the whole face. See FFS.
• Breast augmentation. Common everywhere. What matters is experience with trans women's chests, which are often wider, with nipples set further apart. See breast augmentation.
• Voice surgery. A narrower specialty, so annual numbers run lower than for breast or genital work. Ask which technique they use, Wendler glottoplasty or cricothyroid approximation, and how they work with voice therapists afterwards.

What to look for in the photos

Ask for results on bodies like yours: your build, skin tone, age and starting point. And ask for healed results. That means a year for vaginoplasty, breasts and bone work on the face. The six-week photos many clinics lead with show swelling, not the result.

What to look at, by procedure:

• Vaginoplasty. The shape of the labia and the clitoral hood, how natural the vulva looks standing, and the scars in the groin creases. Ask what depth they typically reach, and how they measure it.
• Facial feminization. Front-on as well as profile. Look at the brow, the hairline scar and the jaw angles. Ask to see results in people with your bone structure.
• Breasts. Cleavage gap, symmetry and how natural the slope looks from the side.
• Body feminization. The hips and waist from behind, where a curve either worked or did not. See body feminization.

Before and after photos should share the same lighting, angle and distance. A change of pose or a tight crop can hide what you most needed to see.

Complications, revisions and who pays

Every surgeon has complications. The one you want is open about them and fixes their own. A revision rate means little until you know what it counts. Does a small trim under local anaesthetic go in the number, or only a return to theatre? A surgeon who explains that without being asked is telling you something good.

Then ask who pays for a revision. Many surgeons include minor revisions within a set time. Others charge. Get it in writing before you pay a deposit. Read revision and complications first, so you can judge the answer. The full question list for the room is on the consultation page.

Aftercare

Most of your contact with the team happens after the operation. Find out who answers post-op questions, whether there is an out-of-hours number and who picks it up. Ask how often you will be seen before flying home, and how remote follow-ups work afterwards. The best Bangkok clinics have this down to a routine. Nurses check you daily, dilation is taught in person, and there is a named contact for the months after you leave. See surgery abroad and travelling for surgery.

Red flags

None of these on its own proves a surgeon is wrong for you. Each is a reason to pause and ask before you pay.

• No figures, or "very low" in place of a number, for volume, revisions or complications
• Only one technique on offer, with no explanation of why the others do not suit you
• Photos that are all early, all on one body type, or inconsistent in lighting and angle
• Promises of guaranteed depth, invisible scars or a specific voice pitch
• A discount that expires, or a large non-refundable deposit before an itemised quote
• All contact through an agent or social media, with no consultation with the surgeon until the day
• No clear answer on who handles a problem once you have gone home

The last matters most if you are travelling. The patients I have seen struggle were rarely the ones with a complication. They were the ones who flew home with no one to send a photo to. The clinics I rate most highly solve that before you ever arrive.

Making the decision

At some point the comparing has to stop. Choose the surgeon who does your operation often and described your body in terms you recognised. They should be honest about what could go wrong, and you should trust them to answer at week three. If you have all four, you are in good hands. Book it, and start on the pre-op checklist.

This is information from someone who has sat in on a great many consultations, not medical advice. Your surgeon's assessment of your body comes first.