Thailand Tourist Attraction: Thailand Tourist Attraction: Bangkok, Thailand

Thailand Tourist Attraction: Thailand Tourist Attraction: Bangkok, Thailand: "Thailand Tourist Attraction: Bangkok, Thailand : 'Bangkok is the capital City of Thailand. It is also known as 'Krungthep' [ กรุงเทพ ] mean..."

Thailand Tourist Attraction: Thailand Tourist Attraction: Dusit Zoo, Bangkok, T...

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Thailand Tourist Attraction: Thailand Tourist Attraction: SAFARI WORLD - BANGKO...

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Thailand Tourist Attraction: Nong Nooch Tropical Garden, Pattaya, Thailand

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Thailand Tourist Attraction: Thailand Tourist Attraction: Siam Ocean World, Ban...

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Thailand Tourist Attraction: Thailand Tourist Attraction: Koh Kood Island, Trat...

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Thailand Tourist Attraction: Thailand Tourist Attraction: Kanchaburi Province, ...

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Thailand Tourist Attraction: Thailand Tourist Attraction: Koh Samui, Surat Than...

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Thailand Tourist Attraction: Thailand Tourist Attraction: The Million -Years St...

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Thailand Tourist Attraction: Thailand Tourist Attraction: Grand Palace

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Thailand Tourist Attraction: Thailand Tourist Attraction: Dream World: Bangkok,...

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World Class Exclusive Procedures: World Class Exclusive Procedures: Why in Thailand?...

World Class Exclusive Procedures: World Class Exclusive Procedures: Why in Thailand?...: "World Class Exclusive Procedures: Why in Thailand? : 'Thailand is one of the most popular holiday destinations in the world today and for..."

World Class Exclusive Procedures: How to Choose A Certified Plastic/Cosmetic Surgeon...

World Class Exclusive Procedures: How to Choose A Certified Plastic/Cosmetic Surgeon...: "When choosing a plastic surgeon, it is important to consider a number of factors. Medical training and surgical experience are primary indic..."

World Class Exclusive Procedures: World Class Exclusive Procedures: VASER Liposuctio...

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World Class Exclusive Procedures: World Class Exclusive Procedures: Durability Facel...

World Class Exclusive Procedures: World Class Exclusive Procedures: Durability Facel...: "World Class Exclusive Procedures: Durability Facelift : 'A facelift is a popular surgical technique where the skin is tightened and reduces ..."

Facial Feminization Surgery In Thailand: How to Choose A Certified Plastic/Cosmetic Surgeon...

Facial Feminization Surgery In Thailand: How to Choose A Certified Plastic/Cosmetic Surgeon...: "When choosing a plastic surgeon, it is important to consider a number of factors. Medical training and surgical experience are primary indic..."

How to Choose A Certified Plastic/Cosmetic Surgeon?

When choosing a plastic surgeon, it is important to consider a number of factors. Medical training and surgical experience are primary indicators of the surgeon’s qualifications.  Board certification is another important criterion. No single factor can guarantee you the best doctor for a specific procedure. Ultimately, it is up to you to decide which surgeon is best for your specific goals and expectations.

To become a plastic surgeon, a doctor must obtain an M.D. (Doctor of Medicine) or a DO (Doctor of Osteopathy) degree. Following this, there are several paths the doctor may follow. Many doctors now spend five to six years in an integrated plastic surgery residency, although some complete three years of general surgery and two years in plastic surgery. 

What does it mean to be a Board Certified Plastic Surgeon?

Choosing a Board certified surgeon can be a very tough job because of the personal information being shared. Just open the yellow pages, magazines, brochures or view news paper advertisements and you’ll find plastic surgeons promoting all kinds of society memberships and board certifications but don’t be confused between boards and societies. Societies are merely professional associations. Board certification is the minimum criterion you should use in selecting a plastic surgeon. So, it is very important that you learn about the doctor’s education, training, certification, and experience in order to guarantee a successful outcome and to make the best choice.

Beware of lots of Letters after the Doctor’s Name:
Many fraudulent doctors’ have quite a few letters after their names. In fact, multiple letters may be the telltale sign of an inadequately trained doctor trying to impress the public. Definitely, your doctor should have the letters M.D (Medical Doctor) or D.O (Doctor of Osteopathy) after his name. He might even have one or more master’s degrees or might also have PhD but these degrees are irrelevant to plastic surgery. Patients are advised to select a board certified plastic surgeon.

Guide to choose a Plastic Surgeon:

• Get Referrals: Begin your search for a plastic surgeon by asking friends, relatives, family doctor, colleagues that are willing to meet with you and share their results of the surgery. Hospital staff such as nurses, surgeons and anesthesiologist is also excellent sources of referrals. You may also do research on the internet, magazines, or in the yellow pages. Chances are a few names will stand out from the others. It will help give you the best possible recommendations.

• Check the qualifications of the surgeon: One of the most important qualifications you should look for in a plastic surgeon is that they are board certified but you must need to know what board has certified your plastic surgeon and be sure that the surgeon has graduated from an accredited medical school.

• Meet the surgeon: Look at pictures of past procedures done by the surgeon. Choose an ethical and confident surgeon and friendly staff members for a long lasting relationship and you should expect good communication, understanding and comfort from the surgeon.

Facial Feminization Surgery In Thailand: Why in Thailand?

Facial Feminization Surgery In Thailand: Why in Thailand?: "Thailand is one of the most popular holiday destinations in the world today and foreigners seek cosmetic treatments for the following reaso..."

Why in Thailand?

Thailand is one of the most popular holiday destinations in the world today and foreigners seek cosmetic treatments for the following reasons:

·                   Low cost surgical treatments

The treatment fees in Thailand are generally between 50-70% less than they used to be in the western countries. This low cost treatment allows tourist to shop for an affordable price and can find a qualified plastic surgeon of choice. Foreigners can leave for an exciting vacation, have the surgery, relax, recover and return home a completely renewed individual.

·                   Quality healthcare services

Thailand has developed a world class series of hospitals and clinics that offers modern medical facilities with access to the latest technology and treatments as well as highly educated and world class trained surgeons. Many foreigners had cosmetic surgery in Thailand and experienced plastic surgeons that treated them with outstanding skills and innovative techniques.

·                   Highly developed infrastructure

Thailand is famous of its magnificent beaches and nature's best scenes. The country has a rich culture with a superb cuisine. Tourist will enjoy many different attractions and a wide choice of accommodation from first class hotels to guest houses and also a safe and friendly place suitable for treatment and recovery.

Facial Feminization Surgery In Thailand: Biography Of Dr. Juta Jansi

Facial Feminization Surgery In Thailand: Biography Of Dr. Juta Jansi: "DR. JUTA JANSI M.D., F.R.C.S.T. PLASTIC AND RECONSTRUCTIVE SURGEON doctorjuta@gmail.com Dr.Juta Jansi is recognized as one of the most exper..."

Biography Of Dr. Juta Jansi

DR. JUTA JANSI M.D., F.R.C.S.T. PLASTIC AND RECONSTRUCTIVE SURGEON

doctorjuta@gmail.com

Dr.Juta Jansi is recognized as one of the most experienced cosmetic surgeons inThailand, for his excellent surgical results and low rate of complications. His cosmetic surgical experiences cover minor and major operations including face, breast, body contouring, and sexchange, especially special exclusive techniques for better results in durability face lift, intraoral facial bone surgery, scarless sexchange surgery(male to female).

EDUCATIONAL BACKGROUND

· Doctor of Medicine, Chulalongkorn University, Thailand, 1984

SPECIALTY TRAINING

· General Surgery, Chiangmai University, Thailand, 1990

· Plastic and Reconstructive Surgery, Chulalongkorn University, 1996

DIPLOMA

· B.Sc.MD.

· Diplomate Board of General surgery, F.R.C.S.T.

· Diplomate Board of Plastic & Reconstructive Surgery, F.R.C.S.T.

MEMBERSHIPS

· Society of Plastic and Reconstructive Surgeons of Thailand

· Society of Aesthetic Plastic Surgeons of Thailand

· Royal College of Surgeons of Thailand

INTERNATIONAL TRAINING/SEMINARS ATTENDED

· American Society of Plastic & Reconstructive Surgeons, Dallas, Texas, USA

· Fellowships in Cranio-Maxillo-Facial Surgery, Changkang General Hospital,Taipei, Taiwan, 1997

· Fellowships in Microsurgery, Changkang General Hospital, Taipei, Taiwan, 1997

WORK EXPERIENCE – 24 YEARS

· General Practitioner, Chiangrai General Hospital, Thailand

·  Surgical Consultant, Surgical Department, Chiangkam General Hospital,Thailand

· Teaching Staff, Surgical department, Srinakarinwirot University Hospital,Thailand

· Plastic and Reconstructive Surgery, Chulalongkorn General Hospital, Thailand(including sexchange surgical training with Dr.Preecha Tiewtranon

· Surgical Staff, Cosmetic Surgery Unit, Yanhee International Hospital, Thailand1998-2008

· Cumulative cosmetic surgery cases over 10,000 cases

PRESENT

· Plastic Surgery Unit, Bumrungrad International Hospital, Thailand

· Cosmetic Surgery Unit, Samitivej Srinakarin Hospital, Thailand

·  Parkman Cosmetic Surgery Clinic, Bangkok, Thailand 

Facial Feminization Surgery In Thailand: Forehead Contouring

Facial Feminization Surgery In Thailand: Forehead Contouring: "Forehead contouring surgery or hairline lowering surgery can be used to reduce an excessively high hairline or large forehead in both men a..."

Facial Feminization Surgery In Thailand: Forehead Contouring

Facial Feminization Surgery In Thailand: Forehead Contouring: "Forehead contouring surgery or hairline lowering surgery can be used to reduce an excessively high hairline or large forehead in both men a..."

Forehead Contouring

Forehead contouring surgery or hairline lowering surgery can be used to reduce an excessively high hairline or large forehead in both men and women. The forehead reduction procedure can be performed at the same time as a Forehead Lift (Browplasty), or alone.
In this procedure, an incision is made at the hairline. A portion of the scalp that does not contain hair can then be removed which results in making the hairline appear lower. The hair follicles near the incision will eventually grow through it and hide the scar.

Duration of the operation:

The procedure usually takes about 2 hours to perform.

Post operative care:
After the forehead reduction procedure, there will be some bruising and swelling. Ice compresses can be used to control the swelling. Your forehead will be loosely wrapped overnight, which further helps to minimize swelling. A drain might be used to help get rid of the fluids and that can collect in the tissues. The individual might also experience numbness and slight pain, both of which will eventually subside and can be controlled with medications. You will be able to shower and shampoo your hair within two days, or as soon as the bandage is removed

Recovery period:
Individuals vary on their recovery time. Many patients are healed enough to go back to work after a week. After one week, your sutures will be removed. Most patients return to work in 7-10 days after their hairline lowering surgery, but some patients return to work even sooner. Most of the visible signs of surgery should fade completely within about three weeks. There may be some shedding of the hair in the front of the scalp within 2-4 weeks after surgery. The hair will come back after several months. Dr. Juta suggests that patients apply 5% Minoxidil to the front of the scalp starting 2-6 weeks before surgery and resuming it for 3 months after surgery.

Possible risk and complications:

Some risks associated with forehead reduction are fluid accumulation, scarring, hair loss at the incision site, and infection. Any hair loss should grow back within a couple of months, however, and antibiotics are generally prescribed to help thwart infections. Unsightly scarring is usually covered by the new hair growth. However, in some cases the individual can opt to have an additional hair graft done in order to cover up the scars.

Anesthesia use:
The procedure usually uses General anesthesia

Hospital admission:
The forehead reduction surgery procedure may be performed in the cosmetic surgeon’s office-based facility, an outpatient surgery center, or at a hospital. This procedure is usually done on an outpatient basis.

Preparation before Surgery

• Assessment of the medical history (any allergies, serious medical condition and all medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation.
• Blood and urine samples will be collected for routine preoperative laboratory tests.
• Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process.
• You will likely to be asked to stop drinking alcohol, a week before the surgery and throughout your recovery period.
• Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.

Facial Feminization Surgery In Thailand: Malar Bone Reduction

Facial Feminization Surgery In Thailand: Malar Bone Reduction: "Malar bone Reduction is the key procedure for those who desire feminization to make face smaller. This is performed on patients with large ..."

Facial Feminization Surgery In Thailand: Mandibular Angle Reduction (Reduction Angleplasty)...

Facial Feminization Surgery In Thailand: Mandibular Angle Reduction (Reduction Angleplasty)...: "Mandibular Angle Reduction (Reduction Angleplasty) reduces the width of the lower face and change a square face to an oval one. The incisio..."

Facial Feminization Surgery In Thailand: V-Line Mandibular Contouring

Facial Feminization Surgery In Thailand: V-Line Mandibular Contouring: "V-line mandibular contouring surgery allows for reduction of the chin to a more slender and oval shape without increasing its length. The ..."

Facial Feminization Surgery In Thailand: Adam's Apple Shaving (Thyroid Cartilage Shaving)

Facial Feminization Surgery In Thailand: Adam's Apple Shaving (Thyroid Cartilage Shaving): "Adam's Apple Shaving (Thyroid Cartilage Shaving) is a surgical procedure in which the thyroid cartilage is reduced in size by shaving down ..."

Facial Feminization Surgery In Thailand: Chin Reduction

Facial Feminization Surgery In Thailand: Chin Reduction: "Chin reduction is a cosmetic surgical procedure that reduces the size of the chin by shaving down the bone through an incision made in the ..."

Facial Feminization Surgery In Thailand: Scalp Reduction

Facial Feminization Surgery In Thailand: Scalp Reduction: "Scalp reduction surgery involves removal of bald scalp and bringing the hair-bearing scalp closer to it to fill in the bald area on the scal..."

Malar Bone Reduction

Malar bone Reduction is the key procedure for those who desire feminization to make face smaller. This is performed on patients with large cheek bones. This is a popular procedure among Asian women since an oval or heart shaped faced is considered to be more pleasing and desirable.
In zygomatic (cheek bone) reduction, both ends are cut and the intervening bone segment (zygomatic bone) is moved inward, backward and downward. So, cheek prominence is depressed and the patient can get small, shallow face and smoother, smarter impression.
The procedure is performed through an incision inside the ear in front of the ear canal, and from inside of the mouth, thus leaving no visible scars. This is then secured by stainless steel wires. The cheekbone heals very rapidly. In a week's time, it will be firm and stable.

Duration of the surgery:

This entire process approximately takes 4~5 hours.

Post operative care:
You will have to take it easy and keep your head elevated while resting and sleeping for 7-14 days after the procedure. Your face will look very swollen in the first 3 days. But, as the days go on the swelling and bruising will dissipate. Any sutures you may have will be removed 7-10 days after surgery.

Recovery period:
You may go back to work 1-2 weeks after surgery.

Possible risk and complications:

The possible risks include: bleeding and prolonged swelling, infection, asymmetry or over resection, injury to facial nerves
the facial nerve to forehead can be injured.

Anesthesia use:
The procedure usually uses General anesthesia.

Hospital admission:
This procedure may be performed in the cosmetic surgeon’s office-based facility, an outpatient surgery center, or at a hospital. This procedure is usually done on an outpatient basis.

Preparation before Surgery
Get lab testing or a medical evaluation. Take certain medications or adjust your current medications. Stop smoking well in advance of surgery and avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

• Assessment of the medical history (any allergies, serious medical condition and all medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation.
• Blood and urine samples will be collected for routine preoperative laboratory tests. X-rays may be taken to evaluate the individual's bone structure.
• Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process.
• You will likely to be asked to stop drinking alcohol, a week before the surgery and throughout your recovery period.
• Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.

Mandibular Angle Reduction (Reduction Angleplasty)

Mandibular Angle Reduction (Reduction Angleplasty) reduces the width of the lower face and change a square face to an oval one. The incision of mandible angle reduction is inside the mouth.

Duration of the operation:

The procedure is performed about 2-3 hours.

Post operative care:
Swelling and skin discoloration are common and usually will subside within a week or two. Stitches will be removed after about seven days. When the operation is carried out from the inside of mouth, gargle your mouth with mouthwash for at least 10 days. Keep incision region clean and dry. Apply prescribed antibiotic ointment to staples and stitches. Dry thoroughly with gauze. Keep ice compresses on the surgical region continuously for the first 48 hours. Do not use hot dryer, when dry up your hair. Avoid steam baths and saunas for several months. Start with clear fluids and increase as tolerated. Avoid foods that are chewy for the first 2 weeks. No chewing of hard foods or tough foods for 2-4 weeks after surgery. You are to stay on a light diet. No alcohol and no smoking for 2 weeks if possible as they increase swelling; or have only in moderation. You will be asked to keep your head slightly elevated for a few days. Rest quietly in bed with head raised on 2 - 3 pillows. During the first 48 hours bed rest is recommended. During the next 3 to 5 days, you should restrict your normal activities, no housework and no physical labor. During the first 5 days after surgery, it is most important not to engage in any activity which will elevate the blood pressure and possibly increase bruising, swelling and bleeding. Walking is permitted as tolerable. Do not lie face down for one month. When bending down, bend at knees, not with head down. 

Recovery period:
Expect to feel tired for 7 - 10 days after surgery, especially after anesthetics. Don't rub or scratch surgical region for at least 2 weeks. Wound dressing should be done twice a day for 7 days, after tape is removed. Take antibiotic for 14 days after surgery. Do not take any vitamin E and aspirin (or acetyl salicylic acid) for 14 days after surgery, because they can increase your tendency to bleed and prescription pain medications will be given for pain relief.

Possible risk and complications:

Get lab testing or a medical evaluation Take certain medications or adjust your current medications. Stop smoking well in advance of surgery and avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.

Anesthesia use:
Mandible angle reduction surgery is performed under General Anesthesia.

Hospital admission:
This procedure may be performed in the cosmetic surgeon’s office-based facility, an outpatient surgery center, or at a hospital. This procedure is usually done on an outpatient basis.

Preparation before Surgery

• Assessment of the medical history (any allergies, serious medical condition and all medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation.
• Blood and urine samples will be collected for routine preoperative laboratory tests. X-rays may be taken to evaluate the individual's bone structure.
• Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process.
• You will likely to be asked to stop drinking alcohol, a week before the surgery and throughout your recovery period.
• Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.

V-Line Mandibular Contouring

V-line mandibular contouring surgery allows for reduction of the chin to a more slender and oval shape without increasing its length. The surgery also reduces the overly strong bone flanking each side of the chin, thus transforming the more masculine U shape to a sharper and more feminine V shape. The chin line is excised into a smooth line. The chin end can be brought together without touch of the nerve. The protruding parts in both sides of the mandible are excised. The narrowed chin end produces the wholly oval V-line face type. Duration of the operation: The surgery may be performed 3-4 hours depending on the extent of the operation. Post operative care: You will be told to keep your head elevated and as still as possible for a couple of days after surgery to help minimize swelling. Avoid alcohol, steam baths, and saunas for several months. Above all, get plenty of rest and allow your body to spend its energy on healing. Recovery period: You may be able to go back to work at least 1-2 weeks after the surgery. Strenuous activities should be avoided, including heavy housework for at least 2 weeks but walking and mild stretching is fine. Possible risk and complications: Complications may include hematoma (a collection of blood under the skin that must be removed by the surgeon), infection, asymmetry and reactions to the anesthesia. You can reduce your risks by closely following your surgeon's instructions before and after surgery.  Anesthesia use: The procedure uses General Anesthesia Hospital admission: This procedure may be performed in the cosmetic surgeon’s office-based facility, an outpatient surgery center, or at a hospital. This procedure is usually done on an outpatient basis  Preparation before Surgery Assessment of the medical history (any allergies, serious medical condition and all medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation. Blood and urine samples will be collected for routine preoperative laboratory tests. X-rays may be taken to evaluate the individual's bone structure. Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process. You will likely to be asked to stop drinking alcohol, a week before the surgery and throughout your recovery period. Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.

Adam's Apple Shaving (Thyroid Cartilage Shaving)

Adam's Apple Shaving (Thyroid Cartilage Shaving) is a surgical procedure in which the thyroid cartilage is reduced in size by shaving down the cartilage to achieve a more feminine appearance. The procedure can be done as an out patient surgery under local anesthesia or under a general anesthesia. The incision is usually 2-3 cm in length. The surgeon makes a horizontal incision at the highest crease of the skin on the throat below submental (chin) area then the vertical muscles in the throat are separated to expose the cartilage.  The thyroid cartilage is reduced, usually by shaving in the most prominent area and the rim of its upper border. The thyroid cartilage contouring is a delicate process and need to be done meticulously especially for those who have calcified (hard) cartilage due to aging process.

Duration of the operation:

The feminization of the Adam’s apple (trachea shave) takes about 1 hour

Post operative care:

• During the first 24- 48 hours, patient may experience some varying degrees of swelling and temporary mild voice weakness that includes lowering of pitch and hoarseness following surgery.
• Apply ice pack to the surgical site for a couple of days to gradually decrease swelling. Swelling will subside over 1-2 weeks and bruising resolves in 1-3 weeks.
• Patient must rest voice following surgery. Avoid shouting or singing for 2 weeks after surgery.
• The procedure leaves a prominent red scar that lightens over 1-3 months.
• Patient will have stitches often supplemented by surgical tape or butterfly bandages for a few days.
• Wound dressing is performed daily. Stitches and tape must be kept dry at all times.
• Patient must avoid electrolysis immediately around the incision until surgeon recommends it to continue.
• Application of antibiotic ointments, vitamin E oil, or other topical preparations is prescribed by some surgeons to aid healing process.

Recovery period:
A piece of gauze will cover the incision for the first 2 or 3 days after Adam’s apple reduction. For about 7 to 10 days you will probably have a burning sensation and some difficulties when swallowing or talking. Patients who underwent Adam's apple removal report that the post op sensation is very similar to a simple sore throat, including a reduction in the ability to speak loudly.

Possible risk and complications:
Complications include permanent change in vocal quality which is the result of too much revision or over dissection of the cartilage that may injure the vocal cords, infection may also occur and hematoma.

Anesthesia use:

Adam's apple removal is done under general anesthesia, with other procedures of facial feminization surgery, or alone.

Hospital admission:
This procedure may be performed in the cosmetic surgeon’s office-based facility, an outpatient surgery center, or at a hospital. This procedure is usually done on an outpatient basis

Preparation before the surgery:

• Assessment of the medical history (any allergies, serious medical condition and all medications taken both prescribed and non-prescribed), physical examination, and laboratory tests will be performed during consultation.
• Blood and urine samples will be collected for routine preoperative laboratory tests. X-rays may be taken to evaluate the individual's bone structure.
• Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process.
• You will likely to be asked to stop drinking alcohol, a week before the surgery and throughout your recovery period.
• Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.