Welcome!
Gender Affirmation Surgery
Gender affirmation is an evidence-based surgical pathway designed to align physical and anatomical characteristics with your true gender identity.
Grounded in established principles of plastic surgery including craniofacial, aesthetic and reconstructive surgery, procedures are planned in deliberate, structured stages to prioritise safety, balanced, and long-term outcomes that are natural and functional.
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My surgical offerings are organised into three clear, focused categories for both feminisation and masculinsation:
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Facial Surgery
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Top Surgery
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Bottom Surgery (selected procedures only)
​My Approach
Gender affirmation is not about rushing into multiple major operations at once. My surgical philosophy centres on preparation, proportion, and patience, recognising that predictable and stable results are achieved by respecting anatomical planes and allowing adequate tissue recovery between procedures.​​
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A Note on Selective Bottom Surgery in Singapore
Complex genital surgery, such as vaginoplasty or phalloplasty, are extensive undertakings where success depends fundamentally on the post-operative ecosystem: dedicated nursing, specialised wound management, focused pelvic floor rehabilitation, and continuous dilation support for example.
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Unfortunately, in my opinion, this specific post-operative support network is not yet mature in Singapore, so I offer only selected, clearly defined bottom procedures where aftercare demands and surgical predictability are assured:
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Bilateral orchidectomy
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Phalloplasty revisions (including urethral stricture repairs and fistula management)
For patients seeking primary vaginoplasty or primary phalloplasty, I can recommend established, high-volume overseas centres that provide integrated, mature inpatient post-operative pathways.
Planning & Technique
1. Facial Surgery
Facial harmony relies on the balance between the underlying skeletal architecture and the overlying soft-tissues. Procedures are structured sequentially to achieve natural, stable contours.
Facial Feminisation Surgery
FFS is typically approached in planned stages to ensure safe healing and optimal aesthetic harmony:
Stage 1 (Upper & Mid-Face): A high-resolution pre-operative CT scan is mandatory to accurately map frontal sinus anatomy, anterior wall thickness, and sinus volume. This CT mapping determines whether burring alone is feasible or if a formal setback cranioplasty (osteotomy) is required. This is commonly performed in conjunction with a hairline brow lift, orbital rim contouring, and rhinoplasty.
Stage 2 (Lower Face): Once the upper framework and nasal proportions have settled, the second stage addresses the lower third. This includes osseous genioplasty (to narrow or set back the chin), mandibular angle reduction or shaving (to soften a square lower jawline), and a lip lift to shorten the philtrum and enhance upper vermilion show.
Facial Masculinisation Surgery
Aimed at creating broader, stronger, and more defined masculine skeletal architecture:
- Chin Augmentation: Osseous sliding advancement/widening genioplasty or custom implant augmentation to add projection and squareness to the lower face.
- Mandibular Angle Augmentation: Widening and defining the gonial angles for a prominent, structured jawline.
- Masculinising Structural Rhinoplasty: Building or straightening the nasal dorsum and refining the tip to achieve strong, straight nasal balance.
2. Top Surgery
Chest surgery creates upper-body contours that reflect your gender identity, tailored to chest wall dimensions, tissue quality, and muscular definition.
Feminising Top Surgery
Transgender women typically possess a wider rib cage, broader sternal gap, and limited baseline breast glandular tissue.
To ensure adequate soft-tissue coverage, prevent visible implant rippling, and create a natural upper-pole transition, breast implants are typically placed in a subpectoral or dual-plane pocket. Implant dimensions are chosen to balance base diameter with chest width, achieving balanced cleavage and projection.
Masculinising Top Surgery
Techniques: Performed via double incision with free nipple grafting for moderate-to-large breasts or chests with significant skin redundancy, or via a periareolar approach for individuals with minimal breast tissue and high skin elasticity.
Contouring Liposuction: Mastectomy is almost routinely paired with targeted liposuction along the lateral chest wall, anterior axillary fold, and inframammary border to feather the edges, avoid "dog ears," and define the lower border of the pectoralis major muscle.
Hormone Management: Patients are typically advised to stop testosterone therapy 4 weeks prior to surgery. Exogenous testosterone thickens the dermis and increases cutaneous vascularity, which can impede fine surgical dissection and increase intra-operative bleeding and haematoma risks.
3. Bottom Surgery (Selected Procedures)
Read on to learn more about select bottom surgery options.
Feminising Bottom Surgery
Bilateral Orchidectomy:
- Performed via a midline scrotal raphe incision. Utilizing the midline raphe allows direct surgical access while strictly preserving the integrity and surface area of the scrotal skin. The scar falls discreetly into the natural midline crease, preventing contracture or scarring that could compromise tissue quality if the patient elects to pursue full vaginoplasty in the future.
- Eliminates endogenous testosterone production, enabling patients to cease or substantially reduce anti-androgen medications.
Masculinising Bottom Surgery
My focus is on the secondary reconstructive management of complications following primary phalloplasty performed elsewhere.
Special emphasis is placed on urethral stricture repairs (commonly occurring at the junction between native and neourethral tissue), closure of persistent urethrocutaneous fistulae, and local scar contracture releases to restore unobstructed voiding and tissue comfort.
Recovery & Expectations
Facial Surgery: Swelling peaks within the first 72 hours and settles visibly by 2 to 3 weeks. Complete bone remodeling and fine soft-tissue re-adaptation following cranioplasty or genioplasty mature over 6 to 12 months.
Top Surgery: Patients usually return to light daily activities and desk work within 1 to 2 weeks. A supportive chest compression binder is worn continuously for 4 to 6 weeks to minimize seroma formation and assist skin re-draping. Upper-body resistance training and heavy lifting are avoided for 6 to 8 weeks.
Bottom Surgery (Selected Procedures):
- Orchidectomy: Ambulatory day surgery with minimal discomfort; routine sedentary activities can resume within 5 to 7 days.
- Phalloplasty Stricture Repairs: Requires temporary urinary diversion via a catheter or stent (typically 2 to 3 weeks) to allow the reconstructed urethral lumen or mucosal graft to heal securely before trial of voiding.
Post-operative care extends beyond routine reviews - it is an integral part of Dr Ng’s surgical philosophy. Through Doctor Stitch, an aftercare service founded to ensure seamless continuity and comfort, every patient is followed up personally by Dr Ng for attentive, discreet, and consistent care throughout the recovery journey.​
Frequently Asked Questions
1. Why is a CT scan mandatory before FFS forehead surgery?
The anatomy of the frontal bone varies significantly. A 3D CT scan maps the anterior and posterior walls of your frontal sinus, bone thickness, and sinus volume. This confirms whether burring/shaving alone is safe or whether formal osteotomy and setback of the anterior sinus wall (Type 3 cranioplasty) is necessary to achieve a smooth forehead contour without breaching the sinus cavity.
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2. Why do I need to pause testosterone before top surgery?
Testosterone causes dermal thickening and increases peripheral vascular vascularity. Pausing testosterone therapy 4 weeks prior to mastectomy reduces tissue engorgement, minimises intra-operative bleeding, and lowers the risk of post-operative haematomas or seromas, ensuring a smoother recovery.
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3. Will undergoing an orchidectomy impact future vaginoplasty?
Not when performed through a midline scrotal raphe approach. This technique avoids lateral incisions, leaving the scrotal skin envelope completely intact and supple. Should you choose to undergo vaginoplasty overseas later, the full tissue reservoir remains available for neovaginal lining.
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4. Why do you not perform primary vaginoplasty and phalloplasty?
Primary bottom surgery is a complex undertaking that requires an extensive, dedicated multidisciplinary post-operative setup, including specialised nursing care, strict dilation regimens, and continuous wound surveillance. This institutional support is still developing in Singapore, so I selectively focus on procedures where surgical predictability and ambulatory aftercare are completely safe and reproducible.
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5. How are post-phalloplasty urethral strictures repaired?
Strictures cause localised narrowing and flow obstruction, most often at the proximal or distal anastomosis. Revision involves surgical exposure and division of the scar band, followed by direct repair or with substitution urethroplasty using an autologous graft (such as non-hair-bearing buccal mucosa from inside the cheek) to re-establish a wide, durable urinary lumen.
​​​Related Reading​
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Rhinoplasty - for structural nasal reshaping, profile balancing, and functional airway preservation
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Gynaecomastia - anatomical principles in male chest contouring and glandular excision
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Medical 3D Printing - virtual surgical planning and custom guides for craniofacial osteotomies
​​References
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Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022 Sep 6;23(Suppl 1):S1-S259. doi: 10.1080/26895269.2022.2100644. PMID: 36238954; PMCID: PMC9553112.
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Capitán L, Simon D, Kaye K, Tenorio T. Facial feminization surgery: the forehead. Surgical techniques and analysis of results. Plast Reconstr Surg. 2014 Oct;134(4):609-619. doi: 10.1097/PRS.0000000000000545. PMID: 24945951.
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Claes KEY, D'Arpa S, Monstrey SJ. Chest Surgery for Transgender and Gender Nonconforming Individuals. Clin Plast Surg. 2018 Jul;45(3):369-380. doi: 10.1016/j.cps.2018.03.010. PMID: 29908625.
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Dunford C, Bell K, Rashid T. Genital Reconstructive Surgery in Male to Female Transgender Patients: A Systematic Review of Primary Surgical Techniques, Complication Profiles, and Functional Outcomes from 1950 to Present Day. Eur Urol Focus. 2021 Mar;7(2):464-471. doi: 10.1016/j.euf.2020.01.004. Epub 2020 Feb 13. PMID: 32061539.
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Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017 Nov 1;102(11):3869-3903. doi: 10.1210/jc.2017-01658. PMID: 28945902.
