Gender-affirming body contouring · New York and New Jersey
Body Feminization Surgery
Body feminization surgery reshapes the waist, hips, and buttocks, most often with liposuction and fat transfer. Dr. Steven Ovadia is a board certified plastic surgeon with fellowship training in gender-affirming surgery at Johns Hopkins, with offices in New York City and New Jersey.
Overview
What body feminization surgery is
Body feminization surgery is a group of procedures that change the proportions of the body, mainly the relationship between the waist and the hips. It is most often done with liposuction and fat transfer: fat is removed from areas such as the waist, abdomen, and back, and placed in the hips and buttocks.
Much of what makes a body read as feminine or masculine comes from where it carries fat. Fat carried around the waist and abdomen gives a straighter outline. Fat carried at the hips, buttocks, and thighs gives a more curved one.
Surgery changes the fat and the contour. It does not change the bones, so the width of the rib cage, shoulders, and pelvis stays the same. Part of your consultation is going over what change is realistic for your frame.
Goals
The goals of body feminization are different for everyone
There is no single right result. What matters is the result that is right for you. Most patients are looking for some mix of these changes.
A narrower waist
Reducing the fat of the waist, flanks, abdomen, and back brings the waist in. A smaller waist also makes the hips look wider by comparison.
Fuller hips
Adding fat over the hips widens the outline of the lower body and softens the straight line from the ribs down to the thighs.
Rounder buttocks
Adding fat to the buttocks gives more projection and a rounder shape, seen mostly from the side.
Fuller breasts
Breast augmentation balances the upper body with the hips when hormone therapy has not given the size or shape you want.
Some patients want a subtle change, and some want as much change as their body allows. Some want one area treated and not the others. At your consultation, you and Dr. Ovadia go over your goals and your anatomy to determine the optimal surgical plan.
Procedures
Body feminization procedures
The change in shape comes from taking fat away in some places and adding it in others. The diagram shows where, from the front and from the side.
- −Fat removedWaist, flanks, abdomen, and back, with liposuction
- +Fat addedHips and buttocks, with fat transfer
- Dashed lineThe starting shape
- Solid lineThe shape after surgery
Liposuction of the waist, flanks, abdomen, and back
Liposuction removes fat through small incisions using a thin tube called a cannula. In body feminization it is used to bring the waist in and to smooth the abdomen and back. The fat that is removed can be used for fat transfer.
More about liposuctionFat transfer to the hips
Fat is placed along the side of the hip to fill the hollow between the hip and the thigh, often called a hip dip, and to widen the outline of the lower body.
Fat transfer to the buttocks
Fat is placed under the skin of the buttocks to add projection and a rounder shape. This is sometimes called a Brazilian butt lift, or BBL.
Breast augmentation
Breast implants add volume to the chest. Planning takes into account the width of the chest and the position of the nipples, so the result is in proportion with the rest of the body.
More about gender-affirming breast augmentationLiposuction and fat transfer are done in the same operation, because liposuction provides the fat. Breast augmentation may be done at the same time or separately. Loose skin of the abdomen is treated differently, with a tummy tuck, which is on the body contouring page.
Fat transfer
How fat transfer works
Fat transfer, also called fat grafting, moves your own fat from one part of the body to another. Nothing artificial is placed.
Fat is collected
Fat is removed with liposuction from areas where you have more than you want, such as the waist, abdomen, and back.
The fat is prepared
The fat is separated from the fluid that comes out with it, so that what is placed is mostly fat.
The fat is placed
Small amounts are placed in many passes through small incisions. Spreading the fat out in thin layers keeps it close to a blood supply, which it needs to survive.
Part of it stays
Some of the transferred fat is absorbed by the body during the first few months. The fat that remains after that is living fat, and it stays.
In the buttocks, fat is placed only in the layer under the skin, above the muscle. Placing fat into or beneath the buttock muscle has been linked to serious complications, and plastic surgery societies advise against it.
Fat transfer depends on having enough fat to move. Patients who are very lean may not have enough for the change they want. Because some of the fat is absorbed, some patients choose a second fat transfer later to add more.
Every surgery has risks. For liposuction and fat transfer these include bleeding, infection, blood clots, fluid collecting under the skin, uneven contours, differences between the two sides, numbness, firm lumps where fat was placed, and less of the transferred fat staying than hoped. Dr. Ovadia goes over them with you at your consultation.
Hormones
Hormone therapy and surgery
Feminizing hormone therapy changes body shape on its own, slowly. How much it changes varies a great deal from person to person. Surgery can add to those changes in the places where hormones have done less than you hoped.
What hormone therapy changes
- Where the body stores fat. The change usually begins within three to six months and continues for two to three years
- Breast development
- Muscle mass, which decreases
- Not the bones. The rib cage, shoulders, and pelvis stay the same
What surgery adds
- Removes fat from the waist, flanks, abdomen, and back
- Adds volume to the hips and buttocks using your own fat
- Adds breast volume with implants
- Also does not change the bones
If you are taking hormones, it often makes sense to let those changes develop before surgery, so the surgical plan starts from a stable shape. Not every patient takes hormones. Dr. Ovadia goes over timing with you.
Candidates
Who body feminization surgery is for
Body feminization surgery is for transgender women, non-binary patients, and anyone else who wants this change in their shape. It tends to work well when:
- You want a change in the proportions of your waist, hips, or buttocks
- You are at or near a weight you can maintain
- You have enough fat in other areas to use, if fat transfer is part of the plan
- You are in good general health
- You understand what surgery can and cannot change
At your consultation, Dr. Ovadia examines the areas you want changed, including how much fat is available to transfer, and tells you what your body allows.
Recovery
What to expect after surgery
Swelling and bruising are normal and expected
The areas where fat was removed and the areas where it was placed are both swollen and bruised at first. Swelling goes down gradually over the following weeks and months.
Compression garments are important
You wear a compression garment over the areas treated with liposuction. The compression helps prevent and minimize swelling. The garment is chosen so that it does not press hard on the areas where fat was placed.
Keeping pressure off the transferred fat
Newly placed fat needs time to pick up a blood supply. For the first weeks you avoid sitting or lying directly on the areas where fat was placed. Dr. Ovadia shows you how to sit and sleep during this time.
Walking starts early
Short walks begin right after surgery. Walking helps circulation and lowers the risk of blood clots.
Some of the added volume goes down
The hips and buttocks look fullest in the first weeks, from swelling and from fat that is later absorbed. The size settles over the first few months.
Results come gradually
You see a change early, but swelling hides part of it. The final shape takes several months to show.
Call the office right away if one leg becomes much more swollen or painful than the other, or if you notice spreading redness, warmth, or a fever. These are best taken care of early. For chest pain or trouble breathing, call 911.
A general timeline
This is a general guide. Everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Insurance
Cost and insurance
Body feminization surgery is sometimes covered by insurance. Some plans cover it when their criteria are met, and some do not. Coverage depends on your plan and is not guaranteed.
Gender-affirming breast augmentation may also be covered when a plan's criteria are met. More about insurance coverage for breast augmentation.
When surgery is not covered, the cost depends on the areas treated, how long the surgery takes, and whether procedures are combined. We go over it with you once your surgical plan is set.
If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
He performs body feminization surgery along with other gender-affirming procedures. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about body feminization surgery
What is body feminization surgery?
It is a group of procedures that change the proportions of the body, mainly the relationship between the waist and the hips. It is most often done with liposuction of the waist, abdomen, and back, and fat transfer to the hips and buttocks. Breast augmentation can be part of the plan.
Do I need to be on hormones first?
Hormone therapy is not required for liposuction or fat transfer. If you are taking hormones, they change where your body stores fat over the first two to three years, so it often makes sense to let those changes develop before surgery. Dr. Ovadia goes over timing with you.
Can surgery make my hips wider?
Fat transfer adds volume over the hips, which widens the outline of the lower body. It does not change the width of the pelvis. How much can be added depends on how much fat you have to transfer and how much of it stays.
How much of the transferred fat stays?
Some of the fat is absorbed during the first few months, and the amount varies from person to person. The fat that remains after that stays. It gets larger and smaller with your weight, like fat anywhere else.
What if I do not have much fat to transfer?
Fat transfer depends on having fat to move. If you are very lean, the change from fat transfer may be small. Dr. Ovadia tells you at your consultation what is realistic for your body.
Is fat transfer to the buttocks safe?
Every surgery has risks. For fat transfer to the buttocks, the most serious risk comes from fat getting into the large veins beneath the buttock muscle. Plastic surgery societies advise placing fat only in the layer under the skin, above the muscle, and that is where Dr. Ovadia places it.
Will the result last?
The fat cells removed with liposuction do not grow back, and the transferred fat that survives the first few months stays. Both change with your weight, so staying at a stable weight keeps the result.
When can I sit normally after fat transfer to the buttocks?
For the first weeks you avoid sitting directly on the areas where fat was placed. Dr. Ovadia tells you how long based on your surgery, and shows you how to sit in the meantime.
Where are the scars?
The incisions for liposuction and fat transfer are small. Where possible they are placed in creases and other places where they are hard to see. They fade over time.
Can it be done together with breast augmentation or other surgery?
Often, yes. Whether it is safe to combine procedures depends on your health and how long the operation would be. Dr. Ovadia goes over this when planning your surgery.
Is body feminization surgery covered by insurance?
Sometimes. Some plans cover body feminization surgery when their criteria are met, and some do not. Gender-affirming breast augmentation may also be covered. Coverage depends on your plan and is not guaranteed. Call or email us and we will go over it with you.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will go over what you are hoping to change, examine the areas involved, and explain which procedures fit your body and your goals.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com