More about advantages of treatments with Fat Derived Adult Stem Cells (ADSC); I recently treated a woman whom I discover a small skin cancer on her upper cheek near her eye. After surgical removal, since it was growing beneath the surface, a deep defect to the muscle about the size of the quarter resulted. The usual surgery with the skin graft or rotating with a skin graft or rotating adjacent skin and muscle to close the defect would leave visible scars. I chose to fill the defect with her own fat, augmented with her own ADSC and let mature heal it. This called healing by Secondary intent and I am a big proponent of it (there is no better surgery than Mother Nature!). The result was spectacular- complete healing in less than a month with no visible defects. Of course, she will be monitored for any future problems. This is great stuff! More later--- Stephen X. Giunta, M.D., F.I.C.S.

Hey! Watch your Ash! – And other words of Holiday advice. For many of us, the Holiday season brings much over- Indulgence in the food, drink, partying, smoking and general relaxation of healthy habits. For others not being able to do or provide the things we would like to – for our loved one’s leads to a different but likely a worse kind of stress. (More about that later). Let’s talk about a few things we can do to make the season ultimately less harmful to our general health and psyche. First we shouldn't beat ourselves up by putting unreal- istic expectations on ourselves. By this I mean you must not put restrictions on yourself about eating, drinking and merry- making that don’t allow you to enjoy yourself, “Christmas comes but once a year”. Over indulgence goes hand in hand with Over Abundance. There are, first, too many good things, celebrations and gifts to tempt us. Trying to avoid these is unrealistic! The old saying “All things in moderation” is still great advice. Set yourself reasonable limits. You don’t have to be a martyr or miss out on the joy of family, friends and all the good things. Remember nothing tastes as good as looking good feels! Second – Know your limitations and weaknesses. We have all fallen victim to our own “mistakes” in the past. We know what to avoid – that attitude of “just one more drink” or another helping of dessert get’s us every time. Pace yourself at parties. Third – for those who’s weight gain is easy and weight loss is difficult. Weigh yourself every two to three days – when you see the scale start to go up you can cut back. This prevents that horrible feeling when you first step on the scale after the holidays and found you've gained ten to fifteen pounds! Fourth, calories still count so count calories. Don’t fall into the trap of saying to yourself “if I just eat all the treats and not my regular meals I’ll be ok?” A balanced diet still works best. Fifth – remember diets don’t work without exercise. Make sure you have a reasonable program that you enjoy and is easy and convenient. Check with your doctor if you don’t already have a program. Happy New Year!! That’s all for now “Without wax” SXG, M.D.

What do the following term mean and how they related to Sex Change Surgery(SCS) and to each other.  Sex Change, Phalloplasty, Gender Reassignment Surgery (GRS)  Transgender/Transexual  Heterosexual/Homosexual  Gay, Lesbian, Bisexual  Transvestite  Pedophilia A brief history will help explain the origin and evolution of these terms. Thru-out history sexual attraction and activity between opposite sexes has been the norm in all major cultures. Anything different has been treated in often diverse ways by different people and in different times. It is sometimes accepted as a normal activity without stigma, sometimes as being revered and elevated in status and sometimes as deviant, even criminal behavior subject to severe punishment, being social outcasts, even death. 21st Century Western Society is becoming more tolerant even accepting of different sexual “lifestyles” but certain cultures and even some so called educated westerners remain prejudiced and refuse to try to understand. Sex Change Surgery (SCS) now known as Sexual Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS) applies to surgical procedures for those who long suffering men or women who feel their real gender is opposite to the body they are living in and wish to live as the opposite sex. SRS/GRS burst upon the U.S.A. In the mid-20th Century with the famous case Christine Jorgensen a man who underwent GRS in Denmark. This became the media frenzy and was treated as a comic fodder. Little by little as more brave individuals sought relief from their suffering surgical procedures to change not only the genital organs but also masculinize or feminize the facial and even body habitus features have been developed. These are now part programs set up with strict physical and extensive psychological criteria for acceptance. Needless to say the whole subject of GRS remains somewhat controversial. PHALLOPLATY the term derives from the Greek “Phallus” meaning an erected penis and the PLASTICOS meaning “to change form”. There are two types; Cosmetic Phalloplasty (CP) which enlarges a normal penis and Reconstructive Phalloplasty (RP) which builds a new penis where there wasn’t one (female to male GRS) or repairs an injured or damaged penis – (war wounds, fire, cancer, etc.) I have specialized only in Cosmetic Phalloplasty and Ancillary masculinization/feminization procedures for more than 20 years (more about those later) Who are these people seeking GRS? The correct term is TRANSEXUALS. Better to answer who or what they are not! They are not homosexual, gay or lesbian or bisexual. I remember then “gay” meant happy, carefree enjoying life. A “gay blade” was a BON-VIVANT a “man about town”. How it transformed to meaning homosexual probably stems from the term “gay Blade” being associated with a “dandy” a rather foppish male thought to have feminine characteristics, not a “real” man. The term ”lesbian” comes from the association with the Greek Island “Lesbos” (now Lesvos) the home of the Sappho the ancient poet and her followers to whom homosexuality was attributed. They are not transvestite who have normal sexual orientation but like to dress as the opposite sex. They are not Pedophiles – attracted sexually to children- acting on this perversion is a criminal offense. However combinations of the about can exist. How are these surgeries performed? Firstly,, male to female GRS is by far more common. The goal is to end up with a normal functioning female body and facials features. This often requires more than one procedure at a time called “stages”. To summarize, the penile body is removed sparing the head to convert to a clitoris for normal sensation. The urine carrying channel is also spared for normal urinary function. The testicles are removed leaving the sac (scrotum) to convert to a vagina and normal labia or external genitalia. Ancillary procedures include;  Female Hormone Therapy  Breast Implants  Body Contouring- for example liposuction or fat transfer to produce more female like shape  Laser Hair Removal ?Hair & Makeup  Changing facial features – smaller nose and chin, building up higher cheek bones, smaller jaw. Reduce the size of the “Adam’s Apple” and sometimes the forehead.*  Voice lessons *these are my specialty Female to Male conversion – A more complicated surgery RECONSTRUCTIVE PHALLOPLASTY involves fashioning a new penis from either transfer of nearby (local) flaps of skin such as the inner thighs or groin area. Preserving the clitoris and the urinary channel to act as the head of the penis called METOIDIOPLASTY is done. A penis prosthesis which provides rigidity for erection is also done. Ancillary Procedures include;  Male Hormone Treatment  Breast Reduction  Body Implant - including; Pectoral Implant to increase muscular appearance of chest, arms and leg implant  Lipo transfer to masculinize the body shape  Voice lessons  Masculinize facial features ( my specialty – I have patented chin and nasal implants and surgeries to improve neck contour – my Hyoid Release Cervicoplasty and mentopexy open and close neck contouring  Hair transplants/Male grooming In summary – I cannot stress enough that the GRS is very serious surgery with the long term commitment and many potentially serious complications both physical and psychological. I hope that someday all people will join in recognizing all members of our sexually normal family. We are all God’s children – brothers and sisters I believe that someday GRS will not be necessary and Genetic Engineering will be the answer. My specialty is Cosmetic Phalloplasty, Facial Plastic Surgery and Body Contouring. Cosmetic Phalloplasty – involves advancing the normal inner penis – gaining length and adding your own concentrated fat to increase the thickness of the shaft. I do not do GRS/SRS or Reconstructive Phalloplasty but I can advise a person seeking these changes have to proceed.