The results of bottom surgery vary depending on the specific procedure, but modern techniques produce anatomy that closely resembles cisgender genitalia in both appearance and function. What you see changes dramatically from the first weeks of recovery to the final result at around one year, so understanding the timeline is just as important as understanding the outcome.
Vaginoplasty: The Feminizing Result
Vaginoplasty creates a vulva with labia majora, labia minora, a clitoral hood, a clitoris, a urethral opening, and a vaginal canal. The tissue used to construct these structures comes from existing genital skin, primarily scrotal and penile tissue, which is reshaped and repositioned. The clitoris is constructed from the sensitive tip of the original anatomy, preserving nerve endings for sensation.
The final result, once fully healed, can be visually very similar to a natal vulva. Scarring is one of the main differences, though surgical techniques have improved significantly. Traditional methods leave a visible scar running along the center of the labia majora. Newer approaches reposition that scar into the natural fold between the inner and outer labia (the interlabial sulcus), where it becomes far less noticeable. In one study of 35 patients who underwent this refined technique, 91% achieved completely concealed scars, while all patients who had the traditional method had visible scarring on the labia majora.
Some patients may need revision surgery to fine-tune the results. Common refinements include adjusting the labia majora for better clitoral coverage (which also reduces hypersensitivity), adding definition to the labia minora, or correcting the urinary stream direction. These are relatively minor procedures compared to the initial surgery.
What Vaginoplasty Looks Like While Healing
In the first week or two, the surgical area looks nothing like the final result. Expect significant swelling, bruising, and discoloration. Sutures are visible, and the tissue appears puffy and distorted. This is completely normal.
Labial swelling gradually resolves over six to eight weeks. Sitting or standing for long periods can make swelling temporarily worse during this window. A brownish-yellow vaginal discharge is normal for the first four to six weeks, and light bleeding or spotting can continue for up to eight weeks.
By three months, swelling has largely resolved and the anatomy starts to look closer to its final shape. The tissue continues to soften, scars continue to fade, and subtle changes in appearance carry on through the full first year. Most surgeons consider the one-year mark the point at which you’re seeing the true final result.
Phalloplasty: The Masculinizing Result
Phalloplasty constructs a full-sized penis using tissue transplanted from another part of the body, most commonly the forearm (radial forearm flap, or RFF) or the outer thigh (anterolateral thigh flap, or ALT). The two approaches produce slightly different results.
The forearm flap typically produces a phallus averaging about 13 centimeters in length and 3 centimeters in width. The thigh flap tends to be larger, averaging around 15 centimeters long and 4 centimeters wide. Both approaches create a cylindrical shaft that can be used for standing urination (once urethral lengthening is complete) and, with an implant placed in a later stage, for penetrative sex.
The skin texture and color of the phallus match the donor site rather than the surrounding groin skin. This means a forearm flap may have a noticeable color difference compared to the surrounding tissue, which is one recognized tradeoff of that technique. The thigh flap sometimes blends more naturally with the skin tone of the groin area, though results vary by individual. Satisfaction rates for skin color and texture are similar between the two methods, with roughly 79 to 84% of patients reporting satisfaction in that category.
Glansplasty and Medical Tattooing
The initial phalloplasty creates a shaft, but the tip looks like a simple cylinder rather than a natural glans. A follow-up procedure called glansplasty sculpts the tip to create the bulbous, defined shape of a circumcised penis head, complete with a visible corona (the ridge where the glans meets the shaft).
Medical tattooing adds another layer of realism. A tattoo artist experienced in this work can add pigmentation to the glans so it looks distinct from the shaft, mimicking the natural color difference. Some patients opt for tattooing that creates the visual appearance of an uncircumcised penis with foreskin, using color and shading techniques. These refinements are optional, but they meaningfully change how realistic the final result looks.
The Donor Site Scar
One aspect of phalloplasty that many people don’t initially consider is the scar left where the tissue was taken. For forearm flap procedures, this is a visible rectangular area on the inner forearm covered with a skin graft. It can appear flattened, lighter or darker than surrounding skin, and the texture differs from normal forearm skin. Because it’s in such a visible location, some patients find it stigmatizing.
Cosmetic refinements can improve the donor site significantly. Fat grafting beneath the skin graft restores volume to the depressed area and improves skin elasticity. Fractional laser treatments can help unify the color and improve texture. Patients who undergo these refinements rate their forearm appearance between 2 and 5 on a 10-point scale where 1 is “normal skin” and 10 is “very different from normal skin,” suggesting meaningful improvement though not invisibility.
The thigh donor site also has a depressed scar covered with a skin graft from the opposite thigh, but it’s easier to conceal under clothing.
Metoidioplasty: A Smaller-Scale Option
Metoidioplasty works with existing anatomy rather than transplanting tissue from elsewhere. Testosterone therapy enlarges the clitoris over time, and metoidioplasty releases the ligaments anchoring it to free up additional length, creating a small phallus from this tissue. The result looks like a small penis, typically around 5.5 to 7 centimeters in exposed length, with patients gaining on average an additional 0.6 centimeters beyond their pre-surgical stretched length.
The labia minora are used to construct the underside of the urethra if the patient opts for urethral lengthening. Scrotoplasty (construction of a scrotum using the labia majora, with or without testicular implants) is often performed at the same time. A monsplasty, which removes excess tissue from the mons pubis, is commonly done alongside the procedure to improve the visual proportions and make the phallus more prominent.
Because metoidioplasty uses the patient’s own hormone-responsive tissue, the result has natural erotic sensation and can become erect on its own without an implant. The tradeoff is size: the phallus is significantly smaller than a phalloplasty result and may not be large enough for penetrative sex in most cases.
Signs of Normal vs. Concerning Healing
Across all types of bottom surgery, the early postoperative period involves swelling, bruising, and discoloration that can look alarming if you’re not prepared for it. Knowing what’s normal helps you avoid unnecessary panic while still catching real problems.
Normal healing includes gradual color changes as bruising fades (often progressing from deep purple to yellow-green), moderate swelling that improves week by week, and mild discharge from healing tissue. The area will look significantly different from week to week during the first two months.
Warning signs that something may be wrong include wound edges pulling apart (dehiscence), which shows up as increasing separation at an incision line, sometimes with more drainage or bleeding than before. Tissue that turns dark black or grey rather than the normal pink-to-red of healing skin can indicate poor blood supply. Sudden increases in swelling, especially if accompanied by increasing pain, warmth, or redness spreading outward from the surgical site, can signal infection or a blood collection forming beneath the skin. Any of these warrant prompt contact with your surgical team.