The F.A.V.E. Procedure

Freestyle Anatomic Vaginoplasty with Enhancements

Unlike conventional penile inversion techniques, the FAVE procedure allows customized tailoring to create the most feminine and natural appearing genital anatomy for each unique patient.  The FAVE procedure was developed after Dr. Maercks’ disappointment with the open and scarred appearance of conventional vaginoplasty techniques.  After gaining experience with multiple techniques and combining his knowledge and experience with genital reconstruction, he devised the FAVE to give optimal aesthetic and functional results to trans-women.

The ‘E’ in fave stands for important enhancements that are not typically or simply not ever found in conventional techniques.  These enhancements include:

Natural appearing clitoral hood origination.

Instead of a short and flat clitoral hood that originates abruptly from the midline, The FAVE creates a natural appearing hood that is gently caressed by subtle folds on each side and originating by a subtle suprapubic mound just like natural female anatomy.

Full length true labia minora.

The labia minora are a very important part of feminine aesthetics and function.  They are for the most part neglected in conventional techniques, only appearing as a short extension from the clitoral hood.  Because of the unique flap developed to create the FAVE labia minora, they start seamlessly from the clitoral hood and travel with constant dimension all the way to the posterior of the vaginal opening reflecting ideal feminine aesthetics.

Internally oriented labia majora.

In conventional vaginoplasty techniques the tissues are pulled in a down and out vector creating a tendency to flatten and spread apart the anatomy especially the labia majora.  The FAVE procedure manages vectors in a completely different manner allowing a “closed” or “Kissing” appearance of ideal aesthetics that Dr. Maercks originally developed for the MACIE cis-gender labiaplasty.

Scarless appearance. 

Conventional vaginoplasty creates large unsightly scars in the groin crease and tends to create the appearance of redundant skin drawing attention to these scars.  The Freestyle flap design of the FAVE procedure allows accommodation of the variable anatomy of each individual patient to provide either completely hidden “scarless” appearance or greatly minimized visible scarring.

100% flap derived vaginal vault.

It is very common for surgeons to use skin grafts to augment the lining of the neovagina to allow for adequate vaginal depth.  This is especially true when penile length is limited.  Grafts always exhibit extensive retraction making painful dilatation and sometimes revisions necessary.  The FAVE procedure is designed with novel flaps and novel arrangements to provide a redundantly large surface area to line the vaginal vault without using any graft whatsoever.  Comparably minimal postoperative care is required because all of the tissue used to create the vagina is vascularized flap tissue.

Optional urethral flap for enhanced natural vaginal lubrication. 

Based on patient preference the long segment of urethra that is usually discarded can be integrated into the FAVE vagina helping with spontaneous lubrication.



Pre-operative view of patient undergoing MTF transgender F.A.V.E vaginoplasty
Pre-operative view of patient undergoing MTF transgender F.A.V.E vaginoplasty


Immediate on the table result after completion with some obvious swelling showing the labia majora extending to posterior fourchette and showing clitoris covered by hood
Immediate on the table result after completion of F.A.V.E. Vaginoplasty. There is some obvious swelling. The labia majora s demonstrated extending to posterior fourchette and showing clitoris covered by hood and pink urethral tissue and well lined natural appearing entry and vaginal vault.  The vaginal vault is 8.5 inches deep and lined with excess to accept a full sized dilator/dildo.  Instead of dilation the patient does daily depth checks with an 8-9 inch dildo for ten minutes.