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Chao et al. Plast Aesthet Res. 2025;12:29 https://dx.doi.org/10.20517/2347-9264.2025.18 Page 11 of 13

tissue, in its mid-section from FTSGs, and proximally from peritoneal flaps. FTSGs: Full-thickness skin grafts.

CONCLUSION
The challenges of gender-affirming vaginoplasty have prompted a wave of innovations and outcomes
research aimed at optimizing surgical approach, donor tissue selection, and functional results. Despite
substantial progress over the past few decades, some patients continue to require improved solutions.
Through careful application of technical innovations, adherence to principles of tissue transfer, and targeted
research, we can continue to expand and refine the surgical options available for these patients.

DECLARATIONS
Authors’ contributions
Conception and design: Chao BW, Pariser JJ
Data collection and analysis: Chao BW, Keiner C
Manuscript drafting: Chao BW, Keiner C
Manuscript editing: Chao BW, Pariser JJ
Oversight and supervision: Pariser JJ
Original drawings and artwork: Demzik A

Availability of data and materials
The dataset generated and analyzed during this study is available from the corresponding author upon
reasonable request.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Chart review necessary for this manuscript was deemed exempt from individual informed consent as part of
a retrospective study regarding outcomes after gender-affirming surgery (IRB protocol #000025711).

Consent for publication
All patient images were obtained with written informed consent prior to photography and publication.

Copyright
© The Author(s) 2025.