Details and Requirements

Zero-depth Vaginoplasty Gender Affirmation Surgery

The following is a detailed collection of pre-surgery requirements or things Dr. Gallagher may ask of you before we can schedule and complete your surgery. These are done to be sure that you are 100% healthy and ready to undergo surgery when the time comes.

Hair Removal

Hair removal is NOT required for zero-depth, orchiectomy and scrotoplasty. You may choose to do this if you would like, but choosing not to do so, will not be a barrier to surgery.

(Body Mass Index)

As you may know, there are some weight restrictions for some gender affirmation procedures, Zero-depth Vaginoplasty is not an exception to that rule, but it is a little less strict. This is due to the lack of vaginal vault being created, we are not as concerned with medical issues related to weight and BMI.

If you are still deciding between the two procedures, we have included information here so you can make an educated decision.

For safety reasons we require our patients undergoing Penile Inversion Vaginoplasty surgery to have a Body Mass Index of no higher than 30. This is because of the risks of possibly life threatening complications increase when a patient is overweight. These complications include infections, blood clots and injury to the bladder and bowel. We understand that this can be very frustrating as bottom surgery is often the last step in gender confirmation, however your safety is of the utmost concern and this is a strict requirement.

For Zero-Depth Vaginoplasty your BMI should not be higher than 34. While we can allow for a patients weight and BMI to be higher for a Zero-Depth procedure vs. a Penile Inversion, we do still want each person going in to surgery to be healthy and physically well before undergoing a big surgery such as this. Based on medical evidence and safety concerns, operating on someone with an elevated BMI can be considered “risky” to undergo an elective procedure (elective meaning: surgery that is scheduled in advance because it does not involve a medical emergency) and because we want all patients to be safe and have positive results, we do have this limit in place.

The BMI is defined as the body mass divided by the square of the body height by the body weight. To find out your BMI, we recommend you perform an internet search for “BMI calculator”.

The numbers you are given there will be close or the same as what we issue you in the office. You can further help you calculate how much weight you will need to lose to be ready for surgery from there.

The weightloss will need to be maintained at least until the time of surgery.

We may elect not to see you for a consultation until your BMI is closer or in range with you being ready for surgery. The amount of weight you will need to lose will help us determine when best to see you in the office.

Along the same lines, if we have consulted with you and you gain more than 5lbs by the time of surgery, we will need to be aware of that as well.

Please ask us if you have further questions regarding the BMI requirement.

How long do I have to stay in the hospital?

Your inpatient stay is determined primarily by how far away you live from our office. There are also certain health circumstance that would be cause for a longer stay.

  1. I live in the Indianapolis area
    1. If you are having penile inversion vaginoplasty or zero-depth and you live in the Indianapolis area, you will be planned for a 3 day inpatient hospital stay.
  2. I live outside of Indianapolis
    1. If you do not live in the Indianapolis area your surgical stay and arrangements will look different. We will ask that you stay in the area for 7 days, part of that time as inpatient and possibly outpatient for a portion of that time. If you will need to fly out of Indiana we will likely put you on a blood thinner to fly back at 7 days. You will either need to plan to return to us for post-op follow up appointments or make arrangements to follow up with another surgeon close to home, or we can speak with your primary care physician so they will be comfortable examining you.
    2. We will require that you follow up with us in 1 month to ensure proper healing.

General Pre-Operative Information

The following information is meant for your general information at this time. When the time edges closer to your surgery date, we will issue you further detailed instructions. Items may be individualized, as patient needs vary.


You will withhold all hormones, blockers and cross-sex, 2 weeks before your scheduled surgery date. Certain circumstances may require Dr. Gallagher to stop your HRT for a longer period of time.

In most cases, you will be allowed to restart your HRT 1 week post-surgery. You will also need to adjust the amounts of your hormones after surgery as your body will no longer require the same levels. Dr. Gallagher can advise on the adjustment and you should follow up with your HRT provider soon after surgery to be sure the adjustments are at their recommended levels.

We know that pausing your hormones can cause anxiety, so it is important to understand that this is done for your health and safety. Clotting (blood clots) after major surgery is a very serious concern and can be deadly. The risk is heightened when you are having surgery in the pelvic region, for this reason, all hormones must be stopped 2 weeks before your scheduled surgery date. Dr. Gallagher will not take any chances when it comes to your health and safety so following orders with this step is of the utmost importance.

Bowel Prep

Bowel preparations are a common and important part of preparing your body for surgery. While a 24 hour bowel prep is required for penile inversion vaginoplasty, it is NOT required with the zero-depth procedure.

General Information

  • Currently all vaginoplasty and zero-depth procedures are exclusively performed at Eskenazi Health & Hospital located in Downtown Indianapolis. Your surgery and inpatient stay takes place in the Burn Unit portion of the hospital and you will stay in a private suite while you are with us.
  • For vaginoplasty’s you will not be able to drive for several weeks, so you will want to take that into consideration when deciding on a surgery date. You will need help with transportation to and from your follow up appointments and any other life events.

Post-Operative Information

This portion is meant to give you general information about your post-op healing time. Once your surgery has been scheduled, you will be issued greater detail on the items of importance.

Time off work

Dr. Gallagher will ask that with a penile vaginoplasty that you be able to take 6 – 8 weeks off work to allow for adequate healing before you are back to your regular schedule. For the first week after leaving the hospital we will ask that you have someone home with you to help with anything you may need.

  • Things to consider with your time off is having enough savings to be able to take the required time off work and still manage your bills and other financial responsibilities comfortably.
  • If you are able to take FMLA at your job we will fill out all necessary documents for you and file them back to your employer. Please do this well in advance of your surgery date to allow enough time for us to process these for you. We prefer that these be emailed or faxed to us to complete. Waiting until the last minute to file for time off may cause your surgery to be delayed or not being paid while you are off work.

Things to plan for

  • Meal prepping, meal delivery services and friends willing to help you with meals after surgery will make things much smoother. Maintaining a healthy diet after surgery is strongly recommended.
  • You will not be able to lift, push, pull more than 5-10 lbs for about 6 weeks after surgery.
  • Whomever will be staying with you to help during surgery should be someone dependable who will be able to stay with you during the entire time you need help. If you do not have someone that can stay with you please let us know so we can work to get you the appropriate support.


No dilation needed or required for zero-depth vaginoplasty!