me to TSSurgeryGuide.com
Your Guide to Transgender Surgeries

Dr. Mayer Review and Cost:


Dr. Toby G. Mayer, M.D.
Beverly Hills Institute of Aesthetic & Reconstructive Surgery
416 N. Bedford Dr. Suite 200
Beverly Hills, CA 90210
Phone: (1) 800-854-8823
Email: info@bevhills.com
Website: www.bevhillstg.com

(Please Review Below) 

 Male to Female (MtF) Cost 
 Eyebrow/Forehead Lift and Orbital Bony Contouring: 
 Cheek Implants: 
 $4,175 - $5,175
 Chin Implant: 
 $2,675 - $3,675  
 Partial Facelift: 
 $14,350 - $15,350  
 $9,000 - $10,000  
 Touch-up Micrografts: 
 Second Flap Procedure: 
 Scalp Reduction: 
 Vocal Feminization Surgery: 

Review of Dr. Toby Mayer Submitted by Gwenyth


 Dr. Toby Mayer specializes in facial feminization and hairline reconstruction services. His office staff is very friendly, and the nurses are extremely competent and do their best to help you relax. Check out Dr. Mayer’s transgender webpage here: http://bevhillstg.com The pre- and post- photos and videos are incredible. Photos of my experience follow at the end of this review.

Hair Transplant Options:

 There are two types of hair transplant options: micrograft transplants and a “flap” transplant procedure, in this case the “Fleming-Mayer Flap” procedure. The advantages and disadvantages of both procedures are discussed below.

Micrograft Hair Transplants:

 In this procedure, a swath of skin about half an inch wide by several inches long in the back of your head is removed. The surrounding scalp is stretched, and the skin is stitched or stapled back together. The swath is then divvied up into individual clumps of 2 to 4 hairs (called follicular units), which are then moved from hair bearing scalp into areas of thinning hair or baldness. The hair falls out immediately but then slowly begins to regrow.


 This is relatively minor surgery that can be done in one day, under local or general anesthesia.


 There are only so many swaths of hair that can be removed from the back of your head (I have been told four). After that, you will have no more donor hair left. It can also take a year or more to complete all the procedures and have the hair start growing again. The biggest drawback though is the fact that if you have significant areas of bald scalp, final hair density will be fairly sparse. I saw several plastic surgeons who specialize in micrograft surgeries; all of them said that I would need three to four procedures. Each procedure can run from $7,000 to $14,000 for the maximum number of micrografts that can be performed in a day (roughly 6,000 follicular units).

 I was told
 that the final density (after three to four procedures) would be somewhat denser than the wispy hair at the front of my receding hairline. I sat a few feet away from a man who had had two procedures performed. He was very proud of his hair, but it was pretty thin; it may have worked on a man, at a distance, but it would never pass muster for a woman.


 Roughly $7,000 to $14,000 per procedure (circa 2012). In my case, the cost would have
 been three to four times this, because I needed three to four “rounds” of transplants.

Fleming-Mayer Flap:

 In this procedure, a two-inch-wide swath of hair is taken from the side and back of your head and rotated and moved to the top of your forehead. Most people do not have sufficient elasticity in their scalp to remove that much skin in one area and stretch the remaining scalp back together. Therefore, a scalp expander is used to provide the required skin. The scalp expander is a kidney-shaped balloon that is inserted under local anesthesia into the skin on the side and back of your head, starting near your temple and going up above your ear, and then down the back of your head to near the nape of your neck.

 The expander is connected to a subcutaneous port at the top of your head. Every three to four days, saline solution must be injected through the scalp into the port, which expands the balloon gradually, over the course of three to four months. The injections must be performed by someone other than yourself, since the port is on the top of your head. When the balloon is fully inflated, the balloon will contain about 350 mL of saline, which means that the balloon is 1½ to 2 inches thick. If you are lucky and have reasonably long hair, the bulge can be hidden, but not easily.

 Two weeks after the balloon is fully inflated, under local anesthesia, Dr. Mayer makes two cuts, one above and one below the expander, and cauterizes the blood vessels along those two lines; this is called a “delay” and it forces the blood to enter the area of the flap from the front near your temple and from the back near the nape of your neck. A week later, another cut is made at the back of the expander, the “second delay”; this forces all the blood supply for the flap to be concentrated in a single blood vessel at the front of the expander, near your temple. One week later, under general anesthesia, Dr. Mayer moves your flap from the side and back of your head to the top of your forehead.


 This procedure has the potential to get you reasonably dense hair right up front, in a natural female hairline pattern. The hair is substantially more dense with a more natural appearance than can be accomplished with micrografts.


 Like micrograft transplants, there are no magical procedures that will give you more hair; the best that can be done is to move the hair around and hopefully better distribute it. Good candidates for this procedure have fairly dense hair on the sides and back of their head. Although the scalp expander essentially creates more skin, hair is not created; it is merely “diluted” by about 50 percent. So whatever density of hair you have on the sides and back of your head, the final density on the side of the hair near where the expander was placed and the final density of the flap that is transplanted will be about half of your density before the expander is inserted.

 The grain, or direction, of the hair is a little unusual. The hair in the flap will be angled to the back of your head instead of growing more straight out, like your original hair did a long time ago. It doesn’t look particularly strange, but it does make it a little more difficult to create some hairstyles, like bangs.


$17,850 (as of 2012)

My Experience:

The Fleming-Mayer Flap

 Dr. Mayer didn’t bat an eye when I told him I was transgender and that I wanted a female hairline. He offers both regular micrograft hair transplants and his own “Fleming-Mayer Flap” procedure; he is willing to do either, though he strongly recommended the flap procedure for me, given how large an area of bald scalp I had.

 After seeing many before and after photos of the various techniques, I selected the Fleming-Mayer Flap procedure. All of the doctors that perform only micrograft surgery dismissed the idea of the flap. One of them literally told me to “run away” from the flap procedure. I am soooo glad I did not listen to them. None of them could have fixed my hairline as well as Dr. Mayer’s Flap procedure.

 I won’t sugarcoat it: I did not enjoy the surgeries one bit. You need four surgeries to complete the flap procedure. The scalp expander insertion was the worst; you are conscious, and it takes a lot of force to get the balloon into the right location. The delays were not bad at all. And the flap rotation surgery wasn’t painful or bad, except for the fact that I don’t enjoy general anesthesia. The gradual inflation of the expander was also not fun, and I had decent discomfort and/or pain during the three to four months of inflation. (I have been told that this is fairly unusual, and that I got unlucky in terms of the proximity of the
expander to a nerve). I was actually shocked that no one noticed the fact that I had a fairly large bulge in the side of my head for several months. It seemed pretty obvious to me, but in general people are not particularly observant, and because it was so gradual, no one noticed.

 After all is said and done, I am incredibly happy with my Fleming-Mayer flap. It has made it possible for me to transition without wearing wigs. I look like a different person, and the results are many times better than I had ever dreamed possible. I highly recommend that you consider using Dr. Mayer for this type of surgery.

Other Procedures:

 In addition to the Flap procedure, Dr. Mayer recommended a bunch of facial feminization procedures for me, including:

Eyebrow/forehead lift and orbital bony contouring: $7,100
Cheek implants: $5,175 / $4,175
Chin implant: $3,675 / $2,675
Partial facelift: $15,350 / $14,350
Rhinoplasty: $10,000 / $9,000
Touch-up micrografts: $4,000
Second Flap procedure: $17,850
Scalp reduction: $4,300
Voice feminization surgery: $5,750

 He does even more procedures, but I didn’t get quotes for those. Prices shown were typically quoted to me in 2011; where two prices are given, the second price is a discount if it is done at the same time as other procedures (to reflect the need for only one general anesthesia). I did not have any of these other procedures done due to monetary and family issues, but I will go back to Dr. Mayer in a heartbeat if/when I decide to do these procedures.

 Note that the touch-up micrografts are only required if you want a smoother transition between the flap and the hair at your temples. In my case, Dr. Mayer did “too good” of a job with the flap, and I really don’t feel that I need a touch-up at my temples.

 The second flap procedure and/or the scalp reduction were offered to me to reduce or eliminate the areas of thinning hair behind my flap. Because the flap is only two inches wide, there is a limit to the extent of what it can cover/replace. In my case, I have two areas of thinness behind the flap that I may decide to either reduce (via a scalp reduction, where a piece of scalp with thinness is cut out and the remainder is stretched and stitched back into position) or eliminate (via a second Flap procedure) sometime in the future. At this point, I am sufficiently happy with my results that I may do neither.


 I highly recommend Dr. Mayer. He really knows what he is doing. I am incredibly happy with my Fleming-Mayer Flap hair transplant; it’s many times better than I ever dreamed possible.

 This is me, the day of the big surgery. I am so freaking bald in this photo. The scalp expander is on my right side (your left), so you can see how much it pooched out my hair. The lines on my head show the future location of the flap. Apologies for the bad hair day, but my hair had been teased around so we could see where the flap would go, and I was a little more worried about other things.

 This is me about one month after surgery. I still haven’t gotten a haircut or learned to style my hair well yet, but the results are incredible.

 This is the final result, only two months after surgery. My hair is extremely fine, which tends to reduce the apparent density, but you can see just how many hairs were transplanted in just one procedure. The ragged edge is deliberate to make the hairline look natural. Thank you, Dr. Mayer!