Dr. Nick Esmonde is a plastic surgeon in Portland, Oregon who has extensive knowledge about Gender Affirmation Surgery and works almost exclusively with transgender and non-binary patients. During his plastic surgery residency, Dr. Esmonde worked in the Transgender Health Program at Oregon Health & Science University. He subsequently completed a Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Beginning in June 2021, Dr. Esmonde will serve as a full-time Associate Surgeon with The Meltzer Clinic offering the full spectrum of gender-affirming procedures.
Latest Research
Metoidioplasty using labial advancement flaps for urethroplasty
Toby R. Meltzer, Nick O. Esmonde. Plast Aesthet Res. 2020;7:61.10.20517/2347-9264.2020.122
A variation of the ring metoidioplasty has been performed for masculinizing transgender surgery by the senior surgeon since 2010. It does not require buccal grafts or vaginal wall flaps. An excisional vaginectomy was completed in all patients. We sought to evaluate the urologic outcomes and complications for this technique. Further, we provide a detailed technical description of the technique, including ancillary masculinizing procedures.
Technical Description and Microsurgical Outcomes in Phalloplasty Using the Deep Inferior Epigastric Artery and Locoregional Veins.
Danker S, Annen AW, Cylinder I, Esmonde NO, Berli JU. Plast Reconstr Surg. 2020 Aug;146(2):196e-204e.
After an initial learning curve, the combination of deep inferior epigastric artery, deep inferior epigastric vein, and great saphenous vein combined with specific technical modifications such as targeted coagulation of the vasa nervorum of the clitoral nerve has proven to be a reliable technique.
“Staging” in Phalloplasty.
Danker S, Esmonde N, Berli JU. Urol Clin North Am. 2019 Nov;46(4):581-590.
This article reviews current techniques for phalloplasty staging and proposes that a staged urethral reconstruction is a reliable technique that allows for potential complications to be managed individually, while minimizing the severity of complications and their impact on the outcome of the final reconstruction.
Providing Gender Confirmation Surgery at an Academic Medical Center: Analysis of Use, Insurance Payer, and Fiscal Impact.
Esmonde NO, Heston AL, Morrison T, Rogers E, Liem T, Amling C, Dugi DD 3rd, Hansen J, Berli JU. J Am Coll Surg. 2019 Nov;229(5):479-486.
We found that providing GCS at our academic medical center is profitable for both the surgical department and the hospital system. This suggests such a program can be a favorable addition to academic medical centers in the US.
The Role of Facial Gender Confirmation Surgery in the Treatment of Gender Dysphoria.
Esmonde N, Najafian A, Penkin A, Berli JU. J Craniofac Surg. 2019 Jul;30(5):1387-1392.
Despite evidence of the efficacy of FGCS, there remains some extant controversies to address, such as reimbursement for these procedures, categorization of aesthetic versus functional surgery, and evaluation of outcomes. This review provides a discussion of these topics, as well as the historical and psychosocial issues specific to transgender patients that surgeons should know when providing FGCS.
Phalloplasty: techniques and outcomes.
Heston AL, Esmonde NO, Dugi DD 3rd, Berli JU. Transl Androl Urol. 2019 Jun;8(3):254-265.
To date, there is no consensus among surgeons regarding the optimum staging of the reconstructive steps. Our primary goal is to outline the most frequently performed and reported options in phallic reconstruction and outline the various considerations that go into choosing a given sequence of procedures for the specific patient.
What is “Nonbinary” and What Do I Need to Know? A Primer for Surgeons Providing Chest Surgery for Transgender Patients.
Esmonde N, Heston A, Jedrzejewski B, Ramly E, Annen A, Guerriero J, Hansen J, Berli J. Aesthet Surg J. 2019 Apr 8;39(5):NP106-NP112.
Chest surgery for nonbinary patients comprises a considerable proportion of transgender surgery practice, and surgeons who provide affirming care should be familiar with the unique characteristics and treatment options for this population.
Differences in Chest Measurements between the Cis-female and Trans-female Chest Exposed to Estrogen and Its Implications for Breast Augmentation.
Nauta AC, Baltrusch KM, Heston AL, Narayan SK, Gunther S, Esmonde NO, Blume KS, Mueller RV, Hansen JE, Berli JU. Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2167.
The trans-female and cis-female populations seeking primary breast augmentation have significant demographic and anatomical differences. This has implications for surgical decision-making and planning to optimize outcomes for trans-female patients.
Phalloplasty Flap-Related Complication.
Esmonde N, Bluebond-Langner R, Berli JU. Clin Plast Surg. 2018 Jul;45(3):415-424.
This article focuses on flap-related complications after creation of a neophallus for transgender individuals. It outlines the most frequently used flaps for this procedure and how flap-related complications can affect the overall outcome of the phalloplasty.
