Dr. Graham Ives, MD is a plastic and reconstructive surgeon in Beverly Hills specializing in gender-affirming procedures. His clinical and research work focuses on advancing surgical techniques and optimizing outcomes for transgender patients across facial feminization, chest and breast augmentation, genital reconstruction, and hair restoration.
Dr. Ives’ research emphasizes evidence-based approaches to improve safety, satisfaction, and quality of life. He has studied facial proportions, breast augmentation strategies, outcomes after gender-affirming mastectomy, vaginoplasty and BMI, and innovative hair restoration techniques for transgender patients. Using large-scale insurance data, he has also investigated demographic trends in the field of gender surgery.
Latest Research
Temporal rotation flaps for gender-affirming hairline feminization: Taking the “M” shape out of masculine hairlines
Ives GC, Martin A, Munabi NCO, Lee JC, Ames JA, Chu MW, Kim DC, Francis SH. J Plast Reconstr Aesthet Surg. 2025 Mar;102:404-411.
Many transfeminine patients experience recession at the temples, which can make the hairline look more masculine. Standard hairline advancement surgery lowers the center of the hairline but doesn’t do much to improve its overall shape.
In this study, surgeons tested a new approach called temporal rotation flaps, which move hair-bearing skin from the sides of the scalp to reshape the temples while lowering the hairline. Among 86 patients, those who had this combined procedure achieved a more natural, rounded hairline shape compared to those who only had standard advancement, and no major complications occurred. This shows that the technique is a safe and effective way to create a more feminine hairline.
A Differential Analysis of Preferred Feminine Facial Contours for Transfeminine Individuals
Doan LL, Ives GC, Cordero JJ, Lee JC. J Craniofac Surg. 2024 Jul-Aug 01;35(5):1389-1393.
Facial feminization surgery is a key part of gender-affirming care for many transfeminine people. While medical literature describes “classically feminine” facial features, little research has focused on what transgender women themselves find most attractive. This study explored the preferred facial proportions of transfeminine patients and compared them to the general U.S. population.
Researchers showed participants digitally altered images that varied in six facial features: the forehead, nose, chin projection, chin height, nasolabial angle (the angle between the nose and upper lip), and jawline. Both transfeminine patients and the general population agreed that a slightly rounded forehead, a gently sloped nose, a nasolabial angle around 105 degrees, and a shorter chin height looked most feminine. However, transfeminine patients rated strongly feminine nose shapes and larger nasolabial angles (around 110 degrees) as more attractive than controls did, and they found masculine features much less acceptable on a feminine face.
The study shows that while there is broad agreement on certain feminine features, transfeminine people tend to prefer stronger feminine traits and are more sensitive to masculine-looking features. This information can help surgeons and patients align their goals and may lead to better surgical outcomes and satisfaction.
Gender Affirming Mastectomy Improves Quality of Life in Transmasculine Patients: A Single-center Prospective Study
Lane M, Kirsch MJ, Sluiter EC, Svientek SR, Hamill JB, Morrison SD, Ives GC, Alman E, Gilman RH, Kuzon WM, Cederna PS, Wilkins EG. Ann Surg. 2023 Mar 1;277(3):e725-e729.
This study from the University of Michigan followed 70 people who had gender-affirming top surgery. Researchers checked in with patients before surgery and again six months later to see how surgery affected their mental health, body image, and overall well-being. The results showed big improvements:
- Depression and anxiety decreased – average scores dropped significantly after surgery.
- Body image improved – patients felt much more positive about how their chest looked.
- Social and sexual confidence grew – people reported being more comfortable in social settings and in intimate relationships.
- Satisfaction was extremely high – patients rated their happiness with results and their decision to have surgery at over 90 out of 100.
Chest Feminization in Male-to-Female Transgender Patients: A Review of Options [FULL TEXT]
Patel H, Samaha Y, Ives G, Lee TY, Cui X, Ray E. Transgend Health. 2021 Oct 4;6(5):244-255.
Most transgender women see only modest breast development from hormone therapy, which is why many pursue surgical chest feminization. Augmentation for trans women is more complex than for cis women because of the differences in chest anatomy, including flatter chests, higher and less-defined inframammary folds, and wider positioning of the nipples. These factors mean surgeons must adapt their techniques to achieve natural, feminine results.
Implants remain the most common approach, but surgeons often use larger volumes than in cisgender patients, and some cases require a staged approach with tissue expanders to create enough skin for the implant. Positioning of implants is also debated: some surgeons prefer submuscular placement to help shape the upper pole, while others favor subglandular placement to avoid unnatural displacement. Achieving cleavage can be especially difficult given the wider nipple spacing typical of natal male anatomy, and surgeons may reconstruct or reinforce the inframammary fold with sutures or mesh to improve results. Fat grafting is sometimes used to refine shape or add volume, but the procedure usually requires multiple sessions because only ∼50–60% of transferred fat survives.
Overall, chest feminization in trans women requires more than just standard augmentation techniques. Surgeons must address unique anatomical challenges and sometimes employ specialized methods to create a chest that feels both natural and affirming.
Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty [FULL TEXT]
Ives GC, Fein LA, Finch L, Sluiter EC, Lane M, Kuzon WM, Salgado CJ. Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2097.
This study looked at whether BMI actually predicts surgical complications in patients undergoing penile inversion vaginoplasty (PIV). The researchers reviewed records from over 100 patients at two university centers and found that patients with higher BMIs experienced similar rates of complications as those with lower BMIs. Major complications occurred in about 17% of patients, while minor complications occurred in roughly 36%, but BMI did not predict which patients would have these issues. The study concludes that obese patients can safely undergo PIV, and BMI alone should not automatically prevent someone from having surgery. Instead, surgeons should consider overall health and other medical conditions when evaluating patients for gender-affirming procedures.
Trends in Gender-affirming Surgery in Insured Patients in the United States [FULL TEXT]
Lane M, Ives GC, Sluiter EC, Waljee JF, Yao TH, Hu HM, Kuzon WM. Plast Reconstr Surg Glob Open. 2018 Apr 16;6(4):e1738.
As more people in the U.S. openly identify as transgender, an increasing number are seeking gender-affirming medical and surgical care. However, patterns of how these services are used are not well understood beyond surveys. This study looked at insurance claims data to better understand who is accessing care, what procedures they are having, and what outcomes they experience.
The researchers analyzed data from nearly 8,000 insured transgender patients between 2009 and 2015. About 1,000 of these patients had surgery, most commonly top surgery. The average patient was a young adult around 30 years old, and patients were geographically diverse. Overall complication rates were low, at about 6%, with the highest rates seen in phalloplasty procedures. The study also found that the number of surgeries performed increased steadily each year. These findings show that gender-affirming care is a growing part of healthcare in the U.S., and existing insurance databases can help providers understand trends, demographics, and outcomes in the transgender population.
