[Note from Anne Lawrence: Elizabeth and Claire wrote to me in June 2003 concerning their unsatisfactory experience of SRS with Dr. Pichet. I've subsequently received two other reports of dissatisfaction. I'm presenting all of these with minor editing, but without further comment.]
J. wrote to me as follows:
October 11, 2003
I thought my experience might be of some help to others. I was a patient of Dr. Pichet in March of 2003. Like the others, I came back with little depth (1- 1/2 to 2 in.). The problem stems from Dr. Pichet's belief that the scrotal skin shrinks and will cause future problems if used as a graft. He believes in the colon procedure and thinks his penile inversion patients will be back for that. We had many discussions, and I feel he would now do a graft, with skin from the belly or leg if not with the scrotal skin, to give me a more reasonable depth. He offered to do that for me with no charge except travel.
Instead I chose to go to Dr. John Taylor of Allure Plastic Surgery Center in New Jersey. I have known Dr. Taylor for years: He did my breast augmentation, and have seen his work on a few friends. The procedure he used on me was to deepen my vagina by reopening the penile skin and adding a skin graft taken from my lower belly (I got a "mini-tummy tuck") to the vaginal canal. He also did a procedure to correct my urethral opening, because the urine stream was being deflected too far forward. The results were nothing short of amazing. I now have 4-1/2 to 5 inches of depth, and my urine flow is in the right path.
Although my Thailand experience was a rich one, it did leave me with an nonfunctional sexual organs. Hopefully no one else will have to experience that. Good comes from everything: Dr. Taylor completed my journey in a beautiful way. He is very compassionate to the needs of the gender community and has a true passion to help each of his patients reach their goals.
K. wrote to me as follows:
September 30, 2003
Dear Dr. Lawrence,
I have noted with interest the accounts on your site concerning women's experiences with Dr. Pichet in Bangkok. I would like to briefly relate my own experience, which was somewhat frustrating and expensive, if not injurious.
I was interested in getting buttock and/or hip implants, and Dr. Pichet's website said that he was experienced at performing these procedures, and showed before-and-after photos. I was told he was the only surgeon in Thailand who did such surgery. I e-mailed Dr. Pichet's office, and had a number of email exchanges with the Dr. Pichet himself. We discussed cost, length of stay, the advisability of one type implant vs. the other, etc. Pichet's responses were always very brief, but direct. Of course I know that any surgery has its risks, but Pichet never indicated in his emails that these procedures were any riskier than others.
Accordingly, I booked a flight from U.S. to Bangkok and arranged for a two-week stay. Once I arrived at Pichet's office, I had a surprise. He basically did everything he could to talk me out of the surgery! Here's what he said:
He added that this was his least favorite procedure to do. And he wouldn't want me to be angry at him if something went wrong.
- the risks of infection are very high;
- the failure rate for the surgery was as high as 33%;
- it was very possible the implants wouldn't get infected till I returned to the US;
- even if there was no infection, he couldn't guarantee that the implants once inserted would be symmetrical;
- he couldn't guarantee they wouldn't move around
- I'd be unable ever again to do vigorous exercise, yoga, and so on.
Now, Dr. Pichet didn't refuse to do the procedure -- he just told me the decision was "up to you." ("Up to you" turned out to be a popular English phrase in Thailand.) Having learned all these various risks, of course I decided to leave my butt and hips intact.
I should mention that in person, Dr. Pichet was very friendly and forthcoming. And his staff was charming and helpful. At the same time, I was just a little frustrated that I'd flown 24 hours and spent about $1000, only to have the main purpose of the trip become pretty much out of the question. Dr. Pichet had every opportunity to express his reservations when we were emailing each other. I would have appreciated it if he had.
Elizabeth wrote to me as follows:
June 23, 2003Claire wrote to me as follows:
Earlier this year I wrote to you concerning frightful experiences of four different girls, including my best friend Claire and myself, at the hands of Dr. Pichet. Legal remedies have been tried and failed due to the legal Thai/Western barrier. I have reported the Dr. Pichet to the IFCC for Internet fraud and it will be sometime before my case comes up.
The primary problem is one of fraud. The fraud is promising a vaginal cavity extending past the PC (pubococcygeus) muscle to the greatest depth possible with existing penile skin. Instead, he performed SRS limiting the vaginal depth to where it meets the PC muscle. The typical depth of all four girls was approximately 1 to 1.5 inches.
Dr. Pichet, in order to cover his tracks, ordered me and the other patients not to dilate for four weeks following surgery, and then to begin dilation for a period of 15 minutes per session once a day, and that eventually full depth would be obtained. Of course by that time the patient in normal circumstances has left Thailand is back in the US/Western Europe. Dr. Pichet advised against using a scrotal skin graft for SRS surgery, saying it was not necessary. He also said that he routinely recommends sigmoid colon procedure in a follow-up surgery for complete depth.
Additionally, in my case, internal bleeding occurred at the surgery site and was hidden for three days until the bandaging was removed. I had hemorrhaged, with pockets of blood ballooning the skin, and signs of gangrene and necrosis were present. I was taken back to surgery seven times to excise necrotic tissue. About 10 days postop, I was visited by the head of Infectious Diseases of the hospital. After culturing the tissue he proclaimed that the tissues at the surgical site had several bacterial infections and I was put on IV antibiotics IV. He required the removal of the Foley catheter, stating it would prevent further infection. My urination was onto raw tissue and the cleaning process by the doctor’s clinic worker was horribly painful. This occurred five to six times a day.
The infections were cleared up, I took my last trip to the OR for the last excision of necrotic tissue, and was monitored for several day for any further development of infection or necrosis. During the final surgery, Dr. Picket took a large skin graft from my left inner thigh and covered the remaining vulva tissue, of which there was now very little.
I had a consultation with Dr. Preecha to evaluate my condition and surgical results. He took notes and photographs, and apologized to me for his former student, saying he never taught Dr. Pichet to perform such surgery. Simply put, he stated in his notes "no hole," i.e., no vagina.
My plans are to return to Bangkok in August or September to undergo corrective surgery to approximate a normal vulva, and a sigmoid colon procedure.
June 24, 2003
My best friend Elizabeth sent you an email about our experiences in Thailand. I, too, was the victim of Dr. Pichet in Bangkok, who now hides by refusing my calls and emails, and even refusing to give me my medical records. Due to the language and time differences, limited legal experience in prosecuting anyone in Thailand, and US lawyers’ laziness, apparently we will be unable to recoup any damages from him. I had our legal cases reviewed by attorneys here in the US, who say we have an "open and shut" medical malpractice suit, but we have had no success whatsoever receiving justice.
Our last hope is to make our sisters aware of this situation in hopes that no one else will suffer. The following letter is long and detailed, but should be read by anyone undergoing SRS. You may edit or modify it in any way you see fit, and may publish it in any form you deem appropriate.
This letter is written in hopes that, somewhere out there, a person will be spared the needless pain, suffering, shame, and embarrassment I and two other people I know have suffered because of Dr. Pichet.
I have always considered myself to be of reasonable intelligence, so I never thought this could happen to me, but it did. I have learned some very valuable lessons at a great personal and financial cost. I pray that my other TS sisters will find this document and will benefit from it.
As everyone knows SRS is not to be entered into lightly. I started crossdressing before I even knew what it was called. Over the years, and through many years of self-discovery and spiritual questioning, I came to understand the feelings I was having. I read everything I could find, talked to everyone I met, and thought I had a good understanding of what was involved with becoming female. My life partner and I researched long and hard to find the perfect opportunity for us both to realize our dream of becoming female. Little did either of us realize the nightmare that lay before us.
We had originally wanted to go to Dr. Preecha in Bangkok, who by most accounts is the premiere Thai SRS surgeon. We tried to communicate for months via email and by phone through the site Zundara.com, which always came up when we did the Internet search on Dr. Preecha. Little did we know that there was a conflict of interest between the Zundara site and the doctor, which was preventing effective communication with him. Dr. Preecha explained this to us when we finally saw him after the damage was done.
My partner Elizabeth was highly motivated to have SRS in a certain time frame, as a result of other pressing personal matters in her life. Because of this and the communication problem, she reluctantly gave up on Dr. Preecha and found Dr.Pichet. Lesson #1: Never let any time schedule, including your own, circumvent your goal of a safe, effective operation. Elizabeth discussed the surgery extensively with Dr. Pichet, so there would be no surprises. She had almost 7 inches of penile length to work with, and Dr. Pichet promised her 5 to 6 inches of depth, "no problem."
C.K. and her good friend Cindy left for Thailand for SRS, and I reluctantly stayed behind in Boston because I needed to find work after being fired for coming out at work. Elizabeth and Cindy arrived in Bangkok ($1000 each ticket) for Elizabeth's surgery. As an added bonus, Cindy was offered a great price by Dr. Pichet for her SRS as well. Only $2650!. I personally wired the additional money, and all in all we paid about $19,000 to Dr. Pichet for the surgeries, not counting my own. Cindy actually got her surgery first and later developed complications. Elizabeth had her surgery within days, but developed a severe infection that almost cost her life. Cindy appeared to heal rather quickly and pushed the envelope, touring Thailand and overdoing the sightseeing, making her problem almost self-inflicted. So everyone had a tendency to overlook her complications.
Elizabeth had some medical concerns that should have halted her surgery, being overweight and smoking cigarettes too much. She was in denial about the seriousness of the smoking, and may have complicated her surgery, but not to the extent of the damage caused by Dr. Pichet. CK developed necrosis (gangrene) soon after surgery. It was life threatening, so she hid it from me to keep me from worrying. Unknown to me, she went back on the operating table a total of seven times, each time to remove necrotic tissue. When I found out, I immediately made plans to go to Thailand myself to help her come home safely.
I arrived a week later, as it took that long to get things in order at home. All I can say is that the first time I saw my loved one’s groin, I broke down crying. There was nothing but a bloody gaping wound. No labia, and certainly no vagina. Her condition caused her to have to stay an extra month in Thailand. The entire time, Dr. Pichet blamed her weight, her smoking, and just about anything he could find other than taking any responsibility himself. I discussed her condition extensively with him and was convinced that her complications were understandable.
When I met Dr. Pichet for the first time, Elizabeth told him of my desire to have SRS surgery, too. With no prior knowledge of my status as a transgendered person, nor any knowledge of my physical condition other than what I told him, his first response was, "Do you want to have SRS today?" You could have knocked me over with a feather! What about the Standards of Care? What about the letters of recommendation? What about all the other maze of details we all have experienced? My desire to be female overwhelmed my good judgment. I wanted it so badly that I ignored the problems my two friends had had, and I arranged my SRS for a day later. Lesson #2: Never act on a spur-of-the-moment decision, no matter how badly you want something or how convenient it is.
Dr. Pichet told me my case would be easy. I was thin, a non-smoker in great health. I was almost 8 inches erect, and he promised me 5-6 inches of depth, "no problem." I had my surgery on February 28, 2003. My surgery supposedly went perfectly, with no complications. I awoke sore but very happy, and Elizabeth and I lay side by side in the hospital, healing both physically and spiritually. After four days, the cotton plug in my vagina was unpacked, and through the haze of pain killers I was told everything looked good, "no problem, don't worry."
When I asked about dilation, he explained to me that I needed to heal more before I could start dilating. Every day I was told "later, one more day.” It was not until much later that Dr. Pichet told us he wanted us to start dilation 30 days after surgery! His 14 years of experience told him that dilation was unnecessary before then, and that it was "not possible" for the vaginal cavity to close up, because the penile shaft skin would not allow the PC muscle to close. I was an idiot and trusted him, even though everything I had read previously was to the contrary. After three weeks I demanded to start dilating. I demanded that the doctor show me himself how to dilate. He took the one-inch stent, put some lube on it, and inserted it into my vagina about two inches, rotating it slightly. He was very specific about the technique, and the duration and pressure of the dilation. He stated that it was his experience that gentle rotation would gradually open the vagina. He specifically told me to dilate no more than once a day for 10 to 15 minutes. I followed his directions, because it was impossible for me to believe that he did not know what he was doing. Lesson #3: If you are not sure of the doctor's opinion, demand what you know to be right. If he won't honor your wishes, get to another doctor immediately.
The end result of my surgery was that Dr. Pichet left me with a little over one inch of vaginal depth. My partner and I finally had enough, and went to see Dr. Preecha to review our concerns. Dr. Preecha saw us the next day. The expression on his face as we told him our story reflected his astonishment. He examined us both while apologizing for Dr. Pichet. Dr. Preecha, who had actually taught Dr. Pichet, apologized and said "I did not teach him like that." Dr. Pichet had decided on his own that dilation was not necessary. He believed that scrotal skin grafts never work, and wanted to do sigmoid colon procedures only. In fact, Dr. Pichet told me that when he did my sigmoid he would remove all of the penile shaft skin because "it was better." I realized far too late what had actually happened.
I believe that Dr. Pichet is doing what is commonly known as a "Katoy SRS." Katoys are Thai transgendered male prostitutes, who only need the outside appearance of a vagina. That type of surgery costs about $1500 maximum. Katoys perform oral sex as women, but never intercourse. My $4000 ("special friend price") was for a full 5-6 inch depth. It is now obvious to me that Dr. Pichet never attempted to make a vaginal cavity at all. My entire procedure was a scam. Dr. Pichet must be pocketing the difference, plus getting the additional business for the sigmoid surgery. My almost 8 inch erect penis with a promise of 5-6 inch depth "no problem, don't worry," has been reduced to a neovagina with a little over one inch total depth. I now must have the sigmoid colon surgery, which I did not want to do, if I am to have any vagina at all. Needless to say, Dr. Preecha, not Dr. Pichet, will be doing that surgery.
Dr. Preecha told us he done only 175 sigmoid colon procedures out of all the SRS surgeries he had completed. I, my two friends, plus three other girls we met here who went to Dr. Pichet, will all have to have dangerous, painful, and expensive sigmoid operations to have any vaginas at all. Coincidence, or scam?
Girls, please! Spread the word. Save your money, do it right, go to Dr. Preecha! And while you're at it, please throw a prayer or two our way for a good resolution to this nightmare.