Glans Decisions

I am currently weighing the options regarding the glansplasty portion of my phalloplasty. This post summarizes information I've collected so far.

What is the Glans? 
The glans (aka glans penis, head, tip) is the bulbous structure at the distal end of the penis. Typically, in cis men, it is completely or partially covered by foreskin and in circumcised cis men it is completely visible. In the absence of technologies to create a foreskin phalloplasties, creating a visible glans is a way of defining  the head of the penis. More specifically, doctors are creating the corona of the glans, which is the base of the glans that forms a rounded and projecting border defining the head from the shaft of the penis. This procedure is referred to as a glansplasty.

Glansplasty Overview
Surgeons take a thin flap of skin from the shaft, rolling it up like a hat brim and suturing it in place to create the corona. Then they tightly wrap a skin graft to that open area so that it slightly narrows the circumference, enhancing the bulbous nature of the glans as it heals. Although surgeons use slightly different techniques, there is a great overview of this procedure on page 10 of the Patient Guide to Phalloplasty (NSFW Warning: Explicit photos).

Crane typically does the glansplasty in stage 1 of RFF phalloplasties because there is a rich network of arteries around the wrist. This creates an excellent blood flow from the base to the tip of the penis, reducing associated complications that might otherwise come with doing a glansplasty at this stage. Crane explains this in his excellent video on How to Choose Donor Sites.

Trends
The trend that seems to be emerging on the few closed FB groups that I'm a part of, which include several hundred trans men (a good percentage of them post-op) is the following: The vast majority of people who have a glansplasty during the same initial surgery as the phalloplasty seek revision. Those who get it at a later time have more defined results and are less likely to want or need a revision. These individuals range in having it done 3 weeks to 3 months to 9 months after the initial phallo surgery.

The results that appear most defined, in my opinion, are coming from the use of the Norfolk technique (or a version of this) where the surgeon uses a full-thickness rather than a split thickness graft to make the glans.

Considerations
You may be asking, what's the big deal about having a defined glans? This is mostly a personal preference. I bring this up here because if someone, like me, wants their glans to be defined, they might not get what they're looking for without requesting specific surgical techniques. Furthermore, folks opting out of getting a surgically placed erectile device may have more success with non-surgical options like The Elator with a more defined glans.

The trouble is that I'm very drawn to getting a glansplasty at stage 1 mostly because of the aesthetic component and fearing a continuation of my dysphoria without it. I've looked at a dozen or so stage 1 post-op phalluses w/o glansplasty (it is common practice in the UK and with ALT to do it in later stages) and it's hard for me to see the results as more than a tube of skin. As hard as I try, I don't see an uncircumcised penis (although my partner can). I'm not sure if this is a manifestation of my internalized transphobia, but I'm worried that if I don't get a glansplasty in stage 1, even one that needs a revision, that my dysphoria will be pretty bad. BUT, I also want a defined glans.

I'll be emailing Crane's PA soon to learn more about my options and post updates here.

UPDATE
I received the following email from Toni, Crane's Physician Assistant in Austin, TX:

"As far as the Glansplasty. We do that at the time of the procedure and we do the same technique that is shown on page 10 [referring to the description of the Norfolk technique]. We use a full-thickness skin graft and a rolled edge to the glans. Some people do get a little flattening of the ridge over time. If you have this, it can be revised later, possibly at the time of the testicular and penile implant."

This clears things up for me a little, although I'm not entirely satisfied with the response. I'm still concerned with the amount of flattening that is trending, but I may need to concede that this will just be a likely revision and continue with the process as is. I'm going to put it on my list of things to discuss with Crane in my in-person pre-op appointment on November 29th in Austin.