Sun, Sand, Sea, Surgery: Phuket’s Sex-Change Doctor

“I think that imagination is very important,” says Dr Sanguan Kunaporn, when reflecting on his life’s work. For some, the imagination is unleashed with a pen or a paintbrush. For Dr Sanguan, however, his creativity flows through the scalpel.

His meticulous surgical methods, finely honed after years of practice, have elevated Dr Sanguan from a general practitioner in rural Thailand to a world-renowned plastic surgeon in less than 20 years.

The Bangkok-born doctor arrived in Phuket 13 years ago to work at the government-run Vachira Hospital, where he performed countless reconstructive and cosmetic procedures. He now runs the clinic Phuket Plastic Surgery Institute and performs operations at Phuket International Hospital (PIH).

Dr Sanguan forms a key part of the island’s drive to be a “health tourism hub”, where people come to Phuket for quality medical procedures at reasonable costs, then spend their days or weeks of recovery relaxing in paradise. Indeed, such is the demand for Dr Sanguan’s work that PIH does not need to market his services.

Many of his patients are from Western countries, some of whom are willing to endure the seven- to nine-month wait for Dr Sanguan’s highly sought after, male-to-female sexual reassignment surgery (SRS).

SRS is just one part of Dr Sanguan’s extensive plastic surgery work, but it’s undeniably the most fascinating. Even Dr Sanguan, who has performed some 500 SRS operations, remains slightly in awe of it. “It’s very amazing, very amazing,” he says. “I have given many lectures and presentations [about SRS] to groups of people, the community, other surgeons. I can see on everyone’s face that they think that it’s unbelievable.”

There are many professions in which one can claim to make an impact on another individual. There are few, however, where seven or eight hours of your hands-on work will forever change the course of a person’s life. As Dr Sanguan says, “Every case is interesting.”

While he can describe in graphic detail, without blinking, the two-phase procedure for creating a woman’s sexual organs from a man’s, Dr Sanguan holds a certain reverence for SRS. He doesn’t forget that his patients are real, breathing people, not subjects upon which he can refine his techniques.

“I call it the life-altering surgery,” he explains. “After surgery, the patients start a new chart of their life, in another sex role.”

Dr Sanguan sees his SRS work not as a way to trick nature but as a method to release an individual from the trap he’s been caged in all his life – that is, the wrong body, the wrong sex. This is what his patients tell him.

“Some patients of mine say that they really recall what they wanted to be since they were two or three years old,” he says. “They wanted to play with girls, to wear their mother’s clothes, to wear lipstick, paint their eyes – since childhood. This really surprised me.”

While Dr Sanguan is modest about his abilities, Internet web sites and chat rooms dedicated to transsexual issues are full of testimonials of his former patients, who expound on his particular skill in creating the female sexual organ.

“There are only a handful of doctors with his reputation for SRS, maybe 12 doctors in the world,” says American plastic surgeon Dr Harold M. Reed, who recently visited Phuket to observe Dr Sanguan’s work. “For most transsexual patients, the important thing is the depth of their [vaginal] wall – and his dissection of that space is very meticulous, very careful.”

Dr Sanguan is also well known for making sure that a key bundle of nerves in the male organ find their way, intact and functional, to the newly formed female organ. His mastery, many claim, is that it not only looks the part, but that it feels the part too.

While a functional organ is important, another crucial factor in the success of an SRS operation is the support of family and friends, Dr Sanguan says. Among most of his patients, that level of support is high. Amazingly high.

“Some patients come to Phuket with their mother,” he says. “Some patients come with their ex-wife. Some patients, they bring their present wife. Some patients come with the whole family – present wife and three kids. One patient of mine came with her son. At that time [before the operation], her son called her ‘mum’ already.”

It is clear that Dr Sanguan views his work as that of helping people. He cares about the outcome of his surgeries. He keeps in regular contact with many of his patients, following their recovery and new life after their return home. He’s mild-mannered and soft-spoken, yet he exudes a quiet confidence that would assure anyone about to undergo a major life change that they’re in good hands.

But he’s certainly no pushover. Unlike some plastic surgeons – the most famous examples being those who, in stages, largely removed the face of pop-star Michael Jackson – Dr Sanguan refuses to accept patients who seem to be harbouring “unreasonable expectations” about what surgery can do for them.

Among his SRS patients, all must pass certain criteria indicating that they are ready for the procedure. They’ve had extensive psychological evaluations, have had hormone treatments for at least one year, and have done a “real-life test” – that is, lived as a woman for 24 hours a day – for at least six months before undergoing the operation.

Though the 40-something doctor, an avid cyclist and beacon of calm, looks like a model of health and vitality, one wonders if, like the painter who experiments with self-portraits, he’s ever considered cosmetic surgery for himself.

Dr Sanguan laughs and says “never”, though he concedes that some of his colleagues have suggested that it might be time to consider hair transplants. “I say, maybe in a few years, but not right now. I’m ok with this.”

This is an edited version of an article I wrote for Phuket Magazine a while back. Some information may be out of date but Dr Sanguan is still here in Phuket and is as busy as ever!