While feminizing hormone therapy can produce extensive visible changes for trans women, one aspect of the body that remains largely unchanged is the skeletal structure. Trans women who were not treated with puberty blockers in adolescence generally lack options when it comes to fixed skeletal features, such as broader shoulders, a wide ribcage, and narrow hips.

HRT can promote fat redistribution to create a more feminine body shape overall, but when this is not sufficient to produce the desired body shape, some trans women have turned to more dangerous options such as the injection of loose silicone. This carries a number of serious risks, including migration of silicone, inflammation, the development of abscesses, infection, ulceration, sepsis, organ failure, and silicone embolism leading to limb loss or death. Unlicensed silicone injection has been linked to numerous deaths of trans women, and surgery can be required to remove silicone that has migrated or hardened.

A recently developed plastic surgery technique offers the possibility of cosmetic hip widening using a new approach. While previous methods of hip augmentation focused on the soft tissue and used encapsulated implants or fat transfer, this new method affixes metal implants directly onto the pelvic bone. Korea Biomedical Review reports:

To widen the pelvic bone, Wu started the process with a 3D printer to create the “pelvic osteoplasty” – the first skeletal aesthetic technique used to create a customized hourglass figure. Small incisions will be made on the lower back (posterior superior iliac spine) to hide the scars with clothes, undermining the muscles to create a tunnel for the implant. The implants will be drilled with 3.5-mm cancellous screw fixations onto the surface of the iliac crest- the curved ridge at the top of the pelvic bone.

Although the procedure is still experimental and not yet available to the public, it is expected to debut this year, with minimal side effects and recovery time:

The procedure takes less than an hour under general anesthesia, and patients can be discharged after a few hours. Side effects of this surgery would be minor common surgical complications, including pain, infection, loosing of the implant and minimal decrease of the sensation of surgical site which usually recovers. The cost for the implant is $4,500, and hospital fee is $10,000, including anesthesia and other supplies.

Provided that this procedure is safe and effective, this may represent a novel cosmetic option for trans women (and anyone else) seeking a visibly wider pelvis through modification at the skeletal level. ■