In early 2025, I had the pleasure of observing penile inversion vaginoplasty procedures at Women’s College Hospital with Dr. Alexi Millman and her reconstructive urology team. I produced this sequence based on my observations.
Media and software: graphite, pen and ink, Adobe Photoshop, Adobe Illustrator
Client: Dr. Alexi Millman, Dr. Yulia Wilk-Goldsher, Michael Corrin
Content advising: Christopher Smith
The process of creating each illustration in this sequence consisted of initial OR sketches from life, iterative preliminary drafts, and a final inked illustration accompanied by a written description.
To begin this process, I completed research on penile inversion vaginoplasty to familiarize myself with the steps involved. I reviewed the relevant anatomical structures, read written descriptions of the surgical techniques, and watched videos of the surgery to prepare for observation and avoid confusion in the OR.
After this, I observed three surgeries, during which I made rough sketches from life throughout the procedures. As the surgeons were open to teaching and answering questions, I consulted them sporadically to ensure I understood the procedure.
Due to the complexity of the surgery, I knew I would have to select a limited number of steps for my final sequence. I chose to focus on the creation of the neovaginal canal. It involves the inversion of the degloved penile skin, suturing of a skin graft to the penile skin tube, and the use of a vaginal dilator to insert the skin tube into an established space between the bladder and the rectum.
Once I established this focus, I started to create drafts of the illustrations. Throughout the drafting process, I met regularly with my course professor and the surgeon with whom I was observing to improve upon anatomical accuracy, correct depiction of the procedure, and clarity of communication.
I continued with an iterative drafting process during which I completed sketches, received feedback from my content advisors, and subsequently refined and edited my sketches until they were as clear and accurate as possible.
Concurrent with this process, I also developed and refined a written description of the procedure to accompany the illustrations in the final presentation.
Once I had refined my sketches to a finalized state, I proceeded with inking a final product for each of the illustrations. I completed some of these illustrations with traditional pen and ink, then moved into working digitally with Photoshop and Illustrator for the rest.
The final layout of the sequence describes the steps needed to prepare and construct the neovaginal canal in penile inversion vaginoplasty, from the preparation of the skin graft to the final establishment of the canal.