64 years old Transman ( Female To male Transsexual) from Australia. He underwent surgeries 3- 4 times, both in Serbia and Thailand and was not happy with the outcome. He was also having one non healing long standing ulcer (owing to left over vaginal tissue inside), for which he got refusal for surgery in Australia. He was operated at Olmec. The existing ulcer was treated by proper exploration and meticulous vaginal obliteration. The metoidioplasty along with urethral extension was carried out by elongating the urethra and buried clitoral tissue. The penile length was augmented with adjacent tissues as used in penile lengthening. About 2 inches fully sensate erectile penis was achieved. The scrotoplasty (scrotal reconstruction) was carried out at the same sitting using unique technique followed by Dr Narendra Kaushik (Rotation advancement flap). In this technique labia majora tissue is rotated and advanced anteriorly. We get a nice natural scrotum which is anteriorly (much forward) placed and avoids sitting over the scrotum like in cis man scrotum. The adjacent fat is used to give filling effect. Owing to old age and scarring of the tissues, scrotum has been reconstructed with existing tissues without implants. In these cases Implants can be put in at a later date once the swelling and healing is over (To avoid chances of infection and implant rejection). The post operation picture after 24 days has been sent by the client himself with an e mail expressing extreme gratitude.