Introduction: A key genital gender affirming surgery (gGAS) option for transfeminine patients is vaginoplasty without creation of a vaginal canal, commonly referred to as ‘shallow-depth vaginoplasty' (SDV), which is an alternative to full-depth vaginoplasty (FDV). Together with the advantages of SDV (lower complications, no need for dilation/douching), achieving “normal appearing” anatomy is typically important for patients. However, no surgical technique for how to create a recessed vaginal introitus has been published. We aim to: 1. Assess patient decision-making priorities when choosing SDV over FDV; and 2. Describe a novel surgical technique to create a recessed vaginal introitus regardless of penile shaft length and 3. Patients’ perception of how it compares to a cis-gender vulva. Methods: Of the 110 patients who underwent primary feminizing gGAS at our institution between 4/2017 and 7/2022, 35 (32%) underwent SDV and were emailed a link to an anonymous, electronic Qualtrics® survey querying decision-making and satisfaction. Our technique is described. Results: Prioritites: Achieving external appearance “comparable to” a cis-vagina was the second-highest ranked priority for patients (after “elimination of male genital anatomy”) (Figure 1a) Surgical Technique: To achieve a recessed skin-lined introitus, we place gathering sutures to create a “dimple” on the penile or scrotal skin to be used, and then tether this dimple to two structures: the tendon of the Bulbospongiosus muscle, and diffuse perineal body tissue behind the urethral bulb. (Figure 1, b-d) Attractiveness: When asked how patients perceive their vagina compared to a cisgender woman’s of similar age and weight, 3/29 (10%) reported they “do not know what a cisgender woman’s vagina looks like” and were excluded from further analyses. The remaining 19/26 (73%) reported their vagina was “similar in appearance” and 7/26 (27%) “somewhat similar in appearance.” 21/26 (81%) found their vagina to be “similarly attractive”; 3/26 (10%) “more attractive”; and 2/26 (8%) “less attractive” than a cis-gender woman’s vagina. Conclusions: For women to choose SDV, it is essential that the cosmetic appearance of the vulva be as indistinguishable as possible from a cis-gender woman’s vulva. The surgical technique presented appears to offer this. SOURCE OF Funding: Richard Onofrio, MD Research Grant to the CSMC Transgender Surgery & Health Program