My decision to have facial feminization surgery (FFS) isn’t about beauty, so much as freedom. I have a vision of running out for a carton of milk on a Sunday morning in a headscarf and jeans, without makeup, and not being clocked. To appear female by default, rather than by decorative strategies, would mean that who I am out to—and when and where—becomes my choice, affording me more space as I go about my life. But appearance for trans people also reaches inward: when the manifest body feels congruent with the spirit, it heals us.
To me, the most amazing result of FFS involves the “gender” of a person’s gaze. Male and female eyes are fairly identical. What’s different—and considerably so—is the surrounding terrain: the brow and orbital bones (more prominent on men); eyebrows that either float over the sub-orbitals (female) or sit on or below them (male); the slope of the forehead (steeper on women), the angle of nose to forehead (more acute on men). I now know more about the craniofacial skeleton than any Jeopardy! Champion. Yet when I see before and after FFS photos, where deep-set, predatory male eyes have morphed into open, nurturing female eyes, I am stupefied.
In the trans community FFS surgeons have a kind of celebrity status, referred to by last names and nicknames in Reddit threads and chat rooms. The surgeons also know one another—which is not to say there’s much collegiality. Dr. A had no problems showing me photos of a botched surgery performed by Dr. B. The next week I met with Dr. B, who showed me the butchery of Dr. A. Some are plastic surgeons, limited to working with flesh and surface bone. Others are maxillofacial surgeons, licensed to do Frankenstein-like things. A man from Buenos Aires performs osteotomies—cutting out the frontal sinus bone, re-sculpting it, then repositioning it in the forehead at a deeper recess—on every one of his patients. (“Otherwise, you will never look like a woman.”) “These foreigners will fuck you up,” a plastic surgeon from Chicago said, then told me I needed a facelift, neck lift, lip augmentation, and cheek and chin implants, for a price nearly double that of any “foreigner.” A team of dashing young doctors from Spain charmed the pants off me while a woman performed “Virtual FFS” across the table on her laptop. After 15 minutes she projected my photoshopped face on the wall, and there I was: Barbie.
Whatever happened to the Hippocratic Oath? Do these doctors behave the way they do—seducing and hard-selling and upselling us—because trans folks project desperation? Are their ethics loose because this is “elective” surgery, or is it because of competition among them?
Part of the Hippocratic Oath calls for doctors to admit what they don’t know. In the end I chose a surgeon who said just this—“I don’t know”—when I asked what forehead procedure he envisioned doing. “For you, we may not have to do much,” he said, “but I can’t be sure until I go in.” I liked his touch, his credentials (that he didn’t need to recite them), and the fact that he comes from a part of the world where my face is from. His fee is fair, and includes a week of recovery at a residence above his clinic. And his before and after photos: superb.
There are trans women who would never do surgery, some who elect not to take hormones, and I of course honor them. Each of us needs to find her way home.
