Story of a face
March 21, 2018 1:43 AM   Subscribe

The New Yorker on facial feminization surgery. Challenging gender norms, beauty standards, the fraught notion of "passing," and affirming one's true self. (Note: contains somewhat graphic description of surgery about halfway through.)
posted by stillmoving (52 comments total) 29 users marked this as a favorite
 
That was focused a lot more on the process than anything else. Not that process is unimportant, but I don't particularly care about the surgeon's shoes or snack breaks. I'd have preferred to hear from the patients how it changed their daily life.

Also, why nothing on AFAB? Is it really true that growing facial hair means that you pass as a man, even if you're short?
posted by Trifling at 4:34 AM on March 21, 2018


Trans men who have access to hormones certainly tend to have an easier time of passing, in general (there are exceptions of course) because testosterone causes the voice y to break as well as facial hair growth, etc. Short men are less unusual or remarkable than very tall women. Slight men are less unusual or remarkable than very wide-shouldered women. There also isn't really much of a trans male equivalent to FFS.
posted by Dysk at 4:41 AM on March 21, 2018 [19 favorites]


I am getting FFS next year. I had GRS this past November.

This here: And, for all his patients, having more feminine faces meant that they were less likely to find themselves the focus of invasive, prurient interest

Being in a locker room at the gym, naked with other women, getting these looks from people is too much. The fear I feel and have to overcome every time I walk into a restroom or locker room has convinced me to get FFS. I cannot stand the looks of fear, disgust, then relief I get when people see me walk in (fear) watch me undress (disgust) then see I have a vag not a penis (relief).

So yeah AMA.
posted by Annika Cicada at 4:48 AM on March 21, 2018 [71 favorites]


Also wow does the New Yorker need a copy editor. Insure != ensure.
posted by Dysk at 4:54 AM on March 21, 2018 [10 favorites]


The article: "Most insurance companies still classify facial feminization, which can cost as much as sixty thousand dollars, as an elective surgery."

Yes, that's because it is. Any surgery that isn't "get to OR right now or you might die" is an elective procedure, pretty much. It doesn't mean optional.
posted by Dysk at 4:59 AM on March 21, 2018 [7 favorites]


Also, why nothing on AFAB? Is it really true that growing facial hair means that you pass as a man, even if you're short?

Because we don't exist, obviously. /sarcasm It's certainly not true that transmasculine people on testosterone just grow facial hair and are therefore read as male (which is what the article implies)-- facial hair obviously isn't everyone's thing, ability to grow meaningful facial hair varies just as widely as it does for cis men and not everyone on testosterone is read as male consistently, regardless of facial hair. (There is facial masculinization surgery out there, but it's like a footnote to a footnote to a footnote.)

The "because we don't exist" was sarcastic, but the invisibility is actually relevant here. Transmasculine people's genders are read and policed differently to transfeminine people's genders and it has to do, in part, with a general assumption that transmasculine people don't exist--if you get read as male, most people will read you as a cis man by default. Anyway, it adds up to a fairly different experience. I'm happy to chat over me-mail or whatever, but it's kind of a derail here.
posted by hoyland at 5:13 AM on March 21, 2018 [48 favorites]


I might think differently if I were an insurance company, but to me surgery that can resolve serious issues (like "looks of fear, disgust, then relief") for a person should be in a different category from "elective," aka "you're on your own, good luck." I was glad to see in the article that at least a few insurance companies are doing so; I hope that becomes the standard of practice.
posted by Dip Flash at 5:16 AM on March 21, 2018 [10 favorites]


Sure, it should be covered. So should lots of other elective procedures, kunne catarct surgery. "Elective" just means not an honest-to-god life-threatening emergency.
posted by Dysk at 5:20 AM on March 21, 2018 [7 favorites]


And like, I am a trans woman. I do not pass. Like, basically ever. I am very familiar with those looks. I've also had trans-related surgery that was covered on the NHS and that was elective too. So are all the hip replacements that people have done on insurance. Elective has a medical definition, and in medical contexts, that is the one that should be used. Implying that surgeries like these are emergency procedures (which is the alternative to elective) is disingenuous at best.
posted by Dysk at 5:23 AM on March 21, 2018 [13 favorites]


In my particular case I have great insurance with amazing coverage for trans people and I’m getting all my stuff done at Mayo Clinic so it’s mostly hassle-free aside from the actual getting the surgeries.
posted by Annika Cicada at 5:38 AM on March 21, 2018 [5 favorites]


I have insurance, and I mostly like my face. But I also have no idea if I pass or how to know for sure. I imagine my voice is a bigger liability, and face surgery scares me more than other surgeries for some reason. I'm gonna go ruminate now.
posted by ikea_femme at 8:02 AM on March 21, 2018 [4 favorites]


face surgery scares me more than other surgeries for some reason

Good reason. ANY surgery has risk of complications, MRSA, etc. And your face is connected to your vision, smell, taste, brain and all kinds of societal things. I'm cis-het, but I considered an elective surgery for my misaligned jaw at one time, and decided against it. Not being judgemental about the (extremely interesting!) article, just my own take after consulting doctors.

I have some tooth problems now, 20 years later, that would have been mediated had I done the surgery, but I'm still fine with my decision.
posted by jeff-o-matic at 8:10 AM on March 21, 2018 [1 favorite]


True. It's just hard. Especially to hear it works well for so many people. And I don't know if I can be a fair judge of my own appearance, or how it factors into passing or being comfortable with myself.
posted by ikea_femme at 8:39 AM on March 21, 2018 [1 favorite]


There is no way to ever know for sure and just because you can get trans surgery doesn’t mean you have to. I started all this at 38 years old and I’ve spent 5+ years pondering it and I’ve landed on “fuck it, it’s available I’m going to do it all”
posted by Annika Cicada at 8:55 AM on March 21, 2018 [10 favorites]


Passing isn't mandatory. I have issues with my face (much like I do with the rest of my self) but I have no interest in FFS, partly for political reasons (though it isn't in anyone to take a stand if they don't want to) and partly because I strongly associate faces with identity. Me with a different face wouldn't be me anymore (this does not generalise to everyone else). Whenever I get the looks (which is a fucking lot) or the scrutiny, or I get misgendered (again, happens a LOT) I am pretty adamant that it's the other fuckers who need to change, not me.
posted by Dysk at 9:11 AM on March 21, 2018 [23 favorites]


I guess I do have my whole life to think about it. I sort of miss acceptance being the best and only sustainable option.
posted by ikea_femme at 9:12 AM on March 21, 2018


This was a very interesting article and I appreciate so much the discussion here.
posted by cooker girl at 9:58 AM on March 21, 2018 [3 favorites]


This hits hard. Just the other day I caught a really unflattering view of my unshaved mug in my front facing phone camera, and got stuck in a "What are you doing, holy crap you're f'ugly!" loop for a moment.

A huge part of my coping strategy and skills is basically "You're always going to look weird and like a freak, but you're kind of used to that, and at least you'll be a happy freak."

That and "Your insides better be both beautiful and tough, because you're going to need all the good friends you can get."

Trying to be a good person on the inside definitely has helped me ignore slings and arrows in the past. "You're a freak!" is easier to ignore when you've got "Well, at least people like me and I sleep pretty easy at night." in your pocket.
posted by loquacious at 10:19 AM on March 21, 2018 [21 favorites]


When I started all this I said to myself "it's probably a good idea to wait 5 years before getting surgeries just so I can discern between "What has HRT done for me, to me and against me" and "what about my body will cause me a lifetime of physical dysphoria that needs to fucking change?".

And yeah, it was right around the 5 year mark of coming out that I had GRS and right after that everything clicked that I really could personally benefit from all the options available to me.

Everyone is different, YMMV, but I can say as a blanket statement that I don't recommend anyone cavalierly making any of these decisions. I feel like I was a little too glib and blasé going into GRS and that the aftermath and recovery fucked me up big time in ways that I was not prepared to handle (and odinsdream, you seriously helped me stay sane and alive through that all the love and hugs are sent your way). So going into the other surgeries, I feel like I'm better prepared now to experience deeply profound and fucked up feelings that push me to the limit of what I can handle physically, emotionally and psychologically, but will make my life so much better off in ways that I can't even begin to understand with where I am at now.

It's a fucking crapshoot that's for certain.
posted by Annika Cicada at 10:25 AM on March 21, 2018 [21 favorites]


It will be interesting to revisit these stories in another generation or three. In a hopeful future that embraces trans people, accepted standard medical care will include giving trans children supported access to puberty blocker/inhibitor medicines that delay or prevent the aggressive physical changes caused by sex hormones at puberty; the trans girls among those children may never want the intervention of facial feminization surgery. But much like Abby in this story, not every transfeminine person is going to perfectly decide their gender identity before puberty hits, so we need to keep improving the surgeries and improving access to the surgeries as accepted standard medical care as well.
posted by nicebookrack at 10:33 AM on March 21, 2018 [6 favorites]


Yeah, GRS recovery is no joke, emotionally and psychologically. It wasn't nearly as bad as I had anticipated, physically, considering how thorough and invasive a procedure it is. I can barely imagine what FFS recovery would be.
posted by Dysk at 10:34 AM on March 21, 2018


the trans girls among those children may never want the intervention of facial feminization surgery

Hi, some of the trans girls of this generation - even some of us who came out in adulthood - don't want the intervention of facial feminization surgery.
posted by Dysk at 10:35 AM on March 21, 2018 [10 favorites]


I'm sorry, Dysk. I assumed it was self-evident from your thoughtful discussion upthread that not every trans woman or transfeminine person is going to want surgery, but I definitely should have said that explicitly. Trans people aren't a monolith, and surgery has nothing to do with gender identity.
posted by nicebookrack at 10:54 AM on March 21, 2018


Also wow does the New Yorker need a copy editor. Insure != ensure.

They have them but they're preoccupied putting umlauts on everything
posted by Automocar at 11:50 AM on March 21, 2018 [23 favorites]


*preöccupied
posted by Faint of Butt at 11:54 AM on March 21, 2018 [33 favorites]


I'm kind of eh on these utopian wishes for the future where trans people transition as children/teenagers that crop up in what seems like every thread. Not only does it fall for this idea that everyone knows their gender when they're small, it subtly pushes this idea that transitioning as an adult (or after puberty) is somehow unremittingly awful. This is not without cost--trans forums are awash in people saying "I'm too old to transition, I might as well kill myself." But, also, it's not the best feeling with other people's utopian wishes for the future involve wishing your experience out of existence. Make your utopian wish that people are able to transition with minimal friction when they're ready, whenever that might be.
posted by hoyland at 12:28 PM on March 21, 2018 [39 favorites]


*diäëreses
posted by Faint of Butt at 12:31 PM on March 21, 2018 [11 favorites]


Thank you so much for saying that about transitioning when you're ready, hoyland. That's sort of my feeling, too. It's sort of a tied-up mass of worry involving wishing the best for everyone, while acknowledging that what's best and what's possible will always be different for everyone.

But my feelings about this whole FFS thing are so complicated, which is why I'm so grateful for the differing perspectives here. Thank you for posting the article, stillmoving, and to everyone for talking about it.
posted by elsilnora at 1:24 PM on March 21, 2018 [6 favorites]


actually, they're diaereses, and they appear only on doubled vowels

are... are you a New Yorker copywriter
posted by Automocar at 1:25 PM on March 21, 2018 [6 favorites]


actually, they're diaereses, and they appear only on doubled vowels

Actually is unecessary; the correction identifies itself. A careless reader may be led to believe that diareses appear on all doubled vowels instead of subsequent vowels pronounced differently than their predecessors.
posted by The Gaffer at 1:45 PM on March 21, 2018 [9 favorites]


Man, if I'd had access to hormone blockers as a kid, I might still be on them. I'm increasingly confident that my gender identity is somewhere between female and agender, not between female and male, and I might have been pretty happy with an adult version of my ten-year-old body.

My utopian vision is a lot more about everyone being able to make choices about what their bodies look like and do, freely and without ruinous expense, than it is about anything gender-specific. I went to a panel on trans representation in science fiction a couple years ago, and one of the panelists talked a bunch about that, and it resonated with me in a way that conversations about dysphoria and always knowing you're a different gender than assigned ever did. It made it a lot easier to think about my body and my self-image as something unique to me, that I was allowed to control, rather than something that needed to fit into a box even though I'd never found a box that quite fit.
posted by restless_nomad at 2:53 PM on March 21, 2018 [18 favorites]


Reëlection

Diaereses.
posted by jeff-o-matic at 3:00 PM on March 21, 2018 [3 favorites]


The SF author John Varley wrote a lot of stories set in a future where gender changing is commonplace. In fact it's basically expected that people will change their gender multiple times over the course of their lives. At the time (1975-) this was all very new and shocking, but in retrospect it's pretty amazing that everybody (*) is so binary.

(*) Technically not everybody, there's actually a colony of religious cultists who surgically remove all sexual and other distinguishing characteristics because they believe gender dimorphism is a divine punishment, but I think that's just lampshading the issue.
posted by Joe in Australia at 3:19 PM on March 21, 2018 [3 favorites]


My utopian vision is a lot more about everyone being able to make choices about what their bodies look like and do, freely and without ruinous expense, than it is about anything gender-specific

You and me both. I don’t even understand what gender is or why I should have to give a fuck about having one.
posted by Annika Cicada at 3:26 PM on March 21, 2018 [9 favorites]


that said the world being binary I feel way more comfortable being defaulted into womanhood than I do being defaulted into manhood and when I try to roll as nonbinary I’m defaulted into manhood so I just decided that I’m better off pragmatically trying to being read as a woman. So I ended up in this weird binary femme presenting nonbinary trans person situation where I don’t really fit in anywhere.
posted by Annika Cicada at 3:31 PM on March 21, 2018 [11 favorites]


This is a bit of a sideline but what is an online trans forum that those in the know would recommend. Maybe something with the quality of conversation Mefi tends towards in its best moments?

(can memail me if this is too far afield for this thread)
posted by kokaku at 3:34 PM on March 21, 2018 [1 favorite]


I'd appreciate that, too. If anyone knows, memail me.
posted by ikea_femme at 3:43 PM on March 21, 2018 [2 favorites]




So I ended up in this weird binary femme presenting nonbinary trans person situation where I don’t really fit in anywhere.

For the record and conversation, this is essentially what I'm aiming for, and it's not just realistic expectations or settling. It's a really complex mixture of managing expectations and trying to find one's true self and expression.

On one hand, the boy-mask I've been wearing is uncomfortable and doesn't fit at all any more, and never really did.

On the other, my younger and more naive ideas about what I like about feminine style and expression aren't it, either, as they range from basically expressionless "safe" and even dowdy clothes like all black and floor or ankle length everything - and these traits are definitely known coping strategies other trans femme folks have gone through.

On the other other hand, while going andro and genderpunk is fun and a fairly appropriate reaction to having to go through puberty again, this time usually with even less support and approval, but it's also clearly sometimes a defensive mechanism and the "street face" of a lot of trans folks. Like "Yeah, I'm different. I'm also spikey and you don't want to fuck with me."

And actively knowing and aiming for this sort of andro and in-between state was also one of my cogent arguments for treatment under informed consent, in that I've already spent all of my life not fitting in anywhere, anyway. I'd want to hang out with the girls at school and at recess, and they'd reject me both for being physically a boy but also not socialized or experienced in how to express myself in the first place.

And when I was forced to hang out with the boys I was mainly picked on and beaten up a lot, and they definitely didn't like how much I wanted to talk about feelings or other traits.

And this is also why when people ask me to define my gender I'm still resistant and prone to answer "I'm just me. I am my own gender and expression."

And I might as well try to be comfortable and have fun with it.

And thankfully people are starting to listen and get it and understand that gender dysphoria is not only very real, but it's also incredibly awful to go through. It is both painful and confusing.

And part of that understanding is, thankfully, how much our culture's rigid gender roles and expectations have a lot to do with making all of that even more awful.
posted by loquacious at 3:54 PM on March 21, 2018 [15 favorites]


Also, the "I'm spikey, don't fuck with me" thing is definitely one of the reasons I've been working out so much the last few months. I definitely want to look good and like my physical body, too, but it's mainly about self defense, keeping my strength up and also really wanting to take care of my health because I feel like I'm worth taking care of now.

I'm honestly used to being able to naturally defend myself and having that privilege, and I don't intend to give it up.
posted by loquacious at 3:57 PM on March 21, 2018 [9 favorites]


My final form (which I am already on the inside, just making the outside catch up) is tomboy tweefemme skater punk
posted by Annika Cicada at 3:59 PM on March 21, 2018 [6 favorites]


Can “genderclash” be a thing? I wanna be genderclash.
posted by Annika Cicada at 4:02 PM on March 21, 2018 [13 favorites]


Let it be known that genderclash is officially a thing, and Annika is genderclash.

Is 80s powersuit punk a thing? My internal/final form is really - augh, stop typing, fingers, no why - is somewhere more over near the 90s Cheers Kirstie Allie and Kate Mulgrew axis, at least sartorially. But more house/goth/art culture. And black is a color choice, I swear.

Yoga/granola/bikepunk is also a thing around here that I like, which is often hoodies, bike-friendly skirts over sport tights/leggings or yoga-ish pants.
posted by loquacious at 4:21 PM on March 21, 2018 [4 favorites]


Ugh, I wish I hadn't started reading that before work. I guess I'll be spending today in a death spiral of dysphoria.
posted by Pong74LS at 6:02 AM on March 22, 2018 [1 favorite]


I just wanted to say that seeing other trans mefites chime in makes me happy to not be alone. It's a small thing. But the world often feels so overwhelmingly, and it leaves me so weary and feeling like I'll never not be the isolated outsider.
posted by allium cepa at 2:03 PM on March 22, 2018 [4 favorites]


If I survive this, and have the funds, FFS is somewhere in my future.

I'm older, and I know I'll never look like what's in my head. And it's a bitter pill sometimes. But my face is not mine and no amount of time on HRT is going to resolve the worst issues. And I want someday to look in the mirror and put a hand up to touch what is there Is see my fingers touch my face

And I know part of it is seeing my family echoed through my face, and that bothers me in ways I can't quite pin down. But it's real and I'm never going to get any relief unless I change this.

Even if it is incredibly scary.
posted by allium cepa at 2:59 PM on March 22, 2018 [3 favorites]


And oh god. I finally had a chance to read TFA.

"...she experienced one of those dreams that stay with you long after waking, like a prophecy. In it, Sofia sketched a portrait of Abby, and held up the finished work. The woman in the image was extremely feminine, like a model, and Abby felt a jolt of recognition. She thought, That’s me."

I'm trying not to break down, because I had a similar dream shortly after I *knew* and had stopped lying to myself.

In it I saw myself in the mirror, and though it was a completely different face, I knew it was me. And then the person in the mirror smiled at me, and reached out a hand to touch my face. And I felt forgiven, somehow, accepted. Relieved of some burden I didn't even realise I was carrying.

I wonder how many of us have such dreams.
posted by allium cepa at 5:26 PM on March 22, 2018 [3 favorites]


I wonder how many of us have such dreams

For me once a week about?
posted by Annika Cicada at 3:49 AM on March 23, 2018 [1 favorite]


I wouldn't say that I dream of an idealized body or even have an idealized body beyond "reads female and doesn't make me dysphoric." I have trouble keeping track of what on my face is meant to be masculine or not. I know I feel better minus testosterone and plus estrogen. And I'm pretty sure I'd rather not have a dick. It's interesting to me that some of my trans friends have an ideal self and some do not and there are shades in between. ("the hottest version of me" or "how I'd look if I had blockers")

But I'm bathing in privilege. I started relatively young at 27, the hormones worked well, and I came out to myself on a college campus where nobody would bully me.

I have had some dysphoric nightmares. Those are weird. And would probably be more comic than educational for a cis audience.
posted by ikea_femme at 3:20 PM on March 23, 2018 [1 favorite]


I don't actually remember dreams on any regular basis. So when I have one that persists long enough to be retained consciously it really stands out.

Dreaming I saw my face and it was feminine was a shock. I could not have drawn you the face when I woke up. But the emotions were overwhelming. Which isn't really that weird because I've seldom experienced strongly narrative dreams. They tend towards successive washes of sensation and emotion.

I've not remembered a similar gender-aligned dream since. But I've probably only had a handful of dreams persist to wakefulness in the year and a half.
posted by allium cepa at 1:46 AM on March 24, 2018


Ikea_femme - I don't really have an idealized body. I know traits I feel strongly about. But in the end it will be more about feeling better and not dysphoric.

At this point I've never experienced identification with what I see. I honestly have no idea what that feels like. I expect it will be a shock when it happens.
posted by allium cepa at 1:49 AM on March 24, 2018


if anyone here wants to read a bunch of shit I've written about being trans here's this: The Lipstick Ends Of Tomboy Femmes

I can also email you a copy of the PDF, send me a PM and ask me!

HTH. Hugs offered.
posted by Annika Cicada at 7:53 AM on March 24, 2018 [3 favorites]


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