[No Images] Trans Facial Feminisation Surgery Part 1: The Immovable Block of Stone
This edition does not contain images however it does describe medical procedures.
This is the first in a series about the medicalisation of my gender transition. A prologue can be found »HERE. This edition does not contain images, however it does contain descriptions of medical procedures.
The Lies We Tell Ourselves
I’ve always been seduced by the notion that “inside every block of stone there’s a statue calling upon a sculptor to set it free”. It’s the idea that “art” is the unlocking of something that already exists, the idea something that can only be realised into existence by a venerated creator.
It’s bullshit.
At best this self-centred notion mystifies a process, treating craft like magical force of nature. At worst it absolves a creator of responsibility for what they are putting into the world, they are, after all merely a vessel for the “divine force”. More than anything however, this thinking is a great way to avoid admitting how self-indulgent the artistic process can be.
I feel similarly about my transition. I’m nothing if not self-indulgent.
It’s a comfort to think of this process as “a sculptor facing an immovable block of marble”, a comfort succumbing to the romance of “revealing the beauty within”. Yes, transition sometimes feels like hefting a hammer and chisel to whittle down the block of stone that you were born as. Yes, sometimes small stokes feathering marble dust away, getting my lashes done, trying a new lip gloss. Sometimes tiny stone chips flake and shatter on the floor when I bother to do my hair, my makeup. And yes, sometimes when the frustration with the glacial pace of hormone therapy is at its peak, surgery feels like great almighty swings of the hammer knocking away chunks of stone to reveal a face I can love.
[IMAGE: a slice of flesh from my face held in tweezers by the surgeon]
The lure of this mindset fits so well.
This alluring bit of mental gymnastics allows me to weave you a tale of how I work at the monolith of my body until my hands are numb. That every day I feel the bite of the chisel, the dig of it against the stubborn, unyielding matter of “me”. Will I ever finish my masterpiece or is the imagined form pure fantasy? What of those moments of doubt where I wonder if I’m about to knock off some vital piece of marble? Cut away something precious, forever lost? This romance allows me to wistfully yearn that my body was clay, malleable, amorphous, but no, tragic figures of victimhood are sadly made of sterner stuff.
It’s all so delightfully poetic but fails to tell huge parts of the story.
If the “block of stone” is a myth designed to mystify the artistic process, venerate the artist and hide self-indulgence, what am I going to do differently here? Well, quite simply I’m going to show you exactly how a facial feminisation procedure is done. I’m going dispel the “magic” of it. I’m going to show you the application of craft and willpower, but most importantly, I’m not going to hide my self-indulgence behind some fig leaf of “artistic worthiness”.
I’m going to show you myself at my most vulnerable, because I want you to see it.
I want you to know how fucking hard it was for everyone involved.
[IMAGE: Unconscious, incubated, moments before the operation begins]
The First Steps on a Path
There’s a prologue of sorts, >>HERE. Scheduled to publish while I was under the knife, it tells of my first “gender affirming surgery”. Liposuction to siphon two litres of fat from my waistline to give me the hint of an hourglass figure.
This series is an extension of that article. It’s a journal of process and reflection, a chronicle of refusing to pretend that some magic happened. Should I succumb to the flowery romance of “like a butterfly from a cocoon the trans person emerges” it would be a monstrous disrespect to the diligence, training and compassion of those involved.
There will be no curtains drawn to hide the messy mechanics, no misdirection to smooth over the unflattering reality that a team of experts removed and reattached my face. You’ll see the carefully peeled away sections of my cheeks and neck. You’ll see the lurid glisten of muscle and tendon, the seeping fluids and the scattered debris of the pieces they cut away. This surgical team performed a technical marvel over a grueling nine-hour stretch and they didn’t “reveal what was hidden within”…
They reshaped what was there in order to create something new.
[IMAGE: The layers of my face are lifted away, exposing the viscera beneath]
No doubt the rubber-necking internet will yearn to see the flayed innards of my face immediately, but I’m not delivering this all at once. This is the first of five articles and no matter how many demands to “just get to the point and show us your face!” I won’t rush this. I won’t dishonour the people who took the time and care to change my life.
The Morning After
I wake up in a hospital bed and my head feels two sizes too large.
A noise rises in me, and I vomit into the bag already resting on my chest. Bile slides out of me as easy as breathing, as easy as saying “good morning” to the nurse already at my elbow. Yes nurse, I know where I am. Yes, I know what’s been done to me. Yes, I’m feeling nauseous, thank you for having the bag ready for me.
Bless all nurses. Every. Single. One.
I ask for my phone. I need to see. Years of self-inflicted jump-scares from accidentally opening the forward-facing camera in bed have taught me that this is a bad idea. I look anyway because I need to see the misshapen thing on top of my shoulders. My mind flashes to Jack Nicholson in the 1989 Batman film demanding a mirror and wondering if I’m going to smash the screen of my phone on the bed rail and laugh manically at the sight of what’s been done to me.
A thumb-like face gazes back at me, cocooned in gauze, smeared with ointment.
[IMAGE: I’m in bed, still wrapped from surgery the day before. I look like shit]
In all those movies where someone undergoes a facelift, they have a delicate layer of wrapping over their face. The thinnest possible bandage so the audience can see the hinted promise of the beautiful form beneath. Fucking bullshit. Mummified in bandages, greased up and eyes that, despite being unconscious for the better part of twenty hours, look more tired than they’ve ever looked before.
But it’s done. Soon I’ll see my new face.
[IMAGE: We spent the night before eating pizza and watching movies]
FACE/OFF
The night before the surgery I sat my wife and dear friend Morgan, the photographer, down to watch the highly-regarded surgical documentary FACE/OFF. Lovingly brought to life by Nicholas Cage and John Travolta, the film has a spectacularly dumb depiction of the procedure. Sadly, there was no strange suction device to vacuum off my face, but we certainly laughed at the absurdity of it. Even now, a year after the procedure, I can’t help but think of Nicholas Cage when my face itches. I picture him handcuffed, rubbing his itchy post-op face on a concrete wall every time the severed nerves in my face jolt back to life.
They really do feel like ants under my skin.
But we’re not in long stretch of recovery yet. No, we’re still in the hospital. Numb. Sick… but still smiling for the camera.
[IMAGE: Smiling from my hospital bed]
She’s a “thrasher”
Waiting for my surgeon to show me what I now look like, I’m dying for a piss. I’ve neither the coordination or strength to get out of the bed, so the nurse hands over the bottle and asks if I know what I’m doing with it. It takes all my effort to force my body to relax. I pray the skerrick of nauseating anaesthesia still in my veins will assist. A thought drifts to the surface “Didn’t you have underwear on before?” It’s joined by a second, “Is that a scrap of medical tape on your inner thigh?”
When I finally relive myself it comes as a stuttering rattle. My tract feels like squealing copper pipes banging inside the walls of this old house. Oh, yeah, they had a catheter in me, right? And the thought, “Someone’s been handling my penis while I was unconscious?” bubbles up to the now solved no-underwear-medical-tape mystery. All these odd thoughts would be terrifying in a different context, but here… they’re just tossed to the side.
The nurses catch me up on the gaps in my memory. Apparently, I’m “a thrasher”.
[IMAGE: Wrapped in gauze, clutching the doctors hand]
I’m told that as the surgery ends the anesthetist brings you back to the surface quickly, something like twenty minutes apparently. I’ve no memory of it, apparently my becoming “responsive” involved a fair amount of grabbing and reaching and flailing. If they didn’t give me a hand to hold onto, I’d blindly grope for purchase. Eventually they had to restrain me, lest I damage myself.
More uncomfortable thoughts for the growing pile.
Drifting in and out of weary, exhausted sleep, I wait and wonder if when I’m finally handed a proper mirror I’ll see “her” staring back. In the past I’ve only ever caught glimpses of that woman. Brief moments in the mad dash to get out the door, in the rush to throw on makeup or fix my hair, she’ll be there in the mirror and then gone… the woman I’m supposed to look like.
The (Not So) Big Reveal
Finally, the doctor arrives and they waste no time. It’s only been fourteen hours since they closed and wrapped, but they’re just as excited to see as I am. My mind is again on all the tropes of unraveling layer after layer in mounting tension for the big reveal but it’s just a few snips of tape and my headwear comes away in one piece. Cool air is on my cheeks.
[IMAGE: Battered and bruised, barely able to walk]
The surgeon is delighted and gets me to go through a series of facial expressions, smiling, blinking, baring my teeth. They need to see if the nerves have survived, and there’s no better way than to snarl like an animal.
They gently explain all the ways that this is magnificent success while I gaze into the hand mirror. The person staring back at me is not the one I expect. My face is swollen, puffing out all definition and detail. It looks like a mottled mask affixed to my skull. The realisation hits that this whole time I didn’t know what I was expecting, I hadn’t really imagined what I would look like. I understood all the technicalities of it. Understood that just a few hours ago this surgeon removed and reattached my lower face and neck. They carved a sliver of flesh away from my upper lip and scrapped away the fat from the interior of my cheeks. And now, drains still gently pulling crimson fluid from my face, I’m told I am allowed to dress, I’m allowed to leave.
I grip the hand mirror tight. There’s pressure in my chest. “Will I see her?”
But no, there’s no reveal, not yet. Not even a glimmer.
All I can see is the face of a middle-aged transgender woman. A woman who dropped forty thousand dollars on the hope that knocking off a few chunks of marble would reveal the entire statue. I wonder to myself if I’ve made a huge mistake.
Yet another thought for the growing pile of things I’d rather not think about.
–S
The images and text published here are an individual case do not constitute a testimonial or medical advice. Any surgical or invasive procedure carries risks. Before commencing your surgical journey, please seek medical advice from an appropriately qualified health practitioner.
More in this series…
“I paid to have my face cut off and reattached”:
Facial Feminisation, Liposuction and the Hope of Change.
Published while undergoing facial feminisation surgery in 2024, this article describes liposuction and waistline crafting, my first transition surgery.