Trans Facial Feminisation Surgery Part 3: Sleeping Beauty in a Medical Waste Bag

NSFW: This series contains graphic images and descriptions of medical procedures.

Nov 10, 2025

This is the third article in a series about the medicalisation of my gender transition.
An edition without medical images available »HERE. Links to the other articles in this series are available below. Images are by the incomparable Morgan Roberts.

The Things That Changed While I Slept

I’d sat through the online video of my surgeon explaining the procedure, their gentle calm manner at odds with my shivering discomfort with terms like “neck flap” and “redraping the soft tissue”.

All of that was abstract for me until I saw the photos.

I’d spend so much time planning and briefing, outlining the editorial framing of the surgery that I’d forgotten that this was a tangible thing happening to me, and not someone else’s show I was producing. All the planning and thought led to this moment, the moment where there was nothing left to do but submit to the process I’d instigated. So much of transition is around the agency of the individual, having the authority over your body, having informed consent and being responsible for the consequences. Every day it is my hands that shake out the pills to throw into my mouth. Every day it’s my hands that dress me, style me, carry me through the world.

But here, you need to trust others to do it for you and that alone is terrifying.

The Sub Nasal Lip Lift

First, they guide the blade through the purple geometry inked under my nose, outlining the shape to be removed. The blood pools in the sockets of my taped-shut eyes and gathers in the pouches of my ears as they peel the wedge of flesh back, separating it from the layers below.

A careful, delicate flaying with precision steel followed close behind with the florescent yellow tweezers, the bipolar electrocautery device to seal and suppress the flow of blood. Once satisfied it was a simple matter of appropriate anchors and the careful gathering of flesh back together, all the while performing the careful dance around nerve connections and tendons.

My upper lip is now shorter, and when I became conscious it was the first thing I noticed. It’s difficult to describe the strangeness of waking up to find that your mouth is a different shape. This thing you’ve never really thought about suddenly feeling foreign, a mouth full of unfamiliar odd angles, alien to your experience.

But we’re not awake in the hospital room yet. We’re still in the surgical theatre. Unconscious. Absent. Being taken apart and put back together.

Disassembling My Face

The incisions begin at my temples, tracking down around my hairline. It passes in front of my ears, tracing the ridgeline of the tragus, to loop back under my earlobe and upwards to arc into the line of my neck. Slow they pull back and revel the layer of muscle below, electro-cauterising any excessive blood flow.

Your flesh is securely attached to the lower layers and requires careful leverage to separate it. They call it ‘ligamentous release’, the separation of the ligaments from the soft tissue to allow repositioning. These photos remind me of instructional guide on how to skin a deer, but this is anything but butchery. The delicate care they took, the gentle lifting of the membranes of my face to peer through them under surgical light. I later learnt that this was to examine the spiderweb of veins and capillaries, to ensure blood flow was uninterrupted, to check the thickness and where to scrape away fat pads and where to leave them.

The photos make me sick to my stomach, but I can still see the gentle care they took.

As they reposition my cheeks and neck there’s significant excess. This is the ‘drape’ and the ‘flap’. The dangle of the flesh of my neck hangs loose while the seeping blood is packed with gauze, left to settle as they work the other areas.

Deep Plane Lower Face and Neck Lift

While the first side rests, the team moves to my neck, making an incision under the chin. The aperture is stretched to accommodate tools and fingers, so much that the surgeon can nearly put his whole hand inside the flesh of my neck. They scrape and separate and irrigate. Some of my saliva glands are removed to make a little more room to elevate the platysma muscle.

The platysma muscle is the thin sheet of muscle in your neck that extends up into the lower face and down into the chest. It’s the muscle that pulls at the corners of your mouth. The muscle for showing sadness, for grief. Here, the underlaying shape is changed to highlight my jawline. Blessedly I managed to skip the sort of puberty that pushes out brow ridges and jawlines. While I don’t consider the bone structure of my skull to be overly feminine, I can’t help but think about how this is the moment when they would have started grinding bone if I’d asked for it.

Anchoring and Suturing

Satisfied that the seeping has abated the process of reattaching begins. All of this meat is deep-anchored in the underlaying webs of my face. Unlike the “traditional facelift” which essentially just grabs you by the cheeks and yanks backwards to give that windswept look, the intent is to anchor it all in such a way as to not pull on the outer layers. Terms like “vectoring upwards” and “repositioning volume” are used to describe how the muscle and skin are attached to the deeper layers.

The threads are pulled and the everything gathered back together. I can still feel the knots of them in my neck, tiny grains in the meat under my jawline. Now, with a gentle press and rub at them all I can think about how these tiny things, for a time, held my face onto my skull.

Addressing the excess

The skin of my face, having now been placed in a new position and affixed, needs to be addressed. The excess is significant. The flesh at my temples and ears, my jaw and my neck used to be half an inch further inland, there’s nothing left to do but sheer it away.

And then of course there’s the whole other side to do and the final reassembly of it all.

Sleeping beauty laying in her biohazard bag

After nine hours the procedure is coming to a close. It should have been a little shorter, but a needle was lost to the floor at some point. And while there was zero chance of it being left inside me hospital procedure is to halt and x-ray the patient to be certain. I’d love to show y’all the photo that Morgan took of the entire surgical team standing in the anteroom waiting while the machine bombards me. Sadly, the regulations prevent me from showing you the casual camaraderie of the team, just colleagues at the end of a long day having changed someone’s life for ever. But that photo exists, and I feel the welling behind my eyes when I look at it.

The last step is to clean me up and wrap me up. In less than 24 hours the bandages will come off and I’ll be home. But first they must perform a duty I’d never expected. Turns out the easiest way to clean an unconscious patient after extensive face surgery is to put their head in a medical waste bag and douse it with disinfectant.

I never bothered to ask how many stitches I received, but it is in the hundreds. To count at this stage would be kinda pointless. The marching stack starting at my hairline is obviously to bind the skin. Later I learnt that the sutures in my neck are to prevent fluid pooling under the surface. Apparently a relatively new practice, this initial compartmentalising the pockets of my face better allows everything to drain out of me into the two dangling bulbs.

Wrapped and greased and groggily responding to stimulus I’m deposited in my room to sleep off the aesthetic. Originally, I thought that I’d be able to say that the “hard part was done” but I know now that was hubris.

The hard part for others, yes, but the hard part for me? No.

The task of juggling the responsibilities of life and work while my body tries to knit itself back together? The task of staring in that mirror and wondering if, when, maybe I would see the face that I wish to see looking back at me? The nagging thought that this entire thing was a waste of $40,000 that could have been better spent on something else than on trying to make this tired old queer feel a little less tiered, a little less old.

The hard part wasn’t done for me. It was only just beginning.

–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.

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