Trans Facial Feminisation Surgery Part 2: The Veil of Dignity and Vanity

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

This is the second 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.

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“Nothing should be held behind the veil of dignity or vanity”

This was the key instruction to my photographer and surgeon. I told them that if we’re going to document this, then we can’t hold anything back. We can’t flinch from showing the reality of what my face looks like with the flesh peeled away. I explained how the reader needs to see the slump of my unconscious form, tongue lolling around the intubation tube. They need to see the scatter of debris, the glistening red pieces of me that fall to the floor, trodden underfoot.

I told them that my dignity or vanity is secondary to people seeing the reality.

And you will see it.

You’ll see the inside of my face, no matter how uncomfortable it makes me feel.

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An Argument For Not Answering Your Own Phone

I should’ve guessed that convincing a hospital to let a photographer document a surgery would be difficult. It only dawned on me after my first discussion with the clinic practice manager. This led to conversations with the clinic business manager, their surgical coordinator, and even a session with their marketing and PR consultants. I had to learn not just about the minutiae of the surgery to adequately brief the photographer, but also the legal constraints of what constitutes “a testimonial” for when I publish.

I also learned that if you’re the vice-CEO of a hospital who’s been dodging a trans woman’s calls you shouldn’t answer the office line when your executive assistant is on lunch. Yeah, that’s how I finally got this to happen. Persistence, a little luck, and a background in events management.

After days of doggedly calling, I got them on the phone and laid it all out. Ya girl can be very persuasive when she wants.

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Back to the Morning After

Morgan, my photographer, arrives and slumps into a chair.

He’s working his breakfast croissant into his mouth, smiling at me like he knows something I don’t. Which is true. He knows what the inside of my face looks like. I ask him if he “got it”? He keeps smiling, his hands absent-mindedly moving across his camera equipment, twitching over the settings.

I’ve lost count of the shoots that I’ve done with this man over the last decade. Him firing, me over his shoulder directing, us both coaxing reactions out of our subjects. I know when he’s got something good. I can see it in his body, the set of his shoulders. I don’t need to look at the monitor to see if the client brief has been satisfied, I just need to look at his posture. He becomes playful.

“Yeah. I got it.” he says like it’s no big deal, grinning through flaking pastry.

He starts shooting, playing, capturing the dim morning light as it streams through the plantation shutters. Nattering away in that gentle manner that he does, that way that always puts me at ease when I am tense about a photoshoot. Of course, here, instead of fretting about the set dressing, the hair, the makeup, I wait, exhausted for the surgeon to unwrap me and survey their work.

It’s a shame I can’t tell you the surgeon’s name or even the name of their clinic.

The AHPRA (Australian Health Practitioner Regulation Agency) rules are enough to strike fear into the heart of any cosmetic procedure provider. So much so I nearly scuttled this entire endeavour when first raising that I was going to write a piece that profiled “the care and consideration”. My offer to publicly recommend the clinic to others in the transgender community was met with a firm response.

No. Absolutely not. No way. Not allowed do that.

I did a fair amount of walking back. I listened to the wide-eyed stories of diligent operators being scooped up along with the shonky quacks (like the one that did my liposuction) and being drummed out of the business for the smallest infractions. Stories of surgeons being fined thousands because the lighting in their “before and after” web galleries was ever so slightly inconsistent. The rules are there to protect patients because there are operators out there who lie and mislead. It’s just the nature of the sector. So, in addition to not being able to give you names I’ve also scoured every photo to erase any logo or branding from the clinic or hospital. I’ve had to ensure every face was obscured; every identifying feature scrubbed from existence lest this be considered ‘an advertisement’.

It isn’t that they don’t want to be known for this work. It’s that in doing so, would land them in a level of legal trouble that could end careers. So, to make sure that there’s no doubt in your (or an AHPRA rep’s) mind: This article is in no way a recommendation to undergo facial feminisation surgery. The results depicted are unique to me and me alone. This series is for ‘entertainment purposes’, and I urge anyone considering cosmetic surgery to consult with their general practitioner.

But what I can tell you about my surgeon are the small moments.

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Disney Animators, Surgeons, and Long Walks Home

Waiting for my surgeon on the morning of my procedure I couldn’t help but anxiously knead the flesh of my face. Pinching my cheeks, pressing that soft form that had always felt as just being ‘hung’ from my skull.

Taking her for one last spin I suppose?

When my surgeon steps through the curtain, the warm reassurance of their presence is enough to bring a flood of relief, and I think I might cry. They pull up a stool and sit me on a chair while unpacking a pencil case onto the bed. It’s not unlike the pencil case sitting on the desk next to me full of graphite sticks and pastels. Theirs is full of surgical markers, callipers and guide rules. We sit facing each other, knees intertwined in that way only lovers would sit.

There are kind words first, but then I see their focus shift.

They aren’t looking at me now… they are looking into me, at the mechanics of me. I can see them visualising the structure of my face, my neck, my skull. They’re examining the texture of my skin, the way it lays over my jaw, my neck, the way my hairline sits, the fold of my earlobes. They’re considering the flesh with which they will work.

I sit as still as I can while the ticking of their mind considers me.

With a royal purple pen, they start marking out lines, annotating my face. It tickles, especially under my nose where they carefully trace the outline of flesh to be removed. I see the corner of the surgeon’s mouth twitch. For a moment I think they’re smiling at me, maybe laughing at some private joke? No, they’re just making footnotes on the margin my cheek. It happens again and I recognize the gesture.

I’m instantly catapulted back in time. A small child sitting on the rug, far too close the TV.

On the screen is one of those behind-the-scenes featurettes on a Disney VHS. I’m watching old-school animators at their upright desks, fingers fanning pages of key-frames while they grin and scowl and snarl into desk-mounted mirrors. They use their own faces as motion reference for when the anthropomorphic lion or bear performs a musical number.

I do it too when I’m drawing.

Artists pull faces while we work. We connect our own face to our minds, our minds to our hands, our hands to the thing we’re crafting. Only here this is not some scheming animated animal or demure princess being crafted. This ‘artist’ is thinking about how my face will work after they cut it apart and stitch it back together and, without even thinking about it, they’re moving their own face to ensure they’re understanding the anatomy right.

My surgeon caps their purple pen and tells me it’s time.

I’m given the choice: walk or be wheeled.

I choose to walk down the corridor to the surgical suite, my toes sticking out the ends of my compression socks to touch the cold industrial linoleum. I go slow, reminding myself to stay present in the moment. The thought that all this could go horribly wrong flashes through me. The thought that this moment could be one of my last, or worse, that it does wrong and I survive it, to live every day with a horrible reminder staring back at me from the mirror.

As fast as the thought comes it’s gone, slung onto the pile with all the other things I’m choosing not to think about: My wife, standing alone in the elevator having just told me “I love you, I’ll see you soon”. The thought of her lonely drive home, her worry and concern wrapped up tight so as not to leak out.

The pile is getting large.

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White and blue and gleaming brushed metal

The surgical suite is bright and full of people.

Everyone looks up as I enter. I get that unmistakable feeling of stumbling upon a group of people who were just talking about me. Like rounding the corner of the schoolyard and seeing the cluster of cool kids look up at you and suddenly go silent.

But of course, they were talking about me, it’s why they’re here.

So no, not schoolyard bullies, but friends. They all smile behind their blue masks and tell me their names. The kindness of their eyes is only surpassed by the gentleness with which they guide me to the bed. They do their checks, ask me my name, my date of birth, the procedures I’m getting done.

The team has affixed a row of photos of me to the wall, reference material taken at the clinic last week. My face… my soon to be “old face” is staring down at me on the narrow surgical table. She’s watching me, that face, watching like something that knows it’s about to be left behind. Unbidden I think about a sad old dog left on the side of the road. The details of it being lost as it recedes in the rear-view mirror.

I try not to cry.

When all this began, before I even found my surgeon, I told myself that this face won’t be ‘new’. It will still the same skin, the same forty-something-year-old flesh, just rearranged. Before I’d had that first consultation, I kept reminding myself that it may not even be prettier to look at. All those naive hopes to have the high-cheek-boned vampiness of a 1930’s femme-fatale starlet, dangerous and queer and a little bit tragic, will likely never come to fruition. Hell, I may even look “strange” afterwards. Strange in that way you see people who’ve pushed the surgical envelope. The “Mar-a-lago Face”, eye-lifts so elevated that there’s not a single smile line crease around their eyes. Those legions of uncanny valley mannequins frozen in the perfect simulacra of a person with luxury meat-masks crafted to signify wealth and status.

But then I found a doctor who immediately understood the fear I carried.

Their kind reassurance of the realities hit me hard. They explained how this surgery won’t suddenly turn me into the twenty-something woman I wish I’d gotten the chance to be. They weren’t even going to attempt something like that. No, this face, whatever it is reshaped into, can never achieve that, but it will be different from what it was.

Tomorrow I won’t have the face I want, but at least it won’t be the face I don’t want.

They push the drugs, and I wink out of existence for nine hours.

–S

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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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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.

Trans Facial Feminisation Surgery Part 1: The Block of Immovable Stone

Unwrapping the aftermath, Nicholas Cage and the lies we tell ourselves.