How Essential Is My Facial Feminization Surgery?
I took a selfie in the back of the kitchen of the hotel where I worked during the first year of my transition. My face bathed in fuchsia light, I stared into the camera at 45 degrees, my preferred angle, still, because it makes my jaw and my chin look smaller. I typed out, “Once I cut off half my face it’s over for you bitches” in the caption and hit post.
I look very different from the girl in that selfie now. I no longer wear turtlenecks, nor do I part my hair to the side. Only rarely do I put on eyeliner or eye shadow these days. The forty or so milliliters of estrogen that I’ve injected into my thighs since posting it have softened some of the harder edges of my now-thirty-one-year-old face. My jawline and the shape of my chin, though, remain.
They would have looked different if things had gone according to plan. I was supposed to have facial feminization surgery on March 31 (FFS, for efficiency’s sake), a medically necessary procedure that would have reshaped my jaw and chin, along with other bones and soft tissue in my face. Wanting to “cut off half my face” is a flip way of leaning into the full extremity of my want, one that I try to save for when I’m talking to other trans people about it. With them, I might joke that I can’t wait for my jawless victory. Chopped and screwed. A wordless “Cut it out!” hand swipe thudding dully at my mandible. But when I’m talking about it with cis people, as perhaps I am right now, I like to choose my words more carefully.
There’s a lot of loaded shorthand one might think to use when describing this procedure—or, rather, this set of procedures performed simultaneously with the end goal of changing how one is perceived, by both oneself and others. I would try, for example, to circumvent saying something about wanting to look more feminine, much less wanting to look like a woman, to avoid giving whomever I was talking to license to think they know what a woman should look like. True, the surgery literally has the phrase “facial feminization” in the name, but what does that mean? What does a feminine woman look like? Whom do you picture when I ask you that question? Is she fat? Is she white? Do you want to fuck her? Do you want to be her? How do you feel about your answers? Would you want to share them with the rest of us?
These implied questions are why I prefer to say that I still want to look like me but just . . . a different me. A me who lived another life. A me from another timeline, one where I might “get drinks with the ladies” or hear a coworker whine about “wedding season” and know what she meant. One where I might think, It’s just a face-lift, or pity the poor girl who had hers delayed.
Nineteen days before my scheduled facial feminization surgery, I read reports that New York’s governor might cancel elective surgeries on account of the mounting COVID-19 pandemic. The logic made sense to me: Hospitals in the state had a limited amount of personal protective equipment and hospital beds, both of which would become even more limited with each surgery. Canceling elective surgeries to keep people away from the hospital made sense, I thought. Not that it would affect me. My surgery wasn’t elective—it was medically necessary. It said so right there in all three of the letters I had to get from various health professionals in order to argue my case for insurance coverage.
Like this one, from my psychiatrist:
“Ms. Walker meets criteria for the medical necessity of gender affirmation surgery (Coleman et al., 2011). In line with [the World Professional Association for Transgender Health’s] position statement on the medical necessity of surgical interventions for transgender persons, facial feminization surgery (FFS) is not an elective procedure for Ms. Walker insofar as the purpose is not solely to improve her physical appearance, but also to treat her persistent and well-documented gender incongruence.”
I emailed the hospital just to confirm what I thought to be true. “Your surgery is not elective,” they wrote back. “It is medically necessary.”
I’d planned for this not just for months but for years. After what seemed like ages of strategizing and job hopping, countless hours on the phone with a seemingly endless array of gatekeepers, I was finally there. I was nineteen days away from having facial feminization surgery. All I had to do was sit back and let it happen.
I had a three-week aftercare schedule all filled out with more than three dozen friends and family members penciled in to watch over me. HR had approved my time-off request of three and a half weeks, cobbled together using all of my vacation days and what remained of my sick days, plus a little unpaid time to pad out the end. My insurance, which I got through the full-time writing job I now worked, had confirmed that I was approved for coverage, lowering what would have been a mid-five-figure out-of-pocket cost to a significantly more manageable $1,500 deductible.
I had become fixated on my surgery date in the months leading up to it, cluttering a corkboard beside my computer monitor with Post-it notes counting down the days from 95 to 78, 61, and so on. I had Googled “how many days until march 31” so often that it had become my phone’s top autofill. I’d hung so much of myself on that date and what my life might finally look like in the days and years that followed. I imagined that this procedure would have marked the end of a painful, tumultuous years-long period in which everything felt in flux, including my body itself. I would be done with the process of transitioning, give or take a few legal documents that I still wanted to change, and would at last be able to live my life. It was a fantasy but one that I clung to harder the closer it got to becoming real.
Then, on March 13, my surgeon’s office called to see if I would be interested in doing my surgery a week earlier, on March 20. I said yes.
On March 16, my surgeon’s office called again. Mayor de Blasio had canceled all elective surgeries in New York, and my surgery, which had been medically necessary just days before, had suddenly become “elective.” The procedure would still happen, the coordinator on the phone assured me. She postponed my surgery to August, along with whatever visions I had of that better next chapter.
I told myself I’d handle it, but within an hour I was on the Williamsburg Bridge with a half-empty handle of vodka in my bag, the other half poured into a Hal’s seltzer. I was upset and out of it, desperately searching for something—somewhere I could walk to that would numb all the things I was feeling. Getting blackout drunk at a bar was out of the question. I’d been avoiding them for almost a week at that point in an effort to sidestep the virus. Besides, New York City’s bars had all been ordered to shut down by 8:00 p.m. that night. The safest and most available option would be a liquor store and a vodka soda to-go, after I relieved myself at a nearby upscale pizzeria.
“Hi, ma’am, how can I help you?” a man working at the deserted establishment said.
I asked if I could use the restroom, modulating my voice, as I often do with strangers, to sound more like what I thought he thought I’d sound like. He said it was okay and pointed toward the back.
I felt stupid as I walked to the bathroom. Why did I want to get this surgery anyway? The guy had already ma’am’d me. Did I want to get extra ma’am’d or something?
The world offers trans women many fantasies, my friend Joan once said, but very few within our reach. We might dream of romantic love or adequate health care without ever having the chance to experience either. As a result, we might risk believing that our value lies not within ourselves but within whatever good thing we happen to be given, and should that good thing disappear, so too would whatever value it had granted us by proxy. I wasn’t mourning my womanhood but the woman I thought I would be four days later and forever after that. I was mourning the satisfaction that I’d no longer feel, now that all those years of work and preparation would no longer pay off. Like many other people, I thought I finally had my life together. Then the pandemic happened, and it turned out I did not.
I’m not the only trans woman with an affinity for Cassandra, that mythological Trojan princess found in Aeschylus’ Agamemnon and Homer’s Iliad. Cursed with visions of the future that no one will believe, Cassandra is existentially gaslit and, thus, a figure ripe for all sorts of transsexual projection. I’ve felt cursed with visions of my own in the weeks since my surgery was delayed, only mine are of a present that has failed to come to pass. In this other timeline, I imagine that the worst of the swelling would have gone down by now, except for maybe my lip and my cheeks. That’s what my friend Macy told me, that the fat grafts from her stomach took a while to relax and settle into their new home.
I’d probably still be bruised at this point, some three weeks out, with violet half moons floating underneath my eyes. My mom used to say that I bruise like a banana. That’s still the case, if the little purple circles dotting my legs are any indication, a baffling body of evidence I have no memory of collecting, pointing to all of the countertops and bed frames I’ve bumped into over the past few days.
My penchant for bruising would have put me at risk for developing a hematoma, possibly under my eyes, where all the blood displaced by my rhinoplasty, brow-bone reduction, forehead contouring, and frontal sinus setback would have pooled. It’s a rare complication that’s easy enough to resolve, though unpleasant all the same. After a procedure last year, I developed a hematoma, and I feared that such a complication might repeat itself on my face. I’d like to imagine that it did not, though my visions of that other timeline also feature dozens of friends rotating in and out of the small Brooklyn apartment I now find myself quarantined in, bringing me food and watching all the movies on my aftercare watch list. My visions fail to account for social-distancing measures, much less the greater pandemic, making them as inaccurate as they are useless. Still, I hold them close sometimes and torture myself with “What if?”
I can’t say for sure why I took that fuchsia-drenched selfie a few years ago, or why I felt the need to post it. My surroundings weren’t all that notable; I walked through that kitchen at least once per shift on the way to the hotel’s trash room. I also didn’t particularly like being there, thanks to an early encounter with two of the guys who worked in the kitchen. I waved hello as we passed in the hallway. They took one look at my baby trans heels and too much makeup, then burst out laughing. One of them asked the other, “What the fuck is that?” I’d like to say I posted the selfie as a show of self-acceptance, to overcome the hurt that the encounter had left me with, but that’s not quite it. More likely, I just wanted to take a selfie under lighting so flattering that it begged me to whip out the front-facing camera. It was a time in my life of great insecurity and unprecedented alienation, one that I hoped would not last forever. The future would be different from this, the caption declared; not only would I get FFS someday, but once I did, everything would be different. I wasn’t sure how, but it would be.
In this timeline, the one I’m actually living through, I now worry about getting laid off before my new surgery date and losing the health care I get through my employer. At least I could still apply for Medicaid, which covers FFS in New York, but I worry about having to start the thirteen-month process over from square one.
I worry that state-run insurance could disappear in the next five months. I watch my friends get laid off and the relief funds and GoFundMes roll in. I wonder if I’m watching the last gasps of capitalism, as all of its contingent institutions crumble. Those institutions, as much as I loathe them and wish their end, have made my FFS possible: the aforementioned insurance plan, the advertising and venture capital that fund the newsroom I work in, the for-profit hospital where my surgeon planned to operate, the American health-care system and all that it demands to simply access care. If the United States falls, so too would this particular model of medicalized transition that has shaped so many years of my life. So too would my transition as I’d planned it.
When I catch myself wallowing about that prospect, of the end of trans medical care as we know it, I remind myself that this age has been anything but golden. If the system we have in place has failed to serve even me—a white, feminine trans woman who’s extremely into men, the very individual these institutions were built for—then who is it even serving? Why shouldn’t it be replaced with something new and better?
Should our current system of trans care collapse, I can know at least that I’ve prepared somewhat for the possibility. One of the major reasons I got that procedure last year was to destroy my body’s ability to produce testosterone, as a safeguard against losing access to injectable estrogen someday. I wanted to be ready for whatever crisis lay ahead. “I will not live through the apocalypse like every day is the first year of transition,” I’ve told myself, insisting on being ma’am’d even as the world burns.
Now, in quarantine, I find that I’m not in a hell so much as a purgatory: a forced stasis throwing all of our lives off track. In all my crisis planning, I never planned for a crisis like this. It doesn’t feel like the end of anything, or the beginning of something new, at least not yet. It just is, and it will continue to be until someday it’s not. I feel similarly matter-of-fact about my surgery some three weeks into sheltering in place; the hours I’ve spent on Zoom and FaceTime have given me plenty of opportunities to consider this face I thought I’d never see again. I find that my surgery now feels incidental rather than auxiliary, something that will simply happen or not happen rather than a catalyst unto itself. I haven’t Googled the number of days. I trust that they’ll dwindle without my concern.
This article appears in the summer issue of Esquire.
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