Transgender women undergo incredible changes, major and minor, to feel like their appearance can finally match how they feel inside. For some, the process isn’t complete without cosmetic surgery to appear as feminine as possible. But what are their reasons to opt for facial feminization surgery?
Dr. Jeffrey Spiegel, now a renowned surgeon in the field of facial feminization, began developing his technique 16 years ago when a transgender woman first came to his office. Spiegel wasn’t sure what to do — and there was no medical literature to guide him.
The eventual procedure was a success, which led to a stream of referrals that changed his career. “I started thinking a lot about this interesting, unanswered question as to what makes a face feminine, and it became something I focused on,” he says.
We asked the Boston-based surgeon about why some women opt for FFS, and what the post-Caitlyn Jenner era holds.
What dotransgenderwomen want
Though Spiegel says many of his transgender clients do request “a stunningly gorgeous look,” most of them come in with one main concern — and it’s not about how they see themselves:“I want to be able to answer the door without makeup and have someone not say, ‘Good morning, sir.’ I want my facial gender cues to send the right message without having to put so much effort into it.”
Internal vs. external
“A transgender woman has no problem knowing who she is; she knows who she is as strongly as you or I. The problem she has is that you don’t know who she is,” says Spiegel. “So what I need to do is help a transgender woman be seen as she knows she is.”
The cluster of procedures that make up FFS are not all necessary for everyone. And there’s also the consideration that some people want to maintain a shifting identity.
“Some people say, ‘I’m a trans woman, it’s time for me to live that life 100 percent of the time, do everything and I’ll start as soon as I’m healed,’” Spiegel explains. “And others say, ‘I know who I am, but I have my job, my family, my relationships; I’m not ready to fully switch my life just yet, so let’s do a few things where I can still shift back and forth, and do more later.”
The woman in the mirror
Spiegel’s patients often worry whether they will recognize themselves — and just as importantly, will the people in their lives recognize them. “The answer is that you recognize yourself more, and people recognize you more,” he says.
Consider this hypothetical: Bill tells his colleagues that he is transitioning to becoming Susan. Though there may be a conscious understanding, it clashes with the masculine signals of his face being perceived by our subconscious.“After surgery, she walks into the room and the facial cues that are sent are ‘Susan.’ And they recognize you more: They see you not as a different person, but now they see you as yourself, and it’s obviously you on a subconscious level.”
The Caitlyn Jenner Effect?
Though celebrities have been known to drive trends in surgery, both cosmetic and medical, Spiegel doesn’t see Caitlyn Jenner’s story changing the field of facial feminization — because her story is only news to those of us who aren’t transgender.
“The change is that now when Bill comes to his office and says, ‘I’m Susan, I’m a transgender woman,’ people are not going to be surprised by her. ‘Oh, like Caitlyn Jenner! Yeah, I know about that,’” he explains. “And all of a sudden this is no longer a surprising, first-time-I’ve-ever-heard-about-this thing.”
As for driving a new standard of femininity, Spiegel says that’s out of the hands of everyone in the Kardashian clan.
“We don’t as a society define what are feminine facial characteristics or not,” he says. “This is thousands and thousands of years of evolution that have told us what feminine facial features are.” Even cosmetic surgeons don’t have a template: The search for the platonic ideal of femininity is ongoing.