Look Carefully

Medical anthropologist Eric Plemons opens The Look of a Woman with a "simple" argument: "As ideas shift about the kind of thing that sex is, so do the interventions required to change it and the logic of medical practices required to do so" (1). The ethnography of facial feminization surgery (FFS)—a set of bone and soft tissue procedures to make a face that "looks" female—that follows gives a lively account of how materiality functions both as limit and as potential, a topic for which trans and surgery have been key figures in queer theory and scholarship. Through a sensitive and balanced engagement with the "narratives of patients who undergo FFS and the surgeons who perform their operations" (3), Plemons argues that FFS evidences a shift in "trans-therapeutic logics": where an earlier model of sex change located sex in genitals, viewing sex as changeable through genital surgeries and the subsequent having of the "right" parts, FFS accomplishes realness through social recognition in the day-to-day. If both models are binary and take sex as either "right" or "wrong," FFS is distinctive in framing having the right (or wrong) body as a continuous, everyday doing that is a relational accomplishment. Noting the primary role FFS gives to the social life of the body, Plemons asks: What is productive about FFS? What does FFS do?

It is clear from the outset that Plemons knows that FFS is implicated in essentialist models of sex, problematically posits surgery as necessary for trans-¹ people, and is not accessible to the vast majority of trans-women. Yet surgery is still important, in Plemons's words, "not because surgery defines us as trans-people but because it is so very important to so many of our lives" (17). Even for those who do not desire or cannot access them, surgical interventions remain the critical example in discussions of what counts as good health care and what counts as sex (and sex change). Accordingly, Plemons's approach is neither to critique the models of sex on which FFS relies nor to proffer alternatives but to carefully describe and attend to practices. In being "the kind of witness that I would have wanted for myself" (133), Plemons shows these models to be plural, competing, and coexisting.

Plemons traces how FFS emerged in response to a population defined by a desire for genital surgery yet for whom its transformation had not been effective (within which FFS was auxiliary), to one within which recognition (still framed in terms of binary sex) is now conceived as social rather than genital. Plemons argues that social recognition provides the common sense underpinning FFS's transformational efficacy, well captured in one surgeon's articulation of its purpose: "If, on a Saturday morning, someone knocks at the door and you wake up and get out of bed with messy hair, no makeup, no jewelry, and answer the door, the first words you'll hear from the person standing there are 'Excuse me ma'am'" (14). In this model, sex "change" is enabled in the moment of surgery yet animated in such ordinary moments of recognition. The patients and surgeons Plemons speaks with understand FFS as motivated by a desire to change their experience not from being read to passing but from refusal to recognition. With this understanding, it becomes clear that FFS is not the same project extended to a new body part but an entirely new one altogether.

Plemons's discussion of two different surgeons is a neat way to illustrate his points, as it mimics the research and multiple consultations many prospective patients undertake. Plemons tracks how these two surgeons enact competing paradigms of trans-therapeutics: "normalization" and "individual self-actualization." In this sense, even if a trans-woman has resources and is willing, FFS requires investing not just in a surgeon's technical ability but also in their theory of sex/ gender and how it works: on the body and in society. When one patient...