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189 10 Facial Feminization and the Theory of Facial Sex Difference The Medical Transformation of Elective Intervention to Necessary Repair HEATHER LAINE TALLEY Facial Feminization Defined In the 1980s and 1990s, a Northern California plastic surgeon with extensive experience in reconstructive surgical techniques developed a unique collection of procedures marketed to male-to-female (MTF) transsexuals for the purposes of changing facial appearance.1 In the United States, facial feminization surgery (FFS) is promoted and practiced as a distinct set of procedures by primarily four surgeons.2 What distinguishes facial feminization from cosmetic surgery, more generally, is that FFS is expressly aimed at making the face more feminine, rather than simply more attractive—although some accounts of what constitutes beauty suggest that the most feminine faces are often perceived as the prettiest (Etcoff 1999). Facial feminization is accomplished through a variety of procedures including but not limited to a brow lift, a trachea shave, a jawline reduction, a chin reduction, and a face and neck lift. While surgeons are often vague about how much feminization costs, patients’ Web sites report that fees for FFS run between twenty thousand and forty thousand dollars. Like other forms of cosmetic and reconstructive surgery, the results of facial feminization require intensive surgery often lasting hours, sometimes as many as ten. Because procedures are aimed at radically altering multiple facial features , patient’s faces (and skulls) undergo serious surgical manipulation. For example, jawline and chin reduction requires actually breaking or severing the bones of the face with a surgical drill. Facial bones are then resecured with screws, wires, and bone pastes. Brow shave or forehead recontouring involves removing a section of the skull, reshaping it with a device that resembles a dremel drill,3 and reattaching it to the skull. To reduce the distance between the hairline and the eyebrows, a cut is made along the hairline, a section of skin is removed, and the scalp is pulled forward, bringing the hairline down lower on HEATHER LAINE TALLEY 190 the forehead. Swelling, bruising, and scarring are common. Some patients experience changes in the face’s range of motion, reducing the facility with which one moves one’s jaw, for example. Others report a loss in facial sensation, typically a sort of numbness that leaves a face unable to perceive human touch. Like all forms of surgery, infection and death loom as potential side effects. And, of course, the resulting face may not resemble what one had desired. Facial feminization is an invasive, expensive, dubiously successful intervention . And yet it remains a highly sought after technology of transgendering for transwomen.4 By contrast, female-to-male transsexuals achieve masculinization of the face through hormone therapy, thus there is no such comparable set of surgical practices termed facial masculinization surgery. Unlike other academic analyses that query the significance of genital reassignment surgery as a case of the medical production of gender, I take up modes of transitioning that are aimed at the face. Facial feminization is virtually unaccounted for, and yet because of how uniquely visible our faces are relative to other body parts, it follows that facial interventions carry a unique significance. Particularly for transgender people, facial appearance is crucial in navigating everyday life unencumbered by the threat that not passing as one’s self-identified gender presents. I begin by describing the processes through which the male-to-female transsexual face is taken apart, both figuratively and literally, through the deployment of an emergent theory of facial sex difference. I argue that surgeons emphasize the differences between the female face and the male face and ultimately bring into formation a way of seeing the face that inspires the literal taking apart of the skull. While surgeons continually differentiate between sexed bodies, FFS is not simply a mode of “doing gender” but rather, as I demonstrate , a technology of repair. Transwomen’s faces become defined as disfigured , and facial feminization itself is positioned as a method of reconstructive surgery. In essence, I argue that the processes through which facial sex difference is articulated work as a diagnostic strategy that inspires intervention. I conclude by situating facial feminization in a technoscientific landscape alongside other gendered medical interventions that, while they might be considered elective, come to carry the weight of necessary interventions, and I point to moments in the practice of medicine in which gender is conceptualized more fluidly. In doing so, I hope to demonstrate how medicine might be divested of the weight of requirement. This...


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MARC Record
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