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Jack o'lantern

Why I'm letting them do horrible things to my skull


Emily VanDerWerff

Oct 11 2021

4 min read


As you read this, I will be undergoing anesthesia at a Los Angeles hospital so a doctor can make my face look slightly more like my biological sister's face. I'm doing this voluntarily. It's medically necessary, but I still feel a little twinge of, "Wait, they're going to do what???" every time I think about it.

So I mostly don't think about it.

The process is called facial feminization surgery, and here's a pretty good article about it in The New Yorker. (I read this literally hours after I came out to my therapist, and it's hung with me ever since. I haven't re-read it, but I could probably recite various passages to you anyway.) The basic idea is that amid puberty, testosterone caused my body to develop in certain ways that maybe I, a woman, am not terribly enthralled about. Some of those (my height, especially) I can't do anything about. Others (my voice, for instance) I have taken personal steps to deal with.

But there are a few things, like my face, that are going to require medical intervention. So I'm having medical people intervene.

I have complicated feelings about this. FFS has gained a lot of traction as an often necessary procedure for trans feminine people in the past few years. It's much, much easier to get now than it was even when I began transitioning in March 2018. But it's still covered by far too few insurers. Thus, it remains gatekept from all but the most privileged trans women, such as myself. (Vox Media's health insurance is terrific for trans care and is covering all but a tiny portion of the cost of the procedure.)

I used to have some concerns about the roots of FFS, which lie in a kind of "we can solve what a woman looks like using math" ideal of the human face that was used to paint too broad of a brush. But in recent years, more surgeons (such as Dr. Justine Lee, the surgeon I will be seeing) have been taking an approach of just trying to make you look slightly more like you would have if you were born a cis woman.

And, look: I get all of the arguments against that, too. But the truth is: When I look in the mirror, I still see my old face, and I want to give my brain a hard reset.

If I look at side by side photos of the me who started taking hormones on October 20, 2018 and the me who's coming up on three years on hormones, they're night and day. In fact, here's a tweet I posted last year to that effect:

God, I'm a cheesy dork sometimes.


So, yeah, I can admit those photos look different! There's a light that turns on in my eyes across them, and it's really cool to see. But when you see the same face in the mirror every day, it's like watching the hour hand on a clock. You know it's moving, yet you do not see it move.

(Sidebar: I have a similar thing going on with my voice. I'm told by folks that it sounds feminine, I sing in an alto range now, and I am rarely misgendered based on it, even over the phone. But I've been hearing it every day, and your voice always sounds lower in your head, so I can't hear what y'all hear, and it irritates me.)

Anyway, when I look in the mirror, I want to see the person everybody else sees. I want to look slightly more like my bio sisters. There's a reason FFS so often reduces trans feminine people's dysphoria, and it's because when it works, it so often feels like peering into another world.

Also, if ever there were a good time to turn oneself into a human jack o'lantern, October would be it. Even if things go disastrously (and they won't), I'm going to appreciate the synchronicity.

Anyway, that's what I'm up to today. Think happy thoughts for me. I won't be around next week, but a freelance piece will go up both this week and next. And I'll be back sometime in Halloween week with a new visit from your old friend Emily Rogers. (Speaking of peering into another universe...)

Please, I ask, when you see a pumpkin with a face carved in it... think of me?

See you all soon.


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