Making the Gendered Face: The Art and Science of Facial Feminization Surgery By Eric Douglas Plemons A dissertation completed in partial satisfaction of the requirements for the degree of Doctor of Philosophy in Anthropology in the Graduate Division of the University of California, Berkeley Committee in Charge Professor Cori Hayden, Chair Professor Lawrence Cohen Professor Charis Thompson Spring 2012 Abstract Making the Gendered Face: The Art and Science of Facial Feminization Surgery By Eric Douglas Plemons Doctor of Philosophy in Anthropology University of California, Berkeley Professor Cori Hayden, Chair Early surgical procedures intended to change a person’s sex focused on the genitals as the site of a body’s maleness or femaleness, and took the reconstruction of these organs as the means by which “sex” could be changed. However, in the mid-1980s a novel set of techniques was developed in order to change a part of the body that proponents claim plays a more central role in the assessment and attribution of sex in everyday life: the face. Facial Feminization Surgery (FFS)—a set of bone and soft tissue surgical procedures intended to feminize the faces of male-to-female transsexuals—is predicated upon the notion that femininity is a measurable quality that can be both reliably assessed and surgically reproduced. Such an assertion begs the questions: What does a woman look like? What forms of knowledge are used to support a claim to know? This project examines these questions through ethnographic research situated in the offices and operating rooms of prominent American surgeons who perform FFS. I explore the tensions between two different forms of knowledge that surgeons rely on and appeal to in the identification and surgical reproduction of femininity: scientific and aesthetic. The status of “the feminine” at work in Facial Feminization is one that sometimes finds its sense through a link to the biological category of “the female” and other times describes the aesthetic category of “the beautiful.” Though the tension between the female and the beautiful is one that is well worn, it is complicated here by the long-contested ethical and medical status of the transsexual body as a site of sex changing interventions. FFS unfolds at the edge of an ongoing history that draws the contested medical and ethical treatment of trans- bodies into the rapidly changing field of contemporary trans- medicine in the United States. My analysis of FFS, engages with this history and to show how its invocation and articulation in the present gives shape to the ethical and practical dynamics at work in the clinic. From examinations to final sutures, I show how the distinct histories and epistemologies involved in FFS create new forms of knowledge about the feminine body and, in the process, new ways of conceiving of and living in the transsexual body. 1 Table of Contents ***** Acknowledgements ii Introduction iii Chapter 1 Making the Gendered Face 1 The Procedures 32 Chapter 2 “Facial Feminization Surgery Is Different” 36 Chapter 3 The Market in Beneficence 62 Celebrate! 97 Chapter 4 The Clinical Examination 100 Chapter 5 On Race and Resemblance 125 My Adam’s Apple 146 Chapter 6 The Operating Room 149 Chapter 7 And After 167 Bibliography 183 i Acknowledgements ***** Above all, my sincerest thanks go to the patients and surgeons with whom I worked on this project. Their honesty and generosity consistently reached far beyond my expectations. The graciousness with which they shared their spaces and their stories was invaluable to me both as a scholar and as a human being. The things I learned through the research and writing of this project surprised me often, and there is far more than can fit into the document that follows. My hope is that I have done a measure of justice to the complexity and richness of the people and things that I witnessed during my research. My apologies, in advance, for where I have fallen short of this goal. I have been fortunate in this project and throughout my graduate career to have the mentorship and advice of some truly outstanding members of the faculty at Berkeley and beyond. My thanks go to Juana Maria Rodriguez, Sharon Kaufmann, Sabrina Agarwal, Cathy Gere and Rachel Prentice for their interest and assistance in thinking through parts of this project. A special note of thanks goes to the members of my dissertation committee—Charis Thomspon, Lawrence Cohen and Cori Hayden—each of whose comments and conversations made me think harder and so made this product better. This project has also benefited from many hours of thoughtful reading and discussion with my graduate student colleagues. Thanks to Theresa MacPhail, Antony Stavrianakis, Emily Chua, Nick Bartlett, Xochitl Marsilli Vargas, Liz Kelley, Martine Lappé, Allison Tillack, Mara Green, Chris Roebuck and Katie Hendy. Finally, a special word of thanks to my family for their unwavering and long- suffering support of my academic and personal efforts. None of this would have been possible without the loving support and encouragement (in all its forms) of my wife, Anne. I am told that dissertations are not typically dedicated. But whether or not it is officially so, this one is dedicated to you. We did it, Annie! Funding for this project was provided in part by a Wenner-Gren Dissertation Research Grant and a Dissertation Year Fellowship from the Berkeley Center for the Study of Sexual Cultures. ii Introduction ***** In weighing the indication for the [genital sex reassignment] operation, another factor should be considered, namely the physical and especially facial characteristics of the patient. A feminine habitus, as it existed for instance in Christine Jorgensen, increases the chances of a successful outcome. A masculine appearance mitigates against it. Such patient may meet with serious difficulties later on when he expects to be accepted by society as a female and lead the life of a woman. —Dr. Harry Benjamin1 Krista had just completed a five-day post-operative exam when she agreed to sit down to talk with me. She moved slowly down the short hallway of Dr. Howard’s office, her tall, thin frame balanced on the shoulder of her friend, Mark. He had driven her to the appointment, leafed through magazines while Howard examined the progress of her healing, and now guided her tenderly into a chair opposite me. Fresh white gauze bandages wrapped around the crown of Krista’s head, down over her cheeks and under her chin. The short, strayed ends of black sutures were visible at her nasal septum, just under her nostrils, and peeked out from under the dressing on her head in neat rows tracing her hairline as it descended to her ears. Her eyes and eyelids were blackened and swollen but the yellow and greenish tones of healing had already begun to appear. Though Krista was pleased with the progress of her recovery, she had not wanted to be in this situation. In fact, she had actively tried to avoid it. A few years prior, while attending a large conference for trans- people, she had seen Dr. Howard give a presentation on “the ten traits of a male face.” Newly aware of these characteristics, she set about systematically trying to camouflage each of these aspects of her own face without the surgery he recommended. She covered her forehead with long, straight-cut bangs. She covered her nose and brow with bulky eyeglasses. She experimented with make-up to accentuate some features while minimizing others. Though she was somewhat satisfied by the results of her efforts, she was simply tired of all the work. “I just couldn’t stand the thought of doing all of this for the next 20 years. Just to leave the house? I was thinking about it all the time. My hair had to be perfect. My glasses had to be perfect. It was too much.” Long before arriving in the surgeon’s office Krista had spent a great deal of time and effort working to cultivate a gendered body and aesthetic that were recognizable to those around her. Like most Americans today, she had made a lifetime of choices about hairstyles and clothing, diet and exercise, comportment and behavior that were structured, in large measure, to convey to others a sense of how she felt about herself. As a transsexual woman—who was born male and later sought the help of physicians and surgeons in order to make physically manifest her sense of herself as a woman—getting 1 Benjamin 1954:228. iii others to recognize her as the woman she knew herself to be was not easy. Despite adopting the behaviors and aesthetics that many other women use to signify themselves as such—long hair, curvy jeans, fashion jewelry and shoes that looked better than they felt—Krista was often recognized by others to be male. But not only male. She was visible as a male trying to look female. In other words, she was visible as a trans- woman. Being recognized as trans- was, in and of itself, not a problem for Krista. She had come to terms with this aspect of herself and had chosen to be open about her identity with many people in her life. Whereas some trans- people prefer to keep their former identities private, Krista intended to be out as a transwoman. But she wanted to be out on her terms, to be in control of this information about herself. And, in her opinion, her masculine face was spoiling the possibility of realizing this desire. No matter how much and in how many ways she presented herself as a woman, when people saw her, they saw a man.