Facial Feminization Surgery and The Standards of Care

Introduction and Commentary on the “Virtual” FFS ImagesI’d like to provide some commentary on the images presented on the followingpages.One of the first things that you will undoubtedly notice is that I’m just plain“old”. I was 50 years old when I started to transition (soon to be 51) and nothingwill turn back the clock. I have absolutely NO interest in fighting a futile battlewith age and I would NEVER subject myself to massive surgery for transitorygains. It’s not that I’m lacking in vanity or that I consider “cosmetic” surgerywrong in any sense but simply not worth the potential risks for transitory gains. Iwould never try to have insurance pay for procedures that were just designed tomake me look better. I think I look damn good for my age and most of my friendsjust assume I’m much younger than I actually am. We all fight a losing battle withtime and age and I hope to approach it with some dignity. On the other hand, Ihave struggled with my gender identity for my entire life and I approach facialfeminization surgery with great anticipation despite the risks. My quest for facialfeminization surgery is rooted in a simple desire for final gender conformationwith the goal of assimilating as a female member of society at large.The other comment I’d like to make is that while I don’t think I’m unattractive Iam clearly “male” based on my facial features alone. My protruding brows, longchin and prominent trachea are automatic, instinctive and incontrovertible signsof gender. No one looking at me will ever see a woman particularly if they seeme in profile. In some camera views I can look remarkably feminine and quiteattractive but a slight change in position brings one of the “male” gender markersinto stark relief and the viewer automatically changes their interpretation.My body has responded remarkably well to hormone therapy and I finallyhave a sense of connection and indeed “pleasure” with my body; something Ihave never experienced before. Although I’m quite tall, I’m thin and wellproportioned and have the “potential” to be reasonably attractive. Eventually, mybody will largely be transformed into a fair approximation of an attractive (if older)woman’s by hormones and genital surgery. For the first time in my life I have agenuine desire to enhance my body with exercise and diet with a true sense of“ownership” in the results. It’s hard to convey to others the sense ofdisconnection that gender dysphoria causes in those that suffer from it. For meat least it wasn’t a hatred of my body or my genitals but a sense of profounddisconnection that made diet and exercise pointless and ultimately madeeverything else fairly futile.I challenge anyone that doubts the importance of facial feminization surgery inmy case to just imagine trying to walk down the street with a woman’s body andthe face they see in the photographs here. I’m not ugly but my face is profoundlymasculine. In my case facial feminization surgery is an essential part of genderconformation. Genital reassignment surgery is extremely important in the broadsocietal sense because it confirms legal recognition of the change in gender andconfers all of the rights and burdens associated with being female. But from apurely social perspective it does little to change the gender gestalt. If one