We’re all very sensitive about our faces. It’s the part of us that we see most often and it’s the thing we look at most with others. When doing my own research into my transition, it was stressed over and over again: the face was most important. Get the face right. Your bits are inspected never, but your face is looked over thousands of times a day. Next to hair, it’s perhaps our first identity marker.

For transfeminine people, that usually means starting face hair removal as soon as possible. Just taking care of our skin becomes part of the ritual because shaving so harshly and so close every day (sometimes more than once a day) is murder. It might mean makeup, it might not - though I think it’s pretty safe to say that makeup is part of it in the early phase even if it doesn’t stay a central fixture in the long term.

Hormone therapy does wonders for the face, and many feel reasonable after a few months of that doing its magic. But not everyone. At that point, we’re talking about surgery. Course, this all sounds very much like passing magic, and while facial feminisation surgery can certainly help with that, often the focus is more inward.

Before I launch into this, there are places where passing is just a must. Some parts of the world, failing to look right to the wrong people will get you arrested, threatened, humiliated, raped or killed. While I would not call the UK safe, it’s certainly safe enough for me to wax philosophical about balancing dysphoria against passing.

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"IN FACT, THERE ISN’T A SINGLE STEREOTYPICALLY MASCULINE FACIAL FEATURE THAT CISGENDER WOMEN DON’T DISPLAY IN SOME MEASURE OR ANOTHER ON A REASONABLY COMMON BASIS."

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That said, if you are lucky enough to live in a place where not passing isn’t life threatening all the time, we believe that many features we have are characteristically manly when they aren’t. I went through a phase where I noted every prominent browed, hooded eyed woman I saw. There are plenty. Plenty of square chinned women too. And they have noses that aren’t fine little things. In fact, there isn’t a single stereotypically masculine facial feature that cisgender women don’t display in some measure or another on a reasonably common basis. It’s a spectrum, and most transfeminine people don’t land on the 100% masculine end of that feature spectrum.

Some go so far as to say that facial surgeons are basically exploiting vulnerable people. I don’t believe that is really true, but there is a large slice of the transfeminine community that want these treatments. If the empirical evidence is that it can help with cisgender assumption but isn’t necessary to acquire that, why do they want it so much?

There are only two reasons: consistent persecution or dysphoria. Usually both. It’s not so much about how you look, it’s how you feel. It’s about being able to look in the mirror and see what one needs to see. It’s also about having the confidence that everyone around you sees what you need them to see. How we see ourselves - what we want to preserve in our faces - has a tremendous impact on whether we want facial feminisation surgery.

Early in my transition, I wanted surgery. I was told to get the face right, I saw things that weren’t right. So I looked into it. But I don’t now, and there are things I discovered that made me change my mind.

First, everyone told me I looked like my mum. I love my mum and I wanted to look like her. She’s one of the most powerful role models in my life and we are very close. Looking like her, to me, meant I looked right. Second, I discovered after doing my brows and playing with makeup that I have a classically shaped brow line. Face surgery would change that; I don’t want that to change, so whatever other issues I might have, I know I have a natural quality I like that fixing something else would spoil. Finally, some friends at one point told me, upon learning that my ancestry is Danish and Finn, that they could see that lineage in my face. Face surgery would definitely change that. So for me, face surgery would distance me from my origins, my natural beauty, and my loved ones. But I also don’t have any dysphoria about my face.

Dysphoria is the real kick in the teeth. Dysphoria doesn’t have to make sense. It doesn’t care what you might value about your body. It creates a negative filter that no amount of reassurance can pierce. It will make you do drastic things to your body that you know you don’t need for any reason but to satisfy the demon that won’t let you feel like a human being until it’s done. At that point, surgery becomes a sensible thing to do.

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"BECAUSE OUR FACES ARE DISTINCTLY PUBLIC, THERE IS A LOT OF CONVERSATION ABOUT FACE SURGERY IN TRANSGENDER CIRCLES THAT IS OFTEN ACCOMPANIED WITH A JUDGEMENT ON WHETHER A PERSON REALLY NEEDS IT."

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Because our faces are distinctly public, there is a lot of conversation about face surgery in transgender circles that is often accompanied with a judgement on whether a person really needs it. Often, this is designed to reassure a person; it’s a means of support. Unfortunately that same language is used as an idle judgement of a person that does have facial surgery.

She didn’t need it, but she looks great.

If she looks great, why say she didn’t need it? Is it important to make that call? It drives me a little bit crazy. My fiancée was beautiful before her facial surgery but I would never suggest that she didn’t need it. And I know what that comment is meant to say: she didn’t need it to pass, or look good, or look feminine. Perhaps not, but we need these things for deeper reasons. And perhaps the comment didn’t mean to imply that ‘need’ was universal, but it does.

Going back to the idea that it’s surgeons preying on vulnerable people, there is a phenomenon where knowing something can happen creates a desire for it. That doesn’t mean surgeons are preying on people but it does mean that we are more inclined to shelve, cope with, ignore or work around problems we might have when we see no real option to change them. It’s amazing what we do when we have no choice. Transitioning is proof enough of that - who would do that if they had a choice to not? I certainly wouldn’t have. But if I didn’t think transitioning was an option - which I didn’t for many years - I wouldn’t have transitioned. I’d have found another way to deal with my feelings. If I didn’t know bottom surgery was a viable thing, I would work a lot harder trying to find a resolution to that dysphoria. If I didn’t know face surgery was available, I’d not have taken the time to consider it.

Ultimately, the decision to have facial surgery is individual and about one’s personal perception rather than what others see - safety notwithstanding. The reasons don’t have to be practical. They don’t even have to make sense. Nobody can say what we need but us, but nobody can deny that getting the face right is one of the most powerful tools we have for acceptance, both from the public and of ourselves. Whether we want face surgery or not, our reasons are our own.