Personal Essay

Plastic Love: On Face Surgery

The Mrs. Doubtfire house in 2008. Ousterhout purchased the house in 1997. Photo by Jodie Wilson.

In the 1993 trans polemic Mrs. Doubtfire, Daniel Hillard (played by Robin Williams) confesses to a family court judge why he pretended to be an older British governess unwittingly employed by his ex-wife. “I’m addicted to my children, sir. I love them with all my heart, and the idea of someone telling me I can’t be with them, I can’t see them every day—it’s like someone saying I can’t have air.”

In the film, Hillard concocts his alias, Mrs. Doubtfire, by glancing at the newspaper headline: “Police Doubt Fire Was Accidental.” In real life, the detail was eerily prophetic: in 2015, the doormat of the so-called Doubtfire house was lit on fire by Tyqwon Welch, a trans woman allegedly protesting a botched facial surgery. Since 1997, the San Francisco Victorian has belonged to Douglas Ousterhout, Welch’s plastic surgeon and coauthor of the gold-standard technical manual for those seeking what’s come to be known as facial feminization surgery (FFS). It was a fitting home for someone who, as the surgeon put it, “[turns] boys’ faces into girls’ faces.”

Welch had paid $45,000 out of pocket for her surgery. According to her public defender, Welch had sustained a crooked hairline from the septuagenarian Ousterhout’s knife. Welch ultimately conducted her own defense in the ensuing legal battle; she went to prison for arson in 2015.


I’m scheduled for facial feminization surgery in Beverly Hills sometime in the next twelve months. It will be the culmination of years of work: consultation after medical letter after physician’s approval. Months into the winding logistical ordeal of maxillary preparation, I reached an ethical impasse. I wasn’t sure about the decision. Face surgery raises questions about assimilation in a world that does not regard its methods as medically necessary. Its standards, simultaneously stringent and ill-defined, exemplify how black trans women in particular bear the brunt of face surgery’s risks. In the case of Tyqwon Welch, it’s doubtful that Dr. Ousterhout was just having an off day when he botched her hairline. Her disappointment and retaliation are understandable, given face surgery’s very intentions.

Ousterhout touts an assembly-line process, a formula for making, as one SF Gate article described his patients, “perfectly plausible females.” But the category “plausible female” isn’t so much based on patients’ individual preferences—cut here, shave there—as on ideals of cisfeminine beauty and a historical regime of cephalometric standards. A feminine face, according to Ousterhout, has a low hairline and no noticeable brow ridge. His manual Facial Feminization Surgery: The Journey to Gender Affirmation, coauthored with protégé (and current practitioner) Jordan Deschamps-Braley, is full of chapter headings like “Beauty is Still Important to Feminization” and “Symmetry in Facial Features.” The ideal of facial femininity that the pair boost is demonstrably racist. The manual draws from a variety of outdated research rooted in methodologies that take the white face as normative. In particular, it relies on a longitudinal analysis of cephalometric differences informed by an antiquated growth study from the University of Michigan. Its findings hinge on measurements of a “normal” growth form based on statistical averages. Every child measured for the study was white. In other words, the medical standards for FFS still define a “normal” woman’s face as a white woman’s face. And beauty crystallizes as a proxy for whiteness. The manual’s chapter “Reactions from Others” assures readers that “If anyone stares at you after facial surgery, it is likely because you look very attractive.”

It’s tempting to decry these beauty standards as the source of our oppression. At the same time, the aching incongruence of someone like Welch can’t be dismissed. I don’t think I’ll ever recover from the moment when my embodiment became acute, even if now I’ve mustered enough strength to greet myself in the mirror. Face surgery promises security in the public sphere, certainly, but also in private. It is a veritable bulletproof vest against the other’s and the self’s unceasing assaults. In her 2020 Esquire essay on a canceled face surgery, journalist Harron Walker describes a new face as the opportunity to live another life, “one where [she] might ‘get drinks with the ladies’ or hear a coworker whine about ‘wedding season’ and know what she [means].” When a surgeon bungles not only your face but your new life, the opportunity to inhabit not just a congruent body but a holistic, in-group experience one was cheated out of by birth, a couple epidermal inches improperly julienned reads like a form of medically sanctioned assault.


Fortunately for me, my doctor did inform me during our consultation that I have a relatively workable face and that, save for a deviated septum, I won’t actually need severe alterations. I reported this to my then-partner, a cis Jewish woman. She told me her parents would frown on my getting a rhinoplasty, a procedure they associate with a desire to look less Jewish. I wondered if I should forgo the nose job, for fear it might create an obstacle to intimacy. My partner reminded me that she loved my face and would continue to do so, butchered or untouched. “Whether you get FFS or not doesn’t matter to me,” she said: a classic cisgender aphorism so indifferent it verges on apolitical.

Still, the antiblackness and anti­semitism built into face surgery screamed back the inconvenient truth: even though I’m already a white woman, my face surgery might be an attempt to look like an even more white (read: less Jewish) woman. Face surgery was supposed to be a means to confidence. But the more I thought about it, the more it became an offensive inevitability, the reason for an eventually fraught relationship with people with whom I supposed solidarity. At the time, I took any ambivalence about face surgery to imply that my desire for it was wrong, that I was greedy and deviant. A better lesson might have been that my wants aren’t always compatible with the world’s.


Trans women suffer under the medical codes by which we read as “acceptable”—not as women or even proximate cis women, but as sociable, assimilatory. Even the most famous out-not-proud transsexuals receive surgeries to make their womanhood serviceable for a pop-culture narrative. Caitlyn Jenner has all the wealth she could dream of but still earned the Vanity Fair cover to confirm for the culture industry her transcendentally sufficient femininity. Plastic, then, isn’t physical, literal, or final, but a conceptual beacon along an ever-deferred vector. Rethinking face surgery’s more pernicious aspects, I remember how, so often, the means by which we are able to survive marginalization are not coherent. It’s not about food and water spread out at the bottom of a pyramid and cosmetic surgery sharpened at the tippy top. The idea that we should regard as valid even inscrutable desires, ones as seemingly superficial as an agreeable reflection, is something that we purport to teach even our youngest children. This is how I read that line in Mrs. Doubtfire: “It’s like someone saying I can’t have air.”

Do I need face surgery? Perhaps I am beautiful without it. But any validation of my beauty—compliments from strangers, from loved ones—has always led me more toward a critical realization than empowered confidence. If, for my loved ones, my beauty isn’t contingent on face surgery, then why can’t I shield myself against public scorn, misgendering, and a deleterious medical system? Flattery ricochets off of me; a new face becomes not an end but a means.

One time, I was in a dive bar in New England, and a woman who had been staring at me said, “You know who you remind me of?” Usually this is not a question that promises flattery. But then she said, “Jane Birkin,” the actress so glamorous that an Hermès handbag was named for her. I think of myself as vocally anti-assimilationist, but the truth is, I would go days without food and water just to feel self-assured enough to accept that compliment.


In 2020, the historian of neuroscience Danielle Carr wrote an essay called “The Bad Feature” for n+1. The piece is about Carr’s mole removal, a mocktail face surgery she wanted, obtained, and later decried as unethical. In her piece, she argues that individual desire is never natural. All desires, Carr writes, are artificial, manufactured. Following a Foucauldian bent, she regards this fact as the legacy of liberal capitalism. Patients want plastic because surgeons want cash. The problem with this logic—of desire as assimilation—is that there isn’t a “natural” way to sustain the body to begin with. When we see plastic as exceptionally capitulating to a form of political economy, a pedestrian acquiescence to the neoliberal, carceral state, desire’s pernicious aspects get deferred back to the sufferer. If bodily insecurity is coerced and the desire to alleviate that insecurity is also coerced, what options does the patient have? Foreclosing desire is the limit of Carr’s supposed Marxism. Throughout her piece, Carr lets bleed a series of self-flagellating confessions. She regrets her infantile impulse toward corrective surgery. But, because she had the mole removed, she is “not tortured” anymore. This should be cause for joy. Desire, not foreclosure, opens up a space for personal politics, and politicized desire (even if those politics are self-critical) is what organizing rests on.

If plastic promises, it does so without fulfillment. Indelibly marked, I feel, in the name of solidarity, no desire to throw off transsexuality’s curses through an ultimately fatuous attempt at passing. On the contrary, non-passing might even be a political imperative against assimilation. As anyone—Kardashian on down—knows, face surgery won’t exalt us into any in-group of colleague ladies. Even when we do manage to get “in” with cis women, after years they disappoint us—a friend misgenders you in front of their parents, say. No. Face surgery is an unkept pledge to living this life and should snub its critics with willed spite. If face surgery makes its patients less dysmorphic, less symptomatic, it allows those patients to revel in the quotidian jubilance of self-confidence, intrepidness, and escape. More concretely, it allows them to get out, to organize, to be with and for others. Once again, desire foreclosed does not a Marxist make. The fulfillment of desire does not preclude critiquing desire.


To suffer in the name of personally undoing the beauty regime would be a manifestation of ineffectual guilt. Nonetheless, I find it uninspiring to accept “I want,” as Andrea Long Chu suggests1, as enough of a reason to shave inches of bone. If we’re to hail a particular desire as all-consuming, there’s got to be a political dimension to letting it swallow us.

I mentioned earlier that wanting face surgery might be about spite. I’m hard-pressed for an explanation about why I’m doing this if not to flaunt a narrowed jawline or sweep people off their feet. I fantasize about returning from Los Angeles bandaged: an Ithaca-bound Odysseus, or a mangled favorite son beaten down by adventure. But spite and pride require moderation, and, in a hostile world, not just outness but an ethics of working for others is integral to trans flourishing.

Once, I accidentally forgot my hormones on a trip to New York and had to go digging for a solution. Ditziness gave me the opportunity to witness the workings of an up-and-coming trans mutual aid network—a community for sharing information, resources, and support. I got supplemental estrogen in under 24 hours. Hearty social networks can lift the conceptual burdens of face surgery, too. As trans bodies become increasingly visible, our mouths more vocal, a world where a face gatekeeps connections will fall away. Transness is not a solo endeavor.

So often the means by which we are able to survive marginalization are not coherent.



1. In Chu’s 2018 New York Times essay “My New Vagina Won’t Make Me Happy: And it shouldn’t have to.”

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