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Arun K. Gosain, M.D.
The spectacular cover art for the book The Look of a Woman: Facial Feminization Surgery and the Aims of Trans- Medicine by Eric Plemons is the perfect illustration for what lies inside. A continuous line drawing of a beautiful and feminine face stares directly and confidently out at the world while hidden behind it is a second, smaller, barely visible face. Many times during my reading and rereading of this book, I pondered Plemons’ concepts while gazing at Annes Bil’s drawings that clearly depict the visible and invisible selves that are emblematic of the transgender experience.
What creates a truly successful gender transformation? Unlike prior decades’ protocols, which focused on genitalia, Plemons puts forth a more sophisticated concept of trans-therapeutics with the aim of social recognition as the primary goal. In this model, facial feminization surgery is not just a complementary step in the process of male-to-female transition, it is “the very means by which woman comes to be.” More than a refinement of gender-affirming genital surgery, facial feminization addresses the space between people and the myriad social interactions that occur. When in mundane daily interactions the trans-woman achieves recognition by others of her identity, the potential for a normal existence is realized.
In the Introduction, Eric Plemons puts forth the concepts that are echoed throughout the remainder of the book. The Introduction is challenging to get through; it reads like a doctoral dissertation. It is highly worth the time, because it carries the most profound concepts, which will provide any transgender surgeon with a better understanding of the value of social recognition for their patients. The body of the book reads more easily as a journalistic description of the philosophies and experiences of surgeons who perform facial feminization and of patients who have undergone these procedures.
Plemons begins with an exploration of the origins of facial feminization surgery, and then moves to a description of conflicting models of surgical therapy as described and implemented by surgeons Doug Ousterhout and Joel Beck. The middle chapters address the concepts of access to surgery in the larger political and legal context. An amusing interlude gives an intimate account of a surgical offer made by Dr. Ousterhout and the decision made by the author. The final chapters describe what occurs in surgery through an eyewitness account by the scrub-clad author in the operating room, and the real experiences of patients after surgery.
In The Look of a Woman, Eric Plemons gives us a very thoughtful, well-researched, and important statement about the role of facial feminization surgery in trans-medicine. This book is informative and entertaining but also a scholarly document that possibly will help to change the existing genital-centric definition of gender into one that recognizes the primacy of facial reconstructive surgery and social interactions in the meaningful transformation of the trans-woman.