The New Yorker Radio Hour - A Trans Woman Finds Her True Face Through Surgery

Episode Date: April 17, 2018

The staff writer Rebecca Mead recently observed the seven-hour surgery of woman she calls Abby.  (To protect her privacy, Abby’s real name was not used, and her voice has been altered in the audio of our story.)  Abby, who is trans, had undergone hormone therapy, but her strong facial features still led people to refer to her as male, which caused her severe emotional pain. She decided to undergo a reconstructive procedure called facial feminization surgery, in which a specialist would break and reshape her bones.  Mead spoke with Abby before and after the surgery about what it would mean for the world to see her as she sees herself. Plus: The poet Ada Limón moved to Kentucky and fell in love with horses all over again. New Yorker Radio Hour listeners, we want to hear from you.  We have a few questions about the show and how you listen to it. The survey takes about twenty minutes, and your feedback will help us make our podcast better.  Take the survey here.

This is Reservatory, straight of the block for West Boulevard and makes that right? They didn't break that, but they have pretty good access to those people. They're going to subconsciously mocked that lineage. So that's happening. It seems like an incredible story here on many fronts.

From One World Trade Center in Manhattan, this is the New Yorker Radio Hour, a co-production of WNYC Studios and The New Yorker. Welcome to The New Yorker Radio Hour. I'm David Remnick. I'm happy to say I had never been in a surgical theater before. I've never undergone surgery myself, and I've never witnessed a surgery as a journalist before,

and I'm quite squeamish. That's Rebecca Mead, who's been a staff writer at The New Yorker for more than 20 years. In December, Rebecca sat in on a surgery, and it was seven hours long. What she observed was miraculous, but some of it's a little difficult to hear about, So heads up or stomach down. It's a little after 7.30 in the morning, and we're in the operating room. There is an iPhone plugged in, and throughout the operation, this will be playing music,

mostly Britpop from the 1960s. Abby is in a violet-colored surgical gown, and she's lying on the operating table. She's sedated. She's on a respirator. The first incision is just under the chin. Dr. Deschamp Brawley makes a small cut there and proceeds to reduce her Adam's apple. I just want to mention that we've altered Abby's voice at her request to help protect her privacy. The first time I talked to Abby, it was on Skype in the fall of 2017. Hi, how are you?

Hey, good. Yeah, likewise. Seeing her on the screen, she looked very attractive. She was very pretty and very feminine looking. She has these incredible eyes. Her features are strong. She's a very striking-looking person. And she told me that she was quite happy with the way that she looked face on.

But the problems she felt were more visible when she turned her head to the side. And she showed me that when she turned her head, it was much more possible to see the protrusion on her brow above her eyes and the Adam's apple in her throat bulging. And those were the things that made her really unhappy with her appearance. But with something like facial features, those are chiefly defined by the size in proportions of the bones. You know your facial bones. Developments during puberty for me that I just can't undo.

Abby had been taking hormone replacement therapy for months by the time I first talked to her, and it had had some major effects on her appearance. Her skin was much softer. She'd taken other steps towards transitioning socially. She'd changed her name legally. And she told me that in the summer of 2017, she'd finally crossed an invisible line whereby she was more often addressed by a feminine pronoun than by a masculine one. and yet there were still things about her face that she was deeply unhappy with.

It's always extremely subtle cues that when you meet someone for the first time, you know, the fraction of the second, and that's what informs you of who this person is, how they should be addressed. And one of the ways that the world chiefly interacts with you is by your face, right? It's by looking at you. So she's naturally a very outgoing person, a very friendly person, an open person. but she became more withdrawn, and there were even things about her mannerisms that changed. She told me that she no longer wanted to turn her head, because when she did that, her Adam's apple bulged out.

So instead of turning to look at something, she would just flicker her eyes to the left or to the right, and she would keep her chin tucked down. She demonstrated for me, and she looked like she was an actor playing a character in a Jane Austen movie. And I think that for her, she became more self-conscious and less social and less willing to make eye contact with others because she felt that she was going to be judged or evaluated or wondered about. I'm just very aware of how much of visibility there is for our community out right now, which is really great. But also, at least in my opinion, I think it makes it harder, a little bit harder for, trans individuals just to go about the daily lives.

In the past, you would walk down the street and kind of view somebody as just being, oh, you know, that person's atypical or looks, you know, just little, you know, unique or something like that. And now I think they're just more scrutiny to really trying to like, oh, is that one of the people that I've heard about in the news or I've read about? Is that one of them? You know, it's kind of voyeuristic and we don't want that attention. Abby isn't her real name.

She's very security-minded. She's aware that there is a disproportionate amount of violence committed against trans people. For her, she wants to be able to move through the world without drawing attention to her gender. And a friend of hers had had surgery, had what's called facial feminization surgery, and had been very pleased with the results, and so Abby started to look into it for herself, and she's a teacher of biology, and she could really understand what the procedures

that she would be undergoing were. Dr. Deschalbrily is a craniofacial surgeon and is trained in repairing faces that are deformed by congenital abnormalities or even by accidents, and he trained under a surgeon named Doug. August Osterhout, who in the 1980s was a pioneer of facial feminization techniques, and chose Dr. Deschamps Brawley as his successor. That's okay.

There's a lightboard that has Abby's x-rays up on it and schematic drawings that the surgeon has done to show him where, you know, a millimeter needs to come off here and two millimeters here. And there are also these photographs that are taken of Abby digitally altered by, pictures of her as he is aiming to have her be six months from now. I don't take my small label. By 8.35, he has finished with the tracheal shave and moves on to her brow and cuts into her face just below the hairline. Quick slice down one side, sort of down the hairline then behind her ear, and then another

cut on the other side and this is the point at which if you're a listener who is squeamish be warned he starts to peel her forehead away from her skull it looks like

peeling the skin of a mango away from the flesh of a mango so there's this kind of fleshy flap that is coming down and exposing the bone beneath. This is the point at which the whole thing starts to feel rather like a science fiction movie. Having been terrified that I was going to be a puddle on the floor, I was completely riveted.

Her forehead is now being lifted off her scalp and folded down over her eyes. Dr. Deschamprolley looks at the images on the wall and takes out a little pencil and draws the shape of the planned incision on her bone. You know, a typical masculine forehead has a much more pronounced brow ridge than a typical feminine forehead. He uses something called a reciprocating sore

to cut away a piece of bone. he lifts it off and cuts this piece of bone into four and then reshapes it, ties these pieces back together with stainless steel wires, and then puts it back in her forehead and flaps her face back up over it, smooths it down and sort of eyeballs it, just to see how it looks.

Is it or is it not a kind of beautification surgery? Is that the wrong way to think about it? to an extent it is a little bit of beautification, but only because I think our society tends to view more typically feminine faces as being more beautiful. There's definitely an aspect to the surgeries that have to do with that. But my motivations just aren't cosmetic. My motivations aren't superficial for it is to relieve, you know, dysphoria. to help the world see me as who I am.

So gender dysphoria is a clinically recognized condition, best understood as a severe dislocation between one's inward sense of self and one's outward appearance. The difference between ordinary dissatisfaction with what you see in the mirror and genuine gender dysphoria is the difference between not really liking your thighs and feeling like your thighs do not belong to you,

that these are not your thighs? You have this really strong mental image of what you look like, how you act, everything, just this kind of like some total, you know, your mental image of yourself. And then when you look in the mirror or look at your face or something, it projects like the extreme opposite of that mental view of yourself can feel like just extreme

extremely intense and extremely negative emotions. You know, anger, frustration, depressed and angry and upset, and usually it's all at once, and they roll together and roll from once to next. And it's completely debilitating, completely crippling. So after the surgery, what do you hope to see when you look in the mirror?

Um, myself. This is a really long surgery. Seven hours in total. And around 11.30, Dr. Deschamp Rawley takes a break. Goes down to the hospital cafeteria and grabs himself a Coke and a packet of peanut butter crackers. By noon, he's back in the operating room. Abby has quite a strong lower jaw. He opens her mouth wide and cuts.

and cuts the flesh that connects her cheek to where her teeth are. He calls me over to take a look. I can see her skeleton, and he's cutting away the bone of her jaw with a reciprocating sore. It's quite forceful. He tapers her jaw, and then he gets to the middle, which is her chin. and then excises this T-shaped piece. It's quite a large piece of bone that gets pulled out.

And it's like watching a piece of gristle being pulled out of a meat pie. There's a specially designed little piece of metal, like a little bracket, that joins the bits of bone together and cinches them together so that the chin is smaller. Five weeks after the operation, I went to see Abby at home. It's in a biohazard bag. She'd kept the bone as a memento.

Classic container. It's like a little of my sticker with my ID on it. It still was in my mind that they were able to go cut all this out, take it all out. Sew it back up and everything's fine. When I saw her, she just started back at work. she had told a few close colleagues what she was doing but for the most part she told anybody

who asked or needed to know that what she had undergone was a corrective surgery she was a little self-conscious about the swelling in her face although to my eye it really didn't look very swollen at all given what I'd seen her go through it is amazing to see you because you look it's so

I mean it's just what are your impression I'm curious you look well you look lovely thank you I'm fishing for confidence yeah no I know well you look completely beautiful obviously

but it's I'm trying to find words for it I mean you you look familiar and yet not the same I think you look more different than I thought you were going to Yeah.

So her whole face is very different. Although the changes, the actual surgical changes can be counted in millimeters, the way that she holds herself has already changed. You said to me before you had this done that you sometimes had these moments where you would see your reflection and that it made you unhappy to. Yeah. And I wonder whether you have that. I haven't had that same experience since.

It's just not there. You know, other patients of Dr. Deschamp Brolly, who I'd interviewed, had told me that the experience of seeing themselves revealed for the first time when the bandages came off was incredibly emotional and moving, and one person told me that she had burst into tears. Abby did not have that experience. You know, finally, when she looked in the mirror, all the bandages were taken off

and she looked at herself in the mirror she thought, oh yeah, that's my face. One of his medical team told me something really interesting when they have cis patients, you know, non-trans patients and they have some type of surgery done.

You know, if you're in a car accident and you had to get your nose altered in some way or your chin or something changed, it just like takes time for you to kind of get over that mental image of who you were, and now you're looking at your reflection and those two things aren't matching, so you start freaking out. They told me that that really doesn't happen as much with their

trans patients. It's just like, you're like, oh, cool. It's just, like, over and done, their trans patients just tend to just to accept, you know, their quote-to-quote new face. Yeah. Rebecca Mead wrote about Abby and a lot more in the technique of facial feminization surgery. You can find her article at New Yorker.com. We altered Abby's voice to help protect your privacy. This is the New Yorker Radio Hour. Stick around. I'm David Remnick, and next time on the New Yorker Radio Hour, we have something very special lined up, an interview with James Comey.

Comey has a new book about to come out, and there's going to be a lot to cover, the election, the Russia investigation, Hillary's emails, Donald Trump, and the future of Robert Mueller's investigation. I'll be talking with Comey live at Town Hall in New York, and you can hear it all? the next day at new yorkerradio.org, wherever you listen to the show, don't miss it. For today, we're going to close things up by getting outside with the poet Ada Limo. Limeon grew up in California and then spent a long time living in New York City. Some years back, she left New York to live with her boyfriend, now her husband, in Lexington, Kentucky. Fewer rats, more horses.

Hey there. This is cactus. A cactus. Beautiful quarter horse. You know why I call him Cackey? What? Where's his name? Nimone's last book was called Bright Dead Things,

and it's all about adjusting to a new home, a new relationship, and the constant talk of thoroughbreds. We're standing in front of the main entrance here to Keenland, and they've got this beautiful stone walls, and it kind of looks like a castle. Keenland, I think, is one of the prettiest race courses and all of the United States. Now, this isn't where the Derby happens.

Churchill Downs is where the Derby is raced, but Keenland is a beautiful old track that has this very historic, stately feel in the middle of beautiful horse pastures all around it. It feels like spring might actually come. The sun's not quite up. It's a little cloudy. Being here when it's empty is kind of lovely.

So right now we're walking through the main track area before we get to the actual race track. So this is where you have the concessions, where you get your popcorn and your Kentucky's burgu, which is a sort of legendary Kentucky food. I'm not a huge fan. Don't tell anyone. You get soft pretzels and popcorn and soft ice cream for the kids. and then as we keep walking up here, you'll see all of the bedding windows.

I grew up going to the track occasionally with my stepfather who loves to play the ponies, but we would go to the Sonoma County Fair and go to the track out there. People always asking me, you know, what... You have so many horses in your palms, what are they a metaphor for? And I think they're not really a metaphor.

Like out here, they're just horses. The very first time I came to Keenland, it was here to meet Zanjada, who is a famous Philly, who I just adore. She's famous for having won the Breeders' Cup Classic, the only Philly to have won the Breeders' Cup Classic. and she was sort of an icon of mine, and so it was fun to get to meet her. And that was actually the very first time I came to Keenland.

I think one of the things I love about watching them race is the thrill that they seem to get from it. Like they actually seem to be enjoying the race. So right now I'm looking at the main track, which is a dirt track, has almost like a reddish quality. And it's loose dirt, even though we got some rain. It looks like it's bouncy. They try to keep it so it's healthy for the horses to run on. And then the track right behind it is the turf.

Now right now we've got thoroughbred going by Thoroughbred racehorse. There's something about them that is so beautiful as they race. And as they just stand there in the pasture, and out here in Kentucky, you know, they're about as common as birds. This area right here is the apron, and this is where if you just pay general admission, you can come and sit and stand on the rail and root for your horse. On a busy day, it will just be packed and loud and ruckus. It's a great sound. kind of like coming out here when there's no one here. It feels like there is some sort of ghost of energy within the space, as if it's, you could almost hear the echoes of roars.

People screaming with joy because they actually won big for the first time. This is a poem I wrote for the Kentucky Oaks Day, which is when all the Phillies race, and it's one of my favorite races. How to triumph like a girl. I like the lady horse's best, how they make it all look easy. Like running 40 miles per hour is as fun as taking a nap or grass. I like their lady horse swagger after winning. Ears up girls, ears up. But mainly, let's be honest, I like that they're ladies. as if this big, dangerous animal is also a part of me. That's somewhere inside the delicate skin of my body, there pumps an eight-pound female horse heart.

Giant with power, heavy with blood. Don't you want to believe it? Don't you want to lift my shirt and see the huge, beating, genius machine that thinks, no, it knows it's going to come in. first. The poet Ada Limone at Keenland Racecourse in Lexington, Kentucky. You can find the poem she's published in The New Yorker at New Yorker.com. I'm David Remnick. Thanks for joining me. Catch you next time. The New Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Merrill Garbus of Tune Yards with additional music

by Alexis Quadrado. This episode was produced with help from Johnny Vince Evans, Malik Baji, Jenny Cotaldo, Michelle Moses, Emily Mann, and Jessica Henderson. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.