Best FFS Place?

[Sophia Sage]

I am not so sure about this. Getting too much done seems to be awkward and some trans women who had FFS look a bit odd because if that, because either too much was changed and it just shows - or because the FFS can after all just change some of the facial features and it is not complete. Some features are not changeable with FFS and if you feminize those parts that can be changed to the max, but have other parts unchanged, it is a weird puzzle. I especially see this if people have a rather large and long head and get the usual things forehead, nose, chin, jaw done but the shape of the face overall is still a bit masculine - then there is a face with very delicate features that is shaped more like that of a woman who would have a bit less feminine features.

Yes, actually, all good points.  What I was trying to convey is to go all out given the constraints of your face.  Now, I have a bit of a long face.  And due to the particulars of my mandible, only so much work could even be done there -- it is here I got as much as I could, as it was my weakest link.  This starting material subsequently informed how to approach the rest of my face.

My rhinoplasty, for example, was done with this in mind -- I now have a "straight nose" because that's the sort of nose that women with long faces tend to have (as opposed to the super-cute turn-up nose we often see on shorter faces) and it was likewise narrowed not as thin as possible, but in proportion, the most feminine proportion that would "work."  I had my forehead completely reshaped, as that's probably the most important facial feature in which people are read, but it's not like I have completely flat orbits -- again, that just wouldn't work given the starting material.  Likewise, I had a scalp advancement, but only in proportion to the rest of my face.

So when I say "radical" what I'm really getting at is a more esoteric understanding of that word -- of "getting to the root" or the "fundamentals."  Feminize every feature, with respect to the whole.  Which likewise means, leave no stone unturned, but I'm not recommending a piecemeal approach.

Think of it this way.  Our faces aren't atomized when people look at us.  The whole is seen, and everything works in concert. Now, if you change one feature, the worst feature -- say it's your brow bossing, which you get down to the root -- then what is the impact on everything else?  It probably makes sense to subsequently adjust your nose and how it joins up at the bridge.  And how does this confluence of features reflect on the lower portion of your face?  Remember, we can't really shorten the distance between the eyes and the mouth, so this informs how much we can shorten the chin -- though maybe it makes sense to taper it a bit, and round out the back of the mandible, and smooth down the line between the two.

Why do you suggest this - do you think there is a bigger benefit of doing more radical work?

(Personally I am still undecided on how much I would want to change - its such a hard balance between looking like "me", looking natural, being as feminine as possible, risks of damage fro surgery,...)

Perhaps a better word is "comprehensive."  The reason is because of the effect it can have on identity.  After having everything done, I no longer kept "reading" myself in a way that would lead me to clocking myself.  There was a sense of "grace" that I could finally subconsciously bestow upon myself.  If I had left, for example, my chin undone, it would still have been a point of internal contention.

But then, I really needed every trace of "him" gone, because it was getting in the way of seeing "me" in the first place.  I struggled to identify "me" in the mirror, just couldn't see it until I had all this done.

The grace I could give myself subsequently made it much easier for everyone else to do the same. 

I've seen one result where the transitioner was too subtle, because they still wanted to look like "themselves" -- like, the jaw was still square, just a bit softer.  The brow bossing was still there, just softer.  And so her face still ended up looking kind of square and masculine, but more like an adolescent male rather than an older female.  The effect was androgyny, rather than full feminization.  Now, maybe that's the whole point for someone who identifies as androgynous, fair enough.  But she wasn't purposefully androgynous -- no, she was someone who was trying to hold on to as much of her previous life as she possibly could.  She just couldn't let go.

Your mileage may vary.

I transitioned at age 25 and passed well after 2 years or so. It started to get less good over the years and now at age 41 it still works ok, but I am still feeling dysphoric about it ins ome ways and I fear that at age 50 or 60 it will probably rather get worse, so I consider doing a FFS rather now than in 10 year - basically I tell mysefll now or never - I would hate to have to do FFS at age 55 and then curse myself over not doing it at age 41, getting rid of dysphoria much earlier.

By "young" I meant those in their early twenties, so yes, this is exactly what I mean.  Age is not kind to our faces, and what works in your twenties isn't quite all that in your thirties, let alone your forties.  You're entering middle age.  Do it now. 

A good friend of mine had facial surgery over twenty years after her transition; she was also middle aged by that time.  And for her, it was like lightning struck.  She lived pretty much stealth the entire time, so it's not like she "needed it" to pass; nonetheless, the world shifted after she got the works done.  It was like death and rebirth.

[anjaq]

Think of it this way.  Our faces aren't atomized when people look at us.  The whole is seen, and everything works in concert. Now, if you change one feature, the worst feature -- say it's your brow bossing, which you get down to the root -- then what is the impact on everything else?  It probably makes sense to subsequently adjust your nose and how it joins up at the bridge.  And how does this confluence of features reflect on the lower portion of your face?  Remember, we can't really shorten the distance between the eyes and the mouth, so this informs how much we can shorten the chin -- though maybe it makes sense to taper it a bit, and round out the back of the mandible, and smooth down the line between the two.

Perhaps a better word is "comprehensive."  The reason is because of the effect it can have on identity.  After having everything done, I no longer kept "reading" myself in a way that would lead me to clocking myself.  There was a sense of "grace" that I could finally subconsciously bestow upon myself.  If I had left, for example, my chin undone, it would still have been a point of internal contention.

This is rather difficult to evaluate and decide. I think one has largely to hope for the surgeons to make a good judgement over this? But I know that this seems not to be enough as I have seen some surgical results where I would see this effect - some part looks feminine and another part seems like it was looking androgynous before but now looked more masculine than the rest. How do you determine this - what really is needed. I tried to make a VFFS but honestly it is not helping a lot in that sense because all the changes are so subtle that its hard to see which parts are making sense...

sult where the transitioner was too subtle, because they still wanted to look like "themselves"

This I do not really understand, I would hope to rather see "myself" more after such a surgery.

By "young" I meant those in their early twenties, so yes, this is exactly what I mean.  Age is not kind to our faces, and what works in your twenties isn't quite all that in your thirties, let alone your forties.  You're entering middle age.  Do it now. 

A good friend of mine had facial surgery over twenty years after her transition; she was also middle aged by that time.  And for her, it was like lightning struck.  She lived pretty much stealth the entire time, so it's not like she "needed it" to pass; nonetheless, the world shifted after she got the works done.  It was like death and rebirth.

Wow ok - thats a strong suggestion in favour of doing it. This is what I think - I either have to do this now, even though even surgeons tell me I do not need it - or I have to forget it for good. Is this at all possible - to relly let go of this thought , once it has been there for a while?

I read the journals of Melanie Anne Phillips, she described something similar and also phrased it as sort of a deat and rebirth scenario (well more like purgatory and afterlife). I am fascinated that I read this now several times that people who had a good "passing" still did FFS and then experienced a huge change in how they feel and their personality. I am not sure if this would happen to me, but it sounds like something desireable for sure ... I had something similar with voice surgery - a sense of liberation and feeling more confident to express female impulses which I did not allow myself to do  before.

Did your friend write something about this experience as a blog or something? I would love to hear more on this, her situation seems to be similar to mine...

[Sophia Sage]

This is rather difficult to evaluate and decide. I think one has largely to hope for the surgeons to make a good judgement over this? But I know that this seems not to be enough as I have seen some surgical results where I would see this effect - some part looks feminine and another part seems like it was looking androgynous before but now looked more masculine than the rest. How do you determine this - what really is needed. I tried to make a VFFS but honestly it is not helping a lot in that sense because all the changes are so subtle that its hard to see which parts are making sense...

Well, yes, and this partly why we go to consultations.  But it doesn't hurt to do your own research.  Look at instructions on how to draw faces, for example, to get an idea of proportions. Or google the differences between male and female skulls.  Get your X-rays and CT scans taken, so you can see what you're actually dealing with. 



See the dots in the chin?  Those are traversed by the facial nerves.  If you were to redraw that jaw, the new line must still be outside those dots.  And in the back corner of the mandible, sometimes it flares -- it may not be possible to completely cut it down, or you'll end up with an inverted corner cut out.  Nonetheless, the female chin is shorter proportionately than the male, not as wide, and doesn't drop down so far in the mandible, which itself takes a flatter angle, or rather a more direct line towards the mastoid process.

In these skulls, the male's brow bossing is a bit slight, but it's made more pronounced by the flat slope of the forehead.  Sometimes shaving down the bossing isn't enough -- the entire forehead must be reconstructed to produce the desired effect, because the top of it needs to come forward while the bottom needs to be set back, with a smooth transition between the two.  It's much easier to do this with a prosthetic than taking out the bone pieces, breaking them down, and putting them back together again.  Not to mention the fact that bridge of the nose is set further back in the female skull than in the male skull.

There's nothing that I know of that can be feasibly done with the bone between the nose and the upper teeth.  This is a hard limit, which will in turn determine the proportions of the chin and forehead. 

And all this is going to vary tremendously from skull to skull. 

Getting back to general proportions -- in most "attractive" women, for a frontal portrait, we typically see about the same vertical difference between the center of the eyes and the center of the mouth as we do from the eyes to the hairline, while the distance from the center of the mouth to the bottom of the chin is about 62%. 

Looking at your avatar, then, for example, we'd want to see the hairline advanced significantly (scalp advancement can take it down 1 inch, 1.5 inches at the very outside) while the mouth/chin distance probably only needs to be reduced by like 6%.  Roughly speaking.  I mean, 6% isn't going to make or break anything, but every little bit helps.

The chin itself needs to be tapered -- right now it's too wide and flat. There might be limits to what can be accomplished here, depending on the where the facial nerves are, and how flared the mandible is.  However, even just rounding down the shape of it is going to make it look more feminine. 

I can't tell about the brow, of course, because the picture is so blurred.  That's actually the most important, I think, because we are so drawn to looking each other in the eyes.  However, even here the shadows in the orbits would be lightened up, bringing out the eyes, I think. 

Wow ok - thats a strong suggestion in favour of doing it. This is what I think - I either have to do this now, even though even surgeons tell me I do not need it - or I have to forget it for good. Is this at all possible - to relly let go of this thought , once it has been there for a while?

You know your face better than anyone.  You see it in the mirror every day, and I'd expect you have pictures of your profile as well.  Do you see what's actually going on in your bones, and knowing what you know, does it make you dypshoric? 

What I saw in myself made me dysphoric.  I passed okay before facial surgery, I didn't get clocked, but I could tell there was a slight subconscious disconnect in how other people were reading my face before realizing a woman was standing in front of them.  "You pass fine!" friends and family would say, and I wasn't getting clocked (it certainly helped to have an excellent voice), but after the facial surgery it really was a whole new world.  Because if I could discern, with conscious attention, those aspects of my face that went against the grain, so to speak, it's sure darn tootin' that the general public was picking up on it too, even if it was all subconsciously. 

And all that went away after facial surgery. 

Did your friend write something about this experience as a blog or something? I would love to hear more on this, her situation seems to be similar to mine...

I have no idea if she's around, or would share.  The way she put it to me, though, was that facial surgery was "the real sex reassignment."  Hopefully some others with similar experiences will chime in.

And of course, even "subtle" work is still radical surgery. It's expensive, and there are risks, and recovery is time-consuming and is often quite painful.  Expect to be out of commission for several weeks, and not quite right for at least a couple months.  Balance all that out with your dsyphoria.  As far as I'm concerned, it's that feeling that's always driven my own decisions about transitional work -- well, that and material reality. 

As always, your mileage may vary.  The hard part is really figuring out what you want.

[Amy Rachel]

This is rather difficult to evaluate and decide. I think one has largely to hope for the surgeons to make a good judgement over this? But I know that this seems not to be enough as I have seen some surgical results where I would see this effect - some part looks feminine and another part seems like it was looking androgynous before but now looked more masculine than the rest. How do you determine this - what really is needed.

Piping in again, I do think you have a very good point. Proportion and balance play into it.

People read faces in two major ways. One group reads overall shape, hair, structure and identifies the person. The other sees all the details of the eyes, the nose, the lips, but miss the overall structure. Ever see a man come in to work having shaved off his years-old beard and some people don't recognize him while others don't notice anything different? That's how all over the map people can be in seeing and recognizing people.

The best surgeons will understand this. I will talk about Dr. O because I consulted with him, and he's retired now so advocacy is not part of this. In his consults, he used measurements. For him, it was about measuring reference points on your face and identifying what would need to be done to bring your bone structure into the proportions that fit within the common female range of facial proportions. Knowing what to measure is key.

Growing up, I think many of us probably focused on our jaws as a center of horror. Especially during puberty. Too big, too square, too rough. But it turns out that while jaw is non-trivial in how people identify others, it does not weigh as heavily in the scale of things in how people gender others. The forehead, as it turns out, is a much bigger deal, and becomes all the more so as we age.

With an excellent surgeon, then, I'd suggest submitting to their full analysis, listen to their reasoning, research their results, and then go with the full deal. Fixing brow bossing alone may make the nose appear more masculine. Changing the nose may have no effect on gendering. Major jaw work with nothing else also could have little effect on gendering, just making a "strong" man's face into a weak-jawed-man's face—as others read it.

Also to note: The forehead is a complex area of the skull, with many variations of structure among us all. Dr. O classified them as Type I, II and III. Type I was solid and could be simply shaved down. Type III, on the other hand, has a hollow sinus cavity which can't just be ground down. You'd end up with a big dent in your forehead. The doctor in this case would carefully cut out a front plate, reduce the framing skull material, then re-set the front plate, thus retaining the integrity of the cavity. So be sure that your FFS surgeon is very expert in these areas. (Dr. O began his career working with children with extreme cleft palates and other severely disabling birth conditions, so his FFS work was really an outgrowth of that and based on a deep understanding of how facial bones should work together.)

One more comment about hairline: Don't obsess to much about a high hairline. Further back is another matter, but if you look at women around you every day, many have hairlines that seem to go halfway back across their skulls, and yet they look completely female. That's because of the bones underneath. On the other hand, sometimes you see a woman with very bold bone structure but the rest of her comportment, complexion, style, hair, etc. take her squarely into female gendering. It's a gestalt thing.

But I agree with the other comments. If you can have both, it can feel like a life reboot!

[anjaq]

Well, yes, and this partly why we go to consultations.  But it doesn't hurt to do your own research.  Look at instructions on how to draw faces, for example, to get an idea of proportions. Or google the differences between male and female skulls.  Get your X-rays and CT scans taken, so you can see what you're actually dealing with. 
......
You know your face better than anyone.  You see it in the mirror every day, and I'd expect you have pictures of your profile as well.  Do you see what's actually going on in your bones, and knowing what you know, does it make you dypshoric? 

What I saw in myself made me dysphoric.  I passed okay before facial surgery, I didn't get clocked, but I could tell there was a slight subconscious disconnect in how other people were reading my face before realizing a woman was standing in front of them.  "You pass fine!" friends and family would say, and I wasn't getting clocked (it certainly helped to have an excellent voice), but after the facial surgery it really was a whole new world.  Because if I could discern, with conscious attention, those aspects of my face that went against the grain, so to speak, it's sure darn tootin' that the general public was picking up on it too, even if it was all subconsciously. 

....
The hard part is really figuring out what you want.

Indeed this is the hard part. You saw my real photos and why it is hard. Some of these things listed only apply slightly but of course they all do apply somewhat. And apparently to even change my forehead, most of the surgeons suggested taking it back with a type 3 surgery. Not sure why.
I sometimes feel that disconnect, that other people seem to think a bit - but it can also be paranoia. Same when I see myself - I feel it is not so good at times, that I look maleish - the next moment its gone - and then it comes back again...

I think with my face the question is less about how strongly it can be feminized because there are these hard limits - I doubt I would have to go to all those limits to get into a regular female range - but of course if I want to see change, I would have to go further than just that.

With an excellent surgeon, then, I'd suggest submitting to their full analysis, listen to their reasoning, research their results, and then go with the full deal. Fixing brow bossing alone may make the nose appear more masculine. Changing the nose may have no effect on gendering. Major jaw work with nothing else also could have little effect on gendering, just making a "strong" man's face into a weak-jawed-man's face—as others read it.

Well so far the comments of the surgeons ranged from "you do not need FFS" to "your face is faminine but also somewhat masculine, but to remove the slight masculine features, we would have to work in all areas".
Some gave me a list and basically said I could choose, because all of it is optional. So that was not a tremendous help - lol

[Sophia Sage]

Indeed this is the hard part. You saw my real photos and why it is hard. Some of these things listed only apply slightly but of course they all do apply somewhat. And apparently to even change my forehead, most of the surgeons suggested taking it back with a type 3 surgery. Not sure why.

Perhaps the bone itself is quite thin, in which case you can't just shave it down, you have to take it out and either break it down and put it back together, or replace it with a prosthetic.  If you want the most dramatic change, Type 3 revision is the way to go.

Well so far the comments of the surgeons ranged from "you do not need FFS" to "your face is faminine but also somewhat masculine, but to remove the slight masculine features, we would have to work in all areas".

Yeah, it would have to be all or nothing with what you have.

I sometimes feel that disconnect, that other people seem to think a bit - but it can also be paranoia. Same when I see myself - I feel it is not so good at times, that I look maleish - the next moment its gone - and then it comes back again...

The ghost in the mirror.

Here's a question -- how much has this feeling grown, if any, in the past five years?

[anjaq]

Perhaps the bone itself is quite thin, in which case you can't just shave it down, you have to take it out and either break it down and put it back together, or replace it with a prosthetic.  If you want the most dramatic change, Type 3 revision is the way to go.

So far I only have limited X-rays and the surgeons decided this more on experience, I guess. One surgeon said they basically always assume a type 3 since the other methods are rarely enough.

Yeah, it would have to be all or nothing with what you have.

This kind of sucks as it is a lot of surgery for subtle changes in all these areas.

The ghost in the mirror.
Here's a question -- how much has this feeling grown, if any, in the past five years?

Yeah - its a bit ghostly... which makes me often think that its more in my head - since the feedback of others is that they see nothing therelike. So the ghost is possibly only haunting me and maybe I need a ghostbuster or a therapist or something that gets this feeling out of my head.

In the past 5 year this improved, actually. I have radically changed my hormone therapy and its working much better now and I lost 30 kilos. Also after the voice surgery my confidence level went up and this also changed my perception. But since these changes, things stayed about the same.

[Sophia Sage]

This kind of sucks as it is a lot of surgery for subtle changes in all these areas.

I don't think the forehead/nose would be all that subtle, though, because of how much it would bring out your eyes. In your 3/4 shot, for example, your far eye would not be occluded by the bridge of your nose. 

Yeah - its a bit ghostly... which makes me often think that its more in my head - since the feedback of others is that they see nothing therelike. So the ghost is possibly only haunting me and maybe I need a ghostbuster or a therapist or something that gets this feeling out of my head.

Your ghost is only visible -- and barely, at that -- when I was actively looking for it, and even then only at certain angles. (Another reason for non-disclosure, of course, people look for the ghost because of that narrative.)

So, if I had to look for it to see it... is it possible that you yourself are looking for it?  And if so... why?

[anjaq]

Yes, this is probably something I do - for some reason, maybe because of being too self-conscious or not enough slef confident or anxiety - I may subconsciously look for it. I know that I will sometimes check my face to see if it is looking good or not and then this happens. Of course if I do not look at my face I will not think so much about it. If I see my face, there is always an  impulse to see how it looks like and then I often get this stupid dysphoric feeling...

[R R H]

Or google the differences between male and female skulls. 

Some male skulls and some female ones.

They are not absolutes and there are many cis males with more so-called female shapes and vice versa.

[Sophia Sage]

Some male skulls and some female ones.

They are not absolutes and there are many cis males with more so-called female shapes and vice versa.

I'm not speaking in absolutes, but in generalizations -- because it's the general case from which categories are constructed (automatically, subconsciously) in the first place.  In other words, there's a spectrum, with two different bell curves, and we want to get on the right curve (and the right side of that curve) if at all possible. Especially if there are other non-correctable obstacles in consideration.

And of course, those generalizations will shift from one population to another.  A typical male Asian skull might fall closer to the female European distribution -- which plays well in Europe, but not so well in Korea. 

Again, my concern is always about eliminating dysphoria, which is caused by misgendering from self and others.

Yes, this is probably something I do - for some reason, maybe because of being too self-conscious or not enough slef confident or anxiety - I may subconsciously look for it. I know that I will sometimes check my face to see if it is looking good or not and then this happens. Of course if I do not look at my face I will not think so much about it. If I see my face, there is always an impulse to see how it looks like and then I often get this stupid dysphoric feeling...

How do you feel about doing this to yourself for the next ten years?

[R R H]

I'm not speaking in absolutes, but in generalizations -- because it's the general case from which categories are constructed (automatically, subconsciously) in the first place. 

Not forgetting the constructions and, indeed, reconstructions on this topic made by surgeons like Dr Ousterhout who then, surprise surprise, made an absolute packet out of the grand theory.

I've no doubt heavy engineering can help with some people greatly and that's fabulous. But much more can be achieved through hormones and skin and muscle lifts than people give credit for, as they know full well in Thailand which has the most beautiful MtF's I've ever seen without ever having skull reconstruction. And I'm not speaking solely of Asians either.

yours a slight sceptic

x

[anjaq]

How do you feel about doing this to yourself for the next ten years?

Not fun, no. I wonder if I can stop doing this to myself without something radical as surgery. If its only in my head, maybe I can somehow cure it in my head, I hoped.

I've no doubt heavy engineering can help with some people greatly and that's fabulous. But much more can be achieved through hormones and skin and muscle lifts than people give credit for, as they know full well in Thailand which has the most beautiful MtF's I've ever seen without ever having skull reconstruction. And I'm not speaking solely of Asians either.

Hormones are bascially a mus - I would never want to be without them. Soft tissue work to feminize a face is limited though, in my opinion. It may work in some people, but I think it is time limited - so it will fade with time, and some of it basically is beautification and since beauty is considered female, it works. I believe the reasons why there are so many well looking Thai Trans women are different ones. First of all, many Thai trans women have access to hormones at a very young age, so they feminize more, this will get better in western countries in the future, I hope. Then, a lot of the depictions of thai trans women are about women in their 20ies or 30ies. In that age, I did not worry so much about my face, i was feminine looking - its the age that gets you eventually. Also I believe the trouble trans women in thailand endure may be different. The are nor per se shunned and bullied by everyone, maybe they will not get so much hardened, which also changes the looks of the face. Instead they may have to endure being a sex worker to py for surgery, but this leaves a different effect on the face, possibly...

I guess its all different factors - bones, muscles, soft tissue, fat, style, hormones - sometimes it is enough to have some, sometimes it is not. In my case it is enough without bone work - enough to "pass" and live normally without being bullied or bothered. Not quite enough to be happy about myself, but that is a question I will have to answer to myself - if this justifies a big surgery. I bet a majority of trans women in the west would trade my looks with theirs immediately because of that "passing privilege". They call me crazy for even considering doing any surgery (except mabe if I really want to I could get my nose done or some lipo).

But I am curious - what procedures do you think are so effective and common in Thailand that make the Thai trans women look more feminine while avoiding bone work? Maybe those can be an option to push things far enough for me to not need bone work.

[Sophia Sage]

I wonder if I can stop doing this to myself without something radical as surgery. If its only in my head, maybe I can somehow cure it in my head, I hoped.

If we had that power, we never would have needed to transition in the first place.

I guess its all different factors - bones, muscles, soft tissue, fat, style, hormones - sometimes it is enough to have some, sometimes it is not. In my case it is enough without bone work - enough to "pass" and live normally without being bullied or bothered. Not quite enough to be happy about myself, but that is a question I will have to answer to myself - if this justifies a big surgery. I bet a majority of trans women in the west would trade my looks with theirs immediately because of that "passing privilege". They call me crazy for even considering doing any surgery (except mabe if I really want to I could get my nose done or some lipo).

They called us crazy for transitioning, too.

Anja, have you ever considered the fact that you were always female?  That what you see in your face is not a reflection of "him" -- because there never was a "him."  Perhaps what you see is not a ghost, but the memory of a false persona that you constructed to survive, until you could do what you had to do to simply be yourself.  Perhaps that image is a reminder of your strength, and courage, and resiliency, and what you really need to do is let go of the past, or at the very least to reconfigure it.  That there's a different story here.

Or maybe you're Ripley in the escape pod, and there's an alien that needs to be ejected out the airlock. 

[anjaq]

If we had that power, we never would have needed to transition in the first place.

Well I am not sure of that - Its a different magnitude. The dysphoria about th whole thing back then was massive - now the dysphoria about the face is more a nuisance than that big life threatening matter ...
And if FFS would not exist, I would probably be able to deal with it. Just as I have to deal with having wide shoulders and short legs and other things that I do not like about my body

Anja, have you ever considered the fact that you were always female?  That what you see in your face is not a reflection of "him" -- because there never was a "him."  Perhaps what you see is not a ghost, but the memory of a false persona that you constructed to survive, until you could do what you had to do to simply be yourself.  Perhaps that image is a reminder of your strength, and courage, and resiliency, and what you really need to do is let go of the past, or at the very least to reconfigure it.  That there's a different story here.

Or maybe you're Ripley in the escape pod, and there's an alien that needs to be ejected out the airlock.

Well I must say it does not even remind me of some "him". I see old pictures and feel nothing - I feel like its not me in that picture even if I know I was there. Its something else - I think its not "him" its maybe "it" - the "transwoman" I may often have considered myself to be after transition. You know - I knew I was a woman but being mean to myself I considered myself to be a second class woman. And my face was one of these things that made me see myself as second class because of the masculine elements in it.

I am not sure I get the Alien metaphor though, although I like the movies a lot

[R R H]

I believe the reasons why there are so many well looking Thai Trans women are different ones. First of all, many Thai trans women have access to hormones at a very young age, so they feminize more, this will get better in western countries in the future, I hope. Then, a lot of the depictions of thai trans women are about women in their 20ies or 30ies. In that age, I did not worry so much about my face, i was feminine looking - its the age that gets you eventually. Also I believe the trouble trans women in thailand endure may be different. The are nor per se shunned and bullied by everyone, maybe they will not get so much hardened, which also changes the looks of the face. Instead they may have to endure being a sex worker to py for surgery, but this leaves a different effect on the face, possibly...

Good points Anjaq

But I am curious - what procedures do you think are so effective and common in Thailand that make the Thai trans women look more feminine while avoiding bone work? Maybe those can be an option to push things far enough for me to not need bone work.

They do a lot with lifts: brows, full facial. But they also do work like soft implants into the upper forehead. Warlockmaker explained it to me: in effect it produces the same or similar feminine female contouring as the heaving grinding beloved by some western surgeons without any of that invasive work. They do similar implant work on cheeks.

By the way, re the Thai kathoeys and hormones I've had many conversations with them and have been surprised at how many say they no longer take hormones, or only occasionally. The reason is that they have achieved a lot of feminisation and do the rest with makeup, at which they are absolutely brilliant. See, I think that touches on a big difference. Do we want to be female or look female? An over-reliance on makeup to achieve our ends means it can be a bit of a shock in front of the mirror late at night with those wipes. On the other hand, I guarantee that every cis woman on the planet over the age of 40 has the same issue.

I think I'm just feeling that for some MtF's there may be a different, less invasive, means to achieve at least the same ends as those angle grinding machines.

[anjaq]

They do a lot with lifts: brows, full facial. But they also do work like soft implants into the upper forehead. Warlockmaker explained it to me: in effect it produces the same or similar feminine female contouring as the heaving grinding beloved by some western surgeons without any of that invasive work. They do similar implant work on cheeks.

Well but soft Implants are not really a permanent solution, are they? They can get old and they can shift or if the skin around it shrivels and get sold, one can see the implants, like one can see my breast implant now that I have aged a bit... then you get those older trans women who look like it because one can see they had "work done".

By the way, re the Thai kathoeys and hormones I've had many conversations with them and have been surprised at how many say they no longer take hormones, or only occasionally. The reason is that they have achieved a lot of feminisation and do the rest with makeup, at which they are absolutely brilliant. See, I think that touches on a big difference. Do we want to be female or look female? An over-reliance on makeup to achieve our ends means it can be a bit of a shock in front of the mirror late at night with those wipes.

Well "Kathoeys" are not the same as transsexual women. It is maybe more something like "trans" - an umbrella that even includes feminine gay men in Thailand, as far as I know. For me, having to use Makeup to appear female but knowing that underneath it is not so, and seeing this in the evening causes dysphoria. If this is not happening because the main dysphoria would come from being seen as male by others - well, different story.
If I would learn how to do good makeup - somethin I did not learn in my past 18 years since transitioning - I am sure I could make my face very feminine with it. But it would not change much for me, I guess, since the "ghost" strikes more often in the bathroom at home when there is no makeup involved anyways.

Regarding hormones - of course if you start hormones as a teenager and keep taking them until puberty is over, not taking them afterwards will do less damage and only slowly reverse the effect over years. Especially if there was an orchie involved or the hormones have done that, no testosterone will do harm, then this can go well for years. I am not sure what the life expectancy of kathoeys in Thailand is - One rarely sees images of elderly kathoeys....

[Sophia Sage]

I never wear makeup anymore.  Makes me feel fake.

And if FFS would not exist, I would probably be able to deal with it. Just as I have to deal with having wide shoulders and short legs and other things that I do not like about my body

Just because we can deal with, given no alternatives, doesn't me we should deal with it, given alternatives.

If there was a pill that cost $100,000 that would change nothing, except for rewriting my DNA, I'd take it.  If there were surgeries that would effectively make me proportionately smaller, I'd get them.  Something to reduce the breadth of my shoulders?  Absolutely.

No, these things don't bother me, and don't get in the way of living a woman's life.  But they'd still make me more comfortable.

Its something else - I think its not "him" its maybe "it" - the "transwoman" I may often have considered myself to be after transition. You know - I knew I was a woman but being mean to myself I considered myself to be a second class woman. And my face was one of these things that made me see myself as second class because of the masculine elements in it.

I am not sure I get the Alien metaphor though, although I like the movies a lot

The Alien in your particular context is the "transwoman," while you are Ripley, simply a woman.  At the end of the original movie, Ripley escapes in her escape pod, but the Alien has stowed away on board, lurking in the shadows.  She has to figure out how to eject the Alien out of the airlock before she can truly sleep.

This is a post-transition metaphor -- the denouement after escaping the Nostromo.

[R R H]

Personally, and this is just my view, use of the term Alien is as inappropriate as it is unrealistic.

I've never believed this idea that the 'me' that was Richard was not me, or in some way didn't exist. That way lies delusion.

Cis women use makeup and, given half the chance, many would have facelifts and botox etc. Beautification is not something unique to MtF's and, again, I think it's unrealistic to think otherwise. There's nothing 'fake' about this. It actually plays into the very thing you are seeking to avoid. All human beings are somewhere on a continuum of maleness and femaleness. I consider myself a woman and like most every other woman on the planet I enhance my appearance by using makeup. It's not an issue for me. The idea that that is fake is as absurd as suggesting I shouldn't wear beautiful female clothes to look good.

Anjaq, kathoeys is a very broad term as you know, encompassing both pre-op transsexuals and post-op transwomen and women. I've talked to many many of them down the years and it's a massive umbrella term. By no means all, by the way, are involved in the sex industry either. I've quizzed people on this and had figures from 10-25%. Certainly a great many kathoeys have nothing to do with that industry. I think we need to be careful not to impose western categorisations like transsexualism on a long-established Asian tradition. That way lies what Edward Said called 'orientalism.'

[oneoftwo]

Good points Anjaq

They do a lot with lifts: brows, full facial. But they also do work like soft implants into the upper forehead. Warlockmaker explained it to me: in effect it produces the same or similar feminine female contouring as the heaving grinding beloved by some western surgeons without any of that invasive work. They do similar implant work on cheeks.

You have been pretty harsh in your characterization of western surgeons who do bone work.  Essentially accusing Dr. O of running a "racket" or something similar for doing forehead remodeling of the bone structure.

Consider this: Most good facial surgeons, that actually know how to also do both implants and bone work  ---   will tell you that implants are a distant poor 2nd choice to doing bone work.  Lots of negatives associated with implants.  There is a significant rate of short and long term infections associated with implants.   Often you have to end up taking antibiotics before (and after) every trip to see the dentist,  to protect against blood born infection locating in /around the implant(s).   Often the ONLY treatment for an implant infection is to remove the implant.   

Then what ?  Do that again ?    Isn't that the definition of insanity?   What are you going to tell your co-workers when you show up for work - - 10 days after the implant removal?

Aesthetically,  part of the reason for doing the type III foreheads is because the eyes are set so deeply in most western men - - compared to females - -  that adding forehead implants to mask the brow ridge does nothing to change the gender marker associated with the deep set eyes.  In many instances, a camafloge implant above the brow may make that marker more significant.