The wrong trousers

‘Facial feminisation surgery is my only option. What will a female me look like?’

David Thomas’s transgender diary

‘HMM… THE CHIN projection is perfect,’ murmurs Mr Christopher Inglefield, consultant plastic surgeon, as he gently prods my jawline.

It’s not a compliment I’ve heard before. But then, it’s not often that one sees a doctor with the specific intention of reshaping one’s entire face. That, though, is what I have to do if I am to have any hope of a successful transition.

I wish it weren’t so. The thought of my face being cut into, remodelled and stitched back together is terrifying. I have an overactive imagination and letting it rip on all the things that can go wrong with a lengthy, potentially disfiguring operation is a nightmare.

Besides which, I’ve been looking in the mirror at the face nature gave me for the past six decades. It’s not perfect, but it’ll do fine for me. Or it would, if my mind and body matched one another. Like it or not, facial feminisation surgery is the only option if I am going to look on the outside how I feel on the inside.

Inglefield sums up that fine-butnot-fine dichotomy later, when I ask him how technically challenging the whole process will be. ‘The most challenging thing is the tip of the nose, and the thickness of the tissue I’ll be working on to create a more refined, more feminine look. The rest is pretty straightforward.’

‘Do you really need to operate on my nose, then?’

‘Yes, it dominates your face too much.’ Inglefield pauses and then adds, ‘If you were going to be David for the next 25 years, I’d say, “Forget it.” But trying to get it refined as much as possible is going to be worthwhile.’

Intellectually, I get it. But emotionally it’s much harder. For all of us, our face is who we are. It connects us to our parents, our siblings and our children: all those visual clues that say, ‘We are of one blood.’ I am scared of losing that sense of personal identity and familial connection. But what will a female me look like?

In the weeks before the consultation I use an iphone picture app that can change the sex of a person’s face. For most people, it’s just a bit of fun. But for me, it is a way of getting some idea of what I might look like after my operation. The results aren’t too bad: still my basic face, and certainly no supermodel, but a perfectly nice-looking woman.

The first thing that strikes me, though, is, ‘I look just like Harriet!’ She’s one of my two younger sisters and that resemblance is very reassuring. I’ll still belong.

So off I go to the London Transgender Clinic, where Inglefield practises. I tell him I’m after the minimum amount of work needed to make me passable as a woman, while still being me. I then list the features that after years of research and vanity I have targeted for treatment.

The flesh around my lower cheeks and jawline is too heavy, but my upper cheeks are too hollow. My top lip needs lifting, because women’s top lips are set higher than men’s: closer to their nose and revealing their top teeth as they talk. My browline is too glowering and the groove between my eyebrows is too deep. And yes, I agree, the tip of my nose is way too bulbous.

Inglefield examines me, taking detailed measurements of my face. The survey complete, his list of necessary procedures tallies almost exactly with mine. I’d like to believe that’s because my bright mind and sharp eye have combined to produce a devastatingly acute analysis. But the cynical journalist in me suggests that his business depends on charming his patients. With his snowy hair, comforting manner and lilting Trinidadian accent, Inglefield is very charming indeed.

‘It’s not about changing you. It’s about you looking in the mirror and thinking, “I see me, but a softer me.” It’s getting that balance,’ he reassures me.

He then adds, ‘There are things we have to consider that are about maleness, and things that are about being 60. And they’re very different.’

He describes the face and brow lifts as essentially just ‘freshening’ my appearance. ‘The lips will be what feminise your face the most.’

I’m surprised that the simplest procedure will be the most impactful, but Mr Inglefield points out, ‘What do people look at when they see a face? The eyes and mouth. It’s that triangle.’

I get out my ipad and show him the app’s image of me as a woman. ‘Could I actually look at all like this?’

Mr Inglefield looks at the screen, makes the image larger and examines it more closely. ‘Yes, that’s mostly achievable. The nose is the only issue. It won’t be as refined as the one in the picture.’

Ah, my damn nose again, still getting in the way. But I reassure myself with the fact that, overall, the news is really good. Next we get down to the details of what exactly will be done, and only then do I truly grasp the full extent of the gruesome six-hour procedure, how much discomfort I will be in, and how great the cost will be…

Author David Thomas still lives as a man, but has begun the male-to-female gender transition that will eventually result in becoming a woman. Each week he chronicles his progress