Semiotic Review 7: Blank Faces | review published September 2019 |
DOI: https://doi.org/10.71743/4dzg9046 | Copyright © 2019 Cassius Adair CC BY-NC-SA 4.0

Seeing Women

Plemons, Eric. 2017. The Look of a Woman: Facial Feminization Surgery and the Aims of Trans-Medicine. Durham, NC: Duke University Press.

Cassius Adair
ca8sg@virginia.edu

I’m writing this review as my friend N snoozes on the couch, sleeping off his double mastectomy. Yesterday we sat in a trendy waiting room full of photographs of slender, long-lashed women, silhouettes of youthful femininity. We flipped through a “before and after” binder that included, in addition to snapshots of tummy tucks and facelifts, photos of men with new horizontal lines below their pectorals. These men had had breast tissue removed, nipples grafted on, and liposuction performed, sculpting their upper bodies into more conventionally masculine forms. Now N’s flesh is shaping him into one of those “after” images, constructing his new contours, bringing online nerve endings that have been severed, forming scars shaped like twin smiles across his chest.

My first-hand experience of transgender medical care, I’ll admit, led me to imagine that I wouldn’t learn much from Eric Plemons’ The Look of a Woman: Facial Feminization Surgery and the Aims of Trans-Medicine. I’ve undergone gender confirmation surgery; I’ve shepherded friends through it; I’ve personally advocated for its inclusion in my university’s insurance policies. The triumph of this book is that I could simultaneously see my intimate world reflected in its pages and gain new insight into the methods and meanings of transgender surgery.

The Look of a Woman is a medical anthropologist’s study of facial feminization surgery (FFS), a collective term for a group of thirteen individual surgical procedures. Transgender women might undergo these surgeries, offered through a small number of plastic surgeons’ offices, to modify their brow ridges, noses, cheekbones, chins, and thyroid cartilage. Plemons begins with a fascinating account of the development of FFS, an understudied element of trans history and medical history that I hope will be taught in undergraduate gender studies courses. From there, the core of the book examines the social logics of FFS: the ways that the rhetoric of self-fulfillment replaced the logic of gender conformity in trans surgical care, the role of affect in curating gender-conforming and positive surgical experiences, and the extent to which FFS might reorganize theories of social recognition. After these grounding chapters, Plemons offers an intense (and often grotesque) account of the surgery itself, a description which his skill as a writer transforms from a voyeur’s peek behind the surgical curtain into a thoughtful meditation on embodiment. The book concludes with a series of post-operative conversations with transgender women, revealing the individualized and contextual nature of these surgeries. In a surgical procedure that is so public-facing– excuse the pun– the procedure’s success is measured primarily by whether strangers look at the patient and see a woman. This final chapter underscores this social reality, while placing the patients themselves, rather than the surgeons and their boosters, as the arbiters of surgical accomplishment.

By concentrating on the material life of specific surgical procedures, Plemons avoids the trap of debating the legitimacy of trans embodiment in the abstract. Trans people, especially trans women, are often accused of reifying gender norms when they choose to acquire surgeries like FFS. Plemons, to his credit, sidesteps this tiresome debate through the simple act of taking these critiques as given. Of course, this regime of medicine operates through gender-normative and Eurocentric ideas about how men and women should look. Of course, surgery that reconstructs bodies reconstructs those bodies according to social norms. Thankfully, Plemons spends little time playing defense. These claims about surgery are true whether the patient is an injured cisgender firefighter or a healthy transsexual painter, and presuming that trans people have extraordinary responsibility for the operations of gender is one of patriarchy’s most exhausting red herrings.

Instead, The Look of a Woman provides a smart way to think about trans embodiment outside the feedback loop of gender essentialism and genital surveillance. Plemons foregrounds the face, not the crotch, as the site of everyday social encounter through which gender is instantiated. The trans women who spoke to Plemons for his study want to be recognized differently. Worried that their faces make them look too masculine, they are willing to be unrecognizable as themselves in order to be called “ma’am” by strangers on the street, by check-out workers in the grocery store. Yet FFS rarely counts as “sexual reassignment surgery” for the purposes of state documentation, and rarely does it register as a “sex change” in the cultural imagination. By foregrounding FFS, then, The Look of a Woman necessarily offers a reconsideration of what trans medicine means when it is not solely concerned with conforming to legal determinations of sex.

The face, in particular, has long been understood as a site of social meaning, producing forms of interpersonal knowledge that exceed mere gender categorization. Plemons’ work shows that a face that fails to signal gender conformity can result in painful forms of social harm. One subject in The Look of a Woman described her wish that she “could go out on the street dressed like I’m dressed right now– just a pair of pants and a T-shirt and some sneakers– [...] and that when I went into a grocery store the person would say, ‘Can I help you, Miss?’” (139) If this individual is not seen as a woman when shopping at her local supermarket, Plemons asks, what will it matter if a doctor or a judge or a politician sees her as one? If she is mis-recognized as a deceptive man, she is vulnerable to harassment and assault, no matter what her papers say. Being recognized in the social is thus so important that sometimes it demands the fortitude—and the finances—to have one’s face broken and put back together.

The Look of a Woman pushes trans studies to center the material body within the field’s discussion of social and political recognition. Over the last decade, trans scholars such as Paisley Currah and Lisa Jean Moore, Dean Spade, and Aren Aizura have critiqued state frameworks of gender recognition for their essentialist prescription of, in Plemons’ phrasing, “the terms by which membership in the category woman is granted, by whom, and at what cost” (94). Through his ethnographic method, Plemons is able to show not just how states dictate gender recognition based on genital status, but how community members determine gender inclusion or exclusion via face-to-face encounters. Perhaps because scholars such as Spade have legal training and draw upon a Foucauldian analysis of state systems, trans studies engages “recognition” primarily as a relationship between states and populations, a process through which marginalized groups gain nominal acceptance (often without material redress). However, as Plemons shows, recognition has another meaning: the ability to walk into a grocery store and be called “Miss.” While “visibility” as a political sine qua non might be a tepid ground on which to build a movement, as Reina Gossett, Eric Stanley, and Johanna Burton’s astonishing new anthology Trap Door (2017) shows, there is nevertheless a lived material body, encountered by other individuals, and visually assessed as gender-normative or freakish. As such, Plemons’ work helps trans studies stitch together the macropolitics of recognition and visibility with its interpersonal synecdoche, the face-to-face encounter.

Of course, in order to have a conversation about embodied sociality, it helps to have a theory of embodiment. The Look of a Woman ultimately argues for a “middle way” between understanding the trans body as “radical contingency” or “nonsocial materiality” (127). The book’s method offers powerful support for such a thesis, modulating as it does between the social politics of facial feminization, especially the stakes of visual recognition as a condition of womanhood, and visceral descriptions of bone and skin. While not wholly rejecting the phenomenological understanding of trans embodiment put forth in Gayle Salamon’s Assuming a Body (2010), or the posthuman approach that micha cárdenas advances in The Transreal (2011), Plemons argues that positioning trans bodies within “ethnographic time and space” make scholars more able to conceptualize and critique certain forms of violence, such as “when [a] body is hit by a bottle thrown from a passing car,” or is “looked up and down before being denied vital medical care” (126). Surely, neither Salamon or cárdenas are inattentive to such interpersonal forms of harm. But Plemons’ “middle way” thesis holds open the potential for bodies to be transformable, mobile, mutable things, and also account for what happens to bodies that look strange on the street.

That said, it is worth noting that this middle way thesis has a longer genealogy within theories of identity formation and embodiment. Frantz Fanon and Hortense Spillers, for example, both position the body as the site of social difference-making. Disability studies scholars such as Tobin Siebers and Nirmala Erevelles have shown how visual encounters with ambiguous or non-normative bodies can be sites of interpersonal rejection or disgust that in turn signify social exclusion. Plemons’ work would have been strengthened by an approach that situates trans embodiment as one of many sites through which we can understand (in Spiller’s terms) the flesh’s “degree zero of social conceptualization.”

When N wakes up, I’ll tell him all of this, maybe even read to him some of the most exciting and compelling passages from Plemons’ work, describe how social recognition of femininity is attempted through incisions in the forehead, or the bossing down of bone ridges above the eyes. We’ll discuss, eventually, as his cognition returns after anesthesia, how we’d productively teach Plemons to undergraduates, or use it in graduate research. For now, though, as he sleeps, I am thankful for a text that reflects back to me the messy material of my trans experience, both the blood-and-guts transformations and the urgent hope to be seen as someone new.