The New Yorker takes a look at the history of facial-feminization surgery for transgender women.
https://www.newyorker.com/magazine/2018 ... omans-face
Why would facial surgery be more important to a transgender womman than bottom surgery for transgender women?
Dr. Ousterhout:The anthropologist Eric Plemons spent a year observing [surgeon Douglas] Ousterhout’s practice, and recently published a book, “The Look of a Woman: Facial Feminization and the Aims of Trans-Medicine.” He argues that Ousterhout not only honed a set of techniques; he also developed a theory of gender difference.
Ousterhout came to believe that, for trans patients, the most meaningful surgical intervention they could undergo was not genital but facial surgery. Few people you meet see your genitals, but everyone sees your face, and instantly makes assumptions about your gender, based on a subconscious assessment of your features. (Trans men typically have an easier time signalling their gender: testosterone therapy induces the growth of a beard, or the development of male-pattern baldness, and though trans men are sometimes of smaller stature, a short man is hardly viewed as remarkable, in the way that a very tall woman can be.)
Ousterhout initially sought to bring his patients within the middle of the femininity range that he had established through his research into facial shapes. But as he became known as the leading authority in facial feminization—a field that was rapidly being populated by other surgeons—his surgical interventions became more extensive. He gradually came to believe that he should try to make his patients look not just like average women but like beautiful women. In part, this was to counterbalance common masculine traits that a trans patient cannot alter, such as the size of her hands.
But Ousterhout’s decision also had the effect of upholding certain cultural assumptions about what is beautiful or feminine. As Plemons, who is trans, writes, “Feminine is a term in which biological femaleness and aesthetic desirability collapse.” At the very least, Ousterhout wished to enable his patients to open the door to the UPS guy in their sweatpants, without the armor of makeup or careful hair styling, and be perceived as female. But he also believed that he had the ability to give his patients a face that emulated a feminine ideal.