Monograph by Eric Plemons
Developed in the United States in the 1980s, facial feminization surgery (FFS) is a set of bone a... more Developed in the United States in the 1980s, facial feminization surgery (FFS) is a set of bone and soft tissue reconstructive surgical procedures intended to feminize the faces of trans- women. While facial surgery was once considered auxiliary to genital surgery, many people now find that these procedures confer distinct benefits according to the different models of sex and gender in which they intervene. Surgeons advertise that FFS not only improves a trans- woman's appearance; it allows her to be recognized as a woman by those who see her. In The Look of a Woman Eric Plemons foregrounds the narratives of FFS patients and their surgeons as they move from consultation and the operating room to postsurgery recovery. He shows how the increasing popularity of FFS represents a shift away from genital-based conceptions of trans- selfhood in ways that mirror the evolving views of what is considered to be good trans- medicine. Outlining how conflicting models of trans- therapeutics play out in practice, Plemons demonstrates how FFS is changing the project of surgical sex reassignment by reconfiguring the kind of sex that surgery aims to change.
"In the early 1990s, Judith Butler theorized a new performative model of sex/gender; now Eric Plemons provides us with an exemplary ethnographic analysis of how that discursive model materialized as surgical practice, transforming medical treatment for transfeminine people along the way. It is a readable, well-argued, and deeply informed account of how what counts as 'sex' has shifted from genitals to faces over the last few decades. It is of interest not only to members of trans* communities, but to anyone working in the history or anthropology of medicine, and to scholars of gender, sexuality, and embodiment more generally." — Susan Stryker, coeditor of, The Transgender Studies Reader
"What does a woman look like? This fascinating ethnography of facial feminization surgery made me see that question in a new light. There is much here that troubles social constructionist accounts of gender. Sex inheres in skulls and jaws. By reshaping them in line with sex-specific population norms, surgeons help their patients to reach the ultimate frontier in 'passing' as women. But equally Eric Plemons shows that transient beauty ideals and different surgical practices guide sex transformation. A rigorous analysis that is also a sensitive portrayal of the embodied experiences of trans- people." — Alexander Edmonds, author of, Pretty Modern: Beauty, Sex, and Plastic Surgery in Brazil
Articles by Eric Plemons
Women's Reproductive Health, 2022
This article recounts two moments in which revolutions in assisted reproductive technologies (ART... more This article recounts two moments in which revolutions in assisted reproductive technologies (ARTs) opened clinical questions and public debate about whether transgender women should receive doctors' help to become pregnant. The first took place in Australia in the 1980s when advancements in in vitro fertilization and the accident of a full-term abdominal pregnancy opened the potential that people without uteruses could become pregnant. Critics of reproductive technology used the figure of "the pregnant transsexual" to represent the dangers of science and scientists run amok. Now nearly 40 years later, some advocates argue that trans women could receive uterus transplants to become pregnant. Critics have seized on this suggestion to ask whether all women deserve complex reproductive assistance. Based on archival research and interviews with specialist surgeons, I compare these two moments to examine how the figure of the pregnant trans woman has shaped debates about ARTs and how the possible use of ARTs has shaped discussions of the maternal status of trans women. Consistent across these moments is a recognition of ARTs as themselves gender-confirming technologies. The power of their use to confer a fundamental femininity has pervaded anxieties about trans women as beneficiaries of ARTs.
Forensic Anthropology, 2020
Due to disproportionate violence impacting the transgender community, forensic anthropologists ma... more Due to disproportionate violence impacting the transgender community, forensic anthropologists may encounter the remains of trans individuals; however, it is unknown how often trans individuals are represented in casework and if practitioners have sufficient knowledge about trans bodies. After contextualizing forensically relevant demographics for the trans community, this study uses survey data of forensic anthropologists to critically explore the collective knowledge of and experience working with trans individuals; practitioners’ perceptions of sex and gender; and potential opportunities for trans-oriented research. The results indicate that 28.9% of respondents have worked with trans individuals in casework, but 75.0% of forensic anthropologists were unfamiliar with forms and evidence of gender affirming procedures. Additionally, the survey indicates that forensic anthropologists struggle with the binary nature of forensic sex estimation, with 42.4% agreeing that sex is binary and 56.2% disagreeing. Similar opposition was found with reporting gender: 39.5% indicated that gender should be reported in casework and 31.0% disagreed. Moreover, current sex estimation methods are: rigidly binary; not reflective of human biological variation; and inadequate for trans individuals as they are based on assigned sex. To dismantle rigidly binary sex categorization, we propose the adoption of a biocultural and queer theoretical approach to forensic sex estimation and in sexual dimorphism research that challenges heteronormative assumptions, questions typological two-sex categorization, and combats the presumptions that gender and sex are stable, independent entities that convey universal meaning. Relatedly, the expansion of trans-oriented research, which is supported by 95.8% of respondents, will further improve methodological accuracies.
CrossCurrents, 2019
In this article, I examine how the liceity of transgender surgical procedures has been discussed ... more In this article, I examine how the liceity of transgender surgical procedures has been discussed by contemporary American Catholic bioethicists, with attention to how they justify and explain ongoing denials of care. As I will show, Catholic debates about the ethical status of transgender healthcare contribute to the surging American discourse of “religious liberty,” in which it is “freedom of conscience” that exempts Catholic institutions from the duty of providing best-practice medicine. This line of argumentation, well rehearsed with regards to reproductive and end-of-life care, is being newly and somewhat differently applied in the case of transgender medicine. I argue that within this discourse, the contentious status of the transgender body is used as a moral lever to expand the penumbra of “conscience-based” exemptions beyond the issues of life and death that have dominated Catholic healthcare debates for decades.
Medical Anthropology Quarterly, 2019
Since 2014, public and private insurance coverage for transgender Americans' surgical care has in... more Since 2014, public and private insurance coverage for transgender Americans' surgical care has increased exponentially. Training clinicians and equipping institutions to meet the surge in demand has not been as rapid. Through ethnographic research at a surgical workshop focused on trans-genital reconstruction and in a U.S. hospital working to grow its transgender health program, this article shows that effects of the decades-long insurance exclusion of trans-surgery are not easily remedied through the recent event of its inclusion because patient access is not the only thing that has been restricted by coverage denial. Decades of excluding coverage for trans-genital reconstructive surgery have limited the development and circulation of technical skills required to perform these procedures, as well as the administrative processes needed to integrate them into existing clinical workflows. One surgeon estimates that turning expanded access into realized care is "a five or six-year problem." [transgender medicine, surgical practice, insurance, health care administration] In fall 2016, in the basement of an urban hospital in the American Midwest, 20 surgeons, gowned and gloved, were crowded in a small room with garish fluorescent lights and a thermostat that despite multiple attempts, could not be turned down. The floors, tables, and chairs were covered in black plastic sheeting secured by silver duct tape. On the tables, six cadaveric female pelvises-abdomens roughly sewn closed just below their belly buttons, upper legs stumped and sewn mid-thigh-were also duct taped in place, each flanked by an array of surgical instruments. The surgeons were ignoring the pelvises, for the time being. Their attention was trained to the front of the room where the workshop organizer demonstrated one of the procedures that participants had come to learn. As he described his approach and technical sequence, a marketing rep for a medical device company perched over his shoulder with a camera that directed an enlarged image of the surgical field to a pair of computer monitors. The participant-learners watched the monitors or jotted down notes. Some took photos of the monitors at moments of interest, while others used their cell phones to record video of the demonstration (see Figures 1 and 2).
Body & Society, 2019
Facial feminization surgery (FFS) is a set of bone and soft tissue procedures intended to feminiz... more Facial feminization surgery (FFS) is a set of bone and soft tissue procedures intended to feminize the faces of transgender women. In the surgical evaluation, particular facial features are identified as ‘sex specific’ and targeted for intervention as such. But those features do not exhibit ‘maleness’ or ‘femaleness’ alone; they are complexly entwined with morphologies of ethnic classification. Based on clinical observation, I show how the desired feminine ideal conflicted with facial characteristics identified as ‘ethnic’. In FFS practice, ‘masculinity’ and ‘ethnicity’ were entangled as the constitutive outsides by which desirable ‘femininity’ was articulated. I argue that surgery that self-consciously enacts a patient’s move away from physiognomically identifiable ethnicity in order to achieve an ostensibly unmarked and neutral femininity becomes not only a process of feminizing the face but of whitening it, regardless of whether ‘white’ features are the express desire of the patient or aim of the surgeon.
TSQ: Transgender Studies Quarterly, 2018
This special issue of TSQ: Transgender Studies Quarterly explores the vital and contested place o... more This special issue of TSQ: Transgender Studies Quarterly explores the vital and contested place of surgical intervention in the making of trans bodies, theories, and practices. It investigates surgery as an institutionally, culturally, politically, and personally situated practice.
International Journal of Transgenderism, 2017
Facial gender confirmation surgery (FGCS), also popularly known and referred to in the scientific... more Facial gender confirmation surgery (FGCS), also popularly known and referred to in the scientific literature as facial feminization surgery (FFS), was previously treated as a collection of aesthetic procedures complementing other aspects of gender-confirming surgery. Recent literature on quality-of-life outcomes following FGCS has supported the substantial impact these procedures have on overall well-being and reduction of psychosocial sequelae in patients. The World Professional Association for Transgender Health Standards of Care, Version 7 (WPATH SOC 7), did not deem FGCS a medical necessity. Based on these new studies, increasing evidence points to the need to include FGCS among medically necessary gender-confirming surgeries, though more-prospective studies are needed. Updates to the WPATH SOC 8 are proposed based on available quality of life studies.
Medical Anthropology, 2017
Facial feminization surgery (FFS) is a set of bone and soft tissue reconstructive surgical proced... more Facial feminization surgery (FFS) is a set of bone and soft tissue reconstructive surgical procedures intended to feminize the faces of trans- women in order to make their identities as women recognizable to others. In this article, I explore how the identification of facial femininity was negotiated in two FFS surgeons’ practices. One committed to the metrics of normal skeletal form and the other to aspirational aesthetics of individual optimization; I argue that surgeons’ competing clinical approaches illustrate a constitutive tension in the proliferating therapeutic logics of trans- medicine. The growing popularity of surgical practices like FFS demonstrates a shift in American trans- therapeutics away from a singular focus on the genitalia as the location of bodily sex and toward understandings of sex as a product of social recognition.
Medical Anthropology, 2015
1970s American feminist health activists created representations of genital anatomy intended repl... more 1970s American feminist health activists created representations of genital anatomy intended replace the abstracted images of biomedicine’s “modest witness” with what Michelle Murphy has called the “immodest witness,” authority explicitly derived from personal and embodied experience. Decades later, a feminist publication in the tradition of the immodest witness called Femalia, was adopted into the practice of an American surgeon specializing in trans- genital sex reassignment surgery (GSRS). Based on ethnographic and textual research, I show how oppositional claims to represent the “natural” female body—one valued for its medical objectivity and the other for its feminist subjectivity—effectively foreclosed these as modes of authority through which the trans- patient might contribute to her surgical care. I argue that trans- patients’ double epistemological exclusion contributes to a broader asymmetry in the use of patients’ subjective reports in the everyday practice of GSRS and the clinical research by which it is evaluated.
Social Studies of Science, 2014
This article explores the research project that led to the development of facial feminization sur... more This article explores the research project that led to the development of facial feminization surgery, a set of bone and soft tissue reconstructive surgical procedures intended to feminize the faces of male-to-female trans- women. Conducted by a pioneering surgeon in the mid-1980s, this research consisted of three steps: (1) assessments of sexual differences of the skull taken from early 20thcentury physical anthropology, (2) the application of statistical analyses taken from late 20th-century orthodontic research, and (3) the vetting of this new morphological and metric knowledge in a dry skull collection. When the ‘feminine type’ of early 20th-century physical anthropology was made to articulate with the ‘female mean’ of 1970s’ statistical analysis, these two very different epistemological artifacts worked together to produce something new: a singular model of a distinctively female skull. In this article, I show how the development of facial feminization surgery worked across epistemic styles, transforming historically racialized and gendered descriptions of sex difference into contemporary surgical prescriptions for sex change. Fundamental to this transformation was an explicit invocation of the scientific origins of facial sexual dimorphism, a claim that frames surgical sex change of the face as not only possible, but objectively certain.
Journal of Medical Humanities, 2014
Surgeons who perform sex reassignment surgeries (SRS) define their goals and evaluate their outco... more Surgeons who perform sex reassignment surgeries (SRS) define their goals and evaluate their outcomes in terms of two kinds of results: aesthetic and functional. Since the neogenitals fashioned through sex reassignment surgeries do not enable reproductive function, surgeons must determine what the function of the genitals is or ought to be. A review of surgical literature demonstrates that questions of what constitute genital form and function, while putatively answered in the operating room, are not answerable in the discourses of clinical evaluation used to define them. When the genitals—the word itself derived from the Latin genitas meaning to beget—are not reproductive, the question of their function shifts away from the biological and into other registers: pleasure, intimacy, sociality. As condensed sites of meaning and meaning-making around which selves, affects, resources, anxieties and futures are organized, the genitals signify in excess of the categories of ―aesthetic and ―function that surgeons use to assess them. Not reducible to either aesthetics or function, but constitutive of them both, this excess appears in surgical texts in the form of imagined futures of social and sexual engagement and demonstrates a powerful means by which properly sexed bodies are created.
Journal of Medical Humanities, Jun 2013
In this short essay I focus on two ethnographic scenes from the operating room in order to show t... more In this short essay I focus on two ethnographic scenes from the operating room in order to show the OR as a place both assiduously sterile and deeply intimate. In the process of these Facial Feminization Surgery procedures, surgeons and other OR staff reflect on the social changes that the surgery may (or may not) enable even while they are working to enact physical changes in the faces of their patients.
This special issue of Transgender Studies Quarterly explores the vital and contested place of sur... more This special issue of Transgender Studies Quarterly explores the vital and contested place of surgical intervention in the making of trans* bodies, theories, and practices. Trans* surgery has been an object of fantasy, derision, refusal, and triumph. Surgery has been a specter and a savior, provoking both desire and disgust, and providing the grounds upon which intricate theoretical structures have been built. And yet, surgical procedures are also material practices carried out by individual practitioners on the bodies of individual surgical patients, located in time and space. For decades after its establishment in the 1950s, clinicians considered a desire for reconstructive genital surgery to be the linchpin of the transsexual diagnosis. Drawing on earlier legacies of sexology and plastic surgery, and the emerging specialties of endocrinology and surgical transplant, early emphasis on genital surgery determined clinical legibility, shaped forms of identification, produced institutional capacities, and became the object of criticism by those for whom a desire for body alterations indicated profound pathologies on the parts of patients and their willing surgeons. Subsequent contestations of the medico-surgical framework troubled the place of surgical intervention and helped mark the emergence of " transgender " as an alternative, more inclusive term for gender nonconforming subjects who were sometimes less concerned with surgical intervention. Beginning in the 1990s, new histories of trans* clinical practice challenged the institutional claim that transsexuals were uniform in their desire for genital surgery, and trans* authors began to advocate relationships to their surgically altered bodies as sites of power rather than capitulation. Still others refused a focus on surgery-centric conceptualizations of trans* on the grounds that it obscures the conditions of how and for whom surgery is available, values Euro-American histories of transsexualism, and obfuscates that trans* subjectivity might be as much about justice and rights as it is about physical transition. In this special issue we invite engagement with " the surgical " in its many forms. We contemplate a wide scope: physical, technical, and social aspects of the body; trans* and transition-related surgeries, broadly construed; local and international endeavors; the conceptual, the theoretical, and the practical; the historical and the speculative. We invite submissions of original research papers and art pieces that use social scientific and humanistic approaches to address a host of questions about the practice and politics of trans* surgeries. Questions may include but are not limited to the following: How has trans* surgery been construed and presented across different discursive forms, including medicine, fantasy, cultural theory, popular media, the arts, trans-community contexts and more? How have these representations of trans* surgeries helped and/or limited our understanding of trans* identities and bodies and shaped the evolution of trans* politics? How have and how do regulatory, economic, geographic and political constraints shape surgical desires, practices and accessibilities?
Chapters by Eric Plemons
The Routledge Companion to Beauty Politics, 2021
This chapter reviews some significant ongoing debates about the politics of genital aesthetics. R... more This chapter reviews some significant ongoing debates about the politics of genital aesthetics. Rather than a survey of practices, this chapter is organized around three problematics, or sets of conflicts that characterize contemporary debates about genital aesthetics: bodily autonomy, cultural imperialism, and health discourses. For each problematic, I use examples to explore how and for whom particular genital aesthetic practices are contentious, and how broader social, historical, and political forces are implicated in that contention. In this chapter, I aim to show that genital cultivation is, like all forms of bodily cultivation, entangled with broader discourses of politics and power.
Gender Confirmation Surgery, 2020
To distinguish the phenotypic sex of a newborn, observers typically inspect the primary external ... more To distinguish the phenotypic sex of a newborn, observers typically inspect the primary external genitalia and pronounce the child female, male, or intersex. Throughout maturation, and most notably during exposure to increased gonadal hormones during puberty, secondary sex characteristics develop (Table 10.1). These include the development of patterned body hair, the presence or absence of breasts, change in muscle mass, and differentiation of the skeleton, including the face and skull. Among all the secondary sex characteristics, facial features are the most visible in social life and have a significant impact on a person’s vision of themselves in the mirror. They are also the most difficult to alter. This chapter outlines the importance and implications of facial gender markers from a social, historical, and patient perspective.
Book Reviews by Eric Plemons
Anthropological Quarterly, 2013
Social History of Medicine
Online Writing by Eric Plemons
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Monograph by Eric Plemons
"In the early 1990s, Judith Butler theorized a new performative model of sex/gender; now Eric Plemons provides us with an exemplary ethnographic analysis of how that discursive model materialized as surgical practice, transforming medical treatment for transfeminine people along the way. It is a readable, well-argued, and deeply informed account of how what counts as 'sex' has shifted from genitals to faces over the last few decades. It is of interest not only to members of trans* communities, but to anyone working in the history or anthropology of medicine, and to scholars of gender, sexuality, and embodiment more generally." — Susan Stryker, coeditor of, The Transgender Studies Reader
"What does a woman look like? This fascinating ethnography of facial feminization surgery made me see that question in a new light. There is much here that troubles social constructionist accounts of gender. Sex inheres in skulls and jaws. By reshaping them in line with sex-specific population norms, surgeons help their patients to reach the ultimate frontier in 'passing' as women. But equally Eric Plemons shows that transient beauty ideals and different surgical practices guide sex transformation. A rigorous analysis that is also a sensitive portrayal of the embodied experiences of trans- people." — Alexander Edmonds, author of, Pretty Modern: Beauty, Sex, and Plastic Surgery in Brazil
Articles by Eric Plemons
Chapters by Eric Plemons
Book Reviews by Eric Plemons
Online Writing by Eric Plemons
"In the early 1990s, Judith Butler theorized a new performative model of sex/gender; now Eric Plemons provides us with an exemplary ethnographic analysis of how that discursive model materialized as surgical practice, transforming medical treatment for transfeminine people along the way. It is a readable, well-argued, and deeply informed account of how what counts as 'sex' has shifted from genitals to faces over the last few decades. It is of interest not only to members of trans* communities, but to anyone working in the history or anthropology of medicine, and to scholars of gender, sexuality, and embodiment more generally." — Susan Stryker, coeditor of, The Transgender Studies Reader
"What does a woman look like? This fascinating ethnography of facial feminization surgery made me see that question in a new light. There is much here that troubles social constructionist accounts of gender. Sex inheres in skulls and jaws. By reshaping them in line with sex-specific population norms, surgeons help their patients to reach the ultimate frontier in 'passing' as women. But equally Eric Plemons shows that transient beauty ideals and different surgical practices guide sex transformation. A rigorous analysis that is also a sensitive portrayal of the embodied experiences of trans- people." — Alexander Edmonds, author of, Pretty Modern: Beauty, Sex, and Plastic Surgery in Brazil