ReportingAt Tenon Hospital in Paris, a surgeon erases the virile features of trans patients using 3D planning. Interventions to bring body to mind, which these people experience as a rebirth.
3D scanner of a face projected on his computer screen and medical file placed on his desk, the plastic surgeon from Tenon hospital (Paris 20e) Quentin Qassemyar questions his new patient on the reason for his arrival. Agathe, 19, in a light denim miniskirt, a purple crop top and a purple knitted cardigan falling over her shoulders, has been waiting for this moment for eight months: “I wish there weren’t any traces of my past on my face. “ The psychology license student started her identity transition in March 2020, after years of unease: “As a child, I dreamed of accessing girls’ changing rooms and the men’s sections of stores caused anxiety attacks in me. ” Agathe started hormone therapy last December. She now wishes to have recourse to a facial feminization surgery (FFS), or facial feminization.
Since the beginning of the XXe century, numerous anthropometric measurements made it possible to establish the male and female characteristics of the skull. The first FFS started in the 1980s in the United States, initially for cisgender women – who identify with their gender at birth – carrying deformities or wishing to accentuate their feminine features.
In France, in 2020, 14,000 patients were covered by the French health insurance for a long-term affection (ALD) for gender dysphoria – when a person’s gender identity does not correspond to the sex assigned to him at birth. Among them, 187 have undergone at least one act of feminization or masculinization of the face, reimbursed by Social Security – are excluded operations of the nose and cheekbones, considered aesthetic. These data, communicated by the Health Insurance, do not take into account the FFS of trans people who have not made requests for ALD, and the health crisis has greatly reduced the use of these operations.
Arrived at Tenon Hospital in 2017, Doctor Qassemyar alone operates between 80 and 100 trans patients per year on the most determining areas of their face: reduction of mandibular angles (gonioplasty), chin (genioplasty) or forehead (frontoplasty).
In his large consultation room, Doctor Qassemyar tries to understand what bothers Agathe. The talkative and cheerful young woman lowers her mask and pulls her hair back. She wishes to benefit from a frontoplasty and a genioplasty. “Basically, I wanted to redo everything”, she specifies. But the hormonal treatment has refined her size and certain features of her face and started breast development. “We indeed find what we see on your scanner”, comments the surgeon, judging his male forehead “Quite stereotypical”. He pursues : “You have a ‘V’ shaped physiognomy, more feminine than masculine, interrupted by a straight chin. “
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