Eve was created from the rib of Adam
matron asked Rabbi José: "Why did God steal a rib from Adam?"
Rabbi: "Steal? If one were to take away from your house an ounce of silver, and give you in return a pound of gold, that would not be stealing from you."
Matron: "But what need was there for secrecy?"
Rabbi: "It was surely better to present Eve to Adam when she was quite presentable, and when no traces of the effects of the operation were visible."
For the male-to-female transsexual, hormone treatment will slowly help feminise subcutaneous tissue (redistribution, less muscle, more fat), but it will not affect the skeleton of any individual already past puberty when treatment is commenced. However, in some cases, surgery can help feminise the appearance of the underlying skeleton.
Skull and Face
Relating the absolute measures of the male and female face, several surgically correctable differences which will make a dramatic difference in the perceived gender can often be identified to the benefit of a male-to-female transsexual.
Common task include:
reduction: involves advancing forward the scalp between 1.0 cm and 2.5
cm to correct for the receding masculine pattern hairline and to
approximate, when possible, a more feminine 'oval' pattern hairline.
Forehead contouring: involves shaving the brow bossing and, if necessary, contouring via shaving across the forehead.
Forehead augmentation: involves the use of 2, 3, or 4 implants (Gore-Tex Subcutaneous Augmentation Material).
Nasal surgery or rhinoplasty alters the appearance of the nose by shaping and repositioning the nasal bones and trimming the bone and cartilage as needed to create the desired appearance. As example, rhinoplasty is used to correct a large hump, or a broad or round nasal tip. Small changes, such as subtly lifting the tip of the nose will often create a more youthful and feminine appearance.
Commons task include:
Septal Surgery - The strip of cartilage which separates the two sides of the nose is called the septum. It is sometimes bent and interferes with breathing; if so, it may need to be straightened. If it is too long, it is often shortened.
Shaping the Profile - Many women complain of a hump on the bridge (dorsum) of the nose. This is usually made of both bone and cartilage. It is removed with scissors or a saw. When the nose is flat, the profile may be augmented with grafts of bone or cartilage.
Refining the Tip - If the tip of the nose is large or boxy, much of the tip cartilage may be removed or reshaped to refine the shape.
Narrowing the Nasal Bones - If the bridge of the nose is wide, the surgeon will narrow it by fracturing the bone on each side and moving it closer to the centre.
Reducing Nostril Flare - If the nostrils are flared, they may be reduced by removing a small wedge of tissue from the base of the nose.
Common tasks include:
reduction: involves an intra-oral incision which requires an extended
recovery period (with severe facial swelling/bruising for about 10 days).
Chin and Jaw
Possible tasks include:
Jaw reduction: involves a 1.0cm extra-oral incision under the jaw line to cut the bone (on average, by 1.0cm depth) and thus reduce the sharp angle of the back corner of the jaw where it rises up to the ear.
Alternatively, an intra-oral incision can shave (but not cut) the bone. Although this technique prevents external scaring, it is less effective, has more risk of infections, and requires an extended recovery period due to severe facial swelling/bruising.
Chin reduction: involves an intra-oral incision to shorten and narrow the chin (if necessary, including contouring with a hard silicone implant). The technique involves: (1) shaving the bone; (2) cutting the bone; or (3) sectioning out the mid-section of chin and joining the upper and lower sections via steel screws.
genioplasty: involves an intra-oral incision and sliding forward or
backward the lower section of chin (if necessary, including contouring
with a hard silicone implant).
Other Surgical Procedures
Removal or Adjustment
In the first technique, one or two of the floating ribs at the bottom of the rib cage are taken out to have a smaller waist, typically by 1 - 2 inches unclothed. Corsets also become far more effective as they can act upon a greater area of soft tissue rather than rigid bone - although a reduction of more than 4" reduction is likely to soon cause damage to internal organs. The resulting back scars, the vulnerability of exposed internal organs to damage from bangs and bumps, and the possibility of unsightly rib re-growth makes this a very problematic procedure which is rarely performed by reputable surgeons. Actresses Rachel Welch and Marilyn Monroe, and singer Cher, are all often reported to have had this procedure, but with no supporting evidence other than their fabulous hour-glass figures in a dress with a tight waist.
An only slightly less dramatic and dangerous procedure is to break the lower ribs, bend them inwards to reduce the waist line, and force them to mend in the new position by the continuous wearing of a tight and rigid corset for a month or more. Amanda Lepore - who claims to have the most expensive surgically enhanced body in the world - underwent this procedure. She also claims to now have the perfect female figure - 38-22-38 - and combined with her petite 5ft 2in height the result is indeed impressive if you can cope with her excessively feminised facial appearance.
Cost of Surgery
It's worth ending this article by noting the very high cost of feminisation surgery.
Basic procedures such as a "nose job" are widely available, and good quality surgery can be economically obtained from clinics that don't otherwise deal with transsexual women.
But more extensive feminisation surgery is a specialist field in which there are only a few reputable surgeons practicing. Facial femisation surgery from a top surgeon such as Dr. Ousterhout will start at about $10,000 and soar upwards from there. There are cheaper options emerging, particularly in Thailand, but carefully check out the surgeons references and make enquires about them on the Internet. Poor quality surgery is far worse than none.
An example of the benefits of good quality surgery is Jamie (formerly James) Clayton. When just 19 she transitioned and moved to New York, where her make-up skills won her a job as a beautician. Her first surgery was a subtle breast augmentation which barely took her to a 'B' cup - although hardly noticeable it was was enjoyed by her boyfriends, and helped her to pass physically. Next, she paid $16,000 to have sex re-assignment surgery by the highly rated Dr Meltzer when 25 - she wanted her revised genitalia to both look pretty good and to work, happily she says she can even have vaginal orgasms. With "tweaking" to her genitalia, and other "touch-ups", by age 30 she had spent about $50,000 on surgery to get near where she wanted to be appearance wise. Famously, a magazine article published in 2008 called her (only slightly generously) "The Second Most Beautiful Girl in New York", which stirred considerable debate as to whom the first girl was!
A good, if now dated, starting point is Lynn Conway's informative article on Facial Feminisation - based on her personal experiences - at: http://ai.eecs.umich.edu/~mirror/FFS/LynnsFFS.html
For more information on facial feminisation surgery I highly recommended Sally's Resource Morsal at: http://tsresource.info/
For more links, check out the Transsexual Women's Resources website at: http://www.annelawrence.com/facialindex.html
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