Caitlyn Jenner's New Face: The Physical — and Emotional — Effects of Facial Feminizing Surgery

Bruce Jenner in 1988 (top left); Bruce in 1993 (top right); Bruce in 2014 (bottom left); Caitlyn in 2015, on the cover of Vanity Fair (bottom right). (Photos: Corbis/Neal Preston, Getty Images/Ethan Miller, Getty Images/Ron Galella Collection, Vanity Fair)

Imagine looking in the mirror and seeing that, overnight, your face has transformed. Caitlyn Jenner went through this experience after having facial feminization surgery (FFS), a series of procedures that alter the face to increase its femininity.

In an upcoming Vanity Fair interview, she reports suffering a panic attack the day after, and recalls thinking, “What did I just do? What did I just do to myself?” According to Vanity Fair, a counselor from the Los Angeles Gender Center assured her that such reactions were often induced by pain medication, and that second-guessing was human and temporary.

We talked with experts to understand what FFS entails, and explore the psychological ramifications of going under the knife — and changing your appearance to look how you have always felt to be inside.

A Dramatic Transformation

Surface tactics to look more like the opposite sex — clothes, makeup, wigs — only go so far. “If you see a woman with no hair, you don’t think it’s a man. If you see a man wearing makeup and high heels, you don’t think it’s a woman,” says Jeffrey Spiegel, MD, director of Advanced Facial Aesthetics in Chestnut Hill, Massachusetts, who specializes in FFS. But “facial feminization surgery is not superficial. It’s all about bone shape and the interplay of light and shadow.”

It can be incredibly intricate, depending on what you choose to have done. Surgeons will often move patients’ hairlines forward to be closer to the eyes, lift and contour the eyebrows, make the cheekbones fuller by inserting implants, and reshape the nose. They’ll also remove a piece of bone from the skull to open up the eye sockets, shorten the distance between the nose and the mouth to create a short, full upper lip and brighten the teeth, narrow and taper the jawbone for a gentler slope, and remove the Adam’s apple. They also might adjust the vocal chords in order to raise the pitch of the voice, and perform anti-aging techniques like a facelift, necklift, or eyelift.

Related: How Transgender Surgery And Hormones Affect The Body

For a surgeon who does FFS on a regular basis (such as Spiegel, who performs two to four operations each week), the surgery can last four to 10 hours. For a doctor with less experience, the procedures might take longer, over the course of several days. And “depending on what you have done, it takes between one to three weeks to recover and begin looking better,” Spiegel tells Yahoo Health. It may take months before the full effects are apparent.

Becoming the Real You

“People have a variety of responses after surgery, and the most common feeling is impatience,” says Spiegel. “They have waited their whole lives for this moment, and when they wake up afterwards, they still have weeks to go before they can see the change.”

But once they’ve healed from the immediate aftermath, they often experience a profound sense of belonging. “Rather than seeing a different person, they finally see themselves,” explains Spiegel. “They feel that their true self is emerging, and it feels right.”

In fact, the same goes for family members when they first encounter their loved one post-surgery. “People will often ask, ‘Will I recognize my dad/husband/brother?’” Spiegel says. “The truth is that they recognize them even more.” Instead of seeing a man in a dress who calls himself by a woman’s name, which can feel like a disconnect, there is now a woman’s face to match. If anything, their new look seems more natural.

Spiegel maintains that he has never had a patient second-guess the decision the way Caitlyn Jenner seems to have, but since the rest of her experience has been very typical, he wonders if her quote was misrepresented. Perhaps her shock didn’t reflect doubt about whether she’d done the right thing, but awe that she had gone through with it at last. “She might have been feeling, ‘Oh my god, I can’t believe I really did it! After a lifetime of wondering what it would be like, I had the courage to take that step,’” he describes.

Caitlyn Jenner revealed her new face on the cover of Vanity Fair. (Photo: Vanity Fair)

Psychologist Ben Michaelis, author of Your Next Big Thing, who has worked with transgender clients, agrees. “The data assert that over 95 percent of people who choose to live as a different gender than that which they have been identified at birth by others do not regret it,” he says. “If anything, it is a period of elation.” His hypothesis about Jenner’s post-op reaction is that it may have had something to do with the fact that she is a public figure. 

Related: Bruce Jenner Reveals Herself as Caitlyn on the Cover of Vanity Fair

Uncertainty — and the Accompanying Worry

That said, there is an element of worry involved. After surgery, patients are bruised, swollen, sore, and tired, wrapped up in gauze with casts on their noses. “When people wake up, they think they’ll look like a beautiful woman, but in fact they will be in recovery for several weeks before they see the real outcome,” says Spiegel.

This limbo period of uncertainty can be anguishing. “It’s the unknown — you aren’t sure what you will ultimately look like,” says Michaelis. “You may be wondering, ‘Will this work out the way I want it to?’”

Even after a patient has begun to heal from FFS, the ramifications may not sink in right away. “Sometimes people look in the mirror and all they see is their old insecurities and concerns,” says Spiegel. “It can take a while to realize that they now look great.”

These concerns peak when presenting a new visage to the outside world. “Patients’ biggest fear is that it won’t work,” says Spiegel. “They did this so that they will be seen as a woman rather than a man [dressed in women’s clothing], and they go into the surgery with all of these hopes and expectations.”

There is so much riding on the results, and people worry that the outcome won’t live up to their dreams, Spiegel says. When they go to the supermarket, will the person behind the fish counter say, “Yes ma’am,” without giving them a second look, or will they still say, “Hello sir?” When it comes to romance, will there be reciprocal physical attraction?

Thankfully, for the vast majority of people, FFS helps them fully realize themselves as the people they really are — mentally, emotionally, and spiritually.

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