For the handful of people in my life who do not know, I recently had facial feminization surgery (FFS) and breast augmentation (BA) in Guadalajara, Jalisco, Mexico, provided by the expert hands of Dr. Lázaro Cárdenas Camarena. This adventure was the culmination of years of careful saving and exhaustive research and represents the last significant transition-related body modification I anticipate ever pursuing. As I heal from this sizable achievement, I also reflect on it.
What Does it Mean?
Facial and breast surgery are as affirming and lifesaving as reconstructing one’s genitals can be, for those of us who experience relevant dysphoria. Testosterone complicates both regions of the body for transfeminine people who did not have the gift of blockers to suppress their androgenic puberty, and correcting that damage is as much an expression of gender transition as changing one’s wardrobe or name. It is a similar level of inexcusable that these surgeries are so rarely included in insurance packages and otherwise made inexpensively available to people who desire them. With the far greater visibility of faces and busts relative to genitals in one’s day-to-day life, it is arguably even more inexcusable. For many of us, these visually obvious corrections make more difference in our lives than the much more secret fix of vaginoplasty ever could.
It is this visibility that adds an additional wrinkle to these procedures, however. Facial and breast surgery are inextricably entangled in vanity. They do not just undo what testosterone did to bone structure or the lack of a cisfeminine puberty did to breast development, but also come with aesthetic considerations. Transfeminine people, by and large, do not just want to approach the ideal of What We Might Have Looked Like, but also hope to be beautiful afterward, just as our cisfeminine peers desire beauty. Much more so than when I pursued vaginoplasty, FFS and BA put me in a position to evaluate not just my dysphoria, but my relationship to my own appearance more broadly.
In August 2019, I wrote about how comparing my features to those of a selection of famous, beautiful Hispanic women provided some perspective that helped me disentangle my sense of my own beauty from the often narrow, Eurocentric model that many plastic surgery practices take as a given. I emphasized brows in that article, even in its title, and convinced myself that the somewhat more rugose brows of women like América Ferrera and Alexandria Ocasio-Cortez could make me feel better about mine. For a while, they did. But my true feelings would not be so easily set aside. Ultimately, parts of that article showed themselves to be a fit of the-lady-doth-protest-too-much, me attempting to assert a more defiant and more financially convenient reality over the one I truly lived. I was indeed dysphoric about my forehead, and the thought of fixing it ultimately proved too thrilling not to pursue. My forehead would become the single largest line item on my surgery quote rather than something I could reclaim as it was. Going over my photos with Dr. Cárdenas led to the suggestion of a Type III forehead bone reconstruction.
A second tipping point was my nose. I have never had negative feelings about my nose, but I budgeted for the often-standard rhinoplasty anyway on the off-chance that revising my forehead and jawline might make my old nose not work on my new face. During my Skype consultation with Dr. Cárdenas, he first asked me about my active desires, and acknowledged them. I followed up with a request for his thoughts on what else it might make sense for me to change while I was working with him. It came as little surprise when he suggested I add rhinoplasty to my list. At my request and contrary to how he usually operates, he provided a mock-up of what I might expect from a feminizing rhinoplasty, so that I could decide whether this intervention truly made sense for me. This image provided a few days of food for thought. That version of me, nose concave and upturned instead of arched, did not look unattractive, but I could not reconcile her with me. I ultimately decided that my lack of dysphoria, or any other negative feelings, about my nose, or immediate positive feelings about the proposed new one, made this procedure dispensable. My old nose’s shape is at least as indigenous American as it is Mediterranean, and it remains. So, the thesis of “Their Brows Look Like Mine,” in the end, still has something to it.
My breast augmentation came with a few decisions of its own. While the specifics of most of the other procedures could be left to Dr. Cárdenas’s expert eyes and hands, breast augmentation is a highly customizable procedure, with many options to consider. Dr. Cárdenas’s practice has defaults that removed some possible decisions from the process—my implants would be EuroSilicone and the incision would be inframammary regardless—while leaving others. He and I looked at a selection of goal photos I had prepared and settled on round implants with a 12.1 cm radius and to check several volume options, with a maximum of 500 ccs, to figure out what my body could safely hold in its current shape. Dr. Cárdenas considered my desires to be almost weirdly large, which came as a surprise to me, given that they are far from the largest I have seen even first-time breast augmentation patients pursuing in support groups and among my friends, but I trusted his expertise.
Dr. Cárdenas also reviewed my most recent CT scan results to gather information related to my jaw and chin work, which helped determine which lower-face procedures I would ultimately receive.
The decision that most surprised me waited until the in-person consultation. Forehead bone reconstruction comes with the conditions needed for two related procedures—brow lift and hairline advancement—and Dr. Cárdenas offers these at no additional cost to people who seek forehead reconstruction with him. I was initially enthusiastic about both addenda, but my interest in hairline advancement faded in the interim. My hairline had never in fact receded, as far as I could tell, which made advancement seem like a solution to a non-problem. I was not exactly thrilled with my specific forehead proportions, but they seemed not worth addressing, or likely to come with complications that were not worth the trouble. But when Dr. Cárdenas produced a set of calipers and explained the same math that artists use to draw idealized faces to show that my forehead was indeed a bit larger than would best serve my beauty and that addressing this would be trivial while he was already in there working on my brows, the thought of capturing that additional beauty for myself became much more appealing. The scientist in me found the calipers reassuring and the student of history in me found it deeply unsettling, and in between those two feelings, I found the strength to accept a little overt vanity into this whole process. I hope Dr. Cárdenas does not have this specific conversation with his black patients and others from ethnic groups whose forehead proportions do not line up consistently with the metric he used.
Thus did my surgery package emerge:
- Type III forehead reconstruction
- Brow lift
- Hairline advancement
- Jaw contouring
- Chin contouring
- Tracheal shave
- Breast augmentation
- Ancillary costs, including testing, medication, and accommodations.
The Pandemic in the Room
The moment that my finances finally lined up was emotionally intense. Feelings could be held at bay by the impossibility of doing anything about them while I was still building the necessary savings, but once that process was done, it became harder to be patient. Unfortunately, that meant that I was ready to take the plunge at a truly inopportune moment in world history: the covid19 pandemic.
The necessary conversations with Dr. Cárdenas and his team took up a lot of time, during which I vainly hoped that world disease conditions would improve. I made the most decisive arrangements during brief stretches in which things looked positive in Canada and Mexico, but those bright weeks did not last. My local partner and some friends provided various tools I could use to keep contagion at bay, such as better masks than I had been using, to aid my journey and I researched the legalities of my travel. As a Canadian permanent resident, I would be allowed to return home with few obstacles; as the holder of a US passport, I could fly into Mexico and, for connections, the United States without incident despite widespread travel restrictions. There were many layers of privilege in being able to do this at all, and this process highlighted one more.
The wait between when I scheduled my surgery (late November) and when it would take place (late January) was a frenetic trial of flight rearrangements, new testing rules, and terror that I might be ensnared in Canada’s unfolding quarantine scheme. The closer the day came, the more convoluted the transit path became, and its final form included a hot, humid, airsick stay in a sleep pod in the Mexico City airport to endure a short but very inconveniently timed layover. The difficulty that rankled the most, ultimately, was how different travel sites’ different ways of handling the time zone difference between Guadalajara and Ottawa led to me sleeping through the last leg of my journey to Guadalajara and needing to buy a whole new flight a few hours later with 1/3 of my souvenir money. But I arrived, and Dr. Cárdenas’s staff retrieved me from the airport in Guadalajara and brought me to the residence where I would stay for the next twelve or so days.
Dr. Cárdenas’s patients stay in a well-appointed boarding house about 15 minutes away from the hospital where he and his colleagues perform surgery. This residence is full of magnificent art and cozy seating, making it a pleasant place to spend time before and after surgery. It also has cooking and care staff to keep patients and their companions fed and comfortable. The exact relationship between the residence staff and Dr. Cárdenas’s practice is and remains fuzzy to me, as some of them seemed to be associated with the building itself and others served as liaisons with Dr. Cárdenas and possibly other surgeons at the hospital. I was disappointed to learn that the jacuzzi in my bathroom was not functional, but the sizable smart TV and excellent food made up for that small deficiency.
Although Dr. Cárdenas bills his practice as taking place in the large city of Guadalajara, the residence is in the adjacent exurb Zapopan, which has far less tourist traffic and less going on in general. The path between the hospital and the residence, and between the airport and the residence, illuminated two things very clearly: I was not in Ottawa, and I was not in Miami. The Spanish tile roofs and various architectural flourishes I found familiar were interspersed with street layouts and geology that I had not seen before, and signs and marquees referred to unfamiliar brands, laws, and locales. The people I overheard, or spent time around in the residence, spoke Spanish with a level, musical accent I knew mostly from television, which I grew to love and find soothing compared to the slurred harshness of the ones I grew up with, and their beauty added to my sense that I was in good hands. Dr. Cárdenas, after all, was not just a lower-cost provider than the local surgeons I had dismissed, but legitimately one of the best in the world. It was unlikely that the staff and random strangers in the area were his former patients, but experience with this sort of beauty could only be instructive.
I spent a large chunk of the first day exploring the shopping mall a short walk away from the residence. This mall, Andares, did not deliver what I hoped for. I was shopping for gifts for the various people helping me during and after my return, and this mall did not cater to those people’s nerdy, Gothic interests at all, nor did its offerings include the tourist-oriented art objects I would also have liked. It was a beautiful walk, with large goldfish ponds and other scenery interspersed between stalls, storefronts, art installations, and sitting areas, but it felt divorced from place, with little to mark it as truly different from malls I had visited in Miami or Ottawa. The gifts I brought home, ultimately, did not come with the “this was definitely brought home by someone who went to Mexico” impression I wanted, but so far, they are well received anyway. Ironically, if I had had more time in the Guadalajara airport in either direction, I would have found what I was looking for right there.
In the remaining day and a half between then and surgery, I endured a preliminary covid19 test, a blood test, and a cardiological exam, while video-logging a bit to keep my friends aware of where I was and what things were like here. I also spent this time getting acquainted with Guadalajara’s climate, which differs from that of most places where I have spent any time. Although technically a humid tropical climate, this part of Mexico is drier than most places I have spent much time, so the night air loses heat rapidly to the sky and mornings and evenings are surprisingly chilly. Daytime, likewise, has little protection from the beating sun, especially with the place’s altitude. Before long, it was surgery day, and a frenetic morning turned into an anaesthetized slumber and a bandaged waking.
Very little can prepare a person for the experience of waking up from such extensive surgery…other than having done it before. This was my fourth surgical procedure and the second one related to my transition, so I was familiar with the experience of losing consciousness in the busy, sterile confines of an operating room and waking up in a recovery room. I was also familiar with the experience of my body being firmly 100% unready to have food or water in it for many hours to come, and of the mess that came from testing that unreadiness.
There was not much to see on my face in those early moments. I was swollen beyond recognition, with only the pressure band on my reconstructed forehead allowing the results there to be even a little apparent. The bruising would migrate down my face over the coming days, fading as it went. My new breasts, however, were immediately and starkly apparent.
Dr. Cárdenas had made a few executive decisions while I was unconscious. As we had discussed, he tried more than one size of implant, with an eye toward finding the largest size my body would comfortably hold and heal around, and that size turned out to be 450 ccs. This was the extreme upper limit of what my selection of goal photos suggested I consider, and even with how misshapen freshly implanted breasts generally look, I liked what I saw. Dr. Cárdenas had also positioned the incision for my forehead work at an angle, which allowed him to improve the thickness of my hairline near the site of a childhood injury to my temple, a decision I appreciated.
The most frustrating reality of that day was a miscommunication between me and the pre-op staff. I thought I was told to put all of the possessions I had brought with me, other than my masks, in a locker, but it turned out there were some items I was meant to have with me when I awoke. The fact that I had put everything in the locker, which only I was authorized to open, proved to be a major headache for the day and a half that I was in the hospital, which they ultimately resolved by allowing hospital staff to retrieve my things from the locker for me. This miscommunication meant that my loved ones got post-surgery updates via calls from the staff to my emergency contact number, who relayed the news more broadly, rather than via messages or posts from me. It was a relief to be sent back to the recovery residence, even if it felt a bit premature.
I was delicate in the days that followed. Swelling had my eyelids working less well than they had before and the reality of breast augmentation is that one’s ability to lift weight over one’s head, flex well enough to get into and out of bed, and so on is compromised for several days thereafter. Recovery is energetically expensive, so I ate well, and that dovetails neatly with another tricky aspect of the days following surgery: the intestines are one of the last organs to wake after anaesthesia. The medical team gifted me with higher-strength painkillers to complement the ones they had had me purchase before surgery when I complained that the pain, heat, and general discomfort made sleeping difficult, which proved very, very welcome. The haze of those first few nights led me to accidentally knock over a glass I had finished imbibing, to my disappointment in myself, but the staff were gracious about it. I had little appetite for activity more involved than watching Netflix and managed to watch the entirety of Avatar: The Last Airbender, Legend of Korra, and several movies during my stay.
This fragile state lasted only a few days. As the one-week mark approached, I found myself closer and closer to normal, my strength returning and energy rejuvenated. I was not at full capacity yet, and still am not, but getting out of bed stopped being a painful trial and several days of Metamucil, stool softeners, and ignoring my dietary restrictions to counter the constipation with diarrhea eventually cleared my bowels. This resumption of my old, invincible self proved especially welcome when an incoming patient turned out to be a fellow Canadian kinkster with whom I had long, pleasant conversations and who was eager to receive the gift of my massage.
Yes, dear readers: I found a Canadian play partner in Mexico while recovering from surgery. I am unstoppable. I am immanent. I am, in a word, me. The staff were just a touch scandalized.
One hassle I had to navigate surrounding my return was arranging a second covid19 test, to comply with new US and Canadian rules about having a recent negative test result as a condition of travel. The newness of this rule meant that the arrangements that Dr. Cárdenas’s team had with his hospital proved insufficient and they scrambled to find an alternative source. They succeeded, but the trial was harrowing. Just a few days later, it was time for me to head home. Around the same time, they also removed my various stitches and staples and prescribed some additional medication to help with my still-excessive swelling.
The airport in Guadalajara was a mess of frenetic, tense energy, as a long, long line and more involved processing due to new pandemic regulations devoured my two-hour head start. Airport staff offered me a wheelchair, cued by my forehead compress to my medically compromised state, and if it were not for them, I would have missed my flight. It was this assistant’s swift feet, wheeling me through security and then to my gate, that got me there just in time. I had hoped to have lunch in the airport, but that processing delay forced me to settle for eating the complimentary snacks from the incoming planes instead. Dinner at my connection was also a bust, as the airport eateries were mostly closed and were not accepting cash, but my ride back to my home in Ottawa kindly stopped for drive-through food.
The New Normal
I was back to work within a day of my arrival in my home. Returning to active duty was not the smoothest process, but it proceeds apace. I continue to settle into my new shape. As the swelling in my face subsides, I am finally beginning to see what Dr. Cárdenas has done for me, and I am impressed. My new features are undeniably more feminine than my old ones, and they will take some getting used to. My breasts in particular will be healing into their final shape for a long time yet, as the famous “drop and fluff” process works itself out, and I look forward to what they will look like a year from now. Before too long, I will have to redo various forms of identification to match my new features as those features finalize, including finding a new professional headshot to use for company web sites and so on, and I look forward to some very excited clothes-shopping as well.
It is relaxing verging on disorienting to have this whole adventure behind me. I arranged so much of my finances around saving for this goal that the gap where it used to be is cloying in its emptiness. I have other goals to accomplish, but for now, I can rest on this one.
I finally did my last transition surgeries.
And all it took was three years of saving and navigating international air travel during a pandemic.
Advice for Would-Be Cárdenas Patients
- It takes at least 15 minutes longer get between the airport in Guadalajara and the residence in Zapopan than you think it does. Covid19-related processing delays add an additional 30 to 60 minutes to how early you should be on your way back. Add more if you are interested in souvenirs or food.
- The woman selling Corso jewelry from a kiosk in Andares is lovely and you should buy her jewelry if you like jewelry.
- When the hospital staff tells you to put everything in the locker, they are lying. Keep with you, right out to the operating room, anything you want to have with you in your recovery room, such as your phone, medication, deodorant, and hairbrush. The only things you should put in the locker are the clothes you will wear out of the hospital the day you return to the residence.
- Cárdenas’s team will quote a price for your post-op meds in US dollars. You pay for them in a pharmacy near the residence in Mexican pesos. Do not conclude from the USD price that you pay for the prescriptions in USD. This is also true for the second covid19 test for the trip home, if relevant. Staff members were willing to exchange money with me to deal with these difficulties, but I would rather not have had to rely on their kindness.
- Trust Lázaro. Trust the process. Trust the results that will emerge as you heal. He is very, very good at what he does.