FROM HEAD TO TOE
delighted with no lack of tools, staplers and electrical coagulation
devices that could harmonically be small or be giant big jaws. I just
needed to call for it. I agree it is good, it saves time, but it can also
work as a talent diluent. New York. I tried to go to Spain but when I was told I needed to pay
18,000 euros ($24,000 at that time) for four days, I kindly declined.
I started this article saying that education is a privilege, didn’t I?
Well, it also has a value.
Things changed when I started plastic surgery residency. There,
I was propelled to a better understanding of a higher level of hu-
man complexity. Simply stated, physical appearance may be more
important than social values, education or health to many people
because of the extremely competitive world in which we live. People
try to present themselves in their “best” way even though it might
not even be their real selves. All this behavior causes anxiety and
psychological conflict in confronting the risk of rejection and loss
of vitality. I am a doctor and I understand my profession exists to help
people, no matter their circumstances. As a plastic surgeon, I do a
lot of “unnecessary” and “superfluous” procedures—surgeries that
make my patients very happy. After years dedicated to saving lives
in general surgery, I still have an internal conflict with what I can
offer now. I feel my plastic surgery patients benefit from my work
in a more abstract way, just like improving mental health.
It is probable that most everyone suffers at least to some extent
with self-image—I do. It was very hard to keep up with people 10
years younger than me when I repeated my surgical residencies in
the US. I didn’t want to look like an old lady hanging out with the
kids from the 80s. I guess the joy of tasting a Coke kept my skin
hydrated to some extent.
A group that is very effected by emotional confliction is the
transgender population. My first encounter with them was again
in that big ER in Sao Paulo, where sometimes they would come in
crying because they were beaten up. They were so “scandalous” that
it would become a comical time in our day. But with time, I realized
that what I thought was just nonsense was actually a very complex
and serious health care issue.
I remember a series of patients coming with necrotizing fasciitis
from back alley industrial silicone injections. The facial and body
deformities made me realize how much some people are willing
to risk in order to correct their internal chaos, the disconnection
between reality – who you are – and who you would like to be
or present as, which can result in severe anxiety, and manifest as
depression or emotional paralysis effecting all other aspects of life.
Books don’t teach you everything, and time spent with patients
is often the most interesting learning experience. For instance, as a
plastics resident, I spent a lot of hours in the hospital’s prison ward
with paraplegic inmate patients, and one generously shared with me
the capability of how to steal money from an ATM. Full disclosure,
after inconspicuously analyzing the ATM, I concluded my patient’s
technique was obsolete which made me give value to our journal
papers and conferences.
When I started doing gender confirmation surgeries, I faced
a new challenge that helped to massage my surgeon’s ego. It is the
kind of surgery that has no space for errors, no secondary surgery.
The risk, precision and tissue manipulation are thrilling. It involves
bone, cartilage, skin, fat, fillers, implants, bowels, vessels … no limits,
except the brain: how ironic.
I accept and embrace working with any patient independent
of color, race, age, religion, gender and deformity with open mind
and through the front door. I offer my time to listen not only to
the patient but their spouse, their parents and everyone that will
be affected by my work. I am proud of the fact that I performed the
first facial feminization in the state of Iowa during my residency
there and I am about to repeat the same procedure in Kentucky.
Part of my work receives criticism and I understand the reasons.
It is part of life, 14 years of residency made me very resilient in
the whack-a-mole, with me playing the mole role. Differences in
opinion should exist and always be respected because when there
is no freedom of thought, there is no democracy, and an authori-
tarianism can be established. When we lose freedom, we lose a lot;
we lose rights, we might lose the right to study again (and again);
who knows, it has happened before. In the past, my parents ensured
that I had no ceiling blocking me from rising and didn’t let anyone
choose my life for me. For the future, I want to do the same for my
sons, teach them to respect everyone and make our lives a pleasant
journey, following the rest of our dreams and motivations, not a
new cycle of a traumatizing diaspora.
Dr. Fensterer is a practicing plastic surgeon at Dr. Banis Plastic Surgery.
When I spent more time with my transgender patients, I began to
see a very frightened person, most times alone, ostracized by family
and by the system, someone living with an incongruent soul in a
body that also ages. That realization drove me to learn techniques
to help them. I visited several surgeons from Brazil, Argentina and
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