Jess Row - Your Face in Mine

Mr. Wilkinson will be scheduled for hip and buttock augmentation following the completion of the above recovery period. This procedure will involve collagen injections to achieve the desired appearance, as well as extensive scar corrections to make the augmentation as invisible as possible. During this procedure, any existing skin abnormalities, discolorations, etc., will be identified for further treatment or treated in situ if possible.

For the above treatment, Mr. Wilkinson has agreed to pay Silpasuvan Medical Associates a flat fee of USD $100,000 in three installments.

RACIAL REASSIGNMENT SURGERY: POSSIBILITY AND REALITY

BINPHELOUNG SILPASUVAN, M.D.

Cosmetic surgery for the purposes of changing one’s racial or ethnic identity has been an established practice in Western medicine for more than a century, since the first cosmetic rhinoplasties were performed by Jacques Joseph in Prussia in the 1870s. However, medical professionals in the cosmetic surgery field have long avoided referring directly to the racial or ethnic implications of popular and widespread procedures, for understandable reasons. The purpose of this article is to argue for a new era of honesty and demystification about the potential for altering one’s identity through cosmetic surgery and related practices, on the one hand, and on the other to introduce the obviously controversial idea that there may be a need to invent an entire new category of cosmetic surgery, Racial Reassignment Surgery, to meet the demonstrable psychological needs of contemporary patients.

The best way to introduce this second theme, I believe, is to make reference to a theoretical case study, which I have assembled as a composite of many patients I have met in the course of my practice. For the purposes of this case study, the patient is a young British man from London, with characteristic normal Caucasian features, who grew up in a public housing estate among West Indians, works as a DJ playing dancehall music, and is exclusively attracted to West Indian women. This patient displays a strong desire to reduce his feelings of isolation and stigmatization through a change in physical appearance so that he may “pass” in that community.

According to current clinical practice and social reality, this person would be treated in the following way:

If seeing a psychotherapist, his struggles with identity would be treated as psychopathology and not referred to a surgeon.

If consulting a plastic surgeon, he would be told that no surgical alterations to his features are possible (or even legal).

In his community, he might be encouraged, at best, to adopt temporary, expensive, and inconclusive approaches, such as changing his hairstyle, using tanning products, colored contact lenses, and so on.

Is there another way to approach such a case? Consider the following recent medical advancements relevant only to this particular case:

Radically improved understanding of the melanogenic process and the use of peptide-based agents for skin darkening (Silpasuvan 1994, 1996, 1997)

Reconstructive techniques specifically designed for Negroid features (Cavell 2001; see also specifically Worth, “The African American Male Face: A Surgeon’s Analysis,” 2004)

The development of artificial cartilage and collagenoids applicable to permanent solutions for face alteration (Teng 1992, Silpasuvan 1998, Worth 2000)

Although there are several substantial obstacles still in place, such as the inability to perform hair transplants without immune rejection (Covington 1999) the answers to this patient’s needs, so to speak, are staring us in the face: it is possible to initiate a regime of decisive racial reassignment through surgical means, which in tandem with other forms of treatment commonly used in sexual reassignment (voice lessons, for example) could be considered a new field of potential relief for such individuals. And, from a practical point of view, as the world becomes more and more interrelated and national and geographical barriers less substantial, the desire for these procedures will doubtless become more and more acute in the next century.

Subject:JAMA editorial submission

Date:Wed, 27 Aug 2008 11:40:54-0400

From:Freedmark, Gary

To:Silpasuvan, Binpheloung

Dear Dr. Silpasuvan,

We read your editorial submission, “Racial Reassignment Surgery: Possibility and Reality,” with interest. However, we are not able to publish it at this time. While the topic you raise is potentially significant to the global medical community, we feel there is no substantial clinical evidence that would warrant raising this inflammatory possibility in the current media environment. If you have clinical evidence to share, however, please do so in the form of a full-fledged article.

Cheers,

Gary Freedmark

Associate Editor

“Real-life” transitioning plan (RLTP)

Martin Lipkin (GI: Martin Wilkinson)

May 4, 2001

PHYSICIAN STATEMENT

Mr. Lipkin/Wilkinson is an Ashkenazi Jewish/Caucasian American male transitioning to African American (black) male identity. In keeping with the RRS-SOC (Racial Reassignment Surgery Standards of Care, B. Silpasuvan, 1999) he is required to carry out a period of psychological transition during the surgical alteration of his physical identity. Because RRS is an experimental procedure approved only for specific use in the Kingdom of Thailand, RRS patients (unlike gender reassignment patients, as specified in the WPATH Standards of Care, 2001) are not expected to reveal themselves or “come out” during the course of the transition. The adjustment, then, must be an internal one, based on the responses of strangers to one’s new racial status. It is furthermore recommended that this process of transition be conducted in a location that is similar to one’s home city or community but not the home city or community, to reduce the risk of accidental “outing” or self-revelation.

After consultation with Mr. Lipkin/Wilkinson, I have determined that the appropriate period for the RLTP in this case is six months. This is due to financial and practical considerations having to do with the availability of surgical facilities in Bangkok and the expense of the “real life experience” (RLE) away from Mr. Lipkin/Wilkinson’s home.

Before leaving Thailand for the United States, Mr. Lipkin/Wilkinson will receive at least one month of intensive skin pigmentation treatment as described in the Preliminary Treatment Plan. Together with regular shaving of the head and some minor daily makeup application, as well as changes in wardrobe and some preliminary speech therapy, he will have achieved a simulacrum of the appearance of an African American male. All of these appearance alterations are reversible, should Mr. Lipkin/Wilkinson choose not to continue with the treatment.

PATIENT STATEMENT

I left America as the white man Martin Lipkin. I will return as the black man Martin Wilkinson.

I have chosen as the site of my Real Life Experience Philadelphia, the City of Brotherly Love.

For the duration of this Experience I will be a lifelong Philadelphian. My childhood home was the North Allen Projects, now demolished, at the corner of 11th and Poplar. I attended William Penn Primary School and Polytechnic Academy in Center City. And then, as a scholarship student for track and field, Lycoming College, one of a handful of black students on a leafy campus in coal country, five hours from the city. This may explain minor irregularities in my habits of speech. My father died of lung cancer when I was a child; my mother moved to Florida with my two younger sisters after I went to college.