Your Face in Mine (25 page)

Silpa rummages in his briefcase and hands me a packet of Hello Kitty tissues.

No, he says, still smiling. The laws of the universe aren’t a conspiracy. But they are laws.

In the morning, after ten hours of dreamless sleep, I stay in my room, reading, till eleven. Phran brings me a thermos of chamomile tea and half a loaf of milk bread, still in its wrapper from a Chinese bakery. For your stomach, he says, tapping the thermos. Julie-nah made.

It’s been a cloudy morning, with intermittent bursts of sunlight; now a soft rain is falling. The beginning of the monsoon season, I guess. I set the binder down on the writing desk, open my laptop, let myself down into the swivel chair, and switch on the light.

CLINICAL REFERRAL

Patient: Martin Lipkin

Evaluated by: Jorge Lopez, M.D.

Assistant Professor of Plastic and Reconstructive Surgery, Johns Hopkins Medical Center

Gender and Reconstructive Surgery Clinic

April 24, 2001

Dear Dr. Silpasuvan,

I’m writing to refer the above-named patient, Martin Lipkin, to you for evaluation at Mr. Lipkin’s request. Mr. Lipkin contacted me at
the GRS clinic because he was unable to find any other surgeon in the United States who was willing to do a consultation on his condition.

Mr. Lipkin is a twenty-eight y.o. male of Ashkenazi Jewish (p) and unknown-other Caucasian (m) descent. At my request, previous to our consultation, he was evaluated by the GRS clinic psychiatrist, Dr. Tomasi, and found to be suffering from mild but detectable clinical depression but otherwise free from psychological factors that would constitute comorbidity. He is not suffering from any physical complaints other than occasional insomnia and anxiety that he describes as “not debilitating.” He is a recreational user of marijuana but almost never drinks alcohol and does not use tobacco. His family medical history is almost entirely unknown. His mother and father separated when Mr. Lipkin was an infant. He is not in contact with his mother. His father (according to Mr. Lipkin) died of AIDS-related septicemia in 1995 at age fifty-two and left no extant medical records.

Mr. Lipkin believes himself to be suffering from what he himself has titled “Racial Identity Dysphoria Syndrome.” That is, he believes that he was born into a physical identity of the wrong race. He states that for as long as he can remember he has had a vivid but obviously repressed sense that he is living in the wrong body and has recently realized that he is, in fact, internally, African American. He wishes to seek out options for surgical reassignment so that he can appear physically African American.

To my knowledge (and as I informed Mr. Lipkin) there is a) no such diagnosis, and b) no surgeon in the world who would perform any procedure based on such a diagnosis. When he inquired whether it would be possible to pay for cosmetic surgeries that do exist, I told him (as I believe to be true) that the standards of care in plastic/reconstructive surgery would make it nearly impossible to find a surgeon to provide reliable care under these conditions. Mr. Lipkin is a very well informed patient and a very persistent self-advocate and that is how he brought your name to my attention.

It is my understanding that since leaving U of R (where you doubtless knew my former mentor, Martin Trumbull) you established a clinic in Bangkok for radical psychosomatomic disorders. I was not able to locate any recent publications of yours on the subject, but Mr. Lipkin showed me your website, and since I know that you had excellent training, I am recommending Mr. Lipkin to your care with the strongest possible reservations. I refuse to believe that any such syndrome can exist. Notwithstanding Mr. Lipkin’s evaluation, I believe he is suffering from some kind of intellectual or cognitive (if not technically psychiatric) delusion. I do not believe that Mr. Lipkin is a good candidate for surgery of any kind.

Yours sincerely,

J. Lopez

Preliminary treatment plan

Patient: Martin Lipkin (Goal Identity: Martin Wilkinson)

Lead physician: Binpheloung Silpasuvan, M.D.

Agreed to and witnessed March 2, 2001

Mr. Lipkin (hereafter Mr. Wilkinson) has agreed to the following surgical procedures in order to achieve his stated goal of a new identity, “Martin Wilkinson,” an African American male, appearance determined through MorphTech software and certified as the final version by himself and Dr. Silpasuvan.

 


1. Mr. Wilkinson will receive subcutaneous injections of melanotomanine (afamelanotide sulfate) three times daily for one month,
   together with daily UV exposure sessions, to stimulate melanin production, beginning immediately.
   

2. Mr. Wilkinson will be scheduled for initial facial surgery in six weeks, assuming no contraindications from the above treatment. This surgery will involve alteration of the palatine and vomer bone structures and the addition of muscle mass to the orbicularis oris (upper and lower lips), as well as ordinary rhinoplasty with nostril augmentation. Recovery time from surgery is estimated to be one month.
   

3. Following successful recovery from facial surgery, Mr. Wilkinson will proceed with the “Real-Life” transitioning plan agreed to with Dr. Silpasuvan. This transition period may take up to four months.
   

4. 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.

R
ACIAL
R
EASSIGNMENT
S
URGER
Y
: P
OSSIBILITY
AND
R
E
ALITY
B
INPHELOUNG
S
I
LPASUVAN
, 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:

 


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

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

3. 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:

 


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

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

3. 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.