About Face

By Robyn Ross / Photo by Danielle Villasana

From the moment she arrived for a consultation with Dr. Regina Rodman ’01, Emily* was a delightful, upbeat patient. She happily posted “before” photos to social media in anticipation of her facial feminization surgery; once she recovered, she added glamorous, beaming post-surgery selfies.

Months later, Rodman discovered a testimonial the trans woman had posted to an online forum. Emily wrote that, before surgery, she had decided that life in the male body she was born into had become unbearable. She had planned to end it—but, as her last hope, she would try facial feminization surgery. The procedures, Emily wrote, had been miraculous; she felt like she finally could embrace life.

Rodman was startled to learn the stakes had been so high, but she was glad to have contributed to Emily’s newfound happiness. Now, when Emily looks in the mirror, “Her reflection matches the person she knows inside,” Rodman says.

Rodman specializes in gender-affirming facial plastic surgery. Her Houston-based practice helps patients align their physical appearance with their gender identity by changing not just the skin but the bones of the face, creating an entirely new appearance.

Although she had always wanted to be a doctor, Rodman majored in anthropology at Macalester, focusing her studies on medicine with help from DeWitt Wallace Professor Emeritus Jack Weatherford, Professor Emeritus David McCurdy, and Professor Dianna Shandy. She learned ethnographic interviewing techniques she uses today in her consultations, ninety-minute conversations that always begin with the open-ended prompt, “Tell me about yourself.” It’s instructive to notice what patients mention first, she says: their job, their family, what they don’t like about their face. “I learn a lot about their values and how they see themselves by the way they answer the question.”

Rodman began her pre-medicine requirements at Macalester, then later completed them through a postbaccalaureate program at Loyola University. While applying to medical school, she worked for the American Association of Oral and Maxillofacial Surgeons, where some of the doctors talked with her about their reconstructive cases: rebuilding people’s jaws and chins after cancer, military injuries, and other traumas. Before seeing case photos, she hadn’t understood how radically surgeons could transform faces—but now she was hooked.

She earned her medical degree at Chicago’s Rush University and matched with a Houston otolaryngology (ear, nose, and throat) residency, where she learned facial reconstructive techniques. She then completed a facial plastic surgery fellowship that focused on craniofacial surgery, procedures that correct birth defects or reconstruct the bones of the skull, face, and jaw. Rodman discovered she was suited for the long surgeries such cases entailed. “I can spend twelve, fourteen hours in surgery like no time has passed,” she says. “It’s my superpower.”

After her fellowship she returned to Houston, a city she’d grown to love during her residency. In 2016 she launched her private practice focused on facial skeletal surgery. The following year, she received an email asking if she worked with transgender women. The woman wanted V-line surgery, a procedure popular in South Korea that narrows the jaw and chin for a more feminine look. The patient was delighted with her results and spread the word online. Soon, more of Rodman’s practice was facial feminization surgery, a natural extension of what she’d learned in fellowship training.

For patients who want to look more feminine, Rodman performs a browbone reduction, in which she lightens the forehead by removing, reconstructing, and replacing the bone between the eyebrows. She reduces the prominence of the orbital rims, the bones under the outside of the patient’s eyebrows. She does a V-line to slim the chin and jaw, a rhinoplasty to create a more delicate nose, and an Adam’s apple reduction.

“My happiest moment is when people say that they can’t unlock their phone with their face, because the structure of their skeleton has changed,” she says. Patients also will get soft-tissue procedures: a lip lift, hairline lowering, browlift and cheek augmentation. It’s a full face transformation.

But some lawmakers have targeted gender-affirming procedures. Two years ago, the Texas legislature considered a bill that would hold insurers and doctors who provide “gender modification procedures or treatments” financially liable for medical or mental health complications for the rest of the patient’s life, even if the physician wasn’t at fault. The bill would effectively end the treatments in Texas, because providers would be unable to obtain malpractice insurance.

The bill applied to genital surgeries as well as “the removal of any otherwise healthy or non diseased body part” if the procedure was undertaken to transition a patient’s gender from their sex assigned at birth or affirm their perception of their sex.

The bill didn’t explicitly mention facial surgery, but these days, about half of Rodman’s patients are transitioning to another gender. The other half, though, are cisgender women who want browbone reductions, chin reductions, or hairline advancements—procedures that help them look more feminine by societal standards. If the bill became law, would Rodman be responsible for determining whether a patient’s intent was to affirm her gender identity or just look prettier? “Who decides where those lines are drawn?” she muses.

The 2023 bill died in committee, but Rodman worries that, emboldened by a second Trump presidency, Texas lawmakers will resurrect it this spring. Until political leaders force her to make changes or fight back in court, she’ll continue performing the surgeries that patients like Emily have credited with saving their lives.

“It’s that type of response that makes me keep doing this,” Rodman says. “Emily sees her face the way she feels—as a woman—and she thinks now she can live and move forward.”

*a pseudonym

Robyn Ross is a writer in Austin, Texas.