Empowered by Facial Feminization

“I just wanted to feel confident within myself.”

June 9, 2021

Ameirah Neal grew up as the only child of a loving mom in Washington, D.C., and Maryland. She had a great childhood, but she remembers feeling that she just didn’t quite fit in. Ameirah was assigned male gender at birth, but for as long as she could remember, she felt like one of the girls. “I just knew that I didn’t feel in alignment with my body,” she says.

The Start of a Lifelong Journey

As she moved into adolescence, coping with these feelings became even more difficult, and her life took a challenging turn. “I remember a lot of depression,” says Ameirah.

“At the age of 13, I did get the courage to come out and tell my family that I was gay,” she says. Actually, she knew she wasn’t gay; she was transgender. The problem was she didn’t know the terminology or how to put her feelings into words. Also, she was afraid the adults would think she was crazy if she told them how she really felt, she says. “It was dark.”

Thankfully, she was able to confide in her mom about what she was experiencing, and her mom supported her unconditionally through everything, up until she died from breast cancer in 2012.

“She was so crucial and supportive in my transition,” Ameirah says, recalling how her mother helped her get her first bra and sent her money while she was in college studying art, so that she could buy hormones for her transition. “She did the best she could with the little she had.”

Moving Forward With Her Transformation

Five years ago, when Ameirah was 26 years old, she took a major step in her transition: breast augmentation surgery at GW Hospital. Everything went well, and she was “super-excited,” she says. But she still felt there was more in regard to her physical appearance to achieve the outward transformation she was searching for.

She remembers being hesitant to go out and socialize in college because she was afraid people would laugh or make fun of her. “I just wanted to feel confident within myself, there was no self-confidence at all.”

A few years later she decided to pursue the next significant step: facial feminization surgery. This is a highly specialized procedure that alters the masculine features of the face to align them more closely with feminine characteristics and bone structure.

For this procedure, she was referred by a transgender health navigator to board-certified plastic surgeon Jerry Chao, MD, at GW Hospital. Based on her positive experience with her breast augmentation surgery, Ameirah already knew she wanted to go back to GW Hospital, where the staff helped her to feel safe and respected as a transgender woman. Also, she knew Dr. Chao because she’d met with him earlier to discuss the possibility of facial feminization. At that meeting, he explained that she needed to have a tooth removed in order to move forward with the surgery. She had that done in 2018, and in 2019, she met with Dr. Chao again to take the next step in her journey.

A Collaborative Process

“When I first went in, I had this whole image in my head of how I wanted to look,” says Ameirah of the dramatically different look she envisioned for herself. After talking with Dr. Chao, however, she realized that maybe she didn’t need the exaggerated, doll-like features she thought she wanted. Maybe less was more. She trusted his vision.

“One of the first things I ask patients is what they feel makes their face more masculine versus feminine,” Dr. Chao says. “I like to get their opinion and offer mine, then come to an agreement on a plan for surgery.”

Facial feminization requires a very specialized skillset and involves a broad spectrum of procedures. By making multiple alterations to the soft tissues and underlying bones of the face, the aim is to achieve the softer, feminine cues that the brain processes in split seconds, explains Dr. Chao. For example, the feminine brow tends to be softer and smoother than the masculine brow, so there may be a reduction of the brow bone. Also, there may be a tapering and softening of the chin and jawline to achieve a more feminine appearance.

For Ameirah, these subtle, yet impactful, differences were just what she was looking for to bring her outer and inner self into alignment. She remembers being nervous the day of her surgery, but everything went well. “GW was great, the nurses were wonderful,” she says. “I had to stay a full 24 hours, they wanted to monitor me after anesthesia.”

“Recovery is the part I think people should prepare themselves for the most,” she says. There was no pain, she says, just discomfort and a lot of swelling, which Dr. Chao had prepared her for ahead of time. “His office called me like three times to check on me,” she recalls of those early days after her surgery. “That was amazing.”

Living Her Authentic Life

As the swelling gradually went down, her new features began to emerge. “I just love it,” she says of what she now sees in the mirror. “I see a beautiful, strong black woman, instead of a confused little boy trying to find his way.”

“Before the procedure, I felt like I needed makeup to feel like a woman,” she adds. “Now I wear no makeup and I see the beauty inside myself. This surgery has really helped with my self-esteem, self-confidence. I’m just really, really happy … He gave me exactly what I wanted and what I needed.”

Although her journey has been challenging, Ameirah is excited about what the future will hold, including a possible move to New York City (you can help here). The personal growth she’s experienced is reflected in the many paintings she’s created as a freelance artist – including images of empowered black women in royal colors like purples and golds.

“Living her truth,” as she calls it, has been a work in progress, and the physical changes she’s achieved through surgery at GW Hospital have helped her feel more like her true self inside and out. “I think it’s important for women to live their authentic lives and be who they want to be, and not be apologetic for it,” she says.

Gender-Affirming Surgery Services

Dr. Jerry Chao has been providing gender-affirming surgery services at GW Hospital since 2016. He works with a multidisciplinary team to provide individualized care and specialized procedures, including:

• Facial feminization surgery
• Breast augmentation
• Chest masculinization (also known as “top surgery”)

“I think what makes GW Hospital unique is the volume of patients we’re treating,” he says. “Because we specialize in taking care of transgender and gender diverse patients, our staff is equipped and sensitive to the needs of our patients, from clinical areas like knowing exactly what we need to make surgery go more smoothly, to personalized touches that are equally as important, like respecting the person's preferred pronouns and addressing patients the way they prefer to be addressed.” Stories like Ameirah’s are inspiring, Dr. Chao says. “That’s what makes me want to keep doing this.”