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I’m going to quote something that I’ve said before:

It’s really interesting that, normally, the highest ethical principle among cosmetic surgeons is that they are not to operate on patients with unrealistic expectations, but the same doesn’t apply to cosmetic surgeons that operate on trans people. Normally, they’re meant to drill it into your head that any result will most likely be very subtle, and if you are expecting to be perceived drastically different afterwards, then you are a bad candidate for surgery and need therapy instead. But somehow it’s ethically okay to operate on TIPs who believe that surgery will transform them into the opposite sex, and cause other people to view and treat them as such.

I still think about this a lot because there’s really no expectation more unrealistic than ‘I will become a member of the opposite sex’, or even ‘I will effectively change sexes’. By plastic surgeons’ own ethical standards, this should be bonkers.