I feel the needle slide into my face, like a cat scratch, and hold my breath. It’s over in less than a second and the clinician smiles down at me. “Does it hurt?” he asks. “Do you need a break?” I say no, I’m fine, and we continue. Approximately 30 injections go into my face over the course of the next 15 minutes until my cheeks and neck begin to swell. My face stings like I’ve just been slapped.
I am getting fat-dissolving injections, also known as lipodissolve or, in the US, as the brand name Kybella. The injections promise to permanently remove pockets of fat by injecting deoxycholic acid, an enzyme normally found in stomach acid that dissolves fat in food. This acid is instead dissolving the fat in my face.
It is also, I hope, the final procedure of my transition. As a trans man who has been on hormones for four years, I am still sometimes misgendered by strangers. I have, rightly or wrongly, attributed this to my round cheeks making me look too feminine. After a year of pulling and prodding at my face and failing at self-affirmations, I decided it was time to seek out lipodissolve.
In the lead-up to the injections I found myself wondering why I didn’t know any other trans men who had undergone cosmetic procedures. I have a wide circle of trans men friends, and yet I had only seen my trans women friends discuss fillers, botox, and lipodissolve.
I asked Dr. Dan Coventry, who administered my injections and runs DC Aesthetics, about how many trans men he typically sees. He tells me that most of his trans clients are trans women, but there is a growing demand from trans men. He says that, for trans men, “mostly it’s about enhancing the jawline and cheekbones, and sometimes the brow, so it’s mainly fillers and sometimes lipodissolve. It’s often about creating a masculine jaw and cheek bone structure.”
Lipodissolve is available widely in clinics across the UK, often advertised under different names such as “fat sculpting”. While the US brand Kybella championed the treatment in 2015, it has yet to be approved for use in the UK. This means that individual UK clinicians make their own mixtures for the injections, sometimes including anaesthetic. Coventry says: “There was a big surge over the last two years, but it’s plateaued. I think the swelling and need for repeat treatments is a pain for some.”
After putting out a call for trans men considering cosmetic injections, I talk to Michael*, a 21-year-old trans man based in Liverpool, who is contemplating fillers. “I've never really seen any other trans men talk about wanting or having had these procedures done,” he says. “I wouldn't be surprised if dudes are getting work done and just keeping it to themselves.”
For some trans men, cosmetic procedures are for reducing dysphoria. Elliot*, at 23-year-old trans man in Oxford, has had fillers in his jaw and has just booked in for lipodissolve. He sought out cosmetic procedures primarily for dysphoria relief. “The first time I had fillers done I did not stop crying for a week – it was the first time that I looked at myself and felt as though I recognised my own face.”
“As far as I’m concerned, fillers are an important part of my health care,” Elliot continues. “Trans healthcare in this country takes so long on the NHS, so many trans people have to navigate years of limbo without healthcare. Fillers are actually a much cheaper way to handle my dysphoria in the immediate.”
NHS Gender Identity Clinics, where trans people are prescribed hormones and referred for gender-affirming surgeries, have notoriously long wait lists. Wait times for a first appointment at London’s Charing Cross Clinic now stand at three years, and have only got longer during COVID. Acquiring a hormone prescription is often an arduous emotional process for many trans people, and the required psychiatric assessment for a gender dysphoria diagnosis can feel invasive. For trans men like Elliot, cosmetic procedures can be a quick and easy solution while waiting for hormones.
However, some trans men seek out injections for largely cosmetic reasons. Seb, a 22-year-old trans man from Brighton, has had a silicone chin implant is considering lipodissolve. He tells me, “If I’m being honest, at this point it’s more for aesthetics than strictly dysphoria-relief. I’d say my motivations are 90 percent vanity but there is a small part to me that knows there’s safety in being as masculine presenting as possible.”
After my procedure, my face swells enormously and I look like I’ve been attacked by bees. My least favourite part of my face is temporarily exaggerated, and I feel depressed for a few days. After two weeks, however, the swelling goes down and I begin to see a sharper jawline and slimmer cheeks. I get misgendered less and do feel more confident.
The line between essential trans healthcare and purely cosmetic procedures is blurred and messy. Sure, I got lipodissolve for my dysphoria, but I also want to look hot. Testosterone and top surgery have made my life liveable, and I could continue to live a decent life without cosmetic injections, but I am much happier now. Is the difference between a bearable life and a happy one essential? I tell myself that, after spending years living as the wrong gender, I’m making up for lost time. I want to be happy now.
Coventry offers reduced rates for trans clients visiting his clinic, partly because of the NHS wait lists. He tells me: “I’d heard about the long wait lists for trans surgery, which was shocking. I wanted to offer something meaningful to the trans community, so I started offering cost-price procedures for trans people. That means I just charge for the materials.”
It was this cost-price offer that initially drew me to Coventry for my own lipodissolve. He sees his services as more than simply cosmetic, and states: “I would say these procedures are healthcare for trans people, I don’t like using the term cosmetic even, because it’s more than that.” He pauses for a second, before adding: “I mean, it is cosmetic in the most literal sense, but people’s faces are also their identity. That’s why it matters.”
*Names changed at the request of interviewees