Worrying about beauty and appearance is not new, but a constant refrain of medicine, ethics and literature since the ancient Greeks. In the digital age, those worries have escalated, with more than $148 billion forecast to be spent in the US alone by 2030. In 2017 a Report by the Nuffield Council for Bioethics highlighted the ethical and regulatory challenges around cosmetic surgery. Some critics identify the impact of social media, digital photography and self-esteem crises with the growth of cosmetic surgery, as well as a wide range of non-surgical interventions, from make-up to digital skins. Others see cosmetic surgery as one of a wide range of opportunities for individuals to curate their own identity. What of the mental health impact on people pursuing perfection? And what of the experiences of those who look ‘different’? This research tackles the challenges global ethics around facial appearance and identity in the 21st century.