project update

Marilyn Monroe at 100: the face, the fantasy, the fortune

The lips, plump and red, are parted slightly, as if on the brink of speech, about to declare love, perhaps, or a secret. The eyes, heavy-lidded and slightly closed, had winged lashes, thick enough to create actual shadow. A small dark beauty mark dots the smooth whiteness of the left cheek. And surrounding the face is a luminous halo of platinum blonde hair.

You will know this face. Though Marilyn Monroe died in 1962, when she was just 36 years old, her image remains as recognisable as Coca-Cola – the product it has been used to advertise for seven decades. Marilyn would have turned 100 this year, and still that youthful face is deployed across the US, China, and Europe to sell soft drinks, cosmetics, chocolate, designer shoes, and handbags. She remains the archetypal all-American girl, ready for anything: equally happy in pedal pushers eating hotdogs with Joe DiMaggio, and poured into a sheer, flesh-coloured gown to sing Happy Birthday to President Kennedy at Madison Square Garden.

It’s the very malleability of Marilyn’s face, and the fact that her image was frozen in its prime, that makes it so enduringly sellable. But it isn’t a natural face, it was carefully constructed.

Most people know that Norma Jeane started out as a brunette. She arrived in Hollywood with a face that was lovely if unremarkable. She modelled for the Blue Book agency in the mid-1940s, while her first husband James Dougherty was deployed in the Marines. The marriage was partly convenience; in keeping with the lonely and tumultuous private existence that lay behind the Hollywood glamour, they had married when she was just 16, and he 20 to prevent her returning to the orphanage. By 1946 when Marilyn had become a successful pin up model, the couple divorced.

Monroe the movie star emerged out of a careful collaboration between Marilyn and her makeup artist Allan ‘Whitey’ Snyder: together they fashioned her face into a language shaped for the screen, and for visual impact. That cartoonish perfection, from the eyes to the lips, to the pale foundation, mixed to a custom formula to catch the studio lighting, was deliberately stylised and reproducible. It would position her at the epicentre of a burgeoning commercialism in art and culture, from the pop art of Andy Warhol to the nylon tights and bullet bras that would mark the ‘accessible’ glamour of the modern woman.

Marilyn could walk through New York with her face unpainted, wearing flat shoes and a headscarf, and be entirely unrecognised – even at the height of her fame. Through a self-conscious transformation, like a musician picking up her violin, she was one with her instrument: the face, the body, the movement, each quiver perfectly calibrated to invoke desire.

The manufacturing of Marilyn extended to surgery. Her medical records, sold at auction in 2013, included facial X-rays and notes from the office of Dr Michael Gurdin. A ‘chin deformity’ was noted, along with the 1950 cartilage implant that corrected it, and a tip rhinoplasty that produced that snubbed nose.

It was a face that was constructed along explicitly racial lines: platinum, Anglo-Saxon, soft-featured, white, and that reflected the post-war environment. Leading ladies of the Depression had been angular and emotionally remote – think Greta Garbo and Marlene Dietrich, with their sharp, hungry features and mysterious auras. By the 1940s, resilience and wartime spirit were written into the faces onscreen: Rita Hayworth’s defined cheekbones, Lauren Bacall’s sultry angularity, Ingrid Bergman’s classical elegance. Then, as rationing lifted in 1945 and prosperity returned, Marilyn’s fuller lips, luminous skin, and rounded, expressive features suggested vitality and openness rather than distance or control. Hers was the face of consumer capitalism – soft, inviting, full of promise.

What is striking, a century on, is how deliberately that template was deployed beyond cinema. The ‘blonde bombshell’ was not merely a beauty ideal but a geopolitical instrument that American culture projected to the world during the Cold War, when Hollywood functioned as a kind of soft-power embassy. The Voice of America – a US government -funded broadcaster established in 1942 to counter Axis propaganda – existed to promote positive ‘American’ values internationally.

Today, in the Trump administration, it has been noticed that ‘Mar-a-Lago face’, so characteristic of the MAGA elite, has come to define visible, effortful wealth, with the heavy use of face and brow lifts, fillers, sculpted cheekbones and Botox. By contrast, Marilyn’s face promised girl-next-door accessibility, with her whiteness personifying the ‘milk and honey’ modernity of modern America. To a large degree, this privileging of European beauty standards remains at the heart of the Hollywood project: white skin, blonde hair, light eyes, a slender nose and heart-shaped face is core to cinema and advertising, despite the language of diversity.

In private, Marilyn pushed against this narrow politicisation; released FBI files reveal she was under surveillance for her ‘strong feelings for civil rights, for black equality’, and for speaking out against McCarthyism. The Norma Jeane inside the Marilyn mask was a serious and politically aware woman who read Dostoevsky and started her own production company – despite Hollywood being even more dominated by men than it is today.

We can’t separate the power and desirability of Marilyn’s image from the technology that circulated it around the world. In cinema, it was the rapid switching between characters and the close-up, popularised by directors such as D.W. Griffith in the 1910s – most famous for Birth of a Nation (1915) – that brought faces to audiences at a scale and intimacy never experienced. For the first time you could pay your 3 shillings and six pence and sit in a darkened room, with a perfect, emoting face projected 20 feet high in front of you. This face-to-face intimacy was key to the creation of Marilyn as a celebrity – along with colour film common by the 1940s – that brought her peach skin and red lips to life.

Perhaps the most famous reproduction of Marilyn’s image is the series of silkscreens Andy Warhol made in 1962, immediately after her death. Warhol’s work explored the mechanisms of fame, the way an image could be taken and reproduced until it becomes entirely separate from the person it depicted. Warhol made this separation of person and image explicit, along with the commercial reproducibility of the stereotype: bright pink skin, yellow hair, blue eyelids. Reduced to a logo. He reproduced the lips alone, 84 times, across two panels.

By 1962, Marilyn’s face had appeared on so many magazine covers, movie posters, and newspaper front pages that familiarity had become abstraction, in the same way perhaps that her private pain was separated from her public persona. Removed from the flesh and blood woman and placed alongside a Campbell’s soup can and a Coca-Cola bottle, Marilyn’s face became a caricature, instantly recognisable by the beauty mark alone.

Many famous women have since picked up elements of Marilyn’s physicality: from Anna Nicole Smith to Madonna, the ‘material girl’s lips, hair and beauty spot have become a shorthand for Western glamour, beauty and sex.

And then there is Kim Kardashian, who wore Monroe’s iconic 1962 Jean Louis rhinestone encrusted dress to the Met Gala in 2022. Kardashian has built her own cultural identity as carefully as Monroe did, but there is a critically different emphasis, and context. Where Marilyn’s face became a caricature through cultural reproduction – a meeting of technology, art and consumerism – Kardashian’s became one by design. Like Marilyn’s stardom, Kim’s is based on appearance, and on the technology of the screen (in Kim’s case, social media). But the Kardashian brand is based on homogeny rather than uniqueness. Drawing on Black, Latina and Middle Eastern beauty traditions that are repackaged through a light-skinned lens – large lips, catlike eyes, narrowed noses, heavy bronzer, thick brows – there is no singular face at its core.

There is, however, a singular butt, which is said to have caused irreparable damage to the Marilyn’s hand-me-down dress – despite reportedly losing 16 pounds in three weeks to squeeze into it.

What is singular and yet universal about Marilyn’s face is its idealization. What is so enduring about Marilyn’s face, beyond its celebration of consumerism, youth and the West, is its paradoxical blankness: it is simultaneously both filled with meaning and empty enough for other meanings to be attached to it: she stands for emulation and desire, gullibility and shrewdness, sex and innocence, madonna and whore. These contradictions echo the fundamental contradiction in Marilyn’s own life: the child-woman who was never loved enough and the dazzling beauty with the world at her feet. That duality was visible in her half-closed eyes, her parted mouth – each readable as a sign of desire, or submission.

In 2011, Authentic Brands Group acquired the rights to Marilyn Monroe’s face and name, managing her estate alongside the Bob Marley estate and a mixed martial arts clothing line. The labour that went into the creation of an icon has been glossed over, and all we are left with is the artistry, as the image is reproduced endlessly and everywhere, from high-art museums to streetwear, murals and social media.

This year, Marilyn would have been 100 years old, prompting an outpouring of articles and exhibitions that show she still matters. See, for example, the wonderful new exhibition at the National Portrait Gallery in London, curated by Rosie Broadley.

Had Marilyn lived, images of her sagging face and ‘lost’ beauty would no doubt be circulating on Instagram and TikTok. Without the woman, there is just the myth, and the false promise of enduring youth. And in an era of deep fakes, fillers and digital transformations, that gap between the reality and the promise matters more than ever.

Connecting humans: from faces to consciousness

Last month, I found myself returning to a deceptively simple question: is there really such a thing as a loneliness epidemic? The answer, as ever, is both yes and no, and loneliness, as both a feeling and a language, is impossible to separate from history.

I was exploring this issue as part of an “ask the expert” panel for the British Academy, chaired by Hetan Shah, in the Academy’s Age of Self series. What quickly became clear, in conversation with colleagues and an engaged audience, is that loneliness resists easy definition. It is shaped as much by culture and expectation as by individual experience, and the data, which is so often invoked to prove its rise, is far from definitive.

Our discussion ranged widely, from digital culture to menopause, from demographic trends to the subtleties hidden within statistics. One recurring challenge was how readily we reach for simple narratives, such as “epidemic”, when the reality is far more complex. Such language can reinforce the idea that loneliness is always negative and externally caused, rather like germs that invade us, rather than something also shaped by social structures, including neoliberalism.

For my part, I have long argued that loneliness is better understood not as a single emotion, but as an emotion cluster, a constellation of feelings that shift depending on context, history, and the stories we tell about ourselves. I explore this further in A Biography of Loneliness (2019), now translated into several languages.

This raises a broader question: to what extent can we study emotions historically at all? It is something I explore in a recent article for History Today, where I consider the challenges of recovering emotional experience from the past, and what it means to write histories of feeling.

Loneliness continues to sit at the centre of my research into human experience and connection. Over the past six years, however, my work has also taken me in a seemingly different direction, the study of face transplants. Yet the underlying questions are closely related. How do we understand ourselves as conscious and self-conscious beings? To what extent are our physical bodies integral to that sense of self, and to our relationships with others?

These questions formed the basis of my recent conversations on BBC Radio 4’s ‘Start the Week’ with Michael Pollan, Mary Costello and Tom Holland. We discussed the relationship between face and body, self and world, and the ways in which identity, gender and belonging intersect with consciousness.

How we imagine and represent the face is central to how we perceive others’ identity, status and value as humans. And we can trace that through history, as I show in an article for BBC Extra. The ‘seven faces’ I use to tell the changing story of portraiture and the human face include a Stone Age Venus, an Egyptian death mask and a 21^st-century subversion of the norm.

Because what we value, preserve and talk about it has never been neutral. Racism and gender ideology run through so many of our ideas about the face, and value even today. Which brings me back to that ‘Start the Week’ discussion.

What interests me is how much of what we describe as “eternal” or universal consciousness is, in fact, rooted in a particular intellectual tradition: post-Enlightenment, Western, and often implicitly male. Recognising this does not diminish those ideas, but it opens the opportunity to question them – and in so doing, to imagine alternative ways of understanding connection, embodiment and selfhood.

That is one of the subjects of my new research – on which, more soon.

The Many Faces of Truth 

I appeared on BBC’s Moral Maze on Christmas Eve, and the subject was ‘truth’. Which got me thinking about how as historians and writers we aim for truth, but that doesn’t mean what we come up with is the only truth, or the only truth that matters. The relativity of truth comes from our unique perspective on the world, and our place in it. Which means that to some extent truth has always been political –because those perspectives and places are political.

Truth and relativity is central, too, of my book The Face that will be published by Allen Lane in the UK on 26 February (June in the US and by Hachette).

The Face: A Cultural History explores how humans have interpreted faces throughout history and how they’ve shaped our ideas about identity, morality, and social hierarchy. It starts with the recognition that the face is the only part of the body where all our senses come together –and it has a history.

Today, the face is a foundational marker of who we are—from unlocking our phones with facial recognition to having our faces stamped in our passports. In the book, I chart how we have ended up here, for it isn’t a natural or inevitable position.

New technologies and cultural innovations have transformed our conception of selfhood over time: from the growth of portraiture in the Renaissance and the mass production of mirrors and photography in the nineteenth century, to twenty-first century developments like digital avatars and face transplants.

Drawing on research, interviews, and personal narratives—including my own experience living with prosopagnosia (face blindness)—I probe beneath the surface to ask what our faces really say about us.

The book has been reviewed favourably by Katy Hessel in The Times, who describes it as “equal parts gripping and scholarly… a timely book that gets to the heart of contemporary society”. And by Max Liu in the Financial Times, who describes The Face as an ‘elegant and engaging history [that] examines how we have portrayed, judged and reconstructed ourselves.’

I talked more about these aspects of the face on the BBC podcast Instant Genius, and wrote about the politics of the face – with reference to Prince Andrew’s recent downfall, in an article for The Guardian.

One of the most emotive chapters of my book deals with face transplants, a subject I wrote about – again for The Guardian – on the 20th anniversary of this experimental surgery. And you want a deeper dive, here’s the accompany Today in Focus podcast.

I also wrote an article for the Daily Telegraph about the personal experience that led me to study the human face – prosopagnosia, or face blindness. That condition leads me to see the truth of the face, and how that has changed over time, rather differently.

‘People say, just get surgery, and I’m like: Bruh, this is after surgery’

Cosmetic surgery fuels the fallacy that looks bring happiness. But what is it like to live with a striking visible difference? The star of a new film about the subject shares his real-life experiences

Cosmetic surgery is back in the news. After six facelifts, a brow lift, neck lift and a lip lift, the reality star Katie Price has new “butterfly lips”, created with tape and filler that make the lips bigger and curled upwards. Price may have had more aesthetic surgery than most, but she’s not alone in going under the knife. Last year there were 35m such treatments around the world. Facial surgeries – eyelid lifts, rhinoplasties, lip fillers – rose by 20% in 2023. Whatever else is going on – pandemics, economic and political crises, wars, human rights abuses – we cling to the belief that if we fix our looks, we can improve our lives.

It’s an understandable – if solipsistic – belief, given the attention paid to beautiful people; they are the ones who seem to get the jobs, the relationships, the Oscars. We are far more likely to trust, forgive and believe people who are good-looking. And if we can have a piece of that, why would we not, despite knowing some treatments end in tragedy. Last week Alice Webb, a 33-year-old mother of five, died from complications following a non-surgical “Brazilian butt lift”.

Our quick-fix culture prioritises appearance over everything else, including mental health. Social media and artificial intelligence exacerbate this trend. One in three women look at Instagram influencers and feel they ought to get some work done after comparing their faces unfavourably with those created by AI. The more algorithms define “beauty”, the more they lead people to those unattainable versions. It’s a doom spiral.

Not all treatments are influenced by fashion or a fear of ageing. Some 100 million people in the world live with a facial scar, mark or disease that creates “visible difference”, the term used by advocacy groups. “Disfigurement” sounds more pejorative, but it is a surgical term and a protected characteristic under the Equality Act 2010.

Surprisingly, people with major facial injuries do not necessarily experience more psychological distress than those worried about having thin lips or acne scars. Low self-esteem linked to facial difference is entirely subjective, and mental illnesses such as body dysmorphia, are on the rise. Surgical solutions are often peddled as a short cut to cure. But there are no quick fixes, and no proof that cosmetic surgery makes us happier. On the contrary, the more treatments we have, the more we pursue; that “new you” is always just around the corner. For Price, it’s her buttocks:“‘I’ve lost weight. So… that’s the next thing to be filled. A nice, courageous [sic] plump, plum bum.”

The fallacy that being more handsome or beautiful will make us happier is at the heart of A Different Man, now on US release. Directed by Aaron Schimberg, the film stars Sebastian Stan, Renate Reinsve and Adam Pearson. Pearson has neurofibromatosis type 1, a genetic condition that has covered his face in benign tumours, and he is a powerful advocate for people with visible difference. He has previously contributed to my Interface project, which explores the emotional history of the human face, from cosmetic surgery to face transplants. We meet at the King’s College Gordon Museum of Pathology in London, where, surrounded by wax teaching models of facial injury, we talk about A Different Man, and what it might reveal about our makeover culture.

Stan plays Edward, a man with neurofibromatosis, the same condition as Pearson. Edward lives an unfulfilling existence – he is “plodding along”, Pearson says; “he is not unhappy but he’s also not happy”. He lives in a cramped New York apartment and appears awkward and shy, especially around his new neighbour Ingrid (Reinsve), a wannabe screenwriter who thinks she might write a play about Edward. But before that can happen, Edward “gets involved in a medical trial that ‘cures’ him”. Edward becomes a conventionally handsome man (played by Stan without his prosthetic mask). After casting off his old life, and killing off Edward, Guy rises from the ashes. He reinvents himself as a real estate agent, using his looks to sell the dream of a new life.

Inside, however, nothing has changed; Guy remains awkward and insecure. When he meets Ingrid and discovers she has written a play about Edward, he auditions, with the help of a prosthetic mask. He is right for the role because, he tells Ingrid, one of his best friends has a facial difference. But it’s a role he never knew how to play, as he realises when Oswald appears, played by Pearson. In the film, as in real life, Pearson is charming and gregarious, fun to be around. He fizzes with energy and confidence, unlike Guy, who even in his beautified state moves stiltedly, like he’s afraid to take up space. Oswald takes over the play, showing how things should be done, and Guy starts to unravel. As Pearson puts it: “He sees these echoes of the past, or the past he could have had, but he couldn’t bring himself to achieve. And there follows a real descent into madness for Edward.”

The crisis at the heart of the film is that Stan’s character isn’t comfortable in either of his social masks. He couldn’t thrive as Edward, either because he anticipated that others would reject him or because he had already rejected himself. Nor could he flourish as Guy, since the change was merely surface deep. In the end, the disability in The Different Man is how society treats Edward, and how he treats himself.

This fits what psychologists of appearance know about the challenges of facial difference. It is easy to internalise the abuse received by others, and people with visible difference are routinely bullied and harassed, mocked and abused. Just last week it was reported that Oliver Bromley, who also has neurofibromatosis Type 1, was asked to leave a restaurant in south London because he was “scaring customers”.

Pearson is open about the abuse he has experienced. When we met at King’s Cross, he had already spent the morning dealing with social media trolls. Today, with so much emphasis on cosmetic enhancement, people expect Pearson to be able to physically transform, as Edward does. That would be impossible, even if he wanted to: “All these tumours are wrapped around blood vessels and nerves, and I don’t think people realise that. People say, ‘just get surgery’, and I’m like: ‘Bruh, this is after surgery.’”

There is more than one way of being socially marginalised. AI, which promises so much in terms of medical diagnosis and treatment, does not serve people with visible difference well. “Bane of my bloody life,” says Pearson. “Just reading my passport, you do it online and it says, ‘this is a bad photo’, and you say, no, this is a wonderful photo, but your software doesn’t appreciate it. I have problems with the automated booths at airports; I have to unlock my iPhone with a pin number as it won’t recognise my face.”

Oliver Bromley, who has neurofibromatosis Type 1, was told to leave a London restaurant as he was ‘scaring customers’.

Pearson shouldn’t have to be so resilient, but he is. Similarly, his character Oswald turns the presumptions of the viewer upside down by his seeming disregard for his condition. Oblivious to the fact that he might feel socially inadequate, Oswald goes into the world expecting to be accepted and liked. And that, psychologists of appearance say, is the only way to be – because if you are downcast or awkward, if you exhibit the timid gestures that Edward does, you invite awkwardness from others. It is true that confounding expectations makes people act differently; a lot of the time when people avoid the gaze of those who are visibly different, it is because they are uncertain how to act.

What’s uncomfortable about this approach is that it puts all the work on to the person with visible difference. It requires individuals like Oswald – and by extension Pearson – to be exemplars for the “facially different community”. It’s a role that Pearson has taken on graciously, though not always one he has chosen. “When you get the ‘role model’ label thrust on you, and it does get thrust on you, sometimes people think you’re speaking for everyone. And I can only speak for myself. I care about advocacy. Whereas other people might be, ‘that’s not my job to explain it to you’. But then whose is it? Who is better equipped to do it than me? So, if me talking about it ad nauseam, until I get bored, and that means someone like me gets an easier ride, and it makes the world a better place, then rock and roll. It’s not all about me,” Pearson laughs. “It should be, but it’s not.”

Critics have applauded the film’s refusal to give viewers any easy answer to the question of facial difference. I am interested in how far we can move past it, to see a person in their entirety. When Pearson is in a film that doesn’t mention visible difference, we will have evolved as a society. As I walk him to his taxi, Pearson is stared at repeatedly, and I am unsure whether it’s because of his fame, or the way he looks. He tells me that when he first met Stan, and Stan wanted to get into the role, he had said to him: “I could talk to you for ages, until the cows come home, about having a disfigurement and you’ll never, ever get it. Though, equally, what you do understand is what it’s like to be known and lose privacy that way. I’ve always said the two ways to lose your anonymity in society are either to have a disfigurement or become famous. So, I’ve kind of shafted myself on both counts. The public still thinks they own you, or that you owe them something.”

Dr Fay Bound-Alberti is professor of modern history at King’s College London, where she is director of Interface and the Centre for Technology and the Body. Her new book Face Value: A Cultural History of Being Human will be published by Allen Lane in 2025

The reconstruction of a 75,000-year-old Neanderthal woman’s face makes her look quite friendly – there’s a problem with that

From a flaky skull, found “as flat as a pizza” on a cave floor in northern Iraq, the face of a 75,000-year-old Neanderthal woman named “Shanidar Z” has been reconstructed. With her calm and considered expression, Shanidar Z looks like a thoughtful, approachable, even kindly middle-aged woman. She is a far cry from the snarling, animalistic stereotype of the Neanderthal first created in 1908 after the discovery of the “old man of La Chapelle”.

On the basis of the old man and the first relatively complete skeleton of its kind to be found, scientists made a series of presumptions about Neanderthal character. They believed Neanderthals to have a low, receding forehead, protruding midface and heavy brow representing a baseness and stupidity found among “lower races”. These presumptions were influenced by prevailing ideas about the scientific measurement of skulls and racial hierarchy – ideas now debunked as racist.

This reconstruction set the scene for understanding Neanderthals for decades, and indicated how far modern humans had come. By contrast, this newest facial reconstruction, based on research at the University of Cambridge, invites us to empathise and see the story of Neanderthals as part of a broader human history.

“I think she can help us connect with who they were”, said paleoarchaeologist Emma Pomeroy, a member of the Cambridge team behind the research, while speaking in a new Netflix documentary, Secrets of the Neanderthals. The documentary delves into the mysteries surrounding the Neanderthals and what their fossil record tells us about their lives and disappearance.

It was not paleoanthropologists, however, who created Shanidar Z but well-known paleoartists Kennis and Kennis, who sculpted a modern human face with a recognisable sensibility and expressions. This drive towards historical facial reconstruction, which invokes emotional connection is increasingly commonplace through 3D technologies and will become more so with generative AI.

As a historian of emotion and the human face, I can tell you there is more art than science at work here. Indeed, it is good art, but questionable history.

Technologies like DNA testing, 3D scans and CT imaging help artists to generate faces like Shanidar Z’s, creating a naturalistic and accessible way of viewing people from the past. But we should not underestimate the importance of subjective and creative interpretation, and how it draws on contemporary presumptions, as well as informing them.

Faces are a product of culture and environment as much as skeletal structure and Shanidar Z’s face is largely based on guesswork. It is true that we can assert from the shape of the bones and a heavy brow, for instance, that an individual had a pronounced forehead or other baseline facial structures. But there’s no “scientific” evidence about how that person’s facial muscles, nerves and fibres overlaid skeletal remains.

Kennis and Kennis have attested to this themselves in an interview with the Guardian in 2018 about their practice. “There are some things the skull can’t tell you,” admits Adrie Kennis. “You never know how much fat someone had around their eyes, or the thickness of the lips, or the exact position and shape of the nostrils.”

It’s an enormous imaginative and creative work to invent the skin colour, forehead lines or half-smile. All these features suggest friendliness, accessibility, approachability – qualities defining modern emotional communication. “If we have to make a reconstruction,” Adrie Kennis explained, “we always want it to be a fascinating one, not some dull white dummy that’s just come out of the shower.”

Overlaying skeletal remains with modern affect reasserts the recent re-envisioning of Neanderthals as “just like us” rather than club-wielding thugs.

Only in the past 20 years have Neanderthals been discovered to share modern human DNA, coinciding with the discovery of many similarities over differences. For instance, burial practices, caring of the sick and a love of art.

This reimagining of Neanderthals is historically and politically interesting because it draws on contemporary ideas about race and identity. But also because it recasts the popular narrative of human evolution in a way that prioritises human creativity and compassion over disruption and extinction.

THE NEGLECTED HISTORY OF THE HUMAN FACE

It is creativity and imagination that determines the friendly facial expression that makes Shanidar Z sympathetic and relatable.

We don’t know what kinds of facial expressions were used by or were meaningful to Neanderthals. Whether or not Neanderthals had the vocal range or hearing of modern humans is a matter of debate and would have dramatically influenced social communication through the face.

None of this information can be deduced from a skull.

Facial surgeon Daniel Saleh told me about the cultural relevance of Shanidar Z: “as we age, we get crescentic creases [wrinkles] around the dimple – this changes the face – but there is no skeletal correlation to that.” Since facial expressions like smiling evolved with the need for social communication, Shanidar Z can be seen an example of overlaying contemporary ideas about soft tissue interaction on the bones, rather than revealing any scientific method.

This matters because there’s a long, problematic history of ascribing emotions, intelligence, civility and value to some faces and not others. How we represent, imagine and understand the faces of people past and present is a political, as well as social activity.

Historically, societies have made the faces of those they want to be connected to more emotionally empathetic. When cultures have determined, however, certain groups they don’t want to connect to and, in fact, want to marginalise, we have seen grotesque and inhuman ideas and depictions rise around them. Take, for example, anti-Black caricatures from the Jim Crow era in the US or cartoons of Jewish people made by the Nazis.

By representing this 75,000-year-old woman as a contemplative and kindly soul who we can relate to, rather than a snarling, angry (or blank featured) cypher, we are saying more about our need to rethink the past than any concrete fact about the emotional lives of Neanderthals.

There is nothing inherently wrong with artistically imagining the past, but we need to be clear about when that happens – and what it is for. Otherwise we ignore the complex power and meanings of the face in history, and in the present.

Originally published at the Conversation

Standardising healthcare: the case of face and hand transplants

In April I was invited to speak at a U.S. National Academies of Sciences, Engineering, and Medicine (NASEM) held a public committee workshop exploring how to standardise care in face and hand transplants. Hand and face transplants are forms of vascularised composite allografts (VCA) and to date they have developed without an international consensus on best practice. This is in stark contrast to other forms of transplantation, especially solid organs.

My project Interface has previously raised concerns about this disparity, especially considering how patient viewpoints have historically been neglected. In 2022 I held a Policy Lab at King’s College London with my project Interface (then AboutFace) to investigate why there wasn’t a standardised approach to face transplants, and what could be learned from bringing together experts from different sectors, countries, and perspectives. Our recommendations were made available online and developed into a publication for the American Journal of Transplantation.

This NASEM committee forms part of an important move towards recognition of the need for standardised care for hand and face transplant surgeries.

I spoke alongside surgical experts and patients, as the committee workshop brought together international perspectives from across the field of hand and face VCA, and a wide range of geographical regions. The workshop was held in two parts: patient perspectives first, followed by specialists in medicine and ethics. Face transplant recipients included Robert Chelsea and Carmen Tarleton; hand transplant recipients, Sheila Advento, William Lautzenheiser, Laura Nataf and Daniel Benner, all of whom brought important perspectives to bear on the question of patient experience. All talked of the health challenges involved in their journeys, and what they wished they had known before undertaking the surgery.

Some of those patients present – like Robert Chelsea – were openly critical about the systems of medical care that meant he, as the first African American to receive a transplant, was effectively used as a form of data, but without any recognition of the costs involved. Everyone involved in the field of VCA was benefitting in some way, Robert remarked – surgeons developing their careers and their grants; institutions developing centres; the field supposedly becoming more advanced – but what of patients like him, whose bodies and consent were critical to that advancement, but without any similar financial or ethical recognition.

Robert’s remarks were not engaged with by the panel members, other than the statement that nobody present was being paid for their involvement, but they are critical in understanding the history of medical innovation and its need for consenting bodies – at least since the Nuremberg Code.

Following Robert, I stressed the importance developing evaluation measures and metrics based on the subjective experiences of patience. This includes not only the physical experience of having a hand or face transplant, or the ways in which adherence to an immunosuppressant regime brings its own medical challenges, but also the emotional and social aspects of facial transplantation that are less commonly considered. And this neglect isn’t surprising given both the history of medical experimentation and the continued difficulties in measuring emotions as easily as one might, say, blood pressure or cell count.

Moreover, the development of surgical specialisms needs to recognise the historical and ongoing subtexts at work in medical encounters, from the history of slavery and experimentation on black bodies to the gendering of appearance.

The history of medicine matters to the practice of medicine now in complex and entangled ways, as Interface shows. It is impossible to talk about innovation of any kind without reference to the lived experience of human subjects, and the ways surgery is conceived of, practiced, and evaluated. Too often those on the receiving end of medical innovation (and indeed many forms of technological change) are the last to be consulted. The NASEM committee workshop marks an important shift in the right direction. We need to build on that and create space for more voices and more perspectives.

With thanks to the NASEM committee for inviting me to speak, and to my fellow presenters: Martin Iglesias (Angeles del Pedregal Hospital, Mexico); Simon Kay, Leeds Teaching Hospital; Laurent Lantieri, Université de Paris, HEGP Hôpital Européen Georges Pompidou, France; Patrik Lassus, University of Helsinki, Finland; Mohit Sharma, Amrita Hospital, Faridabad