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Visible Facial Difference

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

October 14, 2024 by Fay Bound Alberti

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

The Author

Fay Bound Alberti

‘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”.

Those with visible difference are not helped by our historically entrenched regard for beauty, and use of facial difference as a shorthand for evil. Think GoldenEye, Skyfall, Casino Royale and Joker; or Darth Vader; Freddie Krueger and Voldemort. There have been films specifically about visible difference – Freaks (1932), The Elephant Man (1980), Open Your Eyes (1997) – but little from the perspective of the individual concerned, and virtually nothing in the past 20 years. Why these films are made, and who is involved, matters. “Is it because they have lived experience,” Pearson wonders, “or is there some kind of fascination about the whole thing; are they trying to make audiences more compassionate and empathetic, or are they going for shock value?”

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

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Filed Under: Popular Culture, project update, Visible Facial Difference

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

May 9, 2024 by Fay Bound Alberti

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

The Author

Fay Bound Alberti

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

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Filed Under: Popular Culture, project update, Visible Facial Difference

Standardising healthcare: the case of face and hand transplants

April 9, 2024 by Fay Bound Alberti

Standardising healthcare: the case of face and hand transplants

The Author

Fay Bound Alberti

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

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Filed Under: Popular Culture, project update, Visible Facial Difference

NEW YEAR, NEW YOU?

January 10, 2024 by Fay Bound Alberti

NEW YEAR, NEW YOU?

The Author

Fay Bound Alberti

Blog originally posted at Fay Bound Alberti.

Image of Aaron James, recipient of the first eye and face transplant with his surgeon, Eduardo Rodriguez, courtesy of the NYU Langone

NEW YEAR, NEW YOU?

Many of us turn to the idea of self-improvement in the new year, to changing who we are – whether it’s a new gym ritual, a new diet, a new job or hobby – a new face turned towards the world.

The New Year tends to be a time of resolution and change (even if those changes seldom last beyond the first week of February). So it’s no surprise that there’s a spike in cosmetic treatments every New Year as well as a rise in divorce petitions.

We want the face that fits, that reflects our essential sense of self. The face is, after all, the interface (literal and symbolic) between our ‘self’ and other people.

Yet the face that we have changes throughout our lives, and is changed by other factors, deliberate or intentional. Finding out who ‘we’ are throughout those changes is an ongoing process. And that’s one of the core theme of my project Interface, which took up its new home at King’s College London this time last year.

And what a busy year it’s been! Along with moving Interface, I set up the Centre for Technology and the Body, which is part of King’s Digital Futures Institute, and explores how technology intersects with the human body – past, present and future.

The DFI is uniquely concerned with how we live well with technology, a theme that resonates through my work with Interface. The Centre for Technology and the Body held a number of great events in 2023, and we have put together a fantastic programme for 2024, including Joanna Bourke on evil women and Kashmir Hill on digital faces.

Last year was also a year of international travel, with filming for a new project in the US (more on exciting development to follow), and I gave papers on my face transplant research at conferences in Mexico City and Los Angeles to name just two. It is a pleasure to work with surgeons and patients as well as qualitative researchers, as interdisciplinary research is key to my work.

In 2023 I secured (via my Future Leaders Fellowship renewal) the second phase of Interface’s funding from UKRI, into 2027. That funding will continue to support my work on the history, meanings and ethics of face transplants, as well as new work into technologies of the face: from cosmetics and digital filters to facial recognition systems and 3D printing.

As the field of face transplants progresses – 2023 marking the first ever face and eye transplant – this research will continue to cast a critical lens on the meanings of technologies of the face as a cultural and emotional, as well as a surgical enterprise. As the Interface team showed in a recent article, we don’t know enough about the cultural and emotional impacts of face transplants as a specific and still experimental field of human transplantation. The history of emotion, medicine and the body helps us explore pressing issues in the present, as well as the past.

Interface will be advertising for a new project manager in March, to help us manage the exciting and busy years ahead. Watch this space for more information and links.

In the meantime: happy new year everyone!

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Filed Under: Popular Culture, project update, Visible Facial Difference

The face race

March 15, 2023 by Fay Bound Alberti

The face race

The Author

Fay Bound Alberti

Blog originally posted at the Net Gains site.

In our latest piece for Net Gains? Professor Fay Bound Alberti discusses how the technological face race is one example of how an interdisciplinary approach is crucial to understanding the future of technological advancements in medicine.

The face race

In 2005, Amiens – France, the first face transplant in the world took place. The recipient was a 38-year woman, Isabelle Dinoire, whose face had been mauled by her pet Labrador while she was unconscious. There had been discussion since the 1980s of the potential of a face transplant one day, though France was a surprise forerunner. It was Peter Butler’s team at the Royal Free in London that was popularly, at least in the British media, expected to be first past the post; to win the face race. That very language – of medical firsts – is important, because all technological innovation involves the desire to improve, to enhance, to create, to push current practice in the presumed spirit of ‘progress’ forward in leaps and bounds, rather than inches. For the winners there is kudos and often riches – prestigious research grants, professional reputations. Along the way, however, there are failures, and risks.

In medical contexts, technological innovation is especially fraught, for the risks that are involved involve human subjects – especially those who are in a fragile emotional or physical state, sometimes on the brink of death. Each of us wants our medical professional, especially surgeons, to be enormously skilled and experienced in the procedure that we need – to have undertaken ‘more transplants than you’ve had hot dinners’ as one cardiac specialist said to me. But someone must be first to receive a new procedure, as well as the first to undertake it. The history of medicine is littered with so-called ‘guinea pigs’ on whom technological interventions have been tested, and not always successfully. The cardiac surgeon Christiaan Barnard made it to the cover of TIME magazine for his first successful heart transplant in 1967 but his patient – Louis Washkansky – lived only 18 days.

Face transplants, like hand transplants, are undertaken to enhance rather than save lives – though ‘Quality of Life’ is a much-debated concept. It is often possible to reconstruct faces using an individual’s own tissue, or to involve advanced prosthetics, just as technological innovation is increasingly able to emulate the touch and functions of a human hand. So why choose a face transplant?

Face transplants are a functional and aesthetic choice; reconstructed faces can have a taut and patchwork appearance, with burn patients needing multiple, ongoing operations. The complex skin and nerves around the mouth cannot be reconstructed by traditional means. In medical terms, face transplants are rare and risky procedures – even more than hand transplants; there have been fewer than 50 around the world since Isabelle Dinoire’s pathbreaking operation. There are many reasons for this: a lack of donors (few people want to give away the faces of their loved ones); a limited number of multidisciplinary teams with the skills to undertake the procedure; prohibitive costs – and in countries like the US no third-party insurance coverage – and the risks of taking immunosuppressants. Ten of those people who received face transplants have died of complications relating to the procedure, of cancer (like Isabelle Dinoire, who died at just 49), or by suicide. Two people have received re-transplants when their faces failed.

The future of face transplants is uncertain, especially as the large experimental grants given by the US Department of Defense are running out. New technologies are being adapted and developed to take their place, with tissue engineering being held up as the future promise for patients. Tissue engineering is a branch of Regenerative Medicine that combines stem cells and biomaterial scaffolds to restore organs after injury or disease. Emerging technologies relevant to face and hand transplants include 3D bioprinting, bio fabrication, pluripotent stem cells that are capable of self-renewing, and developing into the three kinds of cells that make up the human body. At present, tissue engineering plays a relatively small role in patient treatment and the procedures are still experimental and costly. These new technologies also come with their own controversies – around animal experimentation, human tissue use, informed consent, scientific integrity, and societal impact. The history of medicine informs us that ethics all too often fall by the wayside once a procedure moves from the bench to the bedside.

The Arts and Humanities play a critical role in helping navigate the complex questions of risk and ethics, of quality of life and the value of human experience. In the case of face transplants, qualitative research is critical to help surgeons evaluate patient outcomes. The experience of drinking through a straw might be a clinically measurable way of determining the success of a transplanted face. How it feels to kiss a loved one with the mouth of another, or to be kissed by that mouth, is not. But it isintegral to the human experience of facial transplantation, as explored by my Interface project, which is funded by a UKRI Future Leaders Fellowship and uses interdisciplinary methodologies to understand the emotional impacts and ethics of surgical experimentation. Interface explores themes relevant to a wide range of technological interventions: from facial recognition systems to deepfakes; from identity politics to cosmetic surgery, from 3D printing to transplanted faces. Such interventions tend to reflect rather than subvert traditional ideas about race, gender, ethnicity, and ability. How we live well with technologies of the face is a pressing ethical and social question. 

The Interface project is housed in the Department of History at King’s within the Faculty of Arts and Humanities. The project is affiliated to the Centre for Technology and the Body, directed by Professor Fay Bound Alberti, as part of the Digital Futures Institute.

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Filed Under: face equality, Face Transplant, facial injury, facial surgery, Popular Culture, Visible Facial Difference

Disfigured Faces, “Accursed Ugliness”, and Hollywood

October 31, 2022 by Fay

disfigured

Disfigured Faces, “Accursed Ugliness”, and Hollywood

The Author

Patrick Adamson

disfigured

The fourth and final blog in our Halloween series, written by Paddy Adamson, brings together the key themes of Hollywood and disfigured faces. As a researcher in film, and a member of Face Equality International’s Lived Experience Group, Paddy brings a unique perspective to the topic. Don’t miss the rest of the series, starting with Fay Bound Alberti’s introduction, Sara Wasson’s blog on Les yeux sans visage and Lauren Stephenson’s analysis of The Eye. Let us know what you think!

Disfigured Faces, “Accursed Ugliness”, and Hollywood

One of the best-known scenes in all of silent cinema unfolds about halfway through Rupert Julian’s The Phantom of the Opera (1925). Young soprano Christine Daaé (Mary Philbin) has been carried down into a suite prepared for her in the cellars under the Paris Opera House by the Phantom (Lon Chaney), a mysterious masked composer who haunts the venue. He promises her a great career, providing she can devote herself to following his orders.

But curiosity about what lies beneath her mentor’s disguise gets the better of her. Stealing up behind him as he plays “Don Juan Triumphant” at his organ, peering over his shoulder as he faces the camera, she snatches the Phantom’s mask away, revealing directly to the audience a cadaverous face of sunken cheeks, protruding teeth, and flared, elongated nostrils. When he turns to look at her, intrigue gives way to screams; the film cuts between the Phantom’s true face and the terror and disgust it inspires in hers.

Said to have led to screaming and even fainting among moviegoers of the day, the Phantom’s unmasking is a shocking spectacle of physical difference and an iconic moment in horror film history – the unveiling of a face that has continued to fascinate in the near-century since. Created by Chaney himself, an actor famed for his extreme transformations, the villain’s look was kept secret until release. Today, his elaborate make-up can be imitated for the price of a high-end Halloween mask.

“Feast your eyes”

Yet, for all that the Phantom’s command as he forcibly turns the cowering Christine’s face toward his – “Feast your eyes – – glut your soul on my accursed ugliness!” – could equally be directed at the film’s audience. There is more to the scene than the thrill of seeing Chaney’s make-up artistry paraded on screen. It provides a revelation vital to the story. Confirmed by the disclosure of his deformed face is the Phantom’s monstrous true nature. The corrupted body of this gruesome physical spectacle befits the corrupted soul of this dangerously deranged outcast from Devil’s Island, his disfigurement the outward expression of the ugliness within.

Film still from The Phantom of the Opera (1925)

For me, as a disfigured viewer, this is the most striking aspect of this iconic moment. Not only is it testament to the longevity and pervasiveness of an all too familiar tendency, unavoidable at this time of year – the imitation of appearance-altering conditions in the name of a “spooky” costume – but it is an uncomfortable reminder of what it means, in the codified world of Hollywood cinema at least, to be facially different.

Physical Appearance as Cinematic Shorthand

Filmmakers have long exploited the meaning-making potential of distinctive physical characteristics, using non-normative appearances as an expedient shorthand for character. The most notorious example of this physiognomic logic is the prevalence of facial scarring among movie villains. Examples range from the monstrous of horror cinema – the burn-scarred Freddy Kreuger foremost among them – to the crime lords and Sith Lords of the latest James Bond and Star Wars blockbusters. Visible evidence of a past gone awry, stated or otherwise, their scars offer a convenient rationale for the malevolent course they now follow.

At the same time, there can be little doubt that the appeal of figures from the Phantom to Kreuger owes also to a fascination with such bodies and the uncomfortable feelings they are supposed to excite. They are the frightful icons behind many a Halloween costume, after all, evidence of a pleasure found in the display or performance of physical difference that can be traced back through the history of film and the freak show. Chaney made something of a career of it, earning the nickname “The Man of a Thousand Faces” for the lengths he went to: strapping his lower legs to his thighs to play a double amputee in The Penalty (1920); labouring under a skin-tight rubber suit and seventy-pound hump as Quasimodo in The Hunchback of Notre Dame (1923); and apparently combining his famed make-up skills with painful wire hooks to create his iconic Phantom.

LOn Chaney

The Man Who Laughs

Paul Leni’s The Man Who Laughs (1928) typifies this marriage of exploitation and empathy, using the non-normative appearance of its protagonist to directly interrogate conventional ideas about the face and the role it plays in how we understand ourselves and others. Originally planned as a Chaney vehicle, this adaptation of Victor Hugo’s novel stars Conrad Veidt as Gwynplaine, a travelling show attraction famous for his wide frozen grin, carved into his face as a child by a Comprachico surgeon under orders from the King of England.

While his condition does not, in theory, preclude his entry into the spaces and pursuits enjoyed by the masses, Gwynplaine’s world is circumscribed by his facial difference. Most welcome on society’s edges, in carnivals and freak shows where difference is a valued commodity, he internalises the daily ridicule and the aesthetic and moral judgements of a callous, grotesquely prejudiced, yet superficially “normal” public; he fears he is unworthy of the woman he loves, Dea (again played by Philbin), for her blindness prevents her perceiving the real him.

To portray a man who can only laugh, Veidt’s wide grin was held in place using a bespoke, and apparently painful, appliance that deprived him of access to normative facial expressions, along with the social cues associated with them. Where the face is conventionally seen as inseparable from selfhood, the foremost means by which we recognise each other, Gwynplaine’s face not only fails to reflect his inner self but seems to contradict it, thanks to the fixity of its lower half; when not covering his mouth via a protective gesture of sorts, he is seen to grin his way through incidents to which such a reaction rarely seems appropriate. His character divorced from his appearance to jarring ends, the result invites audiences to search for an understanding of his agony in his eyes and comportment, and, in the process, perhaps reflect on their assumptions about how a face should react and look.

A Damaging Reliance on Disfigurement

And yet, for all the nuance, or at least ambivalence, that The Man Who Laughs brings to its handling of disfigurement – being, at once, indebted to and critical of the exploitation of facial difference – the film’s enduring place in the popular consciousness again owes overwhelmingly to the unusual look of its protagonist. In 1940, a photograph of Veidt in make-up as Gwynplaine was used by DC Comics artists as a model for a new villain: the Joker – flamboyant nemesis to the noble, honourable Batman.

A staple Halloween costume today, the Joker has gone through numerous incarnations in the intervening eight decades, with the extent and cause of his scarring and famous malevolent grin being repeatedly reimagined. The latest, in 2022’s The Batman, finds him with full-body scarring and a permanent smile attributed to a congenital condition. Director Matt Reeves explains, “…he’s had this very dark reaction to it, and he’s had to spend a life of people looking at him in a certain way…and this is his response.”

Nearly a century on from the unmasking of Chaney’s Phantom, and in a world where media images are routinely decried as a source of body dissatisfaction, Reeves’s comments illustrate the extent to which popular cinema’s damaging reliance on disfigurement as a visible expression of inner corruption or evil continues to go unexamined in many circles. Moreover, they speak to the unique challenges faced by the facial difference community and how these extend beyond the cosmetic and the medical, beyond even the more overt forms of discrimination and abuse to which many of us have grown up accustomed.

Everyday Prejudice

Yet, for all that characters with facial differences are disproportionately given (often lurid) backstories involving some kind of “dark reaction” to what is treated as an inevitable social stigma, the toll such everyday prejudice can have on the life experiences and mental health of those affected by it has rarely been addressed via bespoke legal protections or support. Recent years have, it should be highlighted, seen some more promising signs on this front: the British Film Institute’s 2018 commitment “to stop funding films in which negative characteristics are depicted through scars or facial difference”, and the ongoing efforts of Face Equality International, a global alliance of NGOs working around disfigurement, advocating the overdue recognition of facial difference as a human rights issue in its own right. These are significant steps and, in their being so, reminders of how much remains to be done.

Author Bio

Patrick Adamson is an editor and independent film researcher who lectured at the University of St Andrews from 2021 until 2022, having received his PhD from there in 2020. Specialising in silent Westerns, early popular historical filmmaking, and universalist discourses in 1920s Hollywood, he has been published in journals including Film History and received awards for his research from BAFTSS (British Association of Film, Television and Screen Studies) and SERCIA (Société pour l’Enseignement et la Recherche du Cinéma Anglophone).

He is a member of the Face Equality International Lived Experience Working Group.

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Filed Under: face equality, facial injury, film, halloween, hollywood, horror, human rights, Popular Culture, Visible Facial Difference

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