More than skin deep by Iain Hutchison – Opinion, The Guardian, 30 October 2006

The prospect of face transplants prompts important questions of identity and appearance.

The news that surgeons have been given the green light to perform Britain’s first face transplant has thrown up complex and fundamental questions about the role of the face in determining our identity and how alterations to our face may change this identity.

The surgical intricacy certainly excites the public’s interest but the greatest fascination centres on the idea of “face-swapping” and its psychological repercussions. How does the patient cope? The patient’s family? And what is the impact on the donor’s family of seeing their loved one’s face on someone else?

The face is the one part of our body we regularly show to others. It is our most important means of non-verbal communication. In an instant it can convey a switch from gentleness to anger. Its importance is reflected in our unsettled feelings when people choose to hide their face with balaclavas or hoods – or veils.

There are a variety of reasons why people choose to have facial surgery. In many cases, cancers or trauma have impacted severely on appearance. Some want to have a face that more accurately reflects their emotions. One patient had a lively outgoing personality but a facial appearance that she and others felt made her look constantly miserable. Following surgery, she said: “People now see me as I have always seen myself – a happy, jolly person.”

Some adults in their middle and advancing years seek surgery in the hope of regaining a lost youth. Others have had more distressing experiences. One woman did not regard her face as being unattractive but could not bear to look in the mirror because every time she did she was reminded of her parents – her father, she said, had sexually abused her and her mother had let it happen. And some simply want to disappear. This ambition ended disastrously for the Mexican crime lord Amado Carrillo Fuentes a decade ago, when he died under anaesthesia while having surgery to alter his facial appearance.

People with a facial disfigurement can usually be boosted emotionally as well as physically by having corrective surgery. But some people who develop a disfigurement will crumble and become hermits – even with the most trivial, barely discernible, physical changes.

Unfortunately, there is a group of people who have a complete misconception about their facial appearance. They may feel that their faces are abnormally ugly and seek surgery to correct this. This is called dysmorphophobia. To operate on someone with the condition is just about the worse thing that can be done as it can make them suicidal. In the same way, making someone look physically better who is disfigured, or making someone look younger who is elderly, does not always make them feel better about themselves. Successful physical surgery does not always equate to a successful emotional and psychological result.

The face transplant is indeed a plunge into the psychological and sociological unknown. Our understanding of its likely psychological impact on the identity of the patient and the effect on their family is drawn from all these previous facial surgical experiences. It is not clear how the patient will feel about themselves in the long term, how they will cope should the face transplant fail, or how they will feel about the side effects from the immunosuppressant drugs that they will have to take for the rest of their life. We can be sure, however, to learn even more about the psychology of human beings and our reactions to changing appearance.

Reproduced from The Guardian