The aesthetics of beauty and the social stigmatisation of facial disfigurement Although having a facial disfigurement secondary to trauma, a birthmark, a birth defect or some abnormality does not affect a patient’s health; society deems it often leads to stigmatisation and limitations of opportunities afforded to others.

1. Although having a facial disfigurement secondary to trauma, a birthmark, a
birth defect or some abnormality does not affect a patient’s health; society deems it
often leads to stigmatisation and limitations of opportunities afforded to others.
Facial disfigurement is the state of having one’s facial appearance harmed
medically, either from a disease, birth defect, or trauma. Although this perceived
defect does not usually affect a patient’s health; the condition leads to social
stigmatisation, isolation and incurs limitations of privileges and opportunities
otherwise afforded to those without the problem. It is estimated that presently there
are about 40,000 adults and children in the UK (1 in 150 people) with significant
facial disfigurements and 1 in 500 children is seriously enough affected by facial
disfigurement to result in severe psychosocial problems, poor self-esteem and
depression. Studies have shown that the general population respond to people
with a facial disfigurement with prejudice; intolerance, less trust and respect and
often try to avoid making contact or having to look at them. Although modern
reconstructive surgery and medical treatments help in making some of the unusual
features less noticeable but usually it doesn’t remove them completely and the
patients have to employ coping strategies that include avoidance of social contact,
alcohol misuse, and aggression. For those affected, it can turn a simple social event
into a major ordeal.
The causes of facial disfigurements are highly variable. At one end of the scale are
patients who are born with significant craniofacial abnormalities such as Apert
syndrome, while at the other, we have less aesthetically challenging problems
secondary to skin conditions such as cystic acne, birthmarks or possibly vitiligo.
In between, we have a myriad of cases secondary to diseases such as elephantiasis
or leprosy or because of congenital disfigurements caused by conditions like
neurofibromatosis. A few years ago, facial lipodystrophy syndrome (HLS) was a
major problem for many HIV patients undergoing long-term use of highly active
antiretroviral therapy (HAART).
The psychological facial wasting effects of the condition were
extremely distressing and these patients had high levels of
depression, suicide as well as social withdrawal and isolation.
In fact, a UK study showed that 47% of patients with HLS had HRSD scores for
severe depression. It was for this reason and the lack of proper aesthetic therapy to
manage this complex condition that I pioneered a facial endoprosthesis technique
to replace the malar fat pad in the Ailesbury Clinic some years. It restored dignity
to these otherwise socially isolated patients. Thankfully, the new anti AIDS drugs
thankfully do not give rise to these types of problems.
Weaved into this myriad of pathologies are those who have already suffered great
emotional trauma because of benign or malignant facial cancers, scarring secondary
to road traffic accidents or burns etc. While skin conditions like acne scarring or
vitiligo make not immediately appear to be of major psychological concern, these
patients often disguise their facial disfigurements through camouflage techniques
Dr Patrick Treacy
Dr Patrick Treacy is Medical Director of
Ailesbury Clinics Ltd and Ailesbury Hair
Clinics Ltd. He is Chairman of the Irish
Association of Cosmetic Doctors and
is Irish Regional Representative of the
British Association of Cosmetic Doctors.
Dr Treacy is a renowned international
guest speaker and features regularly on
Irish breakfast television (TV3), RTE and
as an expert panelist with the BBC World
Service. He had a series on Discovery
Health and the Discovery Channel (New
York) filmed a programme about his
work. He is an active member of many
international medical societies and is a
Fellow of The Royal Society of Medicine.
Facing prejudice
Dr Patrick Treacy on the aesthetics of beauty and the
social stigmatisation of facial disfigurement
FACIAL DISFIGUREMENT
16 www.cosmeticnewsuk.com

2. and live a life behind a mask of coloured creams. I personally
witnessed this phenomenon treating one of the most famous faces
in the world for vitiligo a few years ago. Whatever the cause, society
presently dictates that people with a facial disfigurement are
perceived seen to be less physically attractive, less socially desirable
and less likely to find an acceptable spouse. In this article, I will
try and analyse what actually drives such a bias in every cultural
society on earth, especially as it is guided towards people who are
already often have been the victim or gross trauma or unfairness.
Before we start this exploratory journey, let us define two
underlying words; prejudice and belief. The word prejudice comes
from the word prejudgment, making a decision before becoming
aware of the relevant facts of a case. In recent times, this word
has gained prominence when used to refer to legal judgments
toward people or a person because of a bias against their gender,
religion, race/ethnicity, sexuality or possibly social class. Prejudice
is a baseless and usually negative attitude toward members of a
particular group. Common features of prejudice include negative
feelings, stereotyped beliefs, and a tendency to discriminate against
members of the group. While specific definitions of prejudice
given by social scientists often differ, most agree that it involves
prejudgments (usually negative) about members of a group.
Belief on the other hand is the psychological state in which an
individual holds a conjecture or premise to be true. Because our
beliefs are the primary determinant of what we do and feel, and
even what we perceive, all prejudice can usually be traced to belief
systems. Both beliefs and prejudices themselves change with time.
Twentieth century Britain seen many prejudices enacted against
differing races and religions. In the early part of the twentieth
century British people were convinced that Irish immigrants were
not as good as themselves, in later years, Jamaicans, Pakistanis and
Nigerians have taken that role. These beliefs have in turn also been
expressed about Catholics, Jews and more recently Muslims.
Just as we look back at cultural practices of ancient Rome with
repulsion, future generations will probably look back at these
prejudices with similar reactions. It is impossible for us to try and
understand the Roman thinking that feeding Christians to lions
was acceptable as a spectator sport. These beliefs were accepted
two thousand years ago as these people were seen as a threat to the
society that existed then. And they were probably right. History
has decided that Christian religion would displace the Roman
deities and their ministers would give rise
to their own prejudices
in turn,
especially
in the period after the reformation.
So, a belief is really just a statement about a perceived reality
that we individually experience as the truth. But, in fact, no belief
describes the truth about reality. Without exception, beliefs are
arbitrary interpretations of events by individuals. Physical objects
and events certainly occur in the world, but the meaning that we
give the events exists only in our minds, not in the material world.
If this is so, why is the prejudice against facial disfigurement so
strong and why has it survived the ages?
At the outset, it would be easy to blame the stigmatisation of
people with facial disfigurement on the emphasis that our modern
image conscious society places on physical appearance. There
is continual pressure, through media and other marketing tools
for people of every age to conform to what is a perceived normal
appearance. However, throughout the centuries, facial beauty
has being perceived by many cultures as a human quality that
provides a sensory experience of pleasure or goodness. Beauty
has generally has been associated with that which is good and
ugliness has been associated with evil. The Byzantine Emperor was
considered God’s Vice-Regent on Earth and his beauty was taken
as an essential complement to the perfection of Heaven. For this
reason, many deposed emperors were facially
disfigured by being
blinded or having
their noses cut off to disqualify them from
ever reclaiming the throne. During this period of history, society
believed that facial “disfigurement” involved the entity being out
of balance and harmony with nature and ugliness engendered a
deeply negative perception of a person. This simplistic approach
to ugliness and by association to facial disfigurements is still
reinforced today at every stage by the media and by our education
system.Consider our current classic children’s fairy tales, where the
Ugly Sisters equate ugliness with evil and Cinderella with all things
wonderful or indeed the tale of the Sleeping Beauty or the evil old
witch in Hansel and Gretel. It is also reinforced on our TV screens
(Ugly Betty) and with film and video villains such as Freddy (in
Nightmare on Elm Street) and John Merrick (in Elephant Man).
If film makers or novelists were to treat race or sex in the way that
they presently portray beauty or ugliness they would probably be
subject to society’s revulsion and possible legal prosecution. Then
why is society still disrespectful and uncompassionate to people
who are usually not contributory in any way to their condition?
What causes us to turn away in revulsion from a person with a
congenital, traumatic, or malignant facial condition rather than
being compassionate and comforting them?
Symmetry of facial form leads to a person having more sexual
partners and more satisfactory relationships and this is similar
across every culture. In fact, if facial symmetry as a means for
determining beauty has indeed an evolutionary basis, then this
would explain why it is present in every human culture and even
suggests our stigmatisation of facial disfigurement may actually
be innate. This would happen if there was an evolutionary benefit
to society to allow it to remain in every culture across so many
millenniums.
Many scientists now believe that this revulsion may be an innate
defense mechanism designed to protect society against disease and
bad genes. It is well known that a three month old baby will smile
and develop a bonding relationship quicker with a symmetrical face
than they will with their own mother. This is probable evidence

3. that this is not learned behaviour. A recent experiment by the BBC
Inside Out team demonstrated presenter Julia Hankin made up
with tattoo ink by a make-up artist - to give the appearance of a
prominent port wine stain. In the course of the programme she
took a seat on a busy bus route. It took 65 minutes before someone
would sit next to her. Later, on the same journey with the make-up
off, it was a very different story and someone took the seat next
to Julia after about 30 seconds. Professor Nichola Rumsey, from
the Centre for Appearance Research at the University of West
England performed similar research on the London tube and
found that people chose not to sit next to someone when they had a
disfigurement on their face.
Psychologists like Valerie Curtis, a behavioral scientist at the
London School of Hygiene and Tropical Medicine believe that the
emotion of disgust is similar to fear. “Fear evolved to keep you
away from large animals that want to eat you from the outside,” but
“disgust evolved to keep you away from smaller animals that kill
you from the inside.” Our subconscious minds constantly scan the
environment for signs of potential diseases, she says. If we see one,
disgust kicks in and we avoid that object or person like the plague.
It appears that even if we know these people are perfectly healthy,
our minds are responding to them as if they’re not.
So is there anything we can do to change our behavior? Education
is probably a good start. We should strive to make atypical
appearance more familiar and mundane, possibly following the
lead set by Channel 4 and showing people with these types of
appearances on television more often. As doctors we must respect
and give supportive care to patients with facial disfigurements.
For this reason, I have provided an extensive list of specialist
organisations such as Changing Faces or the Disfigurement
Guidance Centre in the United Kingdom who provide support
people living with facial disfigurement and offer advice on all types
of treatment. It’s important for parents to learn about their child’s
condition and not to be afraid to ask their consultant as many
questions as possible. Being better informed about your child’s
condition will help them to learn how to cope with it. There are also
easy-to-learn, practical skills to help parents overcome some of the
common challenges and uncertainties they may face. Children start
becoming curious about their appearance from an early age and
learn from watching their parents deal with challenging situations.
BELL’S PALSY SUPPORT
Bell’s Palsy Association
The only UK-registered charity dedicated
solely to providing help and information
to people with Bell’s palsy.
FACIAL PALSY UK
Charity supporting people who are
affected by facial paralysis.
BIRTHMARK SUPPORT
The Birthmark Support Group
A UK-based support group for anyone
with a birthmark.
BURNS SUPPORT
The Children’s Burns Trust
The Children’s Burns Trust is committed
to providing support for burn- and scald-
injured children and their families.
CLEFT LIP AND PALATE SUPPORT
Cleft Lip & Palate Association (CLAPA)
CLAPA is the only UK-wide voluntary
organisation specifically helping those
with, and affected by, cleft lip and palate.
CRANIOFACIAL CONDITIONS SUPPORT
Support for those affected by
craniosynostosis and associated
conditions.
THE CRANIOFACIAL SOCIETY
A society for the study of cleft lip and
palate and other craniofacial anomalies.
DISFIGUREMENT SUPPORT
Changing Faces
Support for people who have
disfigurements of the face or body from
any cause.
EPIDERMOLYSIS BULLOSA SUPPORT
DEBRA
A UK charity for people with the genetic
skin blistering condition epidermolysis
bullosa (EB).
NEUROFIBROMATOSIS SUPPORT
The Neuro Association
Help, support and advice for
those affected by either form of
neurofibromatosis and their families.
PROTEUS SYNDROME SUPPORT
Proteus Family Network
A UK support group for families and
individuals affected by Proteus syndrome.
RETINOBLASTOMA SUPPORT
Childhood Eye Cancer Trust (CHECT)
A UK-wide charity for families and
individuals affected by retinoblastoma.
SCARRING SUPPORT
The Scar Information Service
Providing information on scarring, scar
therapies and support organisations.
STURGE-WEBER SYNDROME SUPPORT
Sturge-Weber Foundation
Support and information on different
aspects of Sturge-Weber syndrome, a
rare neurological disorder.
TREACHER COLLINS SYNDROME
SUPPORT
Treacher Collins Family Support Group
Support, advice and friendship for people
with Treacher Collins syndrome and their
families.
VITILIGO SUPPORT
The Vitiligo Society
Support for people with vitiligo and their
families in the UK and the Republic of
Ireland.
XERODERMA PIGMENTOSUM (XP)
SUPPORT
XP Support Group
Support for people with xeroderma
pigmentosum and other related
conditions and their families.
Disfigurement support groups offer support, information and advice
on specific conditions that can cause disfigurement.
FACIAL DISFIGUREMENT
18 www.cosmeticnewsuk.com