by Cosmetic surgery is back in the news. After six facelifts, a brow lift, a neck lift and a lip lift, reality star Katie Price has a new “butterfly lip”, created with tape and filler that makes the lips bigger and curled up. 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 worldwide. Facial surgeries – eyelid lifts, rhinoplasties, lip fillers – will rise by 20% in 2023. Whatever else is going on – pandemics, economic and political crises, wars, human rights abuse – we stick to the faith if we set our look, our lives can improve.
An understandable – if solipsistic – belief in beautiful people; they are the ones who seem to get the jobs, the relationships, the Oscars. We are much more likely to trust, live and believe people who look good. And if we can have a piece of that, why wouldn’t we, despite knowing that some treatments would end in tragedy. Last week Alice Webb, a 33-year-old mother of five, died of complications following a non-surgical “Brazilian bump lift”.
Our quick-fix culture prioritizes appearance above all else, including mental health. Social media and artificial intelligence exacerbate this trend. One in three women look at Instagram influencers and feel they should do some work after comparing their faces unfavorably to those created by AI. The more algorithms that define “beauty”, the more they lead people to the unattainable versions. It’s a spiral of doom.
Not all treatments are influenced by fashion or fear of aging. About 100 million people in the world have a facial scar, mark or disease that creates a “visible difference”, the term used by advocacy groups. “Weight loss” sounds worse, but it is a surgical term and a protected characteristic under the Equality Act 2010.
Surprisingly, people with severe facial injuries do not necessarily feel more psychological distress than those worried about thin lips or acne scars. Low self-esteem is linked to a completely subjective facial difference, and mental illnesses such as body dysmorphia are on the rise. Surgical solutions are often touted as a short cut to healing. But there are no quick fixes, and there is no proof that cosmetic surgery makes us happier. On the contrary, the more treatments we have, the more we do; that “the new you” is always just around the corner. As for Price, it’s her butt: “’I’ve lost weight. So… that’s the next thing to fill. A nice, courageous [sic] plump, plump bump.”
The fallacy that will make us more handsome or beautiful is at the core Different Mannow 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 in which his face is covered in benign tumors, and is a powerful advocate for people with a visible difference. He contributed to my previous project Interface, which explores the emotional history of the human face, from cosmetic surgery to face transplants. We meet at the King Gordon College Pathology Museum in London, where we talk about it, surrounded by teaching wax models of facial injury. Different Manand what it might reveal about our reform culture.
Stan Edward, a man with neurofibromatosis, plays the same condition as Pearson. Edward lives an unfulfilled life – he is “plodding along”, says Pearson; “he’s not unhappy but he’s also not happy”. He lives in a shabby apartment in New York and seems awkward and shy, especially around his new neighbor Ingrid (Reinsve), an aspiring screenwriter who thinks she might write a play. under Edward. But before that can happen, Edward “participates in a medical trial that ‘cures’ him”. Edward (played by Stan without his prosthetic mask) is a traditional handsome man. After leaving his old life, and killing 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 uncertain. When he meets Ingrid and learns that 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 didn’t know how to play, as he realizes when Oswald appears, played by Pearson. In the film, as in real life, Pearson is charming and gregarious, fun to be around. He is full of energy and confidence, unlike Guy, who moves stilted even in his beautiful state, because he is afraid to take up space. Oswald takes over the drama, showing how things should be done, and Guy begins to settle. As Pearson says: “He sees these echoes of the past, or the past he might have had, but he couldn’t reach himself. And after that there’s a real descent into madness for Edward.”
The crisis at the heart of the film is that Stan’s character is not comfortable in either of his social masks. He could not be successful as Edward, either because he expected others to reject him or because he had already rejected himself. He could only blossom as a guy, because the change was only surface deep. In the end, the disability i The Different Man it is how society treats Edward, and how he treats himself.
This fits with what look psychologists know about the challenges of facial difference. The abuse received by others is easily internalized, and people who are visibly different are routinely bullied and harassed, mocked and abused. It was reported last week that Oliver Bromley, who also has neurofibromatosis Type 1, was asked to leave a south London restaurant because he was “scaring customers”.
Those with visible difference are not helped by our historically ingrained attention to beauty, and the use of facial difference as shorthand for evil. Think Golden Eye, Skyfall, Casino Royale and Joker; or Darth Vader; Freddie Krueger and Voldemort. Films were specifically about visible difference – Freaks (1932), The Elephant Man (1980), Open Your Eyes (1997). Why these films are made, and who is involved, is important. “Is it because they have lived experience,” says Pearson, “or is there some sort of interest in the whole thing; are they trying to make the audience more compassionate and empathetic, or are they getting shock value?”
Pearson has been open about the abuse he suffered. When we met at King’s Cross, he had already spent the morning dealing with social media trolls. In this day and age, with so much emphasis on cosmetic enhancement, people expect Pearson to be able to undergo a physical transformation, as Edward does. That would be impossible, even if he wanted to: “All these tumors are wrapped around blood vessels and nerves, and I don’t think people understand that. People say, ‘get surgery’, and I’m like: ‘Bruh, this is it after surgery.”
There is more than one way to be socially marginalized. AI, which promises so much in terms of medical diagnosis and treatment, does not serve people with visible difference well. “Get the bloody world out of me,” says Pearson. “You’re just reading my passport, you do it online and it says, ‘this is a bad photo’, and you say, no, this is a great photo, but your software doesn’t show it. I have problems with the automated kiosks at airports; I have to unlock my iPhone with a pin because it won’t recognize my face.”
Oliver Bromley, who has neurofibromatosis Type 1, was told to leave a London restaurant because it was ‘alienating customers’.
Pearson shouldn’t have to be so resilient, but he is. Similarly, his character Oswald turns the viewer’s assumption upside down with his disregard for his condition. Clearly feeling socially inadequate, Oswald enters life expecting to be accepted and liked. And topsychologists say appearance, the only way to be – because if you are restless or awkward, if you show the timid gestures that Edward makes, you ask for awkwardness from others. It is true that confusing expectations make people act differently; often when people avoid the sight of people who are visibly different, it is because they are not sure how to act.
What is uncomfortable about this approach is that it puts all the work on the person who has a visible difference. He calls for people like Oswald – and therefore Pearson – to be role models for the “disparate community”. It’s a role Pearson has embraced with grace, though not always the role he chose. “When you get the ‘role model’ label, and it puts pressure on you, sometimes people think you’re speaking for everyone. And I can only speak for myself. I care about advocacy. Because what others might think, ‘that’s not my job to explain it to you’. But then whose is it? Who better to do it than me? So if I’m talking about ad nauseumuntil I get bored, and that means someone like me gets an easier ride, and makes the world a better place, then rock and roll. It’s not about me,” laughs Pearson. “It should be, but it isn’t.”
Critics suggested that the film refused to give viewers any easy answers to the question of facial difference. I’m interested in how far we can move past it, to see a person as a whole. When Pearson is in a film that doesn’t mention visible difference, we will have evolved as a society. As I walk to his taxi, Pearson keeps staring at him, and I’m not sure if it’s because of his reputation, or his looks. He tells me that when he first met Stan, and Stan wanted to step into the role, he told him: “I could talk to you for years, until the cows come home, have a disability and you will never, ever get it. But, at the same time, what you understand is how to know and lose privacy that way. I have always said that the two ways to lose your anonymity in society are to have a disability or to be famous. So I’m kind of shafted for both reasons. The community still thinks you belong to them, 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 Technology and Foundation Centre. His new book Face Value: A Cultural History of Being Human will be published by Allen Lane in the year 2025
