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40 Aesthetic Medicine • October 2016
FACIAL DISFIGUREMENT www.aestheticmed.co.uk
S K I N / D E R M AT O L O G Y
Dr Patrick...
41Aesthetic Medicine • October 2016
FACIAL DISFIGUREMENTwww.aestheticmed.co.uk
S K I N / D E R M AT O L O G Y
depression,s...
42 Aesthetic Medicine • October 2016
FACIAL DISFIGUREMENT www.aestheticmed.co.uk
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Belief on ...
43Aesthetic Medicine • October 2016
FACIAL DISFIGUREMENTwww.aestheticmed.co.uk
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44 Aesthetic Medicine • October 2016
FACIAL DISFIGUREMENT www.aestheticmed.co.uk
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'Facial Disfigurement' by Dr. Patrick Treacy

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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.

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'Facial Disfigurement' by Dr. Patrick Treacy

  1. 1. 40 Aesthetic Medicine • October 2016 FACIAL DISFIGUREMENT www.aestheticmed.co.uk S K I N / D E R M AT O L O G Y Dr Patrick Treacy on the aesthetics of beauty and the social stigmatisation of facial disfigurement F acial disfigurement is the state of having one’s facial appearanceharmedmedically,eitherfromadisease, birth defect, or trauma. Although this perceived defect does not usually affect a patient’s health; the conditionleadstosocialstigmatisationandisolation and incurs limitations of privileges and opportunities otherwiseaffordedto thosewithouttheproblem. Itisestimatedthatpresentlythereareabout40,000adults and children in the UK (one in 150 people) with significant facial disfigurements and one in 500 children is seriously enough affected by facial disfigurement to result in severe psychosocial problems, poorself-esteemanddepression. 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 they usually don’t remove them completely and the patients have to employ coping strategies, including the avoidance of social contact, alcohol misuse, and aggression. For those affected,itcanturnasimplesocialeventintoamajorordeal. CAUSES OF FACIAL DISFIGUREMENT The causes of facial disfigurements are highly variable. At oneendofthescalearepatientswhoarebornwithsignificant craniofacial abnormalities such as Apert syndrome, while at the other, we have less aesthetically challenging problems secondarytoskinconditionssuchascysticacne,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- termuseofhighlyactiveantiretroviraltherapy(HAART).The psychological facial wasting effects of the condition were extremely distressing and these patients had high levels of Challenging beauty
  2. 2. 41Aesthetic Medicine • October 2016 FACIAL DISFIGUREMENTwww.aestheticmed.co.uk S K I N / D E R M AT O L O G Y depression,suicideaswellassocialwithdrawalandisolation. Infact,aUKstudyshowedthat47%ofpatientswithHLShad HRSDscoresforseveredepression.Itwasforthisreasonand the lack of proper aesthetic therapy to manage this complex condition that I pioneered a facial endoprosthesis technique toreplacethemalarfatpadintheAilesburyClinicsomeyears ago. It restored dignity to these otherwise socially isolated patients.Thankfully,thenewanti-AIDSdrugsdonotgiverise tothesetypesofproblems. 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 may not immediately appear to be of major psychological concern, these patients often disguise their facial disfigurements through camouflage techniques and live a life behind a mask of coloured creams. I personally witnessedthisphenomenontreatingoneofthemostfamous faces in the world for vitiligo a few years ago. Whatever the cause, society presently dictates that people with a facial disfigurement are perceived to be less physically attractive, less socially desirable and less likely to find an acceptable spouse.Inthisarticle,Iwilltryandanalysewhatactuallydrives such a bias in every cultural society on earth, especially as it is guided towards people who have already often been the victimofgrosstraumaorunfairness. PREJUDICE AND BELIEFS 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. >
  3. 3. 42 Aesthetic Medicine • October 2016 FACIAL DISFIGUREMENT www.aestheticmed.co.uk S K I N / D E R M AT O L O G Y 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 has 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? CONCEPTS OF BEAUTY 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. Throughout the centuries, facial beauty has beenperceivedbymanycultures as a human quality that provides a sensory experience of pleasure or goodness. Beauty has generally 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 blindedorhavingtheirnosescutofftodisqualifythemfrom 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 It is estimated that presently there are about 40,000 adults and children in the UK (one in 150 people) with significant facial disfigurements and one in 500 children is seriously enough affected by facial disfigurement to result in severe psychosocial problems, poor self-esteem and depression
  4. 4. 43Aesthetic Medicine • October 2016 FACIAL DISFIGUREMENTwww.aestheticmed.co.uk S K I N / D E R M AT O L O G Y and ugliness engendered a deeply negative perception of a person. This simplistic approach to ugliness and by associationtofacialdisfigurementsisstillreinforcedtoday 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 HanselandGretel.Itisalsoreinforcedon our TV screens (Ugly Betty) and with filmandvideovillainssuchasFreddy (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 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 relationshipquickerwithasymmetricalface than they will with their own mother. This is probable evidence 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 busroute.Ittook65minutes 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 tubeandfoundthatpeoplechosenottositnexttosomeone when they had a disfigurement on their face. Psychologists like Valerie Curtis, a behavioural 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 thesepeopleareperfectlyhealthy, our minds are responding to them as if they’re not. Soisthereanythingwecandotochange our behaviour? 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 > 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 Throughout the centuries, facial beauty has been perceived by many cultures as a human quality that provides a sensory experience of pleasure or goodness. Beauty has generally been associated with that which is good and ugliness has been associated with evil
  5. 5. 44 Aesthetic Medicine • October 2016 FACIAL DISFIGUREMENT www.aestheticmed.co.uk S K I N / D E R M AT O L O G Y >> Dr Patrick Treacy is CEO of Ailesbury Clinics, chairman of the Irish Association of Cosmetic Doctors and Irish regional representative of the British College of Aesthetic Medicine (BCAM). He is also president of the World Trichology Association. Dr Treacy has won a number of awards for his contributions to facial aesthetics and hair transplants including the AMEC Award in Paris in 2014. Dr Treacy also sits on the editorial boards of three international journals and features regularly on international television and radio programmes. He was on the scientific committee for AMWC Monaco 2015, AMWC Eastern Europe 2015, AMWC Latin America 2015, RSM ICG7 (London) and Faculty IMCAS Paris 2015 and IMCAS China 2015. DISFIGUREMENT SUPPORT GROUPS BELL’S PALSY SUPPORT • Bell’sPalsyAssociation–TheonlyUK-registeredcharitydedicatedsolelyto providinghelpandinformationtopeoplewithBell’spalsy.www.bellspalsy.org.uk • Facial Palsy UK – Charity supporting people who are affected by facial paralysis. www.facialpalsy.org.uk BIRTHMARK SUPPORT • The Birthmark Support Group – A UK-based support group for anyone with a birthmark.www.birthmarksupportgroup.org.uk BURNS SUPPORT • TheChildren’sBurnsTrust–TheChildren’sBurnsTrustiscommittedtoproviding supportforburn-andscald-injuredchildrenandtheirfamilies.www.cbtrust.org.uk 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. www.cbtrust.org.uk CRANIOFACIAL CONDITIONS SUPPORT • Headlines – Support for those affected by craniosynostosis and associated conditions. www.headlines.org.uk • The Craniofacial Society – A society for the study of cleft lip and palate and other craniofacial anomalies. www.craniofacialsociety.org.uk DISFIGUREMENT SUPPORT • Changing Faces – Support for people who have disfigurements of the face or body from any cause. www.changingfaces.org.uk EPIDERMOLYSIS BULLOSA SUPPORT • DEBRA – A UK charity for people with the genetic skin blistering condition epidermolysis bullosa (EB). www.debra.org.uk NEUROFIBROMATOSIS SUPPORT • The Neuro Association – Help, support and advice for those affected by either form of neurofibromatosis and their families. www.nfauk.org PROTEUS SYNDROME SUPPORT • Proteus Family Network – A UK support group for families and individuals affected by Proteus syndrome. www.proteus-uk.org RETINOBLASTOMA SUPPORT • Childhood Eye Cancer Trust (CHECT) – A UK-wide charity for families and individuals affected by retinoblastoma. www.chect.org.uk SCARRING SUPPORT • The Scar Information Service – Providing information on scarring, scar therapies and support organisations. www.smith-nephew.com STURGE-WEBER SYNDROME SUPPORT • Sturge-Weber Foundation – Support and information on different aspects of Sturge-Weber syndrome, a rare neurological disorder. www.sturgeweber.org.uk TREACHER COLLINS SYNDROME SUPPORT • TreacherCollinsFamilySupportGroup–Support,adviceandfriendshipforpeople withTreacherCollinssyndromeandtheirfamilies.www.treachercollins.net VITILIGO SUPPORT • The Vitiligo Society – Support for people with vitiligo and their families in the UK and the Republic of Ireland. www.vitiligosociety.org.uk XERODERMA PIGMENTOSUM (XP) SUPPORT • XP Support Group – Support for people with xeroderma pigmentosum and other related conditions and their families. www.xpsupportgroup.org.uk 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 to 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. AM

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