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  • Our face is hugely important

  • because it's the external, visual part

  • that everybody else sees.

  • Let's not forget it's a functional entity.

  • We have strong skull bones

  • that protect the most important organ in our body: the brain.

  • It's where our senses are located, our special senses --

  • our vision, our speech,

  • our hearing, our smell, our taste.

  • And this bone

  • is peppered, as you can see, with the light shining through the skull

  • with cavities, the sinuses,

  • which warm and moisten the air we breathe.

  • But also imagine if they were filled with solid bone --

  • our head would be dead weight,

  • we wouldn't be able to hold it erect,

  • we wouldn't be able to look at the world around us.

  • This woman is slowly dying

  • because the benign tumors in her facial bones

  • have completely obliterated her mouth and her nose

  • so she can't breathe and eat.

  • Attached to the facial bones

  • that define our face's structure

  • are the muscles that deliver our facial expression,

  • our universal language of expression,

  • our social-signaling system.

  • And overlying this is the skin drape,

  • which is a hugely complex

  • three-dimensional structure --

  • taking right-angled bends here and there,

  • having thin areas like the eyelids,

  • thick areas like the cheek, different colors.

  • And then we have the sensual factor of the face.

  • Where do we like to kiss people?

  • On the lips. Nibble the ears maybe.

  • It's the face where we're attracted to with that.

  • But let's not forget the hair.

  • You're looking at the image on your left-hand side --

  • that's my son with his eyebrows present.

  • Look how odd he looks with the eyebrows missing.

  • There's a definite difference.

  • And imagine if he had hair sprouting from the middle of his nose,

  • he'd look even odder still.

  • Dysmorphophobia

  • is an extreme version

  • of the fact that we don't see ourselves

  • as others see us.

  • It's a shocking truth

  • that we only see mirror images of ourselves,

  • and we only see ourselves

  • in freeze-frame photographic images

  • that capture a mere fraction of the time that we live.

  • Dysmorphophobia

  • is a perversion of this

  • where people who may be very good looking

  • regard themselves as hideously ugly

  • and are constantly seeking surgery

  • to correct their facial appearance.

  • They don't need this. They need psychiatric help.

  • Max has kindly donated his photograph to me.

  • He doesn't have dysmorphophobia, but I'm using his photograph

  • to illustrate the fact that he looks exactly like a dysmorphophobic.

  • In other words, he looks entirely normal.

  • Age is another thing

  • when our attitude toward our appearance changes.

  • So children judge themselves, learn to judge themselves,

  • by the behavior of adults around them.

  • Here's a classic example: Rebecca has a benign blood vessel tumor

  • that's growing out through her skull, has obliterated her nose,

  • and she's having difficulty seeing.

  • As you can see, it's blocking her vision.

  • She's also in danger, when she damages this,

  • of bleeding profusely.

  • Our research has shown

  • that the parents and close loved ones of these children

  • adore them.

  • They've grown used to their face; they think they're special.

  • Actually, sometimes the parents argue

  • about whether these children should have the lesion removed.

  • And occasionally they suffer intense grief reactions

  • because the child they've grown to love

  • has changed so dramatically and they don't recognize them.

  • But other adults

  • say incredibly painful things.

  • They say, "How dare you take this child out of the house

  • and terrify other people.

  • Shouldn't you be doing something about this? Why haven't you had it removed?"

  • And other children in curiosity come up and poke the lesion,

  • because -- a natural curiosity.

  • And that obviously alerts the child

  • to their unusual nature.

  • After surgery, everything normalizes.

  • The adults behave more naturally,

  • and the children play more readily with other children.

  • As teenagers --

  • just think back to your teenage years --

  • we're going through a dramatic

  • and often disproportionate change

  • in our facial appearance.

  • We're trying to struggle to find our identity.

  • We crave the approval of our peers.

  • So our facial appearance is vital to us

  • as we're trying to project ourselves to the world.

  • Just remember that single acne spot

  • that crippled you for several days.

  • How long did you spend looking in the mirror every day,

  • practicing your sardonic look, practicing your serious look,

  • trying to look like Sean Connery, as I did,

  • trying to raise one eyebrow?

  • It's a crippling time.

  • I've chosen to show this profile view of Sue

  • because what it shows is her lower jaw jutting forward

  • and her lower lip jutting forward.

  • I'd like you all in the audience now to push your lower jaw forward.

  • Turn to the person next to you,

  • push your lower jaws forward. Turn to the person next to you

  • and look at them -- they look miserable.

  • That's exactly what people used to say to Sue.

  • She wasn't miserable at all.

  • But people used to say to her, "Why are you so miserable?"

  • People were making misjudgments all the time

  • on her mood.

  • Teachers and peers were underestimating her; she was teased at school.

  • So she chose to have facial surgery.

  • After the facial surgery,

  • she said, "My face now reflects my personality.

  • People know now that I'm enthusiastic,

  • that I'm a happy person."

  • And that's the change that can be achieved for teenagers.

  • Is this change, though, a real change,

  • or is it a figment of the imagination

  • of the patient themselves?

  • Well we studied teenagers' attitudes

  • to photographs of patients having this corrective facial surgery.

  • And what we found was --

  • we jumbled up the photographs

  • so they couldn't recognize the before and after --

  • what we found was that the patients were regarded

  • as being more attractive after the surgery.

  • Well that's not surprising, but we also asked them to judge them

  • on honesty, intelligence,

  • friendliness, violence.

  • They were all perceived as being

  • less than normal in all those characteristics --

  • more violent, etc. -- before the surgery.

  • After the surgery,

  • they were perceived as being more intelligent,

  • more friendly, more honest, less violent --

  • and yet we hadn't operated on their intellect

  • or their character.

  • When people get older,

  • they don't necessarily choose to follow this kind of surgery.

  • Their presence in the consultation suite

  • is a result of the slings and arrows of outrageous fortune.

  • What happens to them

  • is that they may have suffered cancer or trauma.

  • So this is a photograph of Henry,

  • two weeks after he had a malignant cancer removed

  • from the left side of his face -- his cheekbone,

  • his upper jaw, his eye-socket.

  • He looks pretty good at this stage.

  • But over the course of the next 15 years he had 14 more operations,

  • as the disease ravaged his face

  • and destroyed my reconstruction regularly.

  • I learned a huge amount from Henry.

  • Henry taught me

  • that you can carry on working.

  • He worked as an advocate. He continued to play cricket.

  • He enjoyed life to the full,

  • and this was probably because he had a successful, fulfilling job

  • and a caring family

  • and was able to participate socially.

  • He maintained a calm insouciance.

  • I don't say he overcame this; he didn't overcome it.

  • This was something more than that. He ignored it.

  • He ignored the disfigurement that was happening in his life

  • and carried on oblivious to it.

  • And that's what these people can do.

  • Henriapi illustrates this phenomenon as well.

  • This is a man in his 20s

  • whose first visit out of Nigeria was with this malignant cancer

  • that he came to the United Kingdom to have operated on.

  • It was my longest operation.

  • It took 23 hours. I did it with my neurosurgeon.

  • We removed all the bones at the right side of his face --

  • his eye, his nose,

  • the skull bones, the facial skin --

  • and reconstructed him with tissue from the back.

  • He continued to work as a psychiatric nurse.

  • He got married. He had a son called Jeremiah.

  • And again, he said,

  • "This painting of me with my son Jeremiah

  • shows me as the successful man that I feel that I am."

  • His facial disfigurement

  • did not affect him

  • because he had the support of a family;

  • he had a successful, fulfilling job.

  • So we've seen that we can change people's faces.

  • But when we change people's faces,

  • are we changing their identity --

  • for better or for worse?

  • For instance,

  • there are two different types of facial surgery.

  • We can categorize it like that.

  • We can say there are patients who choose to have facial surgery --

  • like Sue.

  • When they have facial surgery,

  • they feel their lives have changed

  • because other people perceive them

  • as better people.

  • They don't feel different.

  • They feel that they've actually gained

  • what they never had,

  • that their face now reflects their personality.

  • And actually that's probably the difference between cosmetic surgery

  • and this kind of surgery.

  • Because you might say, "Well, this type of surgery

  • might be regarded as cosmetic."

  • If you do cosmetic surgery, patients are often less happy.

  • They're trying to achieve difference in their lives.

  • Sue wasn't trying to achieve difference in her life.

  • She was just trying to achieve the face

  • that matched her personality.

  • But then we have other people

  • who don't choose to have facial surgery.

  • They're people who have their face shot off.

  • I'll move it off, and we'll have a blank slide for those who are squeamish amongst you.

  • They have it forced upon them.

  • And again, as I told you,

  • if they have a caring family

  • and good work life,

  • then they can lead normal and fulfilled lives.

  • Their identity doesn't change.

  • Is this business

  • about appearance and preoccupation with it

  • a Western phenomenon?

  • Muzetta's family give the lie to this.

  • This is a little Bangladeshi girl from the east end of London

  • who's got a huge malignant tumor on the right side of her face,

  • which has already made her blind

  • and which is rapidly growing and is going to kill her shortly.

  • After she had surgery to remove the tumor,

  • her parents dressed her in this beautiful green velvet dress,

  • a pink ribbon in her hair,

  • and they wanted the painting to be shown around the world,

  • despite the fact that they were orthodox Muslims

  • and the mother wore a full burqa.

  • So it's not simply a Western phenomenon.

  • We make judgments on people's faces

  • all the time.

  • It's been going on since we can think of Lombroso

  • and the way he would define criminal faces.

  • He said you could see criminal faces,

  • judging them just on the photographs that were showed.

  • Good-looking people

  • are always judged as being more friendly.

  • We look at O.J. --

  • he's a good-looking guy.

  • We'd like to spend time with him. He looks friendly.