The man who made faces
Lessons from a surgeon-artist who restored every patient’s sense of self
One of the most basic human characteristics is a sense of self: Who we are and how to identify ‘me’. A ubiquitous, and perhaps under appreciated foundational aspect of this identity is our face. A recent review captures what has long been known about just how important faces are to our self-identity. ‘Self-concept’ is an idea of the self that is constructed based on how we think about, evaluate, or perceive ourselves as well as on the responses of others to the self. Baumeister defines it as the individual’s belief about themselves, including the person’s attributes and who and what the self is. The relationship between self-concept, body-image, and appearance is well documented. As a practical example, we all see our face in the mirror and in photos and automatically recognise ‘ourselves’. Even very young children — including toddlers and infants — will watch themselves in a mirror and modify their facial expressions. The sense of who we are is linked to facial features literally from birth and continues to develop for our entire life.
Because of this, facial disfigurement can have profound psychosocial implications and a change in our sense of identity. Substantial research has described the benefits of traditional facial reconstruction with respect to self-concept. But the mechanics of surgical facial reconstruction must be infused with artistry — a sense of proportion, balance and scale are needed because even seemingly minor distortions can have profound impacts on facial features — and, ultimately, self-identity.
This relationship includes social elements and the impact of appearance on identity in society has long been the subject of popular culture, including music, prose and film. A 1959 episode of the iconic series The Twilight Zone, entitled The Eye of the Beholder, captured this societal reaction to facial features and identity. In this episode, the results of facial plastic surgery that would be considered excellent by culture at the time — a balanced, proportionate face — was instead perceived as hideous by the physicians, who themselves would be viewed as having distorted features. More importantly, when the patient herself looked in the mirror was horrified at how she looked. Facial reconstruction is not simply a matter of anatomy and technical skill — it requires a deeper understanding of the self and society — and a qualitative, human insight into the impact of ‘face’ and how we see ourselves.
The world recently lost a true artist, literally a man who made faces, when Dr Russell Reis died of pancreatic cancer. The world is fortunate indeed to have had the knowledge and artistry of Dr Reis, even for such a short time. He himself was born premature at a time when 3 lb., 3 oz babies did not always survive. Fast forward to the 1980s, and Dr Reis was a founding member of the Vanderbilt University Facial and Reconstructive Surgery programme — not only helping patients recover and reimagine their faces, but also training the next generations of surgeon-artists to continue this important craft.
In a world that is increasingly mechanistic, quantitative, and focused on rigid, and sometimes soulless, “process implementation,” it is difficult to convey the nuance and skill of his artistry. Dr Reis could look at a patient who had been burned, been in an auto accident, suffered from skin cancer, born with a cleft palate or any number of situations that cause facial disfiguration, and somehow see the person’s true ‘face’ and use that as a basis for facial plastic surgery. To be sure, this was not necessarily a straight-forward ‘matching’ of the pre-injury configuration: Some injuries and diseases preclude a ‘return’ to a previous look. And, for some conditions, such as cleft palate, wherein the facial bones never fully fused, his creativity must necessarily include a visualisation of what the face would have been if the bones and lips had closed naturally. An artist’s sense of face perspective and perception, both by the individual and by those seeing them is essential.
Stephen Camarata is a specialist in child development and in developmental disabilities such as autism, Down Syndrome and other conditions resulting in childhood speech and language disorders.
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