A look at photos of Megan Fox over the years reveals a pretty stunning transformation — Megan Fox 2012 could be a completely different person than Megan Fox 2002. And the word "person" is key — our faces are often deeply linked to our sense of who we are. So what happens to that sense when its outward embodiment drastically changes?
According to Vivian Diller, psychologist and author of "Face It: What Women Really Feel as Their Looks Change and What to Do about It," a lot can happen. People tend to overlook the attachment they have to their facial characteristics, she says, and after a major appearance-changing surgery, they sometimes realize "that imperfection is actually part of their identity." Something like a "slightly off nose" might be part of how someone defines herself, without even realizing it — and when it's gone, that self-definition can suffer. Diller says patients in this situation can feel disconnected from their new faces, faces that no longer feel like theirs. "That image that people see in the mirror and take for granted," she says, "actually runs deeper."
Victoria Pitts-Taylor, a sociologist and author of "Surgery Junkies: Wellness and Pathology in Cosmetic Culture," points out that while cosmetic surgery has become "fairly normalized, dramatic transformations are still taboo." One result is that loved ones can also feel like the operations have taken away the person they knew. After her extreme transformation through ten plastic surgery procedures, Heidi Montag said her mom was shocked: "She was looking at me almost like a zoo animal. It wasn't like I was her daughter anymore."
Plastic surgery that drastically changes a person's appearance can "absolutely" affect the patient's sense of identity, says Dr. Z. Paul Lorenc, author of "A Little Work: Behind the Doors of a Park Avenue Plastic Surgeon." In fact, he says, more cautious patients will voice this as a concern, stipulating that they want their eyes or smile to look the same when they come out of surgery.
But a few patients say the opposite — that they want to look like a certain actor or model, rather than themselves. Lorenc says "that's a red flag," because it indicates a desire to become somebody else, a famous person who, in the patient's mind, has no worries or problems. Says Lorenc, "They have this glorified picture of this perfect identity." In this case, a patient actually wants to discard her sense of self by changing her face, but that's usually going to backfire (celebrities don't actually have "perfect identities," after all).
Lorenc says he screens patients to make sure they're not seeking surgery for the wrong reasons. And if he suspects an underlying psychological condition like body dysmorphic disorder, he refers patients to a psychiatrist.
Daniela Schreier, a therapist who has treated patients with plastic-surgery related issues, says this kind of screening doesn't happen often enough. She said that she's seen multiple patients who regret their surgeries, but that the plastic surgeons she's talked to haven't been receptive to the idea of making psychological screening an industry requirement. Some of them, she said, are worried this would hurt their business. And while Dr. Lorenc does screen, he says this decision "has to come from the physician," not from the top.
Diller, however, says that surgeons are increasingly aware of the need for psychological screening. She says a bigger problem is women now in their fifties and sixties who had surgery before this "new wave of understanding" among doctors, and now suffer psychological problems. And, she says, "there are unscrupulous people in every field," and plastic surgery is no exception.
Even screening might not forestall all issues. Most good surgeons presumably avoid the kind of multi-operation bonanza that made Heidi Montag unrecognizable. But the effects of cosmetic procedures — especially drastic ones — on someone's sense of self may be hard to ascertain beforehand. Says Pitts-Taylor, "The transformation of one's appearance through surgery can be radical, and the psychological effects of getting a different face or a drastically different body shape are really hard to predict." Surgeons like Lorenc can screen for body dysmorphic disorder, but they can't know for sure whether their patients will still feel like themselves when their faces are completely different.
Of course, incremental changes over a period of time (a la Megan Fox) may be easier to adapt to than one that happens all at once. Says Pitts-Taylor, "Even very serious changes to appearance can seem more gradual to the person herself or himself."
Still, Diller says our sense of our own identity, especially as it relates to appearance, solidifies pretty young, usually in adolescence. Any physical changes after that will require mental adjustment — and when the changes are major, the adjustment may take a long time. So while our faces are increasingly malleable (if we have the money), our brains may be slow to catch up.