Saving Face
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Saving Face

Disfigurement and the Politics of Appearance

Heather Laine Talley

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Saving Face

Disfigurement and the Politics of Appearance

Heather Laine Talley

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About This Book

Winner, Body and Embodiment Award presented by the American Sociological Association Imagine yourself without a face—the taskseems impossible. The face is a core feature of our physical identity. Our faceis how others identify us and how we think of our ‘self’. Yet, human faces arealso functionally essential as mechanisms for communication and as a means ofeating, breathing, and seeing. For these reasons, facial disfigurement canendanger our fundamental notions of self and identity or even be life threatening,at worse. Precisely because it is so difficult to conceal our faces, thedisfigured face compromises appearance, status, and, perhaps, our very way ofbeing in the world.

In Saving Face, sociologist Heather LaineTalley examines the cultural meaning and social significance of interventionsaimed at repairing faces defined as disfigured. Using ethnography,participant-observation, content analysis, interviews, and autoethnography,Talley explores four sites in which a range of faces are “repaired:” facetransplantation, facial feminization surgery, the reality show Extreme Makeover, and the international charitableorganization Operation Smile. Throughout, she considers how efforts focused onrepair sometimes intensify the stigma associated with disfigurement. Drawingupon experiences volunteering at a camp for children with severe burns, Talley alsoconsiders alternative interventions and everyday practices that both challengestigma and help those seen as disfigured negotiate outsider status.

Talley delves into the promise andlimits of facial surgery, continually examining how we might understandappearance as a facet of privilege and a dimension of inequality. Ultimately,she argues that facial work is not simply a conglomeration of reconstructivetechniques aimed at the human face, but rather, that appearance interventionsare increasingly treated as lifesaving work. Especially at a time whenaesthetic technologies carrying greater risk are emerging and whendiscrimination based on appearance is rampant, this important book challengesus to think critically about how we see the human face.

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Information

Publisher
NYU Press
Year
2014
ISBN
9781479844982

1

About Face

The face is nothing but an instrument panel registering all the body mechanisms: digestion, sight, hearing, respiration, thought.
—Milan Kundera, The Unbearable Lightness of Being (1984)
In 1994 writer Lucy Grealy published Autobiography of a Face, a memoir tracing her life as a self-identified facially disfigured person.1 The book chronicles Grealy’s experiences with facial difference resulting from Ewing’s sarcoma, a cancer of the bone and soft tissue. The cancer metastasized in her right jaw, and the illness and subsequent surgeries resulted in a highly asymmetrical face. Grealy’s book was a national bestseller, earning distinctions as a New York Times Notable Book and one of USA Today’s Best Books of the Year. Reviews praised the book not only as an exceptional work of nonfiction, but also as a deeply insightful account revealing what is it is like to be “disfigured.” Given the acclaim the book received, let’s consider what it is about Grealy’s text that so captured critics and readers. What does Autobiography of a Face suggest about the author’s experience of facial variance and her persistent attempts to “fix” the face? And more broadly, what does the response to Grealy’s story tell us about the vital significance Western societies attribute to appearance in the twenty-first century?
Autobiography of a Face explores one young woman’s bodily and psychic suffering, but more specifically, it chronicles her attempts to cope with facial disfigurement. At nine years old, Lucy Grealy was diagnosed. Following that moment, she tells us that her life was irrevocably changed. As a child, she began a series of treatments both to cure the cancer and to repair her appearance. Autobiography of a Face offers startling insight into the desire (and in moments, the compulsion) to “fix” the face. Like many others with faces defined as disfigured or nonnormative, Grealy’s life story could be told through her medical records. Countless surgeries changed her face and ultimately her future. Most dramatically, the surgical construction of “pedestals,” a procedure Grealy describes below, temporarily restored her lost facial structure:
In the first operation, two parallel incisions would be made in my stomach. The strip of skin between these incisions would be lifted up and rolled into a sort of tube with both ends still attached to my stomach, resembling a kind of handle: this was the pedestal. The two incisions would be sewn together down its side, like a seam. Six weeks later, one end of the handle would be cut from my stomach and attached to my wrist, so that my hand would be sewn to my stomach for six weeks. Then the end of the tube that was still attached to my stomach would be severed and sewn to my face, so that now my hand would be attached to my face. Six weeks after that, my hand would be cut loose and the pedestal, or flap, as they called it, would be nestled completely into the gap created by my missing jaw. This would be only the first pedestal: the whole process would take several, plus additional operations to carve everything into a recognizable shape, over a period of about ten years altogether.2
Ultimately, though, each surgery failed to offer Grealy the permanent fix, the unremarkable or “normal” facial appearance for which she desperately longed. While her pursuit of bodily transformation relied on the same concerted attention and constant cultivation directed toward many kinds of aesthetic interventions, the significance of facial disfigurement imbued Grealy’s bodily repair with particular weight.
Interspersed with descriptions of her interactions with the medical profession, we see Grealy as a child, an adolescent, and later as a twenty-something writer. Throughout the memoir, she searches for some sense of normalcy either through interventions that could repair her face or in relationships that could lend her some sense of self-worth. As a child, she worked in a horse barn. Of the experience, she writes,
The horses remained my one real source of relief. When I was in their presence, nothing else mattered. Animals were both the lives I took care of and the lives who took care of me. Horses neither disapproved nor approved of what I looked like. All that counted was how I treated them, how my actions weighted themselves in the world.3
In her twenties, Grealy attended graduate school at the University of Iowa Writer’s Workshop. There and in the writers’ colonies that followed, she eagerly sought men for casual sex but with the hope they would love her in spite of her supposed ugliness. In adulthood, she was forced to look in the mirror after the doctors with their promised technological miracles had given up and the possible boyfriends intrigued by her tenacity and way with words had moved onto the next girl, one not so “different.” The details of Grealy’s story, and of her experience, are deeply shaped by cultural norms of appearance and gender. The face matters for everyone, but aesthetics carry a particular significance for women. Each of Grealy’s stories centers on her constant quest for normalcy, her desire for male validation and love, and the fragile social status of women with facial difference.
Autobiography of a Face suggests that one’s life is predicated on one’s face and its relationship to one’s sense of self. The “tragedy” of Grealy’s face and the tragedy of her life become one and the same. She writes,
There was only one fact of me, my face, my ugliness. This singularity of meaning—I was my face, I was ugliness—though sometimes unbearable, also offered a possible point of escape. It became the launching pad from which to lift off, the one immediately recognizable place to point to when asked what was wrong with my life [emphasis added].4
Despite an optimistic few final pages, it seems clear that Grealy’s deep desire to be normal and valued will never be satisfied as long as her facial difference remains.
Autobiography of a Face humanizes Grealy, and in the process works to “normalize” facial disfigurement. As a memoir, the book offers an intimate depiction of Grealy’s experiences. She speaks for herself, and her voice rises in stark contrast to the standard approach of talking about (others’) facial differences. Be it the carnival barker who points to the sideshow performer with facial variance (the “bearded lady” or “elephant man”) or the reconstructive surgeon who describes the techniques used on a face (“grafts replace scar tissue”), disfigurement is talked about in ways that position people with faces defined as disfigured as objects. By contrast, Grealy describes what it feels like to look different and how that experience inspires obsession with normalizing interventions. Midway through her memoir and after yet another disappointing surgery, Grealy makes the startling and bleak admission, “For the first time I wished I were dead.”5 Ultimately, she suggests that disfigurement is far worse than those with “normal” faces could ever imagine.
Perhaps the most gripping detail of Grealy’s story is one that could not be chronicled in her memoir: Lucy Grealy is dead. The details of her death, most widely publicized in her close friend and renowned novelist Ann Patchett’s 2004 book Truth and Beauty: A Friendship, are vague. Grealy was an admitted heroin user. Shortly before her death, she was committed to a psychiatric facility for clinical depression and suicidal ideation. On December 18, 2002, her body was found in a bathtub in a friend’s New York studio apartment. Underlying every account of Grealy’s death is the story of her face.6 The drugs and depression may have facilitated her demise, but the story of Lucy Grealy’s life and death is always and forever about facial disfigurement. In all of these accounts, including her own, it was her face that killed her.
But why is this explanation a believable and perhaps even appealing (to some) account of her death? The narrative that positions Grealy’s disfigured face as the cause of her death rests on assumptions about what disfigurement means, the significance of the face in everyday life, and the supposed limits of living with facial difference. If facial disfigurement is unequivocally tragic (as it is depicted in so many accounts) and if our faces are who we are to the world, then life as a facially disfigured person is seemingly not viable. Reviews of Autobiography of a Face both reflect this assumption and reveal what critics found especially compelling about the book.7
In the New York Times, A. G. Mojtabai describes Autobiography as an “unblinking stare at an excruciatingly painful subject.” A Mademoiselle review refers to the “horror” of Grealy’s disfigurement, while a Mirabella review references her “unbearable fate.” Reviews also suggest that Grealy’s disfigurement provided her with significant, expert insights about beauty and attractiveness. A Seventeen magazine review notes, “Grealy beat cancer, but this almost seemed inconsequential compared to the horrors of coping in a world that measures a woman’s worth by her looks.” And a Ploughshares review concludes, “she makes a lyrical statement about the complex relationship between beauty and self-worth in our society.”
Autobiography of a Face tells one remarkable story about the significance of disfigurement and one woman’s deep desire to repair her face, but Grealy’s story is not the only one. I tell a sociological story about the relationship between faces defined as disfigured and the surgical “repair” of these faces. As Grealy’s life and the responses to her memoir demonstrate, facial disfigurement is socially and culturally significant. A physiological state and morphological condition, facial disfigurement is also a social status in the sense that it informs one’s position in society. The power of a bodily state to determine a person’s status is not unique to facial difference. Status is thoroughly informed by the body, and hierarchies of race, gender, age, size, physical mobility, and attractiveness are all attributes of bodily status. Particular categories or social locations carry more social value; others carry less. In effect, humans are varyingly and unequally defined and valued in accordance with our bodies.
The specter of disfigurement, however, saturates our collective imagination. It appears not only in Autobiography of a Face but throughout popular culture as a haunting reminder about the fragility of human bodies. Consider the ways facial variance is used as a plot device to signal a character’s vulnerability in Hollywood films like Mask (1985) and The Man Without a Face (1993), or the young adult novel Wonder (2012). In these stories, disfigurement looms as particularly startling and an especially awful experience rather than as a variation of human life.8 The significance of the face physiologically—as a mechanism for communication and as a means of eating, breathing, smelling, hearing, and seeing—accounts in part for the ways facial variance is routinely thought of as a particularly compromising disability. But it is a central argument of this book that in appearance-obsessed cultures, facial difference is treated as a threat compromising notions of self and identity and profoundly affecting social relations.
Consider the controversial British reality show Beauty and the Beast: The Ugly Face of Prejudice (2011), which pairs a self-identified “beauty addict” and a person with facial difference to live together for one week. Throughout each episode, participants suggest that life is essentially determined by appearance—albeit in very different ways, depending on whether one is considered ugly or beautiful. Ultimately, Beauty and the Beast, not unlike other television shows that take up the issue of appearance (and isn’t all television and cinema, really, about appearance?), suggests that “disfigurements” undermine our social identity precisely because appearance matters so much and because faces are typically, especially in the West, uncovered and always visible.9 This cultural matrix of body, self, and other provides the backdrop for this book, in which I take up what the face means and, more specifically, the responses facial variation ignites.

The Human Face as Sociological Object

It may seem curious to premise a sociological account on a particular body part, and yet this is exactly where I begin.10 In doing so, I suggest that there is a need both to theorize “the body” as an experience and a social construct and to analytically take up the material body and specific body parts.11 Consider, for example, that aesthetic interventions are disproportionately aimed at features like breasts and noses and very rarely at elbows and bellybuttons. Understanding why this is so demands not only a social account of medical technologies but also a cultural history of breasts, noses, elbows, and bellybuttons. The specter of disfigurement coupled with the importance accrued to physiological functions of the face imparts a particular social, political, and moral significance to the technical work of repairing faces. Here, I consider the singular significance of the face and explore how, within institutional sites of aesthetic surgery, facial disfigurement does not simply confer low status on a person but rather is routinely positioned as deadly. Ultimately, this book offers an ethnographic account of the meanings attributed to facial repair and the practices of facial intervention while also exploring the consequences for individuals and society of shifting meanings of aesthetic surgery.
The face, uniquely, is the locus of many organic functions and social processes. Physiologically, “face” describes the conglomeration of body parts including the mouth, lips, nose, eyes, ears, cheeks, forehead, eyebrows, philtrum (the tissue that joins the nose and upper lip), and the skin that covers these features. The face facilitates vital functions, most obviously eating and breathing, but it also mediates each of our “five senses” or methods of perception (taste, smell, vision, hearing, and touch). Thus, the face is a critical functional organ. Yet it is simultaneously a means of communication, a marker of identity and personhood, a signifier of social status, and a form of capital. It is no surprise then that bioethicist John A. Robertson would conclude: “Faces are the external manifestation of our persons (our souls?). They provide information about age, gender, ethnicity, and emotional states, and help to form the image that others have of us. Indeed, our face often provides the image that we have of ourselves.”12 The face, then, is akin to other body parts that enable critical organic functions, but it is unique, too, given its centrality in facilitating social life. As an object, it is thus ripe for sociological investigation of its material and cultural properties.
As a sociologist deeply concerned with issues of social inequality, for me the face is particularly salient for understanding difference and devaluation.13 While it is certainly true that looks can be deceiving—many of the inferences we make based on another’s face may not be accurate—every face-to-face human interaction is premised on the “social fact” that our faces tell us something about each other. The face ostensibly betrays our age, our race and ethnicity, our gender, and our social class. What the face tells others about who we are determines our status in social relations and systems of power. Its lines, colors, features, and adornment are all evidence upon which people are labeled, differentiated, and potentially stigmatized or celebrated.
Put another way, the face is a powerful biosocial resource, directly affecting what Max Weber deemed “life chances” or the opportunities one has to improve one’s social standing.14 Facial appearance, then, is akin to race, class, gender, citizenship status, and sexual identity, and as such, the face might be construed as a form of physical capital, a resource that can be exchanged for other kinds of capital, specifically social status.15 Thus, facial appearance is a currency. Material results ensue from one’s face, be they racial privileges or modeling contracts. Similarly, one’s face can grant one access to a social circle, based on ...

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