Disturbing trend of the year:

NeverEnding Extreme Makeover


View one of the most recognized faces on the planet. Yet each year, Michael Jackson's face becomes less familiar. This is a dermatology site, so typically it's not our place to speculate about the plastic surgeries that celebs pursue. For example, we would never suggest that major actresses like Julia Roberts, Meg Ryan, and Renee Zellweger subject themselves to collagen injections for perfect-for-the-premiere proudly pouting protuberant lips. At least, we haven't had a chance yet. And while we've pondered whether MJ has (or doesn't have) vitiligo, we will not stoop to guessing the how, what, when, and where of his cosmetic surgeries. However, with slight arm-twisting, we feel we might be able to comment on the "why."

What is clear, even to any lay person, is that since the late 1970's, the pop star has systematically altered his appearance. Usually, the goal of cosmetic treatments are to enhance beauty based on various cultural standards. But Jackson's current state seems strikingly out of touch with what is considered attractive. Also jarring is the fact that Jackson didn't begin this aesthetic odyssey looking like Freddy Krueger after a bender. In 1978, most would agree that he was a reasonably attractive fella.

Though we are not psychiatrists by trade, nor is Mr. Jackson our patient, his changing face seems consistent with an increasingly recognized condition: body dysmorphic disorder (BDD). Much like skeletal anorexics may perceive themselves as chubby, those with BDD have an altered perception: they see themselves as ugly, despite the opinion of others. Typically, they embark on a quest to physically alter their appearance in hope of attaining some personal vision of beauty.

Another BDD example seems to be the woman who has had surgeons alter her face to appear feline (true story, right). Even on a milder scale, dermatologists and plastic surgeons are becoming aware to watch for patients whose requests for cosmetic treatments are either excessive or out of sync with their actual inherent hotness.

And it doesn't stop there. With the advent of television series like "Nip/Tuck" and "Extreme Makeover" (above), plastic surgery, once conservatively used by psychologically stable patients well prepared by the possibility of side effects or problems, is now bandied about as a game show prize. The implication is that cosmetic procedures, especially several done simultaneously, are a risk-free trip to happyland (not to be confused with Neverland).

Perhaps the emergence of extreme enhancement as entertainment explains the trend for film makers to introduce a new kind of skin-challenged film villain. These rogues learned a simple fact the hard way: You can't put your best face forward if you don't have a face.





 Severe problem skin: "Underworld"

 "Pirates of the Caribbean"

"Darkness Falls"

 "Cabin Fever"

Evil characters have featured immoral skin since the early Edison film version of Frankenstein. But in the past year, directors have taken things up several notches. Up to now, a bad guy only needed a facial scar, bald head, or the appearance of albinism to put audiences on edge. Now jaded by TV surgery shows, producers have turned to full facial erosion to elicit terror. Frightening fractured-faced foes are featured in "The Pirates of the Caribbean," "Underworld," and "Darkness Falls." A flesh-eating "virus" chomped the cheekbones of cohabitating co-eds in "Cabin Fever." For those with body dysmorphic disorder, intervention is required before they too resemble these dermatologic disasters. Discussion of realistic expectations and even psychotherapy should be considered before there's no face left to nip or tuck.

Runners up, most disturbing trend:

Evil gymnastic albinos

 "Cold Mountain"

 "The Matrix: Reloaded"


© 1996-2008 Vail Reese M.D.

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