Renée Zellweger, Isabelle Dinoire, and the Stakes for Changing the Face

Renée Zellweger, Isabelle Dinoire, and the Stakes for Changing the Face

On October 20, 2014, Renée Zellweger attended the Elle Women in Hollywood event, her first appearance in the public eye after a long hiatus. She looked different; people do, over time. Most people do; some work very hard to continue to look exactly the same. Zellweger’s face was exhaustively discussed, dissected, and criticized in the days that followed in every media outlet imaginable; her face was, for a short period of time, news. Bad news (for her). Not because she used surgery to change her face by erasing the effects of time (that’s just fine for celebrities, it turns out), but because she changed too much. If there is some sort of intervention in the faces we recognize, we prefer not to know.

It doesn’t actually matter what interventions Zellweger used, or why (though for the record, extremely hooded lids like Zellweger’s can affect vision over time, and insurance will even cover an eyelid lift in most of these cases; such a surgery can dramatically impact the appearance of the face). What’s interesting is the widespread feeling of betrayal that people expressed: Zellweger-as-she-was seemed to be a quirky, attainable, accessible version of super celebrity. People identified with her.

Renée Zellweger’s face stood for something. How dare she change it? Who was she now?

We think we know people through their faces. Only some kinds of alterations are acceptable: the ones that best represent who they really are.

That’s the narrative of every makeover television show: a grand quest to align the exterior representation of a person (usually a woman, because acceptable — read: gender-, sexuality–, and race-normative — appearance is women’s work) to the internal self. The face is (we imagine) a kind of index, communicating the truth of that which lies within. Sometimes there is a misalignment, and it is the job of women (and their concerned family and friends, and their expert guides) to readjust. In that case, it’s okay to change how you look. Not only is it okay: it’s your job, because faces are supposed to tell us who people are.

Renee Zellwegger at movie premiere, wearing a long black dress.
Renee Zellwegger, 2016. (Romero/Flickr)

What about when faces get disfigured? And what about when people intervene in their disfigurement not just to change their faces, but to change them through the use of the face of someone else entirely? If faces are indexical to character, how do we make sense of people who have the transplanted face of another?

It’s not science fiction (though it has been, in countless films and novels with exactly this premise.) Since Isabelle Dinoire’s pioneering partial face transplant in 2005, it’s science. But it’s not just science: faces are personal and symbolic and psychological and emotional and economic and cultural and commercial and ethical and social entities. The face transplant surgery encompasses all of those arenas and more, which is why, following that first transplant in 2005, the world basically flipped out.

While few people could explain exactly why they felt so deeply uncomfortable, nervous, and even horrified, everyone was asking the question: just because we could, did that mean we should? People were scared. The surgery seemed to raise fundamental questions of identity to which no one knew the answers. Bioethicists wondered if this surgery was justified. After all, Dinoire was not in immediate medical risk, and the anti-rejection medication is itself quite harmful.

Three surgeons around an operating table, an overhead light illuminates iodine prepped skin.
Surgeons work at Walter Reed Army Medical Center in Washington, D.C. (Chew/Flickr)

The newspapers put Dinoire and her doctors on trial, questioning the speed with which they decided to do this pioneering surgery and wondering if Isabelle Dinoire was up for the rigors of this unprecedented intervention. She lost the lower half of her face when her nose, mouth, and chin were mauled by her dog, who was trying to wake her up after she passed out due to an overdose of sleeping pills.

Though her doctors denied that it was a failed suicide attempt (which would put into question Dinoire’s mental fitness for this pioneering surgery, whose psychological effects were very much unknown), she later confirmed that it was. Dinoire’s donor’s attempt was more successful. Instead of evaluating the surgery and its ethical stakes, Dinoire herself was put on trial. And she failed. She didn’t deserve the surgery. She hadn’t earned the right not to live with disfigurement.

(The furor over Renée Zellweger is so very minor in comparison).

My book Face/On: Face Transplants and the Ethics of the Other thinks about why. Why are faces such a powerful symbol of identity, and what happens when that symbol is undermined? Face transplant surgery, I argue, fundamentally vexes our fantasy of the indexical face: a fantasy because faces have always been manipulated, and a fantasy because what we read in faces is strongly tied to our own race, class, gender, ability, and sexuality biases.

Book jacket, a white woman's face is blurred out, and the words FACE ON with a slash between them is centered.
Face/On: Face Transplants and the Ethics of the Other (University of Chicago)

Face transplant surgery could be radical, forcing us to reevaluate these very biases as faces and bodies become ever more mutable, ever less uniquely tied to one individual as even faces can be shared. It could be, but it isn’t. Instead, once people got over their initial “yuck” reaction, face transplant surgery was rendered deeply conservative, packaged and produced in television news media as yet another makeover story in which people did the labor to make themselves visually conformist and acceptable to others.

There was a lot of initial opposition to the surgery from bioethicists and the lay public, rooted partly in its fantastical nature, but largely in the very real risks that it posed to recipients both psychologically, and, more to the point, physically. Following the surgery, recipients have to take anti-rejection medication that suppresses their immune system. These immunosuppressants make them vulnerable to illness and are themselves carcinogenic; in a very real way, facial allotransplantation (FAT) makes people who are in some ways well into people who are sick.

But this risk-benefit evaluation doesn’t take into account the risks of living a life without a face. Those risks are highly personal, but they are no less real. There are many ways of being sick, and many ways of treating illness. The face transplant insisted on prioritizing mental health and quality of life, even perhaps at the expense of physical health. The surgery fundamentally requires a more expansive view of medical treatment, one that takes into account the lived experience of facelessness and the very real risks it poses. People shouldn’t have to change the way they look to function in the world, but they certainly should be allowed to.

Everyone should be allowed to change how they look. But still, as the Renee Zellweger case shows, we continue to imagine faces to somehow be deeply revelatory of identity. We judge people by their faces, because we think faces are fundamental to who were are, and we get very uncomfortable when that index is unsettled. If we were to accept the promise of the face transplant that faces need not be tied to specific individuals, we would be (more) able to develop new ways of relating to and evaluating other people.

That would be very hard. It would mean that Isabelle Dinoire — whose first word after the surgery was “merci” (thank you) — would not be judged for wanting to change how she looked, but it would also mean that perhaps she might not want to change how she looked. A more expansive approach to knowing and judging others would render faces fundamentally less central.

Face transplants presented a great opportunity to rethink the relationship between face and character, between mind and body, between skin and self. We let that opportunity go by, turning Isabelle Dinoire and those who came after into yet another makeover story, turning people with facial disfigurements and face loss into another version of Renee Zellweger.

People without faces often experience a kind of social death: it shouldn’t be this way. We should see people for who they are with or without their faces. But they should also be able to get new ones, or change the ones they have, if they want. I call for a new ethics of relationality, and new ways of encountering disfigurement and disability that aren’t reliant on the face, that don’t imagine the face to be revelatory of the true self and thus should not be changed.

In that version of the world, faces — and facial disfigurement, and the markings of race, class, gender — become fundamental reflection of lived experience, but are not determinative of who we are. If we accept the promise of the face transplant (and we still can), then it changes how we think about the face fundamentally. Not only Isabelle Dinoire but also Renee Zellweger get to change their faces. Or not.

Sharrona Pearl is an Associate Professor of Medical Ethics at Drexel University. A historian and theorist of the face and body, Pearl is the author of numerous articles, book chapters, and blogs regularly at and on other sites. Her most recent book _Face/On: Face Transplants and the Ethics of the Other_ was published by the University of Chicago Press in 2017.