The birth of modern plastic surgery and the face equality campaign

The centenary of the cataclysmic Great War is happening all around us but is liable to be drowned out by last week’s European events. Let me call for a moment of reflection.

We say on Armistice Day every November ‘we will remember them’ and we should this week. Lest we forget. On Friday 1st July, I will remember the sacrifices of the men and women of the Great War, 1914-18, who gave their lives or were injured in that dreadful event.

One hundred years ago on 1st July, the Battle of the Somme began. There were 60,000 casualties that first day – yes, 60,000 – and by the time the Battle was called off in November, the allies had gained six miles of territory with 420,000 British casualties, 200,000 French and 500,000 Germans. One eye witness account captures the horror on this site.

The reason why this matters to me is that 1st July 1916 is held by those in the dressing stations and hospitals behind the lines on both sides as being the birth day of modern facial and plastic surgery. Never before had so many men been seen with severe facial injuries – and thanks to methods that had evolved in the previous two years of war, never had so many men survived. Governments on both sides were forced to bring together the most ingenious surgeons of the day to tackle the challenge.

On the allied side in the early days of the War, the British New Zealander ENT surgeon, Harold Gillies, worked with Charles Auguste Valadier, a French-American dentist and the French surgeon, Hippolyte Morrestin, to invent new techniques for closing facial wounds and treating the loss of skin and tissue. But as soon as the Somme’s casualty toll became obvious, Gillies was given a whole hospital – Queen Mary’s in Sidcup – to find ways to help the thousands of facially-injured soldiers arriving back in Britain.

Queen Mary's Hospital Sidcup, with Harold Gillies on the right

Queen Mary’s Hospital Sidcup, with Harold Gillies on the right

He assembled an exemplary multi-disciplinary and international team – perhaps better, ‘force’ – and every one of us who have received facial surgery since then owe Gillies and that team a huge vote of gratitude. Gillies’ seminal textbook, Plastic Surgery of the Face, published in 1920 remains a masterpiece.

And it gets even more personal for me because in the Second World War, Gillies again was at the forefront of treating the many casualties and this time created a ‘force’ at Rooksdown House in Basingstoke. My surgeon, Jim Evans, was trained by Gillies there – and when the war ended, the whole team moved, with their archives, to Queen Mary’s Hospital, Roehampton, where I was treated in 1970-75. My last operation in 1974 was a Gillies pedicle, the longest ever attempted according to Jim Evans, from my back to my chin. I wear it with pride.

And it was in the basement of that hospital, next to the medical photographer’s studio which I recall very well, that the archives were found in 1993 and thanks to the brilliant work of Andrew Bamji, have been created into a beautiful archive.

I will also celebrate the work of Henry Tonks, the war artist in Gillies’ work. I count myself privileged to have seen the originals in the vaults of the Royal College of Surgeons in England in connection with a film about Simon Weston’s portrait going on display at the National Portrait Gallery.

But perhaps most of all, my sombre reflection will be about the lives of the men who, after the horrors of the Somme, then went through the pain and agony of those early surgical experiments and then had the strength to try to get back into civvy street. They are the real pioneers, the first generation working for face equality in all walks of life, for respect and fair treatment.

Lest we forget. RIP.

PS: For interest: many books have tried to capture this human experience like Marc Dugain’s The Officer’s Ward (also a fine film), Pat Barker’s Life Class trilogy, The Crimson Portrait by Jody Shields and Louisa Young’s My Dear, I Wanted To Tell You.

Changing Faces sticks to its prinicples

Changing Faces has recently submitted its response to the review of cleft lip and palate surgical care in Scotland. It has been criticised in a few blogs and Facebook posts by some parents for supporting the expert Review Group’s recommendation that there should be a single surgical team based at the new Royal Children’s Hospital in Glasgow in the future rather than two teams as now (one in Glasgow, one in Edinburgh).

This has been a challenging process and it is important that I, as Chief Executive of Changing Faces, explain why the charity has taken this position – and it is the organisation’s view reached after much deliberation and not simply the view held by one or two members of staff.

Our full response is here and should be read in full because it explains that the basis for the decision was our over-riding interest in promoting the best future health care, surgical and psycho-social, for all children with clefts and their families across Scotland.

We reached the conclusion we did after a thorough analysis and careful consideration of all the paperwork in the public domain including all the options appraisal and outcomes papers (see this document and also this document). We also listened to the public meetings and to the views of people who’ve contacted us.

As Chief Executive, I took a close interest in such a contentious issue and subjected the position developed by our Scotland Manager and health policy team to challenge and scrutiny. The position we reached was explicit and unanimous.

We want to be clear on three points:

Firstly, we are very aware of the strong views of individuals and families who have been superbly served by the Edinburgh surgical team over the last decade. They are understandably concerned that they may lose the surgical team’s service and all that goes with it. That is not what the single site proposal would produce because the intention is to bring all the three surgeons and their entire surgical teams together. In doing so, all children in Scotland would have access to the best surgery possible.

We also made it clear that we do not think anything else should change: the integrated and psycho-social care that wraps around patients with clefts and their families is absolutely fundamental. “At present there are eight multi-disciplinary team clinics across Scotland. We believe there should be a cast-iron guarantee in the final report which commits to keeping them as they are…. We also would like to see a commitment to regular follow up psychosocial assessment at all levels of patient care.”

Secondly, our health policy team has submitted evidence to many such consultations over the last twenty years including the original Clinical Standards Advisory Group (CSAG)’s review of cleft care back in the early 1990s. In almost all cases, our view after careful assessment of the evidence and arguments has been that children and adults with relatively rare conditions are better served by and obtain better results from larger teams of surgeons working together, learning from and supporting each other, conducting many operations rather than only a few.

Current surgical opinion is also strongly in favour of the concentration of skills and resources for best outcomes, accessibility and patient safety. We accept that view in this case as bringing the chance that the best surgical expertise will be nurtured, shared and developed for the benefit of all children in Scotland. The two Royal Colleges in Scotland have confirmed that they too accept the expert Review Group’s view (see, for example, this from the Royal College of Surgeons of Edinburgh).

Thirdly, Changing Faces is not ‘playing politics’ in any way here but acting dispassionately in the best interests of patients, present and future, across the whole of Scotland.

The charity rejects completely claims that it has been corrupted or that it is in the pocket of the Scottish Government or has been ‘bought’ by the Review Group. None of these accusations have any truth to them whatsoever.

We also strongly refute the suggestion that our Scotland Manager stated at either of the public consultation meetings that he was in favour of the single site proposal or that he said that he had already made up his or Changing Faces’ mind. He listened carefully to the views expressed at those meetings in his capacity both as our Scotland Manager and as a member of the Stakeholder Consultation Group. This also consisted of Gillian McCarthy, CLAPA, and Emma Ashman, Scottish Health Council. All remained neutral throughout the meetings.

Lastly, should the proposals be accepted by the Scottish Government, Changing Faces urges the Edinburgh surgical team to be open to sharing and developing their great expertise within the context of a single site surgical team in the future for the benefit of all children and young people with clefts in Scotland. Whatever the decision, that benefit will be our focus.

Celebrating excellence in diversity practice

I was delighted to have been asked to speak and give the Lifetime Achievement Award at the Excellence in Diversity Awards in Leeds last week – what a great celebration it was!

I was honoured to speak at the Excellent in Diversity Awards last week

I was honoured to speak at the Excellent in Diversity Awards last week

Congratulations to everyone who was nominated – and the winners should be very proud… and especially to Karin Woodley, Chief Executive of Cambridge House who was given the Lifetime Achievement Award. I salute you!… and what a superb speech you made… “fighting for social justice is our moral obligation”…

Here’s what I said:

I am very pleased to hear that there have been so many excellent submissions for these Awards this year – and that the numbers are rising year on year. This message should go our loud and clear into our society which sadly, is too often characterised as narrow-minded and prejudiced. Not true. Respect, diversity and inclusion are thriving.

What tonight proves is that many many companies and organisations ‘get it’ – they understand the argument that diversity is good for their organisations and good for business – and they want to tap into the strength of the diversity of our society.

At the risk of preaching to the converted, let’s just revisit why investing in diversity can give organisations and companies a competitive edge and bottom-line advantage… three simple reasons:

  • because they can attract the most talented people to work for them
  • because they can retain staff who go through life-changing experiences
  • because they can attract customers who might not shop with them.

Simples.

I am glad to say that Changing Faces has worked with many companies across the UK to help them embed respect for ‘face equality’ and so enable them to attract people with unusual faces into their workplace, retain them if they go through a difficult experience – like a facial cancer or a Bell’s palsy – and ensure that people like me get excellent customer service… and aren’t asked ‘Cor, what happened to you?’ at the check-out desk. Yes it happens.

But we also run into the usual excuses – ‘we are dealing with gender equality this year’ and ‘we are fully trained on disability so don’t worry’. Sadly, it is often not until one of our users reports a bad incident that companies are impelled to do something.

Similarly, in 15 years of Dining with a Difference events, I have been amazed at how the top Boards of big companies frequently do not ‘get it’… They fail to see that disability, disfigurement and diversity are important strategic business issues not just annoying HR problems. Dining has lots of light-bulb moments for them…

I think there is one factor that marks out organisations and companies that ‘get it’ and those that don’t – they have a champion in a senior or high-level position who gets it and is determined to embed ‘it’ into the very fabric of the organisation.

A classic example was a major bank for which we ran a Dining event… we were told that many of the top Board were coming and were tasked with getting one of them as champion… at the end of the evening, the Finance Director got up to say ‘thank you’ and completely unprompted, announced that he’d put his hand up to be the company’s Disability Champion.

He kept his word and went on to become the Chief Executive. The whole company’s approach to disability – and diversity across the board too – changed.

So my message to you this evening is actually a challenge: I task you all with finding and nurturing the next generation of champions on diversity and inclusion in your organisations to take the embedding up to the next level.

Fashion, faces and the future

Last week I had the pleasure of meeting Professor Danka Tamburic, Professor in Cosmetic Science at the London College of Fashion because she is hosting a fascinating Symposium in April, Skin: The ultimate interface, to which I will be contributing with Henrietta Spalding. Our title is ‘Changing Faces: from stigma to face equality’.

The meeting was brought about through the good offices of my old friend, Emeritus Professor Terence Ryan. I met him more than twenty years ago when he was a professor at Oxford University and a highly-respected consultant dermatologist – and there we were discussing skin and the stigma of disfigurement in a fashion college! But no ordinary fashion college – one which has laboratories where students and researchers study the chemistry of skin creams and used to have the Rev Joanna Jepson as its first Rector of Fashion.

Joanna – with whom I have not always agreed! – has written a powerful book called Fashion, Faith and Fig-Leaves: a Memoir, in which she describes her journey in faith and how her rare facial condition affected so much of her adolescence. She became isolated and introverted – and then she risked major maxilla-facial surgery on her chin, teeth and mouth. Which, in her case, was transformational.

Henrietta has also written a brilliant book about her facial paralysis with Professor Jonathan Cole, a neurophysiologist, called The Invisible Smile about life with Moebius Syndrome. It’s a condition which no amount of surgery can change significantly.

It was 45 years on Friday since I looked in the mirror for the first time after fire had severely damaged my face. I knew in that mirror moment that I was a marked man – stigmatised by my scars and disfigurement. Five years of brilliant reconstructive surgery produced my unusual face as it is today. As good as it could get. Contrary to popular belief – myth – that’s it.

Last week too, I read a fascinating article about ‘How long until we can print human faces in the lab?’. The idea that your own stem cells could be used to manufacture a new face if your face is damaged as mine was is still decades away, I suspect, but it might be possible.

Until that happens and such treatment is widely available – and of course, it will not touch many other causes, like facial paralysis – we must tackle the stigma of disfigurement every day in every setting. That’s what Henrietta and I will be saying – and that’s what the campaign for face equality is all about. Join us!

New year, old stereotypes

Happy New Year everyone – and I’d like to start on an upbeat note … but sadly not.

‘The Undateables’ returns to Channel 4 for a new series on Monday night.

For the last four years, this series has brought together people who have medical conditions, disabilities and disfigurements with others with similar conditions (and in some cases no conditions) in an attempt to find love.

undateables

And the good news is that there have been some notable successes, such as Brent and Challis, and our very own Steve and Vicky, whose wedding we’ll see in the new series. Sadly, however, the directors have made no attempt to correct the impression that people who look unusual don’t have love affairs – of course they do! And without the need for a TV show!

But like many programmes from the production company ‘Betty’, my biggest issue is with the show’s title.

As Changing Faces said before the first series back in 2012, the title ‘has the potential to cause unnecessary offence, to perpetuate stigma and encourage abuse or harassment of people with facial disfigurements and disabilities’.

Last summer, the issue was raised at the British Medical Association conference, when doctors accused the programme of exploitation; earlier, the UK Disabled People’s Council said the programme ‘posed a threat to the rights of disabled people under the UN Convention on the Rights of Persons with Disabilities’, and said it was ‘unwatchable’. Jessica Middleton provides an insightful analysis of the title in this blog on The Badger.

Clearly, however, the fact that the programme won a BAFTA nomination, high ratings and lots of social media noise indicates that it’s anything but unwatchable. But if you care to look at the social conversations taking place, many of them follow the line: “I hate the title, but love the show”.

One of the most troubling effects of the show’s title is the suggestion that people who have a disability or disfigurement are outsiders, people you wouldn’t expect to find on Tinder, or meet in a bar, or at a speed dating night. Other dating programmes perpetuate the stereotype.

I’m no fan of ‘Take Me Out’ – it’s rather vulgar in my opinion – but why has it never featured someone with a disfigurement amongst the 15 female contestants in each show? I’m sure some ‘Take Me Out’ fans will remind me of Tony, the man who lost a leg in a football accident, who appeared on the show. But he was the sole male contestant – choosing from fifteen female contestants. Hardly a balanced position.

Slightly better is the other Channel 4 hit, ‘First Dates’. In the last series we met Chuks, who was born with short arms. And in the new series – beginning later in January – we’ll see Arunima, who’s a wheelchair user. And so whilst we can – gently – applaud ‘Take Me Out’ and ‘First Dates’ for having some representation of disability, neither have ever shown someone with a facial disfigurement.

Is that because a facial disfigurement is just too undateable? Could it be that four years of perpetuating the myth of someone with a facial disfigurement being unlucky in love has pushed this form of physical difference beyond the pale?

Proof of the negative way that the title has played out comes in a number of forms. TimeOut magazine has an ‘undateables’ column in their New York and some other editions. Instagram and other social media channels are full of people, mainly teenage girls, complaining that they are ‘undateable’ on account of their looks. Even Battersea Dogs Home now use the word to describe hard-to-rehome pets, animals that the Dogs Trust have called ‘sticky dogs’ for a number of years.

Last spring, on the Changing Faces Facebook page, we invited our supporters to submit photos of their wedding day. It quickly became our most popular Facebook post ever, demonstrating that people who look different don’t love any different. Indeed, our recent supporter survey found that more than two thirds of our supporters are either married or living with a partner. Only around one in five said they were single.

And if you’re wondering: I’ve just spent a wonderful family Christmas which included celebrating the wedding of our third ‘child’.

Changing Faces publishes guidelines for broadcasters on the importance of the language they choose to use – and that includes in their titles. They align with our guidelines for journalists, with which we regularly challenge newspapers – sometimes with some success.

In my view, it’s not good enough to say, “Oh, it’s just a title, the programme is good once you watch it”. Three million people may do that. But what about the attitudes of the rest of the population? Still shaped by such worn-out stereotyping, I’m afraid.

Rightly in 2016, we wouldn’t tolerate a show about women looking for love called ‘Lesser Sex’, nor one about lesbian, gay or bisexual people called ‘Queer Love’. For me, ‘The Undateables’ is just as offensive, and until production companies and broadcasters can be responsible with their show’s titles, we’ll remain a depressingly long way from achieving face equality, eight years on from the launch of our campaign for it.

Let’s make 2016 a year to throw out these titles once and for all!

World AIDS Day

Charlie Sheen’s recent ‘coming out’ as living with HIV shone a much-needed light on the stigma that still surrounds HIV and AIDS, and set me thinking about parallels with disfigurement.

It’s more than thirty years since HIV was discovered, and more than twenty-five years since we lost some high profile names to the condition, such as Freddy Mercury. The combined efforts of people like Princess Diana, Elton John and Bill Gates have raised awareness and provided treatment around the world. And yet people still make jokes, discriminate, and make very uninformed assumptions about people with HIV and the treatments available.

After Charlie Sheen’s story broke, one Mirror journalist wrote about how he “deserves everything he gets”. Can you imagine a newspaper publishing a story about a famous person with cancer, with a comment that they deserved it because they’d smoked? Or someone with diabetes ‘deserving it’ because of their diet? But media stigma abounds on HIV.

I find it shocking that anyone would harbour such views about someone’s medical condition. But at Changing Faces we see and hear of such stories every day: people being discriminated against, targeted in hate crime, suffering in schools and the workplace – all because of their appearance.

People with disfigurements also live with other people’s assumptions, and assumptions are often linked with a judgment. In Lexxie’s interview with BBC Radio 5 Live at the weekend, she spoke about how people assume her birthmark is a bruise. Others with scars or asymmetry on their faces report comments to the effect that they ought to get it ‘fixed’. The work that Changing Faces does to challenge these assumptions – disfigurements can rarely be removed, for example – and stand tall against discrimination, is vital not only for the people that we support, but for the wider society too.

 

I sat with Sir John Hurt – who many will know for his incredible performance in The Elephant Man – at a Project Harar dinner on Saturday. He did voiceover for the chilling 1986 public information television advert on HIV, urging people not to take risks and ‘die of ignorance’. Thankfully, pharmaceutical advances mean that if it’s diagnosed early enough, an HIV diagnosis is no longer the death sentence it once was. But people still have to live with it.

On this World AIDS Day, we should celebrate the medical advances, but commit to ensure that the only thing that dies is ignorance and prejudice.

Face transplantation 10 years on…

Isabelle Dinoire

Isabelle Dinoire pictured in 2009

Hats off to Isabelle Dinoire! Ten years ago today, she signed the consent form to receive the world’s first face transplant – and I wished her well three days later when she appeared in front of a massive press conference – and I wish her well again today.

She deserves the gratitude of people with severe facial disfigurements because she was willing to take what the Royal College of Surgeons’ Working Party in November of the following year called ‘a leap into the dark’.

Of course, not that many people have been willing to take such a leap but around thirty have done so worldwide. Some of the transplants have been immense undertakings involving skin, bone, muscle and much more. Sadly, some patients have died – one at least because they failed to conform to the immune-suppressant drug regime; others probably because the graft has failed.

But most patients survive – and some have told their stories in graphic detail expressing gratitude to the donors’ families and the surgical teams – see the New York Times and The New Yorker in 2012, for example, and this week’s interview on BBC Newsnight and this from a Polish man.

Ten years on, I think several things are clear:

First, that face transplantation is still in its research phase but is proving itself as a very effective method in the surgeon’s armoury for dealing with the functional and aesthetic issues posed by severe facial disfigurements from traumatic and other causes.

Second, that the very complex and highly individualistic challenges of preventing graft rejection and designing effective immune-suppressant drug regimens are being tackled – but there is little public knowledge about patients’ experiences.

Third, that the psychological and social benefits have been well-expressed by those who have gone public – but I continue to be concerned about the quantity and quality of the pre- and post-transplant psycho-social support to both the patient and their family.

Fourth, patients can take on another’s face but their sense of identity is not easily regained – as Isabelle herself expressed in 2008: “It’s not hers, it’s not mine, it’s somebody else’s… Before the operation, I expected my new face would look like me but it turned out after the operation that it was half me and half her… It takes an awful lot of time to get used to someone else’s face. It’s a peculiar type of transplant.”

Fifth, whilst some donors’ families have been willing to go public, I worry that donor family support and privacy have not been given as much attention as they merit.

And sixth, and finally, the media coverage has raised public awareness that face transplantation is a remarkable procedure that can offer improved appearance and functioning for people with severe facial disfigurements – but it is not a magic wand.

In the month after Isabelle Dinoire’s leap-taking, I wrote to the president of the Royal College of Surgeons of England to ask that he and the RCS Working Party update its 2003 report on face transplantation (which had been very hesitant). Last night I re-read the outstanding 2006 report and marvelled at its wisdom – it is the most informed public document about face transplantation and established the highest ethical benchmark for British research teams.

One of my concerns as face transplantation becomes a frequently-used procedure in the next decade is that inexperienced clinical teams will ‘have a go’ – and I think there is a risk that the learning by research teams is not being shared as widely and fully as it could be. I am going to write to Clare Marx, the current President of the Royal College and to her counterparts in the US, France and possibly other countries to suggest that they combine to commission an international review.

But let me repeat: Hats off to you, Isabelle! I shall raise a glass to you this evening!

Doing good

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L-R Jayne Woodley of Oxfordshire Community Foundation, James Partridge, John Nickson

A great evening at the Oxford Union last week! So fascinating to be part of an ancient debating tradition that goes back to Gladstone who was President of the Union in 1830. I stood at the despatch box – opposing the motion – on the same boards as many giants of the political world and wider society of the past 185 years.

It was all done in a very formal process conducted under the watchful eye of Charles Vaughan, the President of the Oxford Union in his white tie and tails.

Those supporting the motion, James Bevan of CCLA, Nigel Mercer, President of the British Association of Plastic, Reconstructive and Aesthetic Surgeons and Sali Hughes, beauty writer and columnist constructed some formidable arguments to support the spending of money on ‘looking good’.

It has economic value, of course – providing employment for millions of people and much scope for charitable giving to medical research and other good causes. And no-one could dispute that the skills of plastic surgeons can improve a person’s looks… and I, for one, do not object to that provided the patient – or customer – has been given realistic information about the risks and benefits and has been told of other ways of gaining self-esteem.

The debate was really about the balance of society’s spending as Professor Danny Dorling and John Nickson and I tried to explain – and with the certainty that the state will be withdrawing from many areas of civil society in the years ahead, there is a real and urgent need to re-balance our priorities towards ‘doing good’.

There were many examples of how that spending could make a difference – but my one regret is that the nine-minute rule for all speakers prevented us elaborating on why such spending, giving or volunteering can make such a difference.

I am immensely proud of the work of Changing Faces’ staff, volunteers, ambassadors and many other people who have been transforming the lives and future prospects of anyone who experiences a disfigurement as I did years ago from severe burns at the age of 18 – and you can read about most significant impact in the last year on our website. My next blog will cover what we are seeking philanthropy for.

Lastly, a big thank you to my supporters for coming and cheering – and to the Oxfordshire Community Foundation for organising such a treat!

Events in Paris and London today

My heart and prayers go out to everyone in France who are trying to come to terms with last night’s ghastly events in Paris. We at Changing Faces are ready to do anything we can to help those injured and their families and we are with all people who stand for freedom and democracy.

Today, I will be in north London marking 40 years of an amazing service which has its roots in the aftermath of the fight against tyranny and barbarism in the Second World War, and so want to assert strongly that from these atrocities can come seeds of good.

The Skin Camouflage Service was created by the British Red Cross at the request of the Department of Health in 1975. In 1975, a nationwide survey of dermatologists highlighted the psychological and social effect of disfiguring skin conditions. The survey found that, while few skin problems are life-threatening, visible conditions – such as vitiligo, rosacea and scarring – could cause great distress and adversely affect almost every aspect of a person’s life.

Joyce Allsworth was appointed to develop the training – and Joyce was a pioneer in skin camouflage because she had been working with companies like Veil, Covermark, Max Factor and Elizabeth Arden in the 1950s and 60s, and they had been inspired, at least in part it is likely, by Sir Archibald McIndoe, the great plastic surgeon at Queen Victoria Hospital, East Grinstead. The patients he treated in the wake of the Battle of Britain and subsequent warfare came to be known as McIndoe’s Guinea Pigs.

Today the Skin Camouflage Service is an integral part of what Changing Faces offers to help people with any kind of disfigurement – from birthmarks, skin conditions, burns or scarring from accidents and violence – to gain self-confidence and self-esteem.

 

Around 5,000 people a year are referred to the service by dermatologists, GPs, plastic surgeons and others – and are advised by our highly-skilled Skin Camouflage Practitioners about the best cream to use – from 150 options on the NHS prescription list – according to their skin colour, type etc and how to apply it. They can then get a GP to prescribe the product – and the feedback we get is that this can be life-changing for many people. You can find out a lot more on our website.

My hope is that this little bit of history can light a tiny ember of hope into the gloom that last night’s events will inevitably produce.

Better to spend more on looking good than doing good?

On Tuesday 10 November, I spoke in a debate at the Oxford Union, organised by the Oxfordshire Community Foundation. This is the text of my speech.

The motion for debate: “This house believes that there is nothing wrong with spending more on looking good than doing good.”

CHECK AGAINST DELIVERY

Good evening, Mr President, Ladies and Gentlemen,

As you will observe, I have come dressed in a fine £150 suit, an elegant shirt from the Charles Tyrwhitt range, a tie out of the top drawer, shoes from Russell & Bromley, and hair styled by Toni and Guy. Total price £250. I enjoy wearing good-looking clothes – but I have no interest whatsoever in owning lots of them – and I’m hopeless at choosing which.

But that’s not important is it, compared to my face. Not pretty. Not looking good? Could do better? Severe burns at 18 made my life here as an Oxford student in the early 1970s extremely challenging. Hundreds of thousands of pounds of taxpayers’ money through the brilliant NHS were spent on getting my face to ‘look OK’.

But not good enough, of course. Because as prevailing orthodoxy would have it, without a good-looking face, I am doomed to three nasty effects: I won’t feel good inside, I won’t be liked by others and, with scars as good/bad as mine, I’m likely to live life in the shadows. I would be well-advised, you might say, to spend a lot more on ‘looking good’ – certainly much more than I do now! Not just on moisturisers but on major reconstructive and cosmetic surgery, perhaps even on a face transplant.

We live in a culture which has swallowed, hook line and sinker, the theory that ‘looking good’ brings big rewards. It also imposes a nasty stigma on people like me whose face doesn’t fit the norms of the day which is profoundly unfair.

In this culture, we are bombarded daily with slickly presented messages which tell us why spending massively on ‘looking good’ is not just good for our psyches but absolutely vital for them. If we don’t aspire to the spotless, wrinkle-free, age-less norms of appearance, our sex lives will be poorer, our self-esteem lower and our job and career prospects diminished.

The facts suggest that over 50,000 people spend £0.5bn on cosmetic surgery and that in all, £70bn each year is spent on ‘looking good’. That’s over £1,000 per person in the UK.

So on generous assumptions and including the cash-value of volunteering, £35bn a year is expended on – or given to – doing good. About half of what is spent on looking good. And by less than the half the population.

So why am I against spending of so much – and certainly any more – on looking good? For three reasons:

First, because I think the link between ‘looking good’ and being successful, feeling good and being loved is far more tenuous than is claimed and can be positively dangerous.

I work with many psychologists and they confirm that self-esteem and self-confidence are hard to acquire for most of us. Research suggests that parental support, academic achievement and the development of skills in sport, art, theatre and many other ways all combine with the quality of friendships, especially in adolescence to create our sense of self-worth. But some people’s self-esteem is heavily dependent on their looks.
Self-confidence too is gained by your ability to manage the many social encounters you have. That means your social skills have to be pro-active and your ability to deal with the judgements of others robust and resilient.

Do looks matter? Yes, of course they do… in the first five minutes of a new encounter, people do take a note of what you look like. But as Professor of Social Psychology, Michael Argyle of this great University showed years ago: when we meet someone, our first impressions are 54% determined by their overall appearance, dress etc, 34% by their gestures and body language, 8% by what they say and how they say it, and 4% by their face.

So looking good does matter but the idea that after those first five minutes, your facial looks – not your facial expressions or the quality of your eye contact – matter more than a little bit, I dispute. Sexual chemistry too is not about superficial face-value judgements – No, it’s a whole body, mind and spirit experience.

Incidentally, if you want a crazy sort of proof that there is not a very reliable correlation between ‘looking good’ and happiness, have a look at the Hollywood divorce statistics!

But psychologists also tell us that the over-zealous search for looking good has very dangerous unintended consequences. Some of those who strive to get a perfect body image do so at a severe cost to their own health. The epidemics of eating disorders, over-exercising, body dysmorphic disorder and self-harm are all obsessive behaviours designed to achieve or reacting to a frustrated search for an illusory perfect good-looking body. Research by Girlguiding found that one in five girls aged nine to 10 said the way they look makes them feel most upset, and 39% of girls say they experience demeaning comments about the way they look every week.

These are the unacceptable social costs of our ‘look good’ economy imposing massive costs on the health system most of which are preventable. The culture promoted by ultra-thin models and air-brushed faces is dangerous and needs countering. The ‘look good’ and ‘eat lots’ economy is unconstrained. Commercial pressures are hard to resist.

So there is definitely something ‘wrong’ with spending on ‘looking good.

Second, I dislike a culture which believes that looking good is not just a nice-to-have but also makes you morally good too. Research shows that many people believe it. Which is hard enough to swallow. But it’s the flipside which I detest.

Our culture perpetuates the nasty stigma that looking ‘not good’, with facial scars especially, means you are likely to be immoral, a villain, a weirdo. This lazy and nasty equation is seen not just in Bond and Elm Street films but in children’s online games too. The baddies in Moshi Monsters have names like Freakface and Fishlips who is characterised as a ‘one-eyed blob of badness’. Last week Children’s BBC gave Guy Fawkes a facial scar that – according to a Fawkes biographer – he never had.

Guy Fawkes with a mysterious facial scar - his leading biographer says there's no record of that scar.

Guy Fawkes with a mysterious facial scar – his leading biographer says there’s no record of that scar.

Encouraging spending on ‘looking good’ legitimates children in schools today being ridiculed because of their scars or birthmarks. We want our culture to respect ‘face equality’ just as race equality is coming to be.

But the third and strongest reason why I am against spending so much – and more and more – on looking good is that the monies could be put to so much better use.
Although when you watch BBC Children in Need this Friday and Comic Relief you might not think so, altruism, philanthropy and volunteering are all in retreat at a time when the need for them are rising.

With the state pulling back from so many areas of life and with more severe austerity cuts in the offing, charities are facing increasing pressures on their services – and there are so many causes to which people could give to or devote time to ‘doing good’.

Which can work miracles to people’s self-esteem and self-confidence. By volunteering to support elderly people in their neighbourhoods, getting a team together to raise sponsored money for a good cause, or finding out about how women survive after acid attacks in India or Britain and raising funds for their rehabilitation… All great ways to feel good… that you are doing something worthwhile.

So, Mr President, I strongly oppose the motion tonight: there is a great deal wrong with spending more on looking good than doing good – it is dangerous, allows stigma and prejudice, and is a waste of money. We are all the poorer because of our society’s excessive search to look good.