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Artificial Intelligence and Facial Discrimination

October 6, 2022 by Fay

AI

Artificial Intelligence and Facial Discrimination

The Author

Phyllida Swift

Phyllida Swift

This blog on artificial intelligence and facial discrimination is the fourth and final installment of our series on facial recognition. Don’t miss our first blog by AboutFace PI Fay Bound Alberti, about what history can teach us about technological innovation, our second by guest author Dr Sharrona Pearl, on human facial recognition, face blindness and super-recognisers, or our third by George King at the Ada Lovelace Institute, on regulating facial recognition technologies.

Artificial Intelligence and Facial Discrimination

Over the past couple of years, here at Face Equality International we have experienced increasing numbers of requests from academics, policymakers, government bodies and businesses to input into commentary and research on artificial intelligence, and in particular ethical considerations around the effect of AI technologies on the facial difference community. The most obvious technology of concern is facial recognition and its potential for bias, exclusion and censorship. All of which are issues with a growing evidence base, but with little progress or acknowledgement of such evidence from technology companies, regulators, or businesses adopting AI into their practice.

At Face Equality International (FEI), we campaign as an Alliance of global organisations to end the discrimination and indignity experienced by people with facial disfigurements (FD) around the globe. We do this by positioning face equality as a social justice issue, rather than simply a health issue, which is all too often the case.

For any equality organisation, the public dialogue on how AI has been proven to replicate and reinforce human bias against marginalised groups is deeply concerning. Granted, it’s reassuring to see increased recognition in society, but this is not without great fear from social justice movements that generations of advancements could relapse at the hands of unregulated AI.

Because as it stands, AI is currently unregulated. A regulatory framework is in development for Europe, but ‘the second half of 2024 is the earliest time the regulation could become applicable to operators with the standards ready and the first conformity assessments carried out.’

Back in March, I was invited to share a statement at an event attached to the United Human Rights Council led by Gerard Quinn, the UN Special Rapporteur on the Rights of Persons with Disabilities. This came off the back of a thematic report into the impact of AI on the disabled community. The themes in this blog will follow similar lines as the statement, in less formal terms.

AI and the disabled community

It’s unsurprising that the most apparent AI-related threat that is relevant to us is facial recognition software. For an already marginalised and mistreated community, AI poses the threat of further degrading treatment. For instance, we already see constant abuse and hate speech on social media, where people with facial differences are referred to as ‘sub-human’, ‘monster’, or ‘that thing’. But algorithms often fail to pick up on such slurs as being derogatory to the facial difference (FD) community, which should fall into the protected group under disability policies.

Social media also poses the problem of censorship through AI, where on several occasions we have seen photos of people with disfigurements blurred out and marked as ‘sensitive’, ‘violent’, ‘graphic’ content. When reported, platforms and their human moderators are still failing to remove these warnings.

There is growing evidence to demonstrate the extent of harms caused by AI software in disadvantaging certain groups. Such as when Google Photos grouped a photo series of black people into a folder titled, ‘gorillas’. We know that several FD community members have reported having their photos blurred out and marked as sensitive, graphic or violent on social media, effectively censoring the facial difference community and inhibiting their freedom of expression to post photos of their faces online.

We know from research that many people make assumptions about someone’s character and ability based on the way they look. A study in America from Rankin and Borah found that photos of people with disfigurements were rated as significantly ‘less honest, less employable, less intelligent, less trustworthy’, the list goes on – when compared to photos where the disfigurement was removed.

Facial_Difference

AI, Dehumanisation, and Negative Bias

Sadly, we’re seeing these assumptions play out in AI led hiring practices too, where language choice, facial expression, even clothing have been shown to disadvantage candidates, whose scores are affected negatively. In a notorious Amazon example, a machine had taught itself to search for candidates using particular word choices to describe themselves and their activities, which ended up favouring male candidates who more commonly used those words. How can we expect someone with facial palsy, for example, to pass tests based on ‘positive’ facial expressions.

We have heard several cases of passport gates failing to work for people with facial disfigurements, and the same goes for applying for passports and ID online. Essentially, this is because the various software tests required to submit photos are not recognising people’s faces as human faces when they are put through. For an already all too often dehumanised community, this is simply not good enough.

Non-recognition of people with disfigurements was recorded by World Bank when it was found that someone with Down’s Syndrome was denied a photo ID card as the technology failed to recognise his non-standard face as a face. This was also apparent for people with Albinism.

There are often alternative routes to verify identity outside of facial recognition, for instance when problems arise with smartphone apps which rely on facial recognition to access bank accounts or similar services. Systems which ask the user to perform an action – such as blinking – can cause difficulties for people with some conditions, such as Moebius Syndrome or scarring. Some apps offer an alternative route for people unable to use the automatic system, but this goes against the principle of inclusive design and may be more cumbersome for people with facial differences. As is often talked about in disability spaces, the additional admin required of someone with a disability or disfigurement can take an emotional toll. Self-advocacy of this kind can be a life-long occupation.

Ethical AI?

So the problem for us is not necessarily in proving that there is a glitch in the system, it lies in making ourselves known to the technological gatekeepers. Those with the power to turn the tide on this ever-evolving issue. Whilst building coalitions with fellow organisations pushing for ethical AI, such as Disability Ethical? AI.

Princeton University Computer Science professor, Olga Russakovsky, said, “A.I. researchers are primarily people who are male, who come from certain racial demographics, who grew up in high socioeconomic areas, primarily people without disabilities.” “We’re a fairly homogeneous population, so it’s a challenge to think broadly about world issues.”

What’s interesting to note is that when we have asked our communities to relay to us their potential concerns about the growing use of AI, across every aspect of society, through polls and forms promoted across social media and via our membership, the response has been rather limited. There is often a consistent dialogue between us and our online communities when discussing issues that affect the FD community, but it appears that when it comes to AI, there has been far less of a response.

A ‘Transparency Void’

After further investigation, our team believes this could be for a number of reasons. Firstly, AI is too broad a technological term that conjures up distant, futuristic notions of robots driving our cars and taking over the planet. Which is very much what I thought of when this topic first landed on my own desk.
The second potential reason could be what we’ve started to refer to in our commentary on the issue as a ‘transparency void’. Meaning that it is far less obvious when a machine is creating barriers, bias or discriminating against an individual on the grounds that they are facially diverse, than it is if it were to be a human giving away cues in their language, their eye contact and their behaviours. In a recent Advisory Council meeting, a member spoke of the frustrations of trying to navigate automated phone lines with set questions, when your facial difference also affects speech. How does one get through to an actual human when there is no option to pass certain automated tests?

AI discrimination will continue to place the burden on the victim of the discrimination to challenge the decision, rather than on the (often well-resourced) entity using the technology. Existing research shows that the number of cases brought in relation to breaches of employment law legislation is just a tiny fraction of those which occur, so this is not an effective enforcement mechanism.

A Rapidly Escalating Issue

This is perhaps the most insidious threat regarding the negative impact of AI on furthering the face equality movement. Who do we hold accountable when AI discriminates based on facial appearance? Because we know for sure that it is already happening, as therein lies another fear for us at FEI, in that many members of the FD community will already be experiencing disadvantages at the hands of AI, without realising it, or without comprehension for how quickly this issue is escalating, with the use of AI in recruitment, security, identification, policing, assessing insurance, financial assessments and across our online spaces. These are not emerging technologies, AI is already here with us in force, and it’s growing exponentially.

It seems the crux of the issue lies in narrow data sets. In simple terms, the faces that AI is used to seeing are only certain types of faces. ‘Normative’, non-diverse, non-facially different faces that is.
We at FEI want to get to the source of the problem, and prevent further damage. It is our understanding, as a social justice organisation, as opposed to a tech company, that the best way to do this is to lend ourselves to the meaningful, robust and ethical consultation and involvement of our community. Whether it’s a question of us supporting companies to widen the pool of faces to diversify their date sets, or us continuing to feed into research and policy consultation, we are committed to making our cause, and the people we aim to serve known to the companies that so often ignore them.

Author Bio

Phyllida Swift

Phyllida is CEO at Face Equality International. Phyllida was involved in a car accident in Ghana in 2015 and sustaining facial scarring. After which, she set out to reshape the narrative around scars and facial differences in the public eye, to champion positive, holistic representation that didn’t sensationalise, or other the facial difference community any further. She started out by sharing her story as a media volunteer for Changing Faces, before taking on a role as Campaigns Officer, and later Manager. During that time, she led the award winning, Home Office funded disfigurement hate crime campaign, along with working on multiple Face Equality Days, ‘Portrait Positive’ and ‘I Am Not Your Villain’. She shared her own experiences of how societal attitudes and poor media representation impacted upon being a young woman with facial scarring in her TEDX talk in 2018. Phyllida sits on the AboutFace Lived Experience Advisory Panel (LEAP).

Further reading

view all
March 10, 2023 | 4 MIN READ

The making of a blueprint. How historical, qualitative research should inform face transplant policy and practice.

January 23, 2023 | 4 MIN READ

Before and After? What the humanities bring to medical images

January 23, 2023 | 4 MIN READ

Diminishing their Voices: Face Transplants, Patients, and Social Media

January 23, 2023 | 4 MIN READ

Robert Chelsea and the First African American Face Transplant: Two Years On

January 23, 2023 | 4 MIN READ

History has Many Faces: researching histories of facial surgery

January 23, 2023 | 4 MIN READ

When face transplants fail: Carmen Tarleton and the world’s second retransplant

January 23, 2023 | 4 MIN READ

Drag Face: exploring my identity through masculine performance

January 23, 2023 | 4 MIN READ

Future Faces

January 23, 2023 | 4 MIN READ

Reflecting on Reflections

January 23, 2023 | 4 MIN READ

Owning My Face

January 27, 2023 | 4 MIN READ

Portrait of an Angry Man – or not?

January 23, 2023 | 4 MIN READ

Picturing Death: Dealing with Post-Mortem Images

Filed Under: facial recognition, guest blog, Visible Facial Difference

Regulating facial recognition and other biometric technologies

August 31, 2022 by Fay

Regulating facial recognition and other biometric technologies

The Author

George King

This blog on regulating facial recognition is the third installment of our series on facial recognition. Don’t miss our first blog by AboutFace PI Fay Bound Alberti, about what history can teach us about technological innovation, or our second by guest author Dr Sharrona Pearl, on human facial recognition, face blindness and super-recognisers.

Regulating facial recognition and other biometric technologies

Sara Wasson, Lancaster University

Our faces are unique and intimately connected to our sense of self and identity. Most of us are able to recognise a very large number of faces and take this quintessentially human ability for granted.

But this important skill is no longer limited to humans. Algorithms can do it too. Specific measurements, such as the distance between our eyes, nose, mouth, ears and so on, can be automatically captured and fed into AI systems. These systems are capable of identifying us within a database or picking us out from a crowd.

Biometric (‘biological measurement’) data is the term for any data derived from measuring our physical characteristics, and this includes our faces, fingerprints, walking style (gait) and tone of voice. Biometric technologies can be used to recognise and identify us, but they are also being used to categorise and make inferences about us.

These technologies were previously almost exclusively used within policing. However, they are now being used by a growing number of private and public actors, including employers, schools and retailers to identify but also to categorise.

This raises a number of legal, ethical and societal concerns. Our human rights, such as our rights to privacy, free expression, free association and free assembly, are potentially at risk.

Discrimination and Bias

There are also issues of bias and discrimination. Some biometric technologies – particularly facial recognition – function less accurately for people with darker skin. But even if the technology could be improved to accurately match faces from all racial groups, ethical problems would persist.

Discrimination and bias can also arise from the social context of policing and surveillance. Facial recognition may be disproportionately used against marginalised communities. Shops may disproportionately add people of colour to ‘watchlists’. Simply making the tech more accurate is not enough to make it harmless or acceptable.

To disentangle these challenges and investigate potential reforms, the Ada Lovelace Institute undertook a three-year programme of public engagement, legal analysis and policy research exploring the governance needed to ensure biometrics are used with public legitimacy.

Through in-depth public engagement research, we found serious public concerns about the impact on rights and freedoms.

Negative Impact on Rights and Freedoms

We began by conducting the first nationally representative survey on UK public attitudes towards facial recognition technology, Beyond Face Value. Respondents were given a brief definition of the technology and answered questions about its use in a range of contexts, such as policing, schools, companies, supermarkets, airports and public transport.

The survey found that a majority of people (55%) want the UK Government to impose restrictions on police use of facial recognition and that nearly half the public (46%) want the right to opt out. This figure was higher for people from minority ethnic groups (56%), for whom the technology is less accurate.

The Citizens’ Biometrics Council, a demographically diverse group of 50 members of the UK public, heard from experts about how they’re used, the ethical questions raised and the current state of regulatory oversight. After deliberating on the issues, the Council concluded that there is need for a strong legal framework to ensure that biometrics are used in a way that is responsible, trustworthy and proportionate.

However, an independent legal review, led by Matthew Ryder QC, has found that the legal protections in place are inadequate. The review shows that existing legislation and oversight mechanisms are fragmented, unclear, ineffective and failing to keep pace.

The review was commissioned by the Institute in 2020, after the House of Commons Science and Technology Select Committee called for ‘an independent review of options for the use and retention of biometric data’.

Building on the independent legal review and our public engagement research, we published a policy report setting out a series of recommendations for policymakers to take forward. A recording of our launch event is available on our website.

Policy Recommendations

Firstly, there is an urgent need for new, primary legislation to govern the use of biometric technologies. The oversight and enforcement of this legislation should sit within a new regulatory function, specific to biometrics, which is national, independent and adequately resourced.

This regulatory function should be equipped to make two types of assessment:

  • It should assess all biometric technologies against scientific standards of accuracy, reliability and validity.
  • It should assess proportionality in context, prior to use, for those that are used by in the public sector, public services and publicly accessible spaces, or those that make significant decisions about a person.

Finally, we are also calling for an immediate moratorium on the use of biometric technologies for one-to-many identification in publicly accessible spaces (e.g. live facial recognition) and for categorisation in the public sector, public services and publicly accessible spaces, until comprehensive legislation is passed.

Biometric technologies impact our daily lives in powerful ways, and are proliferating without an adequate legal framework. Policymakers need to take action to prevent harms and ensure that these technologies work for people and society.

This blog on regulating facial recognition was written by George King. George is a Communications Manager at the Ada Lovelace Institute, with a focus on external relations and engagement. Prior to joining Ada, George worked at the Royal College of Psychiatrists as Communications Officer in their External Affairs team, working across press and public affairs. He has worked for a range of research-based organisations, including the Francis Crick Institute.

Connect with George King (@George_W_King) and the Ada Lovelace Institute (@AdaLovelaceInst) on Twitter.

Further reading

view all

March 10, 2023 | 4 MIN READ

The making of a blueprint. How historical, qualitative research should inform face transplant policy and practice.

January 23, 2023 | 4 MIN READ

Before and After? What the humanities bring to medical images

January 23, 2023 | 4 MIN READ

Diminishing their Voices: Face Transplants, Patients, and Social Media

January 23, 2023 | 4 MIN READ

Robert Chelsea and the First African American Face Transplant: Two Years On

January 23, 2023 | 4 MIN READ

History has Many Faces: researching histories of facial surgery

January 23, 2023 | 4 MIN READ

When face transplants fail: Carmen Tarleton and the world’s second retransplant

January 23, 2023 | 4 MIN READ

Drag Face: exploring my identity through masculine performance

January 23, 2023 | 4 MIN READ

Future Faces

January 23, 2023 | 4 MIN READ

Reflecting on Reflections

January 23, 2023 | 4 MIN READ

Owning My Face

January 27, 2023 | 4 MIN READ

Portrait of an Angry Man – or not?

January 23, 2023 | 4 MIN READ

Picturing Death: Dealing with Post-Mortem Images

Filed Under: biometrics, ethics, faces, facial recognition, guest blog

Facial Recognition: From Face Blindness to Super Recognisers

July 27, 2022 by Fay

Facial Recognition: From Face Blindness to Super Recognisers

The Author

Sharrona Pearl

Sharrona Pearl

This blog is part of our series on facial recognition. Check out our first blog on this theme, by PI Fay Bound Alberti, on facial recognition software, history, and the meanings of the face, and what we can learn about this technological innovation by looking at the past. Today’s blog is written by Sharrona Pearl, and explores the scale of human face recognition, from face blindness to super recognisers.

Facial Recognition: From Face Blindness to Super Recognisers

Face recognition is a wonderful and complicated neurological process.  We are learning more about it every day.  But it’s also a deeply cultural and social and emotional and human one.  Faces are, as I’ve argued in my books and articles, a key part of how we make sense of others, build relationships, communicate, make judgements.  Recognizing faces helps with interpreting emotion.  It tells us something about where people are looking and what they might be looking at.  All this gives us cues about how to interact with others and our surroundings.  Recognizing faces can help us recognize social cues about how to act and what to do in a given situation, and with a given person.  We spend quite some time on how we present our own faces, and we imagine we know all sorts of things about others based on their faces.  The face is both a thing and a collection of things and feelings and ideas.  It has a history and that history is changing.  Face recognition, and the invention of the face recognition spectrum, is part of that history.  The naming that emerged with these categories of “face blindness” and “super recognition” helped people understand something about themselves and how they make sense of others.  They gave name to experience, and in so doing, created new kinds of experiences.  This is true of all categories, but there is special resonance to the face.  Because are faces are, or at least we think they are, who we are. 

Face Recognition

A lot of things have to happen in the brain for us to recognize faces.  It’s actually less extraordinary that some people can’t do it than that so many of us can.  People, in general, are pretty good at recognizing faces; a face may often seem familiar even when we can’t remember names or context.  For some people, it just doesn’t happen as well, and for others, it doesn’t happen at all.  And it’s one of those things that seem to be impossible to understand how it works in others.  As a person who recognises faces pretty well, face blindness just doesn’t make sense to me.  There are all kinds of metaphors and explanations and attempts: imagine you were shown a picture with a pile of lego of different lengths and colours.  Imagine the picture is then taken away.  You would certainly know and recall that it contained lego, and maybe even some broad features of color and shape.  But you are unlikely to remember precisely the order and configuration of each piece.  That, maybe, is what face blindness is like: people can remember that they saw a face, with eyes and a nose and a mouth.  But which eyes; what nose; whose mouth, disappears immediately the face is gone.  Voices, to those with an ear or who have developed this adaptation, may offer consistent clues.  Gait is often ingrained and can be linked to a particular person.  Hairstyle and shape, distinctive piercings and moles and tattoos and glasses all contain lasting resonance.  Face blind people rely heavily on such markers.  But many of these markers can change, sometimes with no notice.  That leaves face blind people without reliable ways of recognizing others; a change of hairstyle or clothing may mean that someone who was identifiable in the morning becomes impossible to distinguish in the afternoon, no matter how hard they look. 

For about 1-2% of the population, no amount of staring at a face will help.  No amount of training will help.  Colour blind people cannot be taught to see colour.  Face blind people cannot be trained to see faces.  Profoundly face blind people simply will not recall the features of a face.  Others can do it slightly better and so on and so on, with the bulk of the population mostly able to mostly recognize most faces.  Relationships help.  Repeated exposure helps.  Paying attention – for most people – helps.  Sharing a powerful moment helps.  And, while memory and face recognition are broadly unrelated at the extremes, memory, taken in conjunction with everything else, helps.  The top 1-2% of the population can do it better than anyone else.  And everyone else can’t be trained to do that either.  How odd it would be to condemn a colour blind person for not being able to distinguish red and blue.  And how odd it would be to castigate someone for failing to recognize a face, or, indeed, for recognizing only some faces rather than essentially all of them. 

Face Blindness and Super Recognition

When face blindness was first described, scientists thought that it was a pathology, a disability that some had to greater or lesser degree.  And everyone else could just recognize faces more or less equally well.  That changed pretty dramatically when Harvard post-doctoral fellow Richard Russell and his team clinically identified super recognition in 2009.  If there is a bottom 1-2%, they theorized, there is likely a top 1-2%.  Those are the supers.  And while they aren’t perfect at face recognition, whatever that means, they perform at the top end of the scale compared to the rest of the tested world.  Which means that it’s still a pretty big bucket, and that the top 1-2% of the top 1-2% are going to look significantly different than even other super recognizers.  As I discuss throughout my forthcoming book, supers are extremely good at a wide variety of face recognition skills: matching images to people or other images; aging people over time; and recalling people in different contexts and identifying them as the same.  While super recognizers do not have a photographic memory for faces, and they actually do sometimes forget a face, they do it much less than everyone else.  Really, super recognizers recall faces independent of the depth of the interaction or relationship they have had with someone.  Most of us recognize the faces of those we know and love better than anyone else.  We are more likely to recall those with whom we have shared a powerful experiences.  For supers, even a brief or fleeting or non-interaction with someone is often enough.  That doesn’t mean they recognize all faces always: it does mean they recall most faces better than others.  Even those they have encountered only briefly, and without meaningful exchanges or relationships. 

Diagnosis or Explanation?

Facial recognition does not exist in a vacuum.  We all recognize faces differently in different contexts and with different cues, even for those of us who can’t do it at all.  In some ways, actually, it’s easier now to get by without recognizing faces, especially if you spend a lot of your time interaction with others online.  (As I write this, we are two years into a global pandemic in which faces are often masked and maybe universally unrecognizable in public, and most encounters with others are on digital platforms that provide names below the faces.  As most of the world got zoomed out, a small group of people quietly celebrated the ability to always know to whom they were talking.  For face blind people, zoom was an unlooked for, unasked for gift that gave the elusive possibility of recognition.)  Recognizing people has never been harder and never been easier.  But also: there are a lot more faces now.  And we encounter them a lot more both in person and through media.  

We can know people don’t recognize faces from their testimony.  But – and this is important – there are a lot of ways to be bad at recognizing faces.  So: is face blindness a proscriptive term or a descriptive one?  Is it a diagnosis or an explanation?  The answer is, of course, yes: it is all these things.  Faceblindness, or prosopagnosia, is a very specific term generated in a specific moment in history with specific reasons, narratives, and causes.  It has to do with specific stuff in a specific part of the brain.  And maybe some of those people in the past had that stuff in their brains, and maybe not.  It’s interesting, of course, to speculate as to whether some of these case studies with associated recognition challenges were actually examples of face blindness.  Many people have made precisely those speculations.  Others refuse to. 

I, as ever, say yes and. 

Author Bio

SHarrona pearl

Sharrona Pearl is Associate Professor of Medical Ethics and History at Drexel University.  A historian and theorist of the face and body, Pearl has published widely on Victorian history of medicine, media and religion, and critical race, gender, and disability studies.  Her current book, from which this material is drawn, is on the face recognition spectrum from face blindness to prosopagnosia and is forthcoming from Johns Hopkins University Press.  This book is the third in her face trilogy, following  Face/On: Face Transplants and the Ethics of the Other and About Faces: Physiognomy in Nineteenth-Century Britain.  She is currently writing a book on “The Mask” under contract with Bloomsbury Academic.  Pearl maintains an active freelance profile, with bylines in a variety of newspapers and magazines including The Washington Post, Lilith, and Real Life Magazine.  Say hi on twitter @sharronapearl.

Further reading

view all

March 10, 2023 | 4 MIN READ

The making of a blueprint. How historical, qualitative research should inform face transplant policy and practice.

January 23, 2023 | 4 MIN READ

Before and After? What the humanities bring to medical images

January 23, 2023 | 4 MIN READ

Diminishing their Voices: Face Transplants, Patients, and Social Media

January 23, 2023 | 4 MIN READ

Robert Chelsea and the First African American Face Transplant: Two Years On

January 23, 2023 | 4 MIN READ

History has Many Faces: researching histories of facial surgery

January 23, 2023 | 4 MIN READ

When face transplants fail: Carmen Tarleton and the world’s second retransplant

January 23, 2023 | 4 MIN READ

Drag Face: exploring my identity through masculine performance

January 23, 2023 | 4 MIN READ

Future Faces

January 23, 2023 | 4 MIN READ

Reflecting on Reflections

January 23, 2023 | 4 MIN READ

Owning My Face

January 27, 2023 | 4 MIN READ

Portrait of an Angry Man – or not?

January 23, 2023 | 4 MIN READ

Picturing Death: Dealing with Post-Mortem Images

Filed Under: facial recognition, guest blog

Before and After? What the humanities bring to medical images

March 28, 2022 by Fay

Before and After? What the humanities bring to medical images

The Author

Graeme Heward

In this short video, Graeme Heward shares his experiences of facial surgery, and project lead Fay Bound Alberti discusses what the humanities bring to medical images.

Before and After? What the humanities bring to medical images

AboutFace cares about the experience of patients and centres them as important historical narrators in the history of medicine. While before-and-after photographs serve an important medical function in recording a physical journey, our research goes behind these images to understand patients’ journeys, including the emotional and physical journey they go through. This video features Graeme’s story, and was produced by filmmaker Barry Gibb. Graeme is a physiotherapist who sits on our Lived Experience Advisory Panel (LEAP), and who has undergone more than 30 surgeries following a diagnosis of sinonasal cancer. Below the video, Graeme reflects on his feelings when watching it back.

Please note that this video contains graphic images of facial injury. If you would prefer not to view these, you can listen to the audio file below, or read the transcript here.

“The first thing I noticed on the video was the sound of my voice.  It was a little nasally however I was articulating my words quite clearly.  Even since that video my prosthetic has been improved and we are constantly trying to improve my appearance with facial stimulation and I’m looking forward to additional magnets soon to keep my prosthetic in better apposition.

It doesn’t make me feel sad to see the video.  It shows how despite some pretty brutal surgery the body and mind does recover and offers a new beginning.  As Fay says, it is not always a smooth passage through difficult times which I’ve described previously as a rollercoaster ride. It reminds me that the prosthetic (which I love) was spawned from a nasal reconstruction disaster not the initial consideration or intent of the surgeon.  I hope that there has been some reflection of my case and that future patients might benefit from a different approach.  I’m pleased the video will be up there.  As a subject it is easier to appear on video than in person – it softens the connection and emotion.

The video shows some brutal images which demonstrate the reality of the situation.  It also shows me smiling and happy in several frames.  There are many images of different phases of facial surgery and disfigurement which help to demonstrate the journey.  It is not just me who has to acclimatise to these changes.  My partner, sons, family and friends quickly get used to my new appearances.  They say it’s still me underneath!  I think Fay describes the before and after as I feel it and my appearance and words are accurately portrayed.”

Transcript – Before and After Photographs: What the humanities bring to medical images

Graeme Heward:
My name is Graeme Heward. I’m 60 years old and I’ve been dealing with sinonasal cancer for over 10 years. I’ve had thirty-two ops, two bouts of radiotherapy, and two chemotherapy cycles, and my average op duration is 3-4 hours. I’d say that six of those ops were absolutely brutal.

Fay Bound Alberti:
Before and after images have become so commonplace in 21st century culture, whether it’s weight loss stories or environmental impact, that we don’t notice anymore that we’re being led to interpret images in this way: as an absolute change from one state to another. Behind before and after photographs of facial transformation is a messy world that often includes adjustments, pain, failures, hope, maybe acceptance. AboutFace explores the history and cultural meanings of face transplants and facial surgery, and one of the key themes that we work with is the idea of ‘before-and-after.’ We take an interdisciplinary, historically informed approach to look at what’s happening when we put together images in a particular way, including the psychological transformation that is expected to accompany a physical one in the before-and-after sequence.

Graeme:
Radiotherapy, I had twice for mopping up following tumor removal. On each session, I endured a plastic mask formed to my face and shoulders that pinned me to a solid plinth. It was horrendous and it brought me to my knees. I was referred by my ENT [ear, nose and throat] specialist to a plastic surgeon. It didn’t go well. The surgeon tried to recover the situation in a further three brutal operations. On reflection, I had a very poor, life threatening experience, with a consultant who I felt was experimenting on me.

I’ve had some crazy appearances throughout my journey. Most notable was a pedicle graft from my forehead to my nose, which resembled the shape of a penis. And the second was a flap graft, from my thigh to my face, which looked like a panty-pad stuck to my face. I’m on my third prosthetic now, in three years. Each time it is a better likeness of my former self. I feel like I’m clawing back something that had been taken away, principally by the cancer.

Fay:
Now this ordering of before-and-after, which makes complete sense from a medical perspective in showing the visible impacts of surgery, matters because it implies a journey that it is not always as straightforward as it seems. AboutFace considers the language and framing of transformative surgeries in visual images, and asks how can we connect to and explore these stories that are hidden from view? Working with people like Graeme helps us to see why it is that bringing together arts and humanities approaches, that look at the history and the ordering of medical photography, for instance, reveals new insights about the social and emotional impacts of surgery. It also helps us think about the cultural meanings of facial transformation in a more human centred way.

Graeme:
My modus operandi has always been to carry on as normal, then other people will follow suit. In ten years of facial disfigurement, I’ve had very little trouble with comments. It’s mostly staring. I’m not for adults staring, but for kids I think that it’s an opportunity to learn something new and how to behave. They’re fascinated by something different and I answer them honestly, like “where’s your eye gone?” Well, it’s a fair question! Smile and the world smiles with you. If I can laugh at myself, then other people can too.

Further reading

view all

March 10, 2023 | 4 MIN READ

The making of a blueprint. How historical, qualitative research should inform face transplant policy and practice.

January 23, 2023 | 4 MIN READ

Before and After? What the humanities bring to medical images

January 23, 2023 | 4 MIN READ

Diminishing their Voices: Face Transplants, Patients, and Social Media

January 23, 2023 | 4 MIN READ

Robert Chelsea and the First African American Face Transplant: Two Years On

January 23, 2023 | 4 MIN READ

History has Many Faces: researching histories of facial surgery

January 23, 2023 | 4 MIN READ

When face transplants fail: Carmen Tarleton and the world’s second retransplant

January 23, 2023 | 4 MIN READ

Drag Face: exploring my identity through masculine performance

January 23, 2023 | 4 MIN READ

Future Faces

January 23, 2023 | 4 MIN READ

Reflecting on Reflections

January 23, 2023 | 4 MIN READ

Owning My Face

January 27, 2023 | 4 MIN READ

Portrait of an Angry Man – or not?

January 23, 2023 | 4 MIN READ

Picturing Death: Dealing with Post-Mortem Images

Filed Under: faces, facial surgery, guest blog, Visible Facial Difference

History has Many Faces: researching histories of facial surgery

May 17, 2021 by Fay

History has Many Faces: researching histories of facial surgery

The Author

Emily Cock

For Face Equality Week 2021, Emily Cock writes about encountering facial difference in historical documents, and the associated emotional and ethical issues.

History has Many Faces: researching histories of facial surgery

This is a post about the conditions in which I am able to research facial difference in early modern history. It is a post about the ways in which book provenance and the building of research collections tie sixteenth-century facial surgery and medicine to the more recent past, and to contemporary ethical issues faced by libraries, archives, and the people who use them. Ultimately, it is a post about the historical research and book collection of physician Ernst Alfred Seckendorf, who was born in Nuremberg on 30 December 1892, and murdered in Auschwitz concentration camp on 11 February 1943.

Dr Seckendorf occupies a small note in a spreadsheet I constructed for my book on early modern rhinoplasty. I was recently reminded of this note while listening to one of the Folger Library’s brilliant 2020-2021 Critical Race Conversations talks. The conversation was a rich discussion between Urvashi Chakravarty and Brandi K. Adams on Race and the Archive. Please do check it out soon.

Adams and Chakravarty cover a lot of ground in the session, but I was particularly struck by their notes on the role of white supremacy in constructing and regulating access to archives. The presence of Seckendorf in my notes on sixteenth-century Italian facial surgery is an illustrative point that all research collections can prove this true, and that efforts to shed light on the stories of one discriminated-against minority can be contingent on the exploitation, subjugation, or even annihilation of another.

Seckendorf and sixteenth-century facial surgery

Seckendorf was a former owner of Chicago Northwestern University’s copy of a pirated edition of Gaspare Tagliacozzi’s De curtorum chirurgia per insitionem (1597; this edition was printed in Frankfurt in 1598 as Cheirurgia nova). As I began to research the provenance of copies of Tagliacozzi’s book during my PhD, I emailed libraries around the world for information on their holdings. I regret that Northwestern’s correspondence was lost with the end of my email account for that university, so I cannot name and thank the librarian who helped me at that institution (I have learned from this mistake in my practice, and now always try to acknowledge this labour!).

In this book, the Bolognese surgeon Tagliacozzi (1545–1599) detailed how a skinflap from the arm could be used to reconstruct a nose, lip or ear. Surgeons would continue to use this skinflap technology into the twentieth century: Sir Harold Delf Gillies (1882–1960), who led the immense developments in plastic surgery in WWI, conceded that the ‘There is hardly an operation – hardly a single flap – in use to-day that has not been suggested a hundred years ago.’ Tracing copies of Tagliacozzi’s and related books helped me to explore the circulation and reception of these ideas in the intervening centuries, and thus levels of access to facial surgery techniques for people with significant facial difference from injury, illness, or other causes.

According to the city’s Wiki, Seckendorf practiced in the Bavarian town of Fürth from 1921, specialising in skin, urinary and venereal diseases. He had an interest in medical history, which extended to translation of Latin texts: his German translation of Italian physician Girolamo Fracastoro’s (c. 1476/8-1553) Syphilis sive morbus gallicus (1530) was first published in 1960. This was the first text to use ‘syphilis’ for a disease that plagued early modern Europe, accruing many pejorative and often xenophobic names. I am grateful to Sara Belingheri at the closed Wellcome Library for providing an ad hoc scan of the book’s biographical notes on Seckendorf and Fracastoro by German dermatologist and medical historian Walther Schönfeld (1888–1977). 

How research collections are formed

Last year, AboutFace hosted a workshop and published a series of posts about the emotional and ethical dimensions of researching and publishing medical images of the face. The contributors raised important issues about the invasion of the photographed person’s privacy, acknowledging and negotiating the emotional effects of these images on the researcher, and using difficult images in teaching, among other topics. But my contribution today perhaps shares the most ground with Michaela Clark’s call to heed the tactile and material when thinking about the photographs and other sources that researchers use to understand historical experiences and ideas of facial difference. In the case of Seckendorf’s copy of Tagliacozzi in an American university library, what conditions have contributed to the construction of archives and public availability of research materials? 

Seckendorf tried to leave Germany in 1937 but was denied. He is still listed in a 1937 medical directory as a “Jewish specialist for skin and venereal diseases” (in Schönfeld, 19). He was arrested in January 1938, officially for performing abortions and for attempting to marry a non-Jewish German woman. Most online portraits of Seckendorf are the photographs used by the police after his arrest, and in the Nazi media when targeting him just prior (see the news clipping on the general German Wiki). It was therefore striking to see an alternative, personal photo used on the Fürth Wiki page. These photographs are, after all, a new archive through which the public understanding of Seckendorf is to be built up, and the choice of image a very deliberate and consequential move. 

There are provenance notes inside the copy of De curtorum chirurgia that can be used to trace some of its sale history. At one point, publisher J.F. Lehmann sold the book in Munich. Someone purchased the book from the still-extant Munich Karl & Faber auction house in 1932. One of these purchases, or possibly even the selling of the book, might have been by Seckendorf. I do not know the circumstances behind Northwestern University Library’s acquisition of this book. Perhaps the prominence of Seckendorf’s bookplate at least indicates a disinterest in denying or destroying the book’s provenance by whoever sold it to the library.

But millions of books were stolen from Jewish owners, including on Jewish topics, with restitution a slow process that receives less attention and funding than for more glamourous objects like priceless art. Schönfeld says that Seckendorf had an extensive (‘umfangreiche’) library of medical literature and history. Further research by people more skilled in twentieth-century German book history than myself will be required to establish the full circumstances of his collection’s dispersal. 

Provenance as ethical practice

I do not know enough about Seckendorf’s practice to explain the specific information he might have gleaned from De curtorum chirurgia, but it intersected with his specialisations in the skin and venereal diseases, since destruction of the nose was strongly associated with syphilis. He published a number of articles on medical history and on current practice. I argue in my book that some surgeons in controversial fields like plastic surgery used history and bibliography to defend their practice: operations to reshape the nose, for example, were not just products of ‘modern’ vanity, but had histories of development to help men injured in wars, duels, and other honourable, masculine pursuits. Perhaps Seckendorf saw similar value in contributing to the historical understanding of venereal and skin diseases.

Tracing books by previous owner is a difficult process: provenance information is often held in libraries’ private or less-searchable catalogue metadata, assuming that they have had any budget to research and catalogue this information to begin with. Nevertheless, I hope that it is only a matter of time before Seckendorf’s library can be reconstructed, if only as a digital catalogue, and his contributions to medical history better appreciated.

In the meantime, Seckendorf’s copy of De curtorum chirurgia, and Adams and Chakravarty’s discussion, remind us of the many historical figures, structures and processes entwined around the research materials that we can sometimes take for granted.

Author Bio

Emily Cock is a Lecturer in Early Modern History at Cardiff University, and author of Rhinoplasty and the nose in early modern British medicine and culture (Manchester University Press, 2019). Emily’s research explores early modern social and cultural histories of medicine, sexuality, and disability.

Further reading

view all

March 10, 2023 | 4 MIN READ

The making of a blueprint. How historical, qualitative research should inform face transplant policy and practice.

January 23, 2023 | 4 MIN READ

Before and After? What the humanities bring to medical images

January 23, 2023 | 4 MIN READ

Diminishing their Voices: Face Transplants, Patients, and Social Media

January 23, 2023 | 4 MIN READ

Robert Chelsea and the First African American Face Transplant: Two Years On

January 23, 2023 | 4 MIN READ

History has Many Faces: researching histories of facial surgery

January 23, 2023 | 4 MIN READ

When face transplants fail: Carmen Tarleton and the world’s second retransplant

January 23, 2023 | 4 MIN READ

Drag Face: exploring my identity through masculine performance

January 23, 2023 | 4 MIN READ

Future Faces

January 23, 2023 | 4 MIN READ

Reflecting on Reflections

January 23, 2023 | 4 MIN READ

Owning My Face

January 27, 2023 | 4 MIN READ

Portrait of an Angry Man – or not?

January 23, 2023 | 4 MIN READ

Picturing Death: Dealing with Post-Mortem Images

Filed Under: ethics, faces, facial injury, facial surgery, guest blog, history

Drag Face: exploring my identity through masculine performance

January 21, 2021 by Fay

Drag Face: exploring my identity through masculine performance

The Author

Isabel Adomakoh Young

Isabel Adomakoh Young discusses identity, race, and performing as a drag king in this week’s guest blog. Don’t miss our other blogs exploring the connections between faces, expression and identity: Daring to be Different, by Amanda Bates and Owning by Face, by Marc Crank.

Drag Face: exploring my identity through masculine performance

As a young woman in the final years of her Bachelor’s degree, I had a complex relationship with my face already. It’s well known by now that women are under an onslaught of marketing and socio-historical pressure to take issue with our natural appearance. Young women, only just getting to know themselves and how they interact with the world around them, are susceptible to this in specific ways. 

Then there was the fact of my being one of a handful of brown faces across the entire university – “the beans in the rice”, as an African American man I once met put it. I was lucky enough, however, to have been raised with priorities beyond surface appearance, and with a sense that I was both Ghanaian (father’s side) and English (mother’s), rather than neither. I was also lucky that my appearance passed for ‘normal’ in all the insidious ways that make some people’s lives easier and some people’s incredibly hard.

I appeared confident enough to my peers, apparently, to be invited to perform in theatre shows, which I did with some trepidation and a lot of enjoyment, until one day I was asked, quite out of the blue as it seemed to me, if I wanted to come to a drag workshop. An actor I knew a bit had cooked up the idea with a director to get a group of women together and explore ‘drag kinging’. It was the first time I’d heard the phrase and it took me a moment to understand. Drag queens are historically men exploring femininity, so… kings must be women exploring masculinity! It makes perfect sense when you think of it, but I certainly never had. 

As the years have gone by since, I learned that not many people have, even now. (The binary concept of swapping opposites has also been exploded by the fantastic variety of drag performance I’ve since encountered, across the gender spectrum. But that was all still to come.) And they’d chosen me, for reasons I was never clear on, as someone who ‘might be interested’. I was.

Image credit: Alex Wojcik

A group of us met in a big college space they’d booked, with carpeted floor and wraparound windows. The two directors did a little presentation; some quotes from gender theorists, images of music hall performers, 80s musicians, smoky cabaret shows, boy bands. Gradually, we moved from discussion to action, pulling on miscellaneous pieces of clothing people had brought, watching the lines of our bodies alter. We asked, what makes a man? What do we do that most men don’t? How would you signify masculinity without words? What might your body do in public space? Alone? What is male seduction like? What about men who don’t read as conventionally masculine? It was fascinating. 

I suddenly became aware how hard I worked, almost unconsciously, to signify femininity to those around me. Decisions I’d made years ago, as a pre-teen, about “what a woman does”, how my face rests or moves, where and how my body should be. Weight on one leg, give way on the pavement, lively smile not slack neutrality. Attractiveness, passiveness, correctness. I’d grown out of ideas like putting your tongue in your back teeth when you smile, or perfecting the America’s Next Top Model “smize”, but there were stealthier, less conscious things still in there. Feminist activism had highlighted oppressive norms to me by then, but not down to my own physicality. 

I realised then that I could let go of some of those behaviours; the ones that I’d chosen not from a place of authenticity but of fear and shame, the ones that didn’t express me.

Not many of the group knew each other, but we leaned in close, sharing eyebrow pencils and contour brushes in what would become a familiar routine, but was, that first time, revolutionary for us. With the scanty internet guidance we could find, and lots of discussion, we re-invented ourselves. Moustaches and beards, sure, but subtler things too. Of course each man is different, but how to signal masculinity to an audience? Might eyebrows be heavier, might an adam’s apple protrude more, a jawline be more square? The art of contouring; many of us were well-practised in traditionally feminine makeup, but now we were in uncharted waters, our old habits useless. It was exciting. I followed along with the group’s decisions, only later recognising that a broad rule for Caucasian men may not be right for a mixed-race king.

Image credit: Stephen Allwright

We laughed as students walked unwittingly past the huge windows, thrilled to be in these new unfamiliar guises. Looking into a hand-mirror, I saw someone known and unknown, like a long-lost brother. As a child, I’d been a tom-boy for years, wishing in some nebulous way to “be a boy”. What if that kid could see me now? I even found my face moved differently; my new character raised one eyebrow suggestively, hooded his eyes and held a sleepy half-smile. He pleased an imagined audience without trying. Where did this all come from?

As we explored the theory of drag more – discussing performative gender, preconceptions and limitations, norms and expectations – the fact that masculinity really is seen as the default was brought home to me. Part of what was so liberating about drag kinging was that we were breaking free of the age-old principle that a man is a blank slate, full of potential and possibility, but a woman is a set thing, constrained; a thing to get right or wrong. 

When we’d formed our company Pecs Drag Kings, and told people about it, we often met blank looks, questions like “But what do you even do?” etc. It takes some thought to realise that masculinity is just as performative as femininity. Just because men mostly don’t paint their faces these days doesn’t mean the concept’s not hugely contrived. Our fun, high energy, surprising cabaret shows bring that truth into focus in technicolour.

Image credit: Harry Elletson

While I’m proud of the brilliant work Pecs make, and the fascinating conversations it sparks – which I love eavesdropping on in the bar after the show – I am most grateful to drag for helping me to find my own gender expression. By pushing boundaries and exploring possibilities, I’ve found a more authentic version of my day-to-day self; in my appearance and in how I move through the world. I set the terms of my gender expression now, each and every day. I’m glad that through our workshops and shows we sow those seeds in others too.

Author Bio

Isabel is a queer theatre-maker, voiceover and writer of English and Ghanaian origins based in London. After studying English at Cambridge, she trained with NYT Rep, then joined the Royal Shakespeare Company for 2019. She co-created the binary-bending collective Pecs Drag Kings, inclusive arts event Brainchild Festival and the bestselling ‘Lionboy’ book trilogy, adapted and toured globally by Complicité.

http://www.isabeladomakohyoung.com/

Further reading

view all

March 10, 2023 | 4 MIN READ

The making of a blueprint. How historical, qualitative research should inform face transplant policy and practice.

January 23, 2023 | 4 MIN READ

Before and After? What the humanities bring to medical images

January 23, 2023 | 4 MIN READ

Diminishing their Voices: Face Transplants, Patients, and Social Media

January 23, 2023 | 4 MIN READ

Robert Chelsea and the First African American Face Transplant: Two Years On

January 23, 2023 | 4 MIN READ

History has Many Faces: researching histories of facial surgery

January 23, 2023 | 4 MIN READ

When face transplants fail: Carmen Tarleton and the world’s second retransplant

January 23, 2023 | 4 MIN READ

Drag Face: exploring my identity through masculine performance

January 23, 2023 | 4 MIN READ

Future Faces

January 23, 2023 | 4 MIN READ

Reflecting on Reflections

January 23, 2023 | 4 MIN READ

Owning My Face

January 27, 2023 | 4 MIN READ

Portrait of an Angry Man – or not?

January 23, 2023 | 4 MIN READ

Picturing Death: Dealing with Post-Mortem Images

Filed Under: faces, guest blog, Popular Culture

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