The causes of facial disfigurement are myriad and complex. There are an enormous range of environmental and genetic factors involved in the formation of somebody’s face, meaning it is very difficult for scientists to correctly establish the reasons for inherited and environmental facial disfigurement. Other environmental factors, for example fire, more easily explained, though no less difficult to treat. This is a brief summary of what is known about some of the most common causes of facial disfigurement. Burns and fractures will not be covered here because they are self-explanatory.
Cleft lip and palate
cleft lip and palate are by far the most common facial disfigurement that people are born with. With so many babies being born with the condition, you would expect that they would be more reliable information as to why the condition emerges. However, the complexity of a growing child in the womb means that establishing the direct causes are difficult. We know from population studies that cleft lip and palate is at least partially genetic.
Populations in Asia and Latin America have much higher rates of cleft lip and palate, showing the condition is not just environmental. It is not directly inheritable; a boy whose father had a cleft lip is not that likely to have one himself. Boys are roughly twice as likely to have cleft lip and palate then girls, although why is not clear. Environmental factors for the pregnant mother appear to increase the risk of cleft lip and palate, including smoking, drug use and alcohol.
Other congenital conditions
The next most common congenital facial disfigurement is port wine stains. Even though every year 10,000 babies are born with port wine stains in the UK, nobody knows why they happen. They’re not life-threatening but they can severely impact someone’s quality of life.
Apert’s syndrome, which is a rare bone formation disease, comes from a single mutation on a single gene. Treacher Collins and Crouzon’s syndromes have identifiable genetic causes as well, with mutations on chromosomes 5 and 8 respectively. Moebius’ syndrome is not inherited but is the result of a rare genetic mutation.
Acne is the most widespread and common facial disfigurement in the UK, affecting 100,000 people every year. It is the result of an infection by the acne vulgaris bacteria, which usually lives peacefully in the skin until conditions during puberty change and the overproduction of skin oil, or sebum, and hormonal changes produce the right conditions for the bacteria to spread and cause infections.
A great deal of research has shown most of the causes of acne. However, properly effective treatments are still not available for everybody.
Stroke and Bell’s palsy
A stroke is a blockage in an artery in the brain, cutting off blood circulation to parts of the brain. When a blockage stops blood from getting to the part of the brain that controls the facial movements, that part of the brain can die. Without it, a person has no ability to control their facial muscles. The brain can rewire itself to control them again but this takes a lot of time and therapy.
Bell’s palsy has similar effects: the loss of muscle control in half or all of the face. The causes are very different, however. Nobody is exactly sure why Bell’s palsy happens, but it is thought that most are due to a viral infection. The most promising culprits of the moment are the herpes zoster and herpes simplex viruses that cause chickenpox, shingles, and herpes. It is possibly an autoimmune disorder, in which the body damages itself when it is fighting off an infection, real or imagined.
A leading cause of facial disfigurement is the surgery needed for removing cancers. Skin cancers are one of the most common forms of cancer in the UK and very often occur on the face. Surgery on the face is extremely delicate and removing any tissue can significantly affect how somebody looks.
Cancers of the head and neck are also leading causes of facial disfigurement. The removal of an eye, surgery in the mouth or jaw, or brain surgery can lead to large and noticeable scars or disfigurement. Reconstructive surgery is usually effective at combating this disfigurement, however, many people have lifelong changes to their appearance.
Although removing an eye is an uncommon result of surgery, it is one of the most noticeably disfiguring conditions. Prostheses are remarkably good these days but cannot match a real eye and people are disproportionately affected by seeing people who are missing an eye.
Thousands of people develop or are born with a squint. This can be caused by problems with the muscles that move the eyes, the nerves that control the eye muscles, or the part of the brain that controls the nerves.