"Six months ago I was diagnosed with cancer of my mouth and I was rushed into hospital where they removed the tumour. Although I'm very grateful the cancer has been taken out, the surgery has left me with a different appearance and my voice has changed. I don't feel I can tell anyone about how I feel in case they just think I'm being vain."

You’ve been through an extraordinary event. Receiving a diagnosis of cancer can be very frightening and the treatment you received happened very quickly and with long-term consequences. Of course you are grateful the cancer has been removed, but this doesn’t mean that you will not mourn and feel sad for the physical and functional changes that have occurred. Your concerns are not an indication of vanity, but just a very normal response to the losses you have incurred.

Rather than trying to cope with these feeling on your own, tell your family and friends that you are finding the changes to your appearance and speech difficult. You may find that they want to give you the support you need but don't know how to ask you. You can also receive support about adapting to these changes from a Specialist at Changing Faces.

"My friend developed bells palsy six months ago and this has left her with a drooping eye and mouth on one side of her face. I would like to help her, what can I do?"

Your friend has undergone an unexpected change to her appearance, and she may possibly be going through a period of grief. Your support could be invaluable. One of the most essential ways to help your friend is just by offering a listening ear. Verbalising that you are willing and able to listen to her when she is ready to talk can be very supportive. Your friend may want to talk through how she feels – about her sadness at the loss of her previous appearance and associated identity; about her anger at the unfairness of developing the palsy; and about her fears for the future.

It’s not unusual for friends and family to feel rather powerless when faced with the distress of a loved one. In your desire to help, you may wish to offer the reassurances that everything is going to be okay and in the long term we hope this in the case. Right now though, whilst these reassurances are well meant they could be construed as if you are not truly hearing her concerns.

Ask your friend how you can help her. She may ask that you just listen, or she may have some more practical needs that you could really help her with, i.e., accompanying her to the shops if she feels self-conscious. If your friend can’t tell you how you can help, then just be present, offer a hug, or perhaps even be a distraction when she needs it.

"I don’t have what I call a "severe" facial disfigurement, but I’m unhappy about the scarring that remains following my car accident. Are you able to help me? I don’t want to waste your time."

Yes, we can help you. Sometimes people can be worried that unless their condition is very noticeable or large they cannot ask for help. This is not the case. We hear from people with various conditions that have affected their appearance, and experience plus research tells us that the size of the "difference" does not necessarily relate to how that person feels about their appearance or how they cope.

More importantly, how you feel about your self is what ultimately matters, and your subjective experience of your difference informs us much more about your distress than the size of your scarring.

It could be useful to explore what it is about your scarring that is making you feel unhappy. Do you feel it is preventing you from doing things in your life? Do you think it will reduce your chances of finding a partner? Do you feel that you are somehow less valuable or lovable as a consequence of having a scar.

Sometimes the value we place in different aspects of ourselves can influence how we cope when those parts of us change. Understanding your underlying thoughts and beliefs may enable you to make some different choices about how you live with your scarring, and how you present your self to other people.

"I’ve decided to go for surgery. Are there ideas or suggestions that may be helpful to consider?"

Firstly, preparation is key. You need to ensure that all your queries and concerns have been answered by the appropriate health professional. This is a really useful means of managing any anxiety. If you still have any outstanding questions write them down in a notepad or diary and take them with your to your hospital appointment. Ask your doctor or nurse before the surgery about what to expect in as much detail as you feel comfortable. Will you have any drips, drains? What about pain relief? How can you communicate if you can't speak immediately afterwards? Involve your family in thinking about what questions you can ask.

It can be helpful to devote some time to thinking about how you want to first see your new appearance. Even if the surgery is something that you are anticipating will have a positive affect in your life, it can still nonetheless be a shock when you first see yourself. This also applies to family and friends. Perhaps you could think about if you would like someone in particular to be with you when this happens? Alternatively, would you prefer for someone else to offer a description of your appearance before you see it? Would you rather be on your own? If you have a particular idea of how you would first like to see your self, it’s essential that you communicate this to your medical or surgical team so that you have some control on this.

Finally, it’s not unusual for some people to still feel a sense of loss for their changed appearance, even if it is one of choice. This can manifest in feelings of sadness, tearfulness, and perhaps uncertainty. This reaction is perfectly normal, but anticipating that this may happen, can enable you to process your feelings more easily.

"I think about my appearance all the time but my friends tell me I look normal. It is starting to disrupt my life, what can I do?"

Some people contact Changing Faces expressing great distress about their appearance. They may feel depressed or highly anxious about the way they look, and feel that their "looks" are attracting lots of negative attention from other people.

Are you finding it difficult to concentrate at work, on your studies or usual activities? Do you try to avoid other people, or try to hide the part of your appearance that you perceive as abnormal or ugly? If your concerns about your appearance are affecting your behaviour and you have been feeling distressed for a few months now, it is important that you seek some support.

The first step to take is to speak with your GP. If there is a medical reason for your change in appearance, it is important to have this checked out. It is possible however that you may be experiencing a condition known as body dysmorphic disorder or BDD. This is a serious condition that can cause considerable distress for the person experiencing it, and for their family and friends. The main impact of the condition is that the individual thinks excessively about either a slight physical difference or perceives that some part of their physical appearance is abhorrent to others although others do not perceive this.

If you think that you may be experiencing symptoms like those of BDD we suggest that you talk to your GP. A referral can then be made to a specialist who will talk through your concerns, and you may be offered treatment in the form of cognitive-behavioural therapy, or medication, or perhaps a combination of the two. Whilst there are still many questions about BDD there is strong evidence to indicate that the condition is linked with a chemical imbalance, and this can be greatly improved with the use of medication.

If you want to know more about this condition, please take a look at the following websites:
http://www.phobics-society.org.uk
http://www.ocdaction.org.uk/home.htm

"I've just been in an accident and it's left me with a big scar on my face. I feel depressed a lot of the time. I just don't recognise myself anymore."

The way you're feeling is perfectly normal. Depression can be part of the grieving process that many people go through following the loss of their appearance. You may also be feeling angry, tearful and resentful. Don't be hard on yourself. You need lots of support right now so try talking to your family and friends about how you are feeling. Changing Faces can also offer support and advice. If you are finding it difficult to eat and sleep, we suggest you visit your GP who should be able to help.

"I've lived with my condition all my life and feel I've done well. But I'd really like to meet someone special now. Is that going to be possible with the way I look?"

We meet many people who have disfigurements in happy, healthy relationships who also wondered if they'd ever meet someone special. You may be worried about being rejected particularly if this has happened at other times. It's important to believe that you can attract a potential partner. This might require challenging some old beliefs about your self-worth and developing some new skills to feel more assertive and confident when you embark on the dating circuit.

Changing Faces runs an Intimacy Workshop for people who want to explore some of the challenges involved in developing close relationships or resuming a relationship when you have a visible difference.

"I've been offered more surgery for my condition but I'm not sure whether to go ahead with it?"

Firstly, you need to make sure you have all the information you need from your practitioner. The most important question to ask is how will the surgery affect the appearance of my face / body and its function.

Secondly, you need to ask yourself some questions and look at your expectations around this surgery. Is this the right choice for you at the present time? Are you trying to please your partner, family or surgeon? Do you think the surgery will help you to feel more acceptable in the eyes of others? What difference will it make to your life and how you feel about yourself?

There are many ways to feel good about yourself and your appearance. Surgery is just one of those ways. If you want to talk this through with someone other than your practitioner or outside your family, you can contact Changing Faces.

"I want to change jobs. How can I present my visible difference as a positive quality?"

Many people who have a visible difference acquire exceptional communications and social skills to handle the reactions they get from the general public and put people at ease.

You may have learnt techniques to reassure people in your presence. You will probably be assertive when the situation calls for it but be able to tune in to other people's feelings and concerns. You may have lots of different ways of dealing with questions about your appearance and know how to use humour as an ice-breaker.

You may have found through living with a disfigurement that you have needed to put in extra energy and effort to hold people's attention and get what you want from a situation. In the same way you will be used to not giving up when a situation goes wrong but trying again knowing that practice makes perfect.

These are skills and qualities that any employer would value. Before you are invited to an interview think up some examples that demonstrate your communications and social skills and use them to introduce your disfigurement in a positive light.

"My child is in the school play this year. I want to see her in it but I feel so nervous in groups of people. How can I increase my confidence?"

What is it that you are nervous about? Are you concerned about other people noticing your difference, asking questions or ignoring you? Have you encountered these challenges in the past?

Preparing a variety of simple explanations to the questions you think you are going to be asked can help you feel more in control. It's a good idea to practice these with someone you trust. Also, if you'd like some support on the night, could you bring someone with you? If you think that your lack of confidence is affecting your ability to enjoy life, you could get in touch with Changing Faces for some advice.

"Since the fire, I've been having recurring nightmares and feeling very anxious. Can you help?"

After traumatic events many people do experience signs of post-traumatic stress. Changing Faces is not able to treat post-traumatic stress because the condition requires specialist assessment and treatment. The first thing to do is speak with your GP and tell him how you are feeling so that you can get some specialist help.

If you are also finding it difficult to come to terms with the way that the burns have affected your appearance you can contact Changing Faces and we will be able to offer you support and advice.