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The Face with Masoud Saman is a podcast about beauty, identity, and the human face. Hosted by facial plastic surgeon Dr. Masoud Saman, each episode explores the depths beyond what social media and the beauty industry show us. From filtered selfies to cultural ideals, we unravel how faces are judged, altered, and celebrated. It's not about chasing perfection. It's about understanding what we value, and why.
Welcome to The Face Podcast.
I'm your host, Masoud Saman.
On this show, we explore the human
face, not just as anatomy, but as
identity, memory, and social meaning.
The face is how we know each other.
It's how we navigate society,
and are recognized today.
I wanna talk about something that most
of us take completely for granted.
granted.
The effortless ability to recognize
thousands of faces across a lifetime.
By adulthood, the average person
can recognize at least 5,000 faces.
Some estimates suggest even more,
and yet none of us were born
with that ability fully formed.
So it's something that
develops slowly over years.
What makes faces so special that
the brain seems to carve out
distinct real estate for it?
It?
Why does the ability mature over such a
prolonged trajectory even into adulthood?
And what happens when it fails to
explore these questions and more?
I'm speaking with Marlene Behrmann.
Berman.
Marlene is a cognitive
neuroscientist and a professor
of ophthalmology and psychology
at the University of Pittsburgh.
Her research has been foundational in
understanding how faces are represented in
the brain, how face recognition develops
Why faces occupy such a privileged place.
In the human mind, in the human brain, and
how this skill unfolds across developments
and what its breakdown reveals about the
architecture of visual cognition, because
sometimes we learn more about something's
working when we study its failures.
Marlene, welcome.
Thank you so much.
You make it all sounds so exciting.
It gets me fired up all over again.
That's wonderful.
I'm so happy that you're here.
I'm so excited that you
accepted my invitation.
Let's start from the beginning.
How did you get into this amazingly
interesting field of study?
Like many people I know,
I was not born to study?
face recognition.
In fact, I discovered it in
a very circuitous trajectory.
I'd initially been trained as a clinical
speech pathologist and audiologist,
and I worked with individuals
who had communication deficits.
I was especially interested in the
fact that after stroke or tumors,
seemed to have lost the ability to
communicate a deficit known as aphasia.
And what struck me most about this
is I would go and see one patient
who had damage, say to area X of the
brain and their language impairment,
had very particular properties.
And then I went to see another patient.
Who also had damage to the same
area, and that patient showed the
same breakdown of their behavior.
occurred to me that there are clear
rules in the brain that govern
complex behavior after damage.
Behavior breaks down in these very
organized and predictable ways.
So how did I get into faces?
I want you to understand these rules.
So I went back to do a PhD and acquire
the skills to conduct research.
And in the course of my graduate training,
I was required to do a small side project.
And I studied some patients who
had lost the ability to recognize
faces after brain damage.
And this was.
Amazing.
There were so many questions.
they recognize animal
faces, cartoon faces?
Some of the patients don't recognize
themselves in photographs or
even their own family members.
And so this started me down this
path of trying to understand the way
the brain processes faces, here I
am today to talk about it with you.
That's fascinating.
So you had a complete 180 of your career.
You were boots on the
ground, clinical field,
diagnosis and treatment, and then
you decided to study the cause.
the cause?
Yep.
Exactly.
It is very fascinating what you're
telling me because prior to my,
my,
facial plastic surgery days, I was an
An otolaryngologist.
an otolaryngologist of course,
we worked very closely with.
Speech pathologist
yes pathologists.
I was a cancer surgeon, head and neck
cancer surgeon, so I did a lot of
laryngectomies, partial laryngectomies
we worked very closely and yes, I also
find these topics very fascinating and
without having known that about you, and
perhaps you didn't know that about me,
Yeah.
we came to this conversation about faces.
Why are faces in your opinion,
so important for us humans,
I think it's pretty obvious to everybody
that recognizing faces so crucial in,
and this is so in every day of our
lives, we use faces to identify friends.
We also use faces to identify foes.
And so in some sense it's critical
for survival and obviously it's really
important for social interactions.
But is that something that
we see across the species?
Do we see that with other
species who have preferential
processing for faces like we do?
it's a great question.
And actually a number of years ago, I set
out specifically to address this question
and did a cross species, a a phylogenetic
comparison of face recognition abilities.
I'll actually tell you that I
don't think that the human brain or
other species, brains have carved
out a very selective area that.
Only is able to perform face recognition.
So we can come to that a bit later.
But suffice it to say that
many other species use faces.
Of course, other primates use faces in
the way that humans use faces, but even.
Chicks are born and they
imprint on their parents' face.
They the template of their parents'
face, like in, in a newborn state.
That's how important face recognition
is for maternal bonding in that case.
But
Yeah.
faces are important.
And
And we see that with infants.
My own children.
I
I
they weren't so good at
recognizing my face, but maybe
about it took about a week.
I had to smile big and
make my eyes big and,
and
do certain things to trigger the activity
perhaps of this center of recognition
that after about a week, they knew when
it was me versus somebody completely.
Different.
And they would smile in, in response.
Sometimes it wasn't my face,
it was the light behind my
head or something like this.
And this kind of sounds like
a skill, it sounds like it's
something that we develop over time.
It's not something that
we're just born with and we
we
possess, and it's something
perhaps that needs to be
to be
practiced.
And what skill does one need
to be able to recognize faces?
So well?
We talked about 5,000 distinct faces.
What,
What
going on?
How are we doing that?
there?
Yeah.
There's no question.
I think there's consensus in the
field that it takes years for
humans to develop this kind of
expertise in recognizing faces.
We are efficient, we are.
It's done rapidly effortlessly.
and one of the big challenges is that
in the grand scheme of different things
we can see in the world, faces are
all remarkably similar to each other.
We've all got two eyes above a nose
that's above a mouth, and so it's
a challenge for the visual system.
Sometimes I think about face
recognition as like a stress test.
the visual system you have to
make fine grained discriminations
between individual faces.
So it might be easy to discriminate
between you and I now because I have
glasses, which is just, so obvious
and right upfront, dare I say.
but really the ability to recognize
faces is not very sophisticated at birth.
So yes, infants are able to recognize.
about faces, and particularly something
about their parents' faces because
they see them the most, almost
like the chicks imprint, babies
imprint on their parents' faces.
And they only, we know that they can't
even see very well soon after birth.
And so they only have a very rough
schematic of what your face looks like.
And then, as you pointed
out, over decades.
The system becomes increasingly
sophisticated and better configured.
Okay.
That that, that makes sense.
That explains why I have to do these
exaggerated things and show teeth and
make my eyes big for, to elicit some
sort of a reaction from a newborn.
But what is the consequence of losing
the ability to recognize faces?
I'm sure if this is a skill, then perhaps.
There was a possibility of losing it.
it.
So this is probably the scenario that
kind of got me excited about studying
faces is that I had this opportunity
to study individuals, adults who were.
Perfectly normal in face recognition
and after some kind of brain damage
lost that ability almost overnight.
It's extremely dramatic, and
really quite hard to understand.
They can see just fine.
It's not like they've gone blind.
They can probably even
say that it's a face.
They just don't know whose face it is.
So this is the disorder that we refer to
as prosopagnosia from the Greek meaning.
Without knowledge of the face.
And what's been, what was interesting
for me, what sort of caught me
initially was that I didn't need
to run sophisticated experiments.
I didn't need to like brush up
on my statistical knowledge.
I just had to show these patients some
pictures of their family members even.
they were unable to recognize them or even
photographs of themselves that they failed
to recognize unless they remembered the
context in which the photograph was taken.
And they told really
amazing stories like this.
One very astute young man told me that
he would go to the grocery store with his
mother and she would go down one aisle
and he would go down the other aisle.
And if they met up at the end of
the isles, he wouldn't recognize
her unless he remembered.
That, for example, she was
wearing a red sweater that day.
So it's
That's fascinating.
impairment and even reflecting on
it, there's something very surreal
or disorienting in not being able to
remember even your own family members.
Recognizing faces, it
just sounds like the most
basic, even though it's very
complex from a neurocognitive and
processing standpoint, but it sounds
like how we navigate the world.
And losing that ability can have
enormous consequences and quality
of life and how we function.
do these people then clinging
onto other visual cues.
cues?
Yes.
No question about it, but also
other cues like auditory cues.
So the same young man would say as soon
as his mother started speaking, it was
so obvious to him that was his mother.
Or other cues like hairstyle, one of
the patients told me that but she and
her husband were professors and they
went to some convocation ceremony
and they said they were going to go
and put on their professorial robes
and they'll meet back at this pillar.
So she comes in her robes and she's
standing there waiting and he is there
as well, but she can't recognize him
because he has changed his clothing.
My goodness.
It is dramatic.
And how common is this?
What is the incidence
and prevalence of this?
So this form of prosopagnosia that we've
been discussing this acquired form so that
it was normal and then something happened
and they lost the ability they acquired.
The prosopagnosia is extremely rare.
There are, however, there is, however,
a second group of Prosopagnosia
patients whom we've come to recognize
in about the last decade who seem
to be unable to recognize faces.
But that's always been the case.
Like they just never
learned to recognize faces.
So I refer to this as congenital 'cause
they always say it's like lifelong.
Yep.
people call it developmental, In my
mind, they failed to master the skill
of decoding the complex arrangement
of the features of the face.
It may be a little bit like, some
kids struggle to learn to read,
have developmental dyslexia.
This may be the right
hemisphere equivalent where they
fail to acquire the mastery.
Of recognizing faces, and
that is not so uncommon.
Several studies have suggested that this
occurs in about two out of a hundred
individuals, 2% of the population.
But do you, are you suggesting
that this is some sort of a skill
acquisition failure versus anatomic or
functional organic issue with the brain?
the brain?
Yes.
It's a great question.
There's a lot of debate
on this particular topic.
Will tell you because I can.
Quote, my own work here is that I am
definitely of the view that there's some
structural anomaly that is preventing
the recognition of faces, and in fact,
in a study that we did a few years ago.
We mapped out the circuit that
the information has to flow in the
brain in order to recognize faces.
There's a whole little set of regions
that all get activated together
to ensure face recognition, and we
showed that in these individuals.
Who failed to acquire face recognition.
There was like a break in the circuit.
The white matter tracks
between the two main nodes of
the circuit were compromised.
And I'm assuming this is
a functional MRI study.
It was a functional MRI study, and
Was like a structural
diffusion tensor imaging study.
Let's see.
add that these individuals
the more congenital version
it appears to run in families.
Which again suggests that there is some
genetic specification for the wiring of
the circuit and transmitted through the
genome is some architectural failure
do we possess the ability to modify
the mapping we have of that face?
Yeah.
This it's.
It's such an important question
because faces never remain the same
from even, my face today and my face
tomorrow will look slightly different
for a whole host of possible reasons.
Like I didn't sleep that well,
and now my eyes are weary.
What's really interesting here
is that our ability to recognize
faces is so robust, and this
Of the challenge in understanding this,
is that we can, we inva to these changes.
So even if I haven't seen somebody for
15 years and they've aged 15 years.
recognize them really well.
Somebody's hair might have gone white.
You still recognize them,
although hair's sort of something
of a different category.
But, maybe somebody has a beard
and then, they shave the beard.
You can still recognize them.
we can, of course, I can recognize
you if you turn your head so I don't
have a full frontal image of you.
No problem.
I know exactly who I'm looking at.
there's something phenomenally
resilient about this capacity.
And that makes it all the more dramatic.
When somebody can't recognize a face,
One of the most common concerns
patients have when they come to see
me is that they wish after their
aesthetic or even reconstructive surgery
to remain looking like themselves.
Yeah,
Of course, it's a bit of a dichotomy
because we're going to make some changes,
yet maintaining that sense of self.
And I think that kind of plays into this.
And in certain patients we trigger a very
prolonged time to reconcile that change
Yeah.
bring it back into that sense of self.
And sometimes I tell my patients,
you get a haircut and you, I know you
mentioned the hair is a little bit
different and I want to explore that,
but you get a haircut, it takes
you a week to get used to it.
it.
And so it's quite fascinating.
Yeah.
I think we do, we have a very
strong sense of our own face.
We've learned it over time.
We've lived with this face
over time and changes in, in
really any aspect of the face.
You have your teeth redone or whatever.
It is really shift.
I am, I can even imagine.
Sort of patients having a crisis because
there is this disjunct between their deep
conceptual sense of what their face is
like and also how society perceives them
Yeah.
that they changed face
after various manipulations.
And the time it takes for a patient
to feel normal about what they
had done on average is two months,
but it's longer in older patients
and shorter in younger patients.
Yeah.
I think it all is our clinical
correlate of this processing system.
This is exactly what we're talking about.
When I tell a patient, look, it's
the first six to eight weeks, you're
not gonna necessarily recognize
yourself or the way you see yourself.
It's complex facial procedures like
rhinoplasty I think they show that the
brain's visual and self-referential
system can gradually remap a kind of
a new facial configuration itself.
Yeah.
So I'm pretty sure that's
what happens because it's
really one face, or two faces.
You had one face and you've now
got a slightly different face.
So it's really just that particular
face that now needs to be updated
in your self-referential system.
It also.
Reminds me that I wanted to tell
you how difficult it is to try and
train individuals who are proso
agnostic to learn to recognize faces.
So most of the sort of attempts to remedy
or rehabilitate the prosopagnosia has
been done in adults, and I now, I think,
have an understanding that it's as hard
to learn to recognize faces in adulthood
as it is to acquire a second language.
It's really difficult.
It's a little bit like not being
able to teach an old dog new tricks.
Yeah,
the dog, the harder it
they're harder.
Yeah.
Yeah.
And so this is of course very
frustrating for people who are
impaired at face recognition.
It's also very difficult for
me because I wanna be able to
intervene and really train this,
Yeah.
to be able to do this.
. Individuals with congenital
prosopagnosia, that's one category and.
and.
It makes me actually think of congenital
deafness versus those who lose their
hearing later on in life or later on, or
proso, noia that happens later in life.
That's right.
What is the psychology or psychological
impact to that sense of self, to
that sense of navigating the world
yeah.
I have.
I cannot think of a single study that has
probed kind of phenomenological very well.
something very obvious.
I think we should.
Really understand what their
subjective experience is really like.
Um, there are, however, a number
of elaborated case studies in the
literature, including the one where as
Oliver Sachs the neurologist wrote The
man who mistook his wife for a hat, he
thought his wife's face was a hat and
he tried to put it on his head, of.
It turns out that's not actually
how this disorder works at all.
The patients almost
always say it's a face.
They don't mistake it for a head.
They just say, I just don't
know whose face it is.
And they sort of, that's the struggle
for them is they might even sack and
see two eyes and nose and a mouth.
I just still can't get Um, so one of
the individuals in the literature,
in this elaborate, um, case study,
lament, his ability to be the same
person that he previously and of,
who he was, um, that it had limited
him as an individual moving forward.
I can imagine.
I mean, this is fundamental to us
as humans to be able to recognize
at a minimum, but each other and
everybody else in our society.
Yeah.
we kind of touched the incidents.
Do we have, uh, specific numbers?
several studies, maybe three,
let's say were done in, one was
done in Germany, for example, the
incoming class of medical students.
Or completed a questionnaire about
whether they can recognize faces or have
have ever experienced some difficulty.
Another one I think was done in India
and another one, um, was done to.
I think they're Australian.
The, the authors, um, and all of
them kind of on this magic number
of about two or in the at large.
That's large
rare.
Yeah.
So, you know, when
I teach, uh, an
auditorium of
students, chances are there is somebody
in that auditorium unable to recognize
Oh I imagine that it'd be an
extremely rare condition, 2% is not
Right.
But these are all of the
congenital or developmental form.
Mm-hmm.
The acquired form.
they must be, they're not even a hundred
patients reported in the literature.
And to your knowledge, are there
corollaries of other pathological
states, whether it be medical
or psychiatric that, or even
traumatic,
that perhaps have triggered
or exacerbated the condition?
Um, I mean, definitely patients
it's, even if they've had it their
whole lives, um, it, it makes not
all, but some patients report that
it has limited their Um, be social.
One individual told us that she was
agoraphobic, like she had sort of fear
of going because she was so anxious
that she would see somebody that she
didn't recognize she'd offend them.
I
Okay.
know one of uh, one
individual with the
same
congenital version who, who is
interestingly a vision scientist
himself, he can't recognize people
and he's got this technique.
goes to conferences and the first thing
he does when he sees or talks to somebody,
if she said, I just need to tell you.
I am not going to be able to
recognize your face, so I'm not
being um, a social or a snob.
You just need to know this is
a, I have this failure, and just
sort of is completely transparent
about it, um, right up front.
Well, I bet after saying
that nobody forgets
Yeah, for sure.
but more into the reverse of I guess I
want to explore whether or not you have
noticed associated with this condition,
meaning, I don't know uh, psychiatric,
uh, are these patients being recognized
or, um, um, diagnosed as issues?
treat it for psychiatric problems.
Um.
I think probably not than in
the population at large, maybe
a little bit more because
there is associated with it for
some
Okay?
Of course.
in the congenital
individuals where there
seems to be this failure
in wiring up the system.
There are some associated
deficits, like some of the.
Patients or individuals have difficulty
do um, navigating, like finding
their way around town, for example.
Um, so there are some
kind of comorbidities.
Some of them definitely
have difficulties reading.
Reading is kind of some some of the same
computational requirements as faces.
There are a small number
of items like the alphabet.
You have to together to make a bigger
thing, just like we have eyes and
nose and a mouth that you have to put
together to make it into a whole face.
there are developmental comorbidities.
Um, and these have been well reported,
but much less psychiatric than
I think you might have imagined.
Yeah.
Yeah.
interesting psychiatric d
you know, disorders that
has a face component like syndrome
Reduplicate These are very esoteric.
Um, and you know, there's like a single
case in in the literature where, um.
Somebody, thinks that the, the, the,
well-known face is actually calls them by
a different name, all different kinds of
historical and past experiences to them.
sort of like the loss between the face
and the memory of who that person is.
So there are some of these, um,
more, more psychiatric disorders.
There is sometimes a
phenomenon in the human brain,
Where an input is perceived as
threatening, useless, or even painful,
and we decide to ignore that input.
Yeah.
Is there a possibility that these
patients acquired the skill of facial
recognition, but the input was distorted
or somehow not serving them, and they
decided I, I'm gonna put the skill aside,
Um,
meaning there is a cognitive,
repressive, uh, not necessarily a
a
neurological.
I see it in the sense that patients come
in for a say, and I ask them to describe
their current nose, and they cannot.
Interesting.
em too much pain, too much.
Something they don't like and
they cannot tell me if the cannot
tell me how big the hump is,
and it's as if it's ignored.
It's as if they look at
themselves and they don't see it.
Yeah.
It's interesting.
yeah, it's a kind of
like selective blindness.
These are very, very I mean to,
first of all, you're dealing with a.
Quite a. rare condition and very
difficult to set, set up the
that give you the information
to really look at every detail.
Right.
it does mean
somebody like me is not going
to be out of work anytime soon.
And there are going to be people
coming who also will be able to
tackle some of these questions.
And that's how science works.
I mean, we are all standing
on the shoulders of giants.
We add another link to the chain
and hopefully it's a meaningful
one and, and, and we move forward.
Marlene, when you're looking at these
patients, you're looking at the studies.
you're in, you have your scientist hat on,
Mm-hmm.
but sometimes you perhaps take it off
and you say, wow, what, what in the hell
Yeah,
has that happened to you?
And what was it about Gimme, Gimme, an
Okay, an example.
So, um.
I have an individual with acquired
was about just be in the, summer
before he was due to start college.
Yeah.
Um, he had trained as a paramedic
and worked in an ambulance, and the
ambulance screeching out one night and
they had an accident and he suffered.
A traumatic brain injury
and became prosopagnosia.
He had some other, he broke some bones.
Those all seem to heal.
He has this, he's now close to 50.
He still is prosopagnosia.
Now, one of the odd things about
this um, is that his family owns
a photographic store and he works
in the photographic store job.
Is to check the photographs
once they come off the printer.
And so I said, I asked him, how is it
possible that you can be doing this job?
And his answer was very uh, instructive.
He said it's easier for him to do it
because he doesn't recognize the face.
He's only looking blemishes or
imperfections in the picture.
And he's really good at picking out
these small little things because
he can basically ignore the face.
So
that is like.
That's
That's
fascinating.
That's amazing to take advantage
of the deficit and put it
Yeah.
Marlene, what haven't I asked you?
asked you?
Has to do with artificial intelligence.
Yeah.
So.
These AI models are supposed to be
really good at face recognition.
I mean, you can even use your
face a, password, uh, at the bank
you know, at the ATM, et cetera.
Mm-hmm.
But in fact.
AI models are
nowhere as good as humans are
faces, for example, they fail.
If you have changed your face in any
very obvious way, they would not do so
well with your patients after rhinoplasty
or some other kind of reconstruction.
And so there's
There's something really
sophisticated and.
Almost natural about the way the
human brain can compute this kind of
information and it's not easily captured
in an artificial neural network.
One of the common almost jokes that
patients tell me after surgery is that
their phone doesn't unlock anymore
and they have to redo their face, uh,
or face
id, and that's exactly that.
Well, we know the brain is plastic.
We, we know that there is, um, hardwired
system can keep up with a system
that can self-regulate and and remap.
and
And go that the human brain can,
uh, and so that's good.
That's good.
We, we will all have jobs still.
We'll have jobs.
If you found this conversation
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and we'll see you next time.
very much.