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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 am your host, Masoud Saman. On this show, we explore the human face, not just as anatomy, identity, emotion, perception, but as a lens to explore humanity and the human condition. The face is how we recognize one another. It's how we re trust, love, fear.
Speaker 1:And in many ways, the most important visual object that we have in our lives is our faces. Today's episode is about something that sounds almost fictional but is very real. Imagine waking up tomorrow morning, and every face you see looks distorted. Eyes shifted, maybe mouth stretched, nose coming down, looking like a dragon or the devil or skin being warped. Maybe one half of the face is drooping and melting.
Speaker 1:You know the face in front of you is normal. This is not a psychiatric problem, but you just don't see it that way. To help us understand this, I am joined by Brad Duchaine. Brad is a cognitive neuroscientist at Dartmouth and one of the world's leading researchers on face perception. Many know his work on prosopagnosia or face blindness, but in recent years his lab has turned towards something even more unusual individuals who can recognize faces but perceive them profoundly distorted.
Speaker 1:His lab has now been contacted by many, many patients, and this is a very rare condition. Perhaps their lab has seen the most number of patients with this disorder. Today we're gonna explore what these distortions look like, where they come from, what they reveal about the architecture of the brain and what they teach us about identity perception and the very idea of what a face is. Brad, it is truly a pleasure to have you here. I am glad you joined me.
Speaker 2:Thanks for inviting me.
Speaker 1:Before we get into it, why don't we rewind to the beginning? Tell me a little bit about where you grew up, how that environment shaped you, and what fascinated you with the study of the brain and in particular this disorder?
Speaker 2:Yeah, so I grew up in Wisconsin, and I came to psychology in kind of a roundabout fashion. I was interested early on in college in the humanities and I think kind of history of ideas. And while reading in many sort of literature on the history of ideas, I started reading a lot of, say, late nineteenth century, early twentieth century philosophy. Then from there I kind of moved into psychoanalysis, Freud, Jung. And that got me interested in psychology.
Speaker 2:I mean, look back now on my interest in Freud and Jung, and I'm slightly embarrassed by it because it's not all that scientific, but it was my entry point into psychology. And then I ended up choosing a psych major. I didn't choose my major till my fourth year of college, which I don't recommend to undergraduates, but went whole hog into psychology from that point on. And then I ended up doing a PhD out in Santa Barbara, where I worked with John Tubi and Lita Cosmodes who were very interested in specialized mechanisms within the brain that have very specific computational functions. And one of the best examples in the '90s of a specific computational function was face processing.
Speaker 2:In fact, there was a book written by Martha Farah, who is now at Penn, that was called Visual Agnosia. And Martha talked about the many different sorts of visual recognition disorders that exist. And one of those was prosopagnosia, where people have great difficulty recognizing facial identity, which you mentioned earlier. And I was fortunate enough to kind of turn myself into a neuropsychologist. And what I mean by a neuropsychologist is somebody who studies people who've got a brain disorder with the aim, A, of understanding that brain disorder and helping people with it, but also, B, of using that brain disorder to reveal how the normal brain functions.
Speaker 2:And so I was doing work at that time with people with developmental prosopagnosia. So they have trouble with facial identity, but they've never suffered brain damage. We'd known for decades about acquired prosopagnosia, where somebody has a stroke, loses their ability to recognize faces, but it was only in the late '90s that it started dawning on a number of people across the world that there were a good number of people out there who had trouble recognizing faces and had no history of brain damage. You're gonna hear or you already have heard from Marlene Berman. She was one of these people.
Speaker 2:She was Carnegie Mellon, Noam Saghiv, who was in Berkeley. There was Shlomo Benton in Jerusalem. So there were a number of people in sort of all the late '90s. The advent of the internet allowed people with these face perception problems to get in touch with researchers for the first time. And so I did a lot of work on developmental prosopagnosia, and then I've kind of expanded from there in different sorts of face perception disorders.
Speaker 1:That's fascinating. That's fascinating. And I, like you, also took the scenic route in college. And I actually do recommend it to undergraduates. I think that gives you a little perspective.
Speaker 1:Prosopometamorphopsia is what?
Speaker 2:So prosopal metamorphopsia, and I'll call it PMO from now on, it's a condition in which the perception of faces is affected and is distorted. So people with PMO look at a face and they would not see the face vertically. They'd see it distorted, and there's a wide variety of distortions that you see in people with PMO. Sometimes it's the shape of the face. Sometimes it's the texture of the face.
Speaker 2:Sometimes it's the color. Sometimes it's all those different aspects of the face at once. We've heard from around two fifty people who've come to us and told us that they think they're experiencing face distortions. We've had a website for four or so years now. And you might wonder, Well, are they making it up?
Speaker 2:We've never had anybody who we've wondered is making it up. This isn't something people, I think, are likely to do that. And they really tell They talk about similar experiences is what we're hearing from people. And frequently when we're talking to these individuals, they tell us something and we say, we've heard that from a lot of people because the experiences they have are very similar. I think many of them find that a relief to know that they're not the only ones who are struggling with this problem because when it first starts for them, it's very hard to find information about it.
Speaker 2:They might think it's an indication of a broader psychiatric condition. But we think of it as just a small little malfunction within a small bit of your face perception system.
Speaker 1:Okay. So this is not affecting any other perceptions? You're not seeing the lamp or the wall or anything else distorted, only faces?
Speaker 2:Well, that's true in some cases, and some of those cases are particularly interesting. We do have some individuals, though, who see distortions to other sorts of objects as well. So we work with a South African man who, if he's looking at a face, he'll see a distortion on the right side of the face, but not the left side of the face, which is a fairly common type of PMO, which we call hemi PMO since it's just affecting half the face. If he looks at a lamp, he might also see a distortion on the right side of the lamp. And so he's got this right sided distortion that applies to a lot of different objects, although maybe we can go into it in more detail, but there are qualitative differences in the distortions he sees for faces compared to what he sees for objects.
Speaker 1:Okay.
Speaker 2:There's good reason to think, and most of this evidence comes from PMO, that when you first look at a face, the two halves of the face are represented separately. So that if I'm looking at a face here, this half of the face is being represented in high levels of my visual system. And I don't mean early visual cortex. We know that anything in the right visual field is represented in early visual cortex in my left hemisphere. But I mean a face, regardless of where it's positioned within the visual field, the right half is represented in my left hemisphere, and the left half is represented in my right.
Speaker 2:And then, as you said, they're brought together. They're fused in the right hemisphere. So that right half that was represented in the left half in the left hemisphere, pardon me is brought over and combined with the other half. This is a little I don't know how effectively I'm conveying this with words.
Speaker 1:No. It's it's perfect. It's perfect the way you're explaining it. It just makes me wonder if this is situation where you see the right side distorted or left side distorted. It's a zero and one situation, or you could see parts of the right left side distorted.
Speaker 1:Can you just see just the eye distorted, for example?
Speaker 2:You can just see individual features distorted. And so, you know, if we're looking at a face and we're just seeing the right eye distorted, that's certainly something. In fact, we've got data from a gentleman out in California. He sees mouth specific distortions. And interestingly, it could be that he sees a distortion on the mouth regardless of where the mouth is, sort of how the face is oriented.
Speaker 2:Alternatively, it could be that he sees a distortion in the bottom half of the face, sort of that so if you turn the face upside down, now he would see a distortion maybe on the forehead. But in fact, it's the distortion sticks with the mouth as you rotate the face around. So it's for him, at least, it's a it's very much a mouth specific distortion.
Speaker 1:Okay. Dimensionality, does that play a role? Meaning, three d versus on screen.
Speaker 2:Yeah, so that's a really interesting dissociation that we do see in some people. Most people that we work with see distortions both in faces and daily life as well as on screens. But there are people who only see distortions in either only daily life or only on screens. And we've collected the most data looking at this distinction with a gentleman named Versus who lives in The US. And Versus sees distortions on every single face he sees in daily life.
Speaker 2:And they're quite intense distortions. He's been experiencing them for about five years. Features are stretched back. There are grooves on the cheek, grooves on the forehead, but he's never well, I shouldn't say never. He almost never has seen a distortion on a face on a screen.
Speaker 2:The only time we were able to get him to see a distortion on a face on screen, his distortions are also affected by color, which we might wanna talk about, And red and warm colors amplify his distortions. So we put a face on a screen behind a red digital filter, and then all of a sudden, he saw a distortion on that face. So but for the most part, has to be a three-dimensional face for him to see the distortion.
Speaker 1:That's amazing. And it shows how complex this whole process is. I wonder if you've put on a VR set or somehow those three d glasses the, you know, the three d movies. I wonder if that screen will will be distorted. That that that's interesting.
Speaker 2:I can give you an answer to that. It it is distorted. So once we had a little what we did was we had him wear a VR headset, and then he looked at faces that either had some depth information or it looked like he was just looking at a flat screen, like a TV screen within VR. With the flat TV screen, he just saw he saw no distortions. Once we added any depth information, the distortions emerged full fledged.
Speaker 2:Now we haven't collected as much data on that as we'd like, but eventually down the road, we'll have a paper about that with DBS's data.
Speaker 1:That's that's fascinating. You know, I on a much less extreme example, and certainly not necessarily pathological, we see that in individuals who look at their faces on a photograph and then the idea they have of their own face when they look at themselves on a film. They look at and they see themselves on film and they are like, Oh, I look like that. But on photo they see themselves differently. I see this in patients especially after we have distorted their mapping of self meaning they have had some sort of a procedure, a facelift or a rhinoplasty.
Speaker 1:It takes usually about two months for patients to catch up with that sense of self again And during the two months, there is a discrepancy between what they see on an image and how they view themselves on film.
Speaker 2:Interesting.
Speaker 1:Now I need to put some thought into it. I wonder if we all function at some level with some level of distortion and what image we have of each other because, you know, you can talk about that about colors. Is my is my blue your blue? Or at least the intensity of that. And I don't know.
Speaker 2:Yeah. This two d, three d distinction that we're seeing is really a surprise because, you know, from a vision science perspective, this your face that's I'm looking at right now, it's landing on my retina. It's very similar to what I would be seeing if you were here in the room with me in terms of what's landing on my retina, and yet the visual system, at least a certain level of face perception, is treating them very differently.
Speaker 1:Yeah. Yeah. And the other corollary to that is the phenomenon, I'm not an expert on it, but of the beauty filters and the induced perceptions and how is that affecting our reception in the brain. So there's a lot of interesting corollaries to what it is that you're studying. Why do you think the face is, specifically the face, so vulnerable to this distortion?
Speaker 2:We do see a substantial percentage of our participants. I don't know what it's gonna be when we have good numbers, but let's say thirty percent will see distortions to hands if they look at them for long enough. Hand and arm seems to be fairly common. And then I mentioned, say, this participant we work with, Nagel, who sees distortions to regular objects as well. So there are these people who are seeing distortions to things other than the face, but it certainly seems like face distortions are more common than distortions to other sorts of stimuli.
Speaker 2:Now part of that might be we spend an awful lot of time looking at faces, they're important to us, we have really precise representations of what faces look like, So we might be more sensitive to distortions of faces than to distortions of the mug that's sitting on my desk here. Yeah. I think it's probably more than that, though, and it might be that we don't have a great under We have a decent understanding about the neural basis of face perception. And it's a very complicated network where you've got, say, from 12 to 16 areas, sort of blueberry sized regions that are connected up with one another, and they all need to be working in coordination to have effective face perception. You put somebody in a scanner, you show them faces, you show them objects, and you find those regions that respond especially strongly to faces.
Speaker 2:You can then go in and record from neurons within those regions, and you find that the neurons that compose those regions are highly face selective. They respond to faces that don't respond to much else, usually. So these areas are all connected up, and you can imagine that if you've got a more complex system, any disruption to that system might lead to a problem with the stimulus that's being represented there, and then you end up seeing face distortions. But and so it could be that object perception depends on a simpler system that's less prone to disruption. There's something called the strange face effect where if somebody goes into a room with low light and then you stare in the mirror for minutes, for a lot of people, I haven't been able to get it to work, but what you'll see looking in the mirror, your face will start distorting in pretty intense ways.
Speaker 2:And so there's an example where just looking long enough, you start noticing something.
Speaker 1:Oh man, you only know what I'll be doing after You're this tired this night. I will, I will. Very interesting. Subclinical distortion, you have two fifty people in your lab now, but I wonder if subclinical distortion is a lot more prevalent and the incidence might be much higher. And the reason I say this corollary to clinical practice is that I see a lot of people that aren't quite body dysmorphic disorder, not there, but what they say they see and what I see are significantly different.
Speaker 1:That they might think that their brow is very high or that the nose is very big and it's not by no objective or subjective measure. And these individuals we generally put in the light BDD category. And there is a lot of discussion in the world of plastic surgery and psychiatry related to clinical treatment of these patients that psychedelics reverse or at least decrease this, well I don't want to call it obsession, but this distortion. That something, do you see any corollaries between PMO and body dysmorphic disorder? One.
Speaker 1:And two, do you think there's any role or has there been any studies on the effects of these kinds of psychedelics and how they may reset these facial recognition centers?
Speaker 2:Yeah. So first with BDD, there's no good evidence on this. I mean, have such a small sample of people who we've heard from who have face distortions that we don't have a good sense for that. I can't say that we've heard from what seems like a disproportionate number of people who have BDD. We also don't ask them if they have BDD, so it might be a question we might want to ask going forward.
Speaker 2:To your point, though, that started this part of our conversation, though, I find it very plausible that people have quite subtle face distortions. I mean, as people know, everybody's perception is a little different. And my perception of the face is different than your perception of the face. I think, for example, that I'm kind of oblivious to noses. And I also know that compared to my wife, I'm very influenced by the hair.
Speaker 2:If somebody's got similar hair to somebody else, I'll say, boy, they look really similar. And my wife will say, what are you talking about? Their faces look totally different. And I said, well, their hair looks same.
Speaker 1:Interesting.
Speaker 2:And I hadn't considered this. I mean, if you got people who've got some of these quite specific distortions to particular features, I suppose it's something of a medical ethics question, what you should say to somebody if they're misperceiving that feature on their face and asking you to do perjury on a feature that in fact they're going to cause that feature to look worse to most other people.
Speaker 1:Yeah, I mean, that's absolutely an ethical responsibility of any aesthetic surgeon or any aesthetic provider to say no, to say no. I mean, we turn away more patients than we accept because of that, because this is so prevalent. This subclinical, I guess distortion is the word I'm going to start using now, because sometimes they look at the face and they mention things that I just don't see, just not there. I can't measure it, I cannot see it. And then it creates a really awkward moment in the conversation as you can imagine and they say, How can you tell me that I don't have huge cheeks?
Speaker 1:And I say, Well, here's a volumetric study of your cheeks. Here is the average cheek volume in an, I don't know, 17 year old female of this race and so you don't. And they leave dissatisfied. But we leave it at that. We don't really look into why they're seeing it this way and your study has just reignited this excitement in me to look at all of this and understand what these subclinical, not quite PMO potential distortions are that my patients, some of them at least, have.
Speaker 1:And do you think that external change or alteration of a face can trigger PMO?
Speaker 2:We haven't seen anybody like that, so I don't have any reason to think that that could happen, but who knows? And back to your these these sorts of individuals, do you have a sense for whether they are also misperceiving the feature they're misperceiving on their own face? Are they misperceiving it on other people's faces as well?
Speaker 1:I haven't specifically asked, but they do often volunteer remarks about their sister or their mother often, saying that my mom doesn't have that. And then when I
Speaker 2:I suppose if they're dissatisfied with the appearance of their feature, that suggests they're seeing it differently on other people's faces.
Speaker 1:And I'm gonna start looking more closely, but from what I can gather right now, I think that oftentimes the noses look very similar. And the nose is kind of special because it's central, it's right here. So how does that right brain, left brain, how does that work? Do you see a lot of nose distortions in your PMO patients?
Speaker 2:Not uncommon, yeah, and when we have people who have hemi PMO it's interesting, mean you'll see the distortions just here but they rarely ever cross over the vertical midline of the face, so there's really this clear division there.
Speaker 1:Interesting. There has been a lot of studies coming out of Harvard Medical School with ketamine, some stuff out of Oregon, like about psilocybin and how those psychoactive chemicals, now medications, reset this sense of dysphoria that comes along with this distorted view of self. Again, not quite BDD, it's not about everything, it's just about one specific thing. Often, there was at least
Speaker 2:distortion they're experiencing. Right? Not a conceptual one?
Speaker 1:What what what do you mean by conceptual?
Speaker 2:What I mean is is it a is it a perceptual error they're making that gets reset, or is it something sort of the way that they're thinking about some feature of their body?
Speaker 1:I don't know because the study measures dysphoria and both of those can
Speaker 2:So it's feeling that they're having.
Speaker 1:Is the feeling related to that perception? But is the perception truly different? Well, we never we haven't really gotten them to say that their perception is distorted. They they think I'm wrong. They're like, you're you're crazy or you're blind.
Speaker 1:You don't you don't see that my nose is huge, and I say, look. I'm measuring it, and it's not. And they say, well, it's your ruler or it's your camera or it's the angle or it's that it's not swollen today. Usually, it is. It's some reason that it's not happening, but it really truly is big.
Speaker 1:And then we just meet a dead end.
Speaker 2:I I realized I didn't ask answer your question about psilocybin and PMO and and whether there haven't been any studies looking to see whether psilocybin can help people with PMO. It's certainly an interesting angle. And as you probably know, sometimes when people are under the influence of psilocybin, they see face distortions. They're more likely to see face distortions. And in fact, I've got some firsthand experience with this from about thirty five years ago.
Speaker 2:And so we're interested in looking at face distortions in people who are on therapeutic doses of psilocybin to see if they are experiencing any face distortions, because we could study the same phenomena in those face distortions that we do in our participants who have PMO. It also might be worthwhile for imagine if twenty percent of the people who, when they take a therapeutic dose of psilocybin, are experiencing some face distortion. Well, it's easy to imagine that could disrupt the therapy that they're going through while they're interacting with a counselor who's trying to help them deal with particular psychological issues. And so if there were ways we can reduce distortions and I mentioned color, for example. There do appear to be ways to do that.
Speaker 2:So anyway, that's an angle we'd like to get into, and we're looking for opportunities to do that.
Speaker 1:And I wonder if PMO If it's unpleasant triggers face blindness.
Speaker 2:Okay. Causing face blindness, prismagnosia. We don't see that. I mean, we do see elevated rates of difficulty with face recognition in people with PMO, which probably isn't surprising. Imagine you're seeing a different face at time one and time two.
Speaker 2:Gonna have more people recognizing it. But there's a lot of people we see who don't seem to have any difficulty with face recognition despite these distortions, and we need to look at that in a systematic way because it's Yeah. Could be that there's a very interesting dissociation between what you're perceiving when you look at a face and the representations you use to make judgments about that face. So imagine you're you're looking at a face that's severely distorted, and yet you're still able to read facial expressions from it normally. That would suggest we've got two different brain systems that are carrying out what you're see or that are underlying what you're seeing and what you're making judgments about, which could well be true, and we see that in the visual system for other aspects of our visual experience.
Speaker 1:That's fascinating. Symmetry is another thing that comes up time and again, and in how people see themselves, at least in my clinical practice and experience, is that a level of asymmetry is detected in the face and then I feel often that is perceived a bit out of proportion. Now knowing I wonder if PMO is severely under diagnosed and under reported And I wonder if there is a continuum. If there's a little bit of PMO, then they're not gonna show up to your website perhaps. If they see a little distortion, they might think it's just them.
Speaker 1:Is it on all faces? Or is it just their own face or somebody else's face or selective faces?
Speaker 2:We hear from a when we talk with our people with PMO, not all of them, but a lot of them seem hypersensitive to asymmetries in faces, so differences between what they're seeing in left half of the face and the right half of the face. They'll say that eye is really higher than the eye on the right. And I'll look at the face. I can see it, but it doesn't jump out at me in the same way that it's jumping out to these individuals we're talking to. So right now we've got a student doing a senior honors thesis, and she's looking at the role of asymmetry in distortions.
Speaker 2:And so what she's showing individuals are faces with different levels of asymmetry in them, including faces that are perfectly symmetric, where we just flip over one half so that we've got a fully symmetric face. Ellie doesn't have data from all that many individuals right now, but what we're seeing in a number of them is we've got a reduction in the intensity of the distortions in the more symmetric faces. So there's something about the there's some computation that's going on in the visual system that's comparing the two halves of the face, and when there's a greater difference between those two halves, that's induces greater distortions.
Speaker 1:Mhmm.
Speaker 2:And we don't know why that would be. Presumably, that's gonna be going on in the left hem pardon me, in the right hemisphere where the two halves are brought together so they could be compared.
Speaker 1:But So so what I'm hearing is that the brain symmetry, yes, but the brain is expecting some sort of a structural coherence. Yes. Okay. So in that patient that was mouth specific, only saw distortions in the mouth, whether you put the mouth up here or whatever. If you took the mouth and isolated it out of a face and just put it on an image, well, I don't remember if that was available.
Speaker 1:Yeah. The Was that distorted, or would it be distorted?
Speaker 2:Don't know the answer for that particular participant, although I do think we've got the data. I do know that from for some of our other participants, Versus, for example, who's the guy that only sees distortions in three-dimensional faces Mhmm. We showed him just little bits of a face. So he was looking at a real face, but we we had ways to mask the rest of the face. And he saw distortions on individual features that were just as strong as what he was seeing when he would look at, say, the nose in the context of the whole face.
Speaker 2:There were a couple features that didn't distort, like, you know, just show him a small bit of chin. Mhmm. Know what he's looking at at that point. So I there there was an isolated feature too. But in general, he was seeing the full blown distortion just in isolated features.
Speaker 1:Brad, what you're doing is unbelievably interesting. That's so exciting. What direction are you taking the lab to now? Where where are we headed with this?
Speaker 2:Yeah. I mean, so we've really just started exploring these face distortions. I mean, we put out or created a website four years ago in hopes that there were people out there who had this condition, and we have heard, as you mentioned, from around 250 now. When we get media attention, we get a spike of people. I suspect we'll hear from some more people because of this podcast.
Speaker 2:So these people are out there. And so that because we're the first to really explore this systematically, there's a lot of low hanging fruit to be investigated here with PMO. And so, you know, we're looking at theoretical questions about the normal visual system that we can look at with PMO. We're also looking at these interventions. I mentioned color.
Speaker 2:One of the other unusual interventions, is really simple that we found can reduce distortions, is just the presence of glasses on the face that's being viewed. And so for a substantial number of our participants, their distortions go way down just when there's just a pair of glasses on the face. We don't know why that is. We're investigating and saying, that true if the glasses are out of place, if the glasses are turned on the side, if they're asymmetric. So we've got these two lines of research, theoretical and also intervention, and there's lots of questions to explore.
Speaker 1:Lots to look forward to and learn and explore. And this is what you brought up is an important point. I will go ahead and place the information about the website and how to contact and get in touch for anybody who if you know of someone who may experience these kinds of distortions or if you are a person who experiences it yourself, feel free to reach out to Brad's lab and the information that will be down in the captions so that not only we learn more but also this will aid in understanding it and perhaps coming up with some sort of a clinical therapeutic.
Speaker 2:So we have participants who have such intense distortions that we show them a face and they don't even know whether it's a man or a woman. They can't tell whether the person's old or young. And yet sometimes they'll have these clear, say, demarcations between the regions that are distorted, so the skin will look black above a line, and then everything below that looks perfectly normal. And so for me it's fascinating to see how perception, sort of breaking up the visual world into the different perceptual components that are being processed independently from one another. And it's just wonderful talking to these people because we're learning a lot from talking to them, and I think they really benefit from finally talking to somebody who's understanding what they're going through.
Speaker 2:We also like to put them in touch with other people who are experiencing face distortions, and so this has certainly been the most exciting part of my career these last five years where we're working with people with face distortions.
Speaker 1:That's fascinating, and it's wonderful that you're doing that and bringing this kind of community for these In surgery we modify millimeters. In PMO the brain modifies perception. And both change how a face is experienced. It makes you realize the face lives as much in the brain as it does on the skin or in the mirror or on the screen. Brad, thank you so much for this lovely conversation.
Speaker 1:As I said, I will go ahead and definitely put the information for how to get in touch with your lab down in the information underneath the podcast. If you found this conversation meaningful and if discussions like this matter to you, please share the episode and subscribe and we will see you next time.
Speaker 2:Thanks a lot for having me on.