Some people are born with disfigurement. They may have a birthmark or a cleft lip and palate, for example. Other people can experience sudden disfigurement after an accident, a disease or a fire.
Coping with a new disfigurement presents a different set of challenges to those faced by people who have had a visible difference from birth or early childhood.
They have to cope with the aftermath of the traumatic event which gave them the disfigurement, battle with the knowledge they will never look the same again, and deal with the reaction their new looks may attract from other people, even those they already know.
Scars caused by burns can be particularly traumatic.
Alice, 18, experienced extensive burns to her face, hands and chest after she was trapped in the burning family home at the age of 11.
Her mother and baby brother managed to escape the flames and she had to jump from a second-storey window after getting stuck in her bedroom.
Alice said: "To begin with I was just so relieved to be alive. It never occurred to me that my injuries were as bad as they were.
“I spent a long time in hospital and doctors worked really hard to try and repair me. But when I finally plucked up the courage to look in a mirror I thought I looked like a monster."
Alice had terrible nightmares about the fire and was frightened of being in buildings where she did not have an easy escape route. On top of these fears, she was worried about people seeing her and hid behind baggy clothes.
"I thought that if my own reaction to my face was anything to go by, other people were going to be even more repulsed," she said.
Skin grafts and plastic surgery
Alice had skin grafts and plastic surgery to repair some of the damage to her skin but many of the scars remained.
Like a lot of people coping with a change in appearance caused by burns, she had to take painful first steps out of hospital care and back into her old life.
She said: "It was very hard to see friends and family members. Obviously people react differently – some cried, some told me I was still beautiful, some tried to pretend there was nothing different, a few couldn't stop staring at me. None of the reactions made me feel better."
Alice spent a long time feeling depressed by her situation. But then she made the decision not to let the accident take over her life.
"I realised that I couldn't rely on other people to make me feel better, I had to do that myself. I took the attitude that people had to either accept me as I was, or get lost,” she says.
“If people stared at me, I approached them and told them what had happened and asked if they had any questions. I confronted bullies and I made the most of my looks with make-up and nice clothes.
“My disfigurement is a challenge I face every day but I stay positive. I start university this year and I have my future ahead of me. I could have died in that fire but I'm still here so I want to make the most of it."
Not everyone has the same approach to disfigurement as Alice. Some people find the challenge and the daily battles of being stared at, asked curious questions, being treated as different or being avoided, entirely overwhelming and distressing.
For teenagers it can be especially hard. Hormones are raging, mood swings are common, plus puberty and the prospect of new relationships are just a couple of the life events faced by teenagers.
A teenager who has a disfigurement has all these worries too. But on top of this they have their own concerns about their looks and how they are perceived. They also have to manage other people’s expectations of them that are based on their appearance.
People can react in a variety of different ways when they are faced with an uncomfortable, awkward or upsetting situation.
One of the best ways to cope with being self-conscious about your looks is to try to hold your head high.
Some people who have a visible difference find the easiest way to do this is to adapt their own attitude to interacting with others and the way they cope with other people's reactions.
Helen Smith, head of children’s and young peoples services at Changing Faces, said: “Many young people find it takes time to adjust to a change in their appearance.
“Often they find that managing other people’s reactions can be really tricky too. But there are lots of things that can help, such as having something to say or do if this occurs.
“It gets easier with practice and time. The important thing is to remember that you are not alone and to ask for help”
You could try:
Reassuring other people that they can ask you questions and approach you about your disfigurement. You could say: “I can see you are wondering about my scars, I was burned when I was younger but I’m OK now.”
Distract people from staring by talking about something else – ask them a question about themselves or what they have been doing.
Explain and educate people about your visible difference and what caused it.
Be assertive and ask people not to stare. Try saying: “I can see you are staring at my scars. Please don’t as it makes me feel uncomfortable.”
Use humour and break the ice.
Think about something else and refuse to let other people make you feel uncomfortable. Try going over the words of your favourite song in your mind.
Remind yourself that you are still you.
Look people in the face and don't avoid their gaze. The easier you make it for other people to chat to you, the easier you will find it to make conversation and put people at ease.
Don’t worry if some of the above ideas seem a little daunting – just take one step at a time.
If all you feel you can manage is a smile and a short conversation with people, this is fantastic. It may take a while to feel your confidence returning. This is perfectly natural and nothing to worry about.
In the long run, you will probably find that by answering questions, by approaching people who seem to be avoiding you or by actively discussing your looks and accident you can take back a sense of control.
In order to do this, however, you must make sure your own perception of disfigurement is the one you want others to embrace.
Nobody is perfect and thank goodness! What a boring world we would live in if we all looked the same. Having an unusual appearance should not make you feel like you have something to be ashamed of.
If anything, a disfigurement caused by a burn is a mark that you survived, that you are here and you are strong. Some people find that by embracing a future they might never have had, they can move forward with more positivity and self-worth.
At difficult times, it is always good to remember that just because you may look different, does not mean you cannot do the things other people do.
Among those who have a disfigurement from burns and have gone on to be success stories is footballer Carlos Tevez.
He was scalded with boiling water as a child and has a scar from his right ear to his chest.
He has been offered help to have the scars improved but has refused, saying that the scars were a part of who he was in the past and who he is today.
Treatment for burns
There are treatments you can have to reduce the appearance of burns scars but it’s important to be aware that not all of these are successful.
Surgery – such as skin grafts and plastic surgery – can make the marks less noticeable but it is rare that a burn mark can be removed altogether.
For more advice on your scarring, you need to see your GP who can refer you to a skin specialist.
Make-up can be used to highlight and enhance facial features. There are special skin cosmetics called camouflage foundations which can cover some scars if you want to. Many people choose not to do this and this is very much a personal choice.
Facing the future
You are not alone and you don't need to cope alone. Some people who experience disfigurement have never met another person with the same problem, but it can really help to find out how others cope.
There are lots of great organisations which offer help and advice to people in this situation and who can introduce you to others with disfigurements.
Don't be afraid to make contact and always remember that you have beauty, talents, intelligence and personality and these are all factors in making up the fantastic person you are.