About Face

Eric Lis

Everybody has the occasional day that they want to look like someone else. A few people actually get to try it.

The old trope of someone surgically changing their face to change their identity has always interested me. Like many geeks, I was introduced to the concept at a young age by Ernst Stavro Blofeld, but characters like Dwight McCarthy, Sean Archer, and the protagonists of any number of video games illustrate just how miraculous plastic surgery is in fiction. In real life, of course, facial reconstruction surgery isn't rather short of miraculous, and facial transplants, though a rapidly-evolving field, are something which the casual reader is encouraged not to look up on Google image search unless you have a lot of empathy or an iron constitution. All that being said, body reconstruction in the name of deception isn't purely of the realm of fiction. Allow me to walk you very briefly the history of espionage-related plastic surgery. I direct the reader to a fascinating discussion of this topic by Roderick Bailey.

We have good historical accounts of government-sponsored plastic surgery of spies going back to around World War II, which was, after all, the era when Western civilization really got the hang of a lot of aspects of the shadier side of warfare that hadn't been used to their full potential by previous generations. At that time, surgical techniques being even less refined than the arguably barbaric cutting-and-suturing that constitutes the best we have to work with today, there were real limits to what could be offered. Records seem to suggest that most cosmetic camouflage (or as British documents apparently refer to it, "permanent make-up") was to enhance a spy's anonymity. This could be for two main reasons. First, some spies dispatched to their own native regions had to be changed enough that they wouldn't be recognized from wanted posters or other alerts. Second, many agents had distinguishing features: scars, deformities, or even just characteristically funny ears or something. In both of these cases, fairly simple surgeries -- a nose job or removal of a scar -- could mean the difference in someone being noticed by enemy authorities. This was, after all, the days before facial recognition software, and most humans are pretty easy to fool if you change a few pertinent details of any object they're looking for. Making people more anonymous made it easier for them to blend into crowds and avoid detection as well as protecting them from being recognized by individuals who had previously met them.

Some of the cosmetic work was fairly simple. British spies masquerading as Continental Europeans had to up gold fillings with porcelain, for example, since gold wasn't used in many regions. Some of the more extensive surgery was described by Sir James Hutchison in his autobiography, wherein he describes surgeons reshaping his nose, shaving off the tops of his ears , and giving him a more heroic chin. Other agents had prominent scars removed. Importantly, such operations did take some time, as although the surgeries might take only a few hours, it could easily take a month for facial swelling to go away, which means such procedures couldn't necessarily be done if an agent needed to be sent out rapidly.

On the surface, this topic may not seem wholly relevant to a fantasy setting, where the availability of spells such as Disguise Self and Alter Self at even low levels makes disguise effortless and obviates the need for post-op recovery times. Consider, however, how prone such disguises are to failure. Aside from the fact that these two spells last less only hours even with the highest-level casters, Disguise Self can be defeated with a simple Will save, to say nothing of being useless against the many simple protections available against illusion magic. Alter Self is more powerful and involves actual bodily transformation, but leaves an active magical aura. More powerful magic may last longer and may not be visible to Detect Magic, but can still be detected by any defences that pick up on polymorphed creatures. I have to assume that any spymaster in a medieval fantasy setting is acutely aware of all the ways a magical disguise can fail, which leaves me to wonder how useful these surgeries might be in a campaign. If anything, I suspect that surgical disguises might be even more effective in a fantasy setting, since the average guard is much more likely to be on the lookout for people using magic; when an easy tool is readily available we sometimes stop watching for people using more complex ones. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on January 18, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system