With recent drastic changes evident in Rene Zellweger’s eyes, lips and cheeks—making her unrecognizable to some—it is natural to question the psychological reasons why some people radically alter their appearances.  This is an especially interesting question when the person doing so—like Zellweger or Mickey Rourke or Kim Novak—makes a living in front of the camera. 

The impulse to look young and attractive is nothing rare or new, of course.  Millions of Americans use Botox, cosmetic fillers, hair pieces, hair extensions and cosmetic surgery to make that attempt.  But it is much more unusual to alter one’s appearance to the extent that Zellweger seemingly has.

Some folks who undergo repeated, extensive cosmetic procedures may have obsessed over one aspect of their body for a long time.  Body dysmorphic disorder is a psychiatric disorder in which a person unshakably believes—contrary to objective evidence—that his or her appearance is unusually flawed and embarrassing.  Repeated plastic surgeries may be attempted to correct the perceived problems.  And people—even stars—could, conceivably, have mild or more severe cases of body dysmorphic disorder arise at any point during their lives.

It also seems possible that celebrities who are comfortable in front of the camera, or motivated to perform in front of the camera, may have been paying special attention to how attractive or “camera-ready” they have looked, for much of their lives—whether in a practical and healthy way, or an obsessive or narcissistic way.  When beginning to age, they are especially vulnerable to becoming worried about the inevitable changes.  When the way you look is directly tied to the way you remain viable professionally, it’s easy to understand why you might panic as you get older, and resort to drastic measures to try to turn back the clock.

It’s also possible that there is an unhealthy psychological cascade that cosmetic surgery could set in motion.  This is a worthy area for research.  When a person changes one aspect of his or her appearance, it seems possible that that single (even relatively minor) change could “liberate” that person from her self-image.  No longer anchored to the angles and contours of her previous reflection, she could feel free (or could feel compelled) to start redrawing every line, opening the flood gates to more and more changes.  This would be essentially the same psychological process that happens when a child is drawing a picture, tries to redraw one aspect of it, becomes convinced that the entire drawing has then been altered by that single change, then tries making more and more changes to “fix” it or “get it right.”

The problem is that there may be no “getting it right” when trying to redraw one’s own face, if a person’s expectations are to erase time.

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team.