It can be distressing if you need surgery to part of your head or neck. When surgery affects your looks, it can alter the way that you think of yourself as a person and can be very difficult to deal with.

Nowadays, it is much less common for people to be disfigured by their surgery, even when very extensive surgery is needed. The scars of the surgery often lie either in the neck or in skin creases on the face and are barely visible. The underlying bone structures can be built up to a near-normal shape using bone grafts from other places in the body. However, if the operation affects delicate structures such as the nose or lips, your appearance will be altered.

It takes time to adjust to a sudden change in appearance, even when it is only small. Although we live in a society that puts a lot of emphasis on appearance, we all know that the relationships that are important to us, with family and friends, are not based just on the way we look. Nevertheless, it is true that how you feel about the way you look is an important part of self-esteem. How we look is one of the ways that we define ourselves. Because of this, changes to your appearance as a result of surgery may affect, in some ways, your sense of who you are.

With any change in appearance, it is quite normal to worry about feeling rejected, both socially and possibly even by your partner. There are many reasons for this concern. Our faces play a big part in communication. Watching facial expression, eye contact, nodding etc are all ways of gathering information about what is being said.  Because of this we look intently at each other when we are speaking. Usually, we accept this without thinking about it, but when your appearance has changed it can be unsettling to be aware of how much people are looking at your face.

The more you are at ease with the changes yourself, the easier you will find it to deal with the reactions of others. Your friends and family may feel unsure about what to say and how to behave. They may worry about saying the wrong thing. The medical professionals looking after you will be able to give them advice about what to expect and how to support you. They may also find it helpful to read our information on talking to someone with cancer, which has tips on how to talk to and support a person with cancer.

It is very important to have a good idea of what to expect before you have your operation. Ask your doctor to be honest about the physical effects of the surgery, and try to discuss them openly with people who are close to you. If you have a partner, it may help for them to see the doctor or nurse with you, so that you can both be fully aware of what to expect afterwards.

It may help to talk to someone who has had a similar experience. Your doctor may be able to put you in touch with other people who can talk to you about how the surgery has affected them, and give you some idea about how it might affect your life. You may also pick up good tips on how to cope with the changes.

When you come round from the operation you may be anxious to know what you look like, but at the same time frightened of what you might see. Once you have recovered physically from the operation, perhaps after 7–8 days, it is a good idea to look at your face for the first time with a doctor or nurse. They will be able to explain the healing process. Even if you had a good idea of what to expect, you may still feel shocked and upset when you first see your face. If your face feels different – for example, numb or swollen – this can add to the shock. You may be extremely upset and perhaps wish that you had never agreed to the operation. You may also feel angry. Give yourself some time. These are very strong emotions and part of you needs to grieve for your previous appearance even as you look ahead to the future.

Remember that the changes to your face will be at their worst in the days and weeks immediately after the operation. Any swelling or bruising will disappear as you heal, and scars will gradually fade over time. The hospital staff will help you, and you can get advice and support from organisations such as Changing Faces or Let's Face It, which help people to cope with a changed appearance. Even if it is difficult, it is best not to avoid looking at your face. Some people find that it helps to change their own dressings at this stage.

If parts of the skin from your face or neck have to be removed completely, they can be replaced, but the skin colour will not match the surrounding skin and the scars may be visible. However, there is a way to reduce the differences of skin colour and disguise the appearance of scar tissue. Camouflage make-up consists of specially designed creams, and is available to suit all skin types and colours in both men and women. Some head and neck clinical nurse specialists, the British Association of Skin Camouflage and the British Red Cross Society offer a camouflage make-up service with individual teaching sessions on how to apply it for the best effect.

Some types of camouflage make-up can be applied to facial prostheses to improve the colour match of the skin. This can be useful in the summer when skin tone changes. If the prosthesis needs colouring it should be taken back to the person or organisation that supplied it.

As you and the people close to you become more familiar with your changed appearance, you may want to think about seeing other people, going back to work, etc. If you avoid social situations, you may find yourself wanting to go out less and less. The longer you leave it, the harder it may be. It is best to start by going somewhere familiar with someone else to give you support.

Be prepared for mixed reactions. You may find that people take far less notice of you than you expected. But if people are staring, don't assume that they are making judgements about you. We all look at each other, and hiding your face will often draw attention to you. On the other hand, some people may seem intrusive and may make remarks. Small children are often openly curious and may ask why you look different. Decide in advance how you will answer. A simple sentence saying that you have had an operation will be enough. You do not have to go into the details.

Learning to deal effectively with other people is often a case of taking the first step by putting them at ease. They will soon respond to you and not to your appearance. Coping successfully with these sorts of social situations will help to build your self-confidence, and this will increase as you gradually take up your normal activities. You can get lots more information about these kinds of social skills from Changing Faces or Let's Face It. They are not difficult to learn, but simply need practice. In time you will gain the confidence to manage social situations in an effective way.

Focus on anything that makes you feel good about yourself or that helps you to accept the change in how you look. Remember that personality, interests and a sense of humour are more important than appearance to the people who know you. These are the qualities that your friends and family value, and these things have not changed. People who are close to you are likely to be less concerned about what you look like and more about how the change is affecting you. Be open about your fears of rejection. Just being open and honest about how you feel can help to overcome any initial awkwardness with others. Given the chance, most people will welcome the opportunity to reassure you of their continuing love for you.

Because treatment for cancer of the head and neck can affect important aspects of yourself such as how you look and perhaps the way your voice sounds, it can also affect the way that you feel about yourself in a sexual way. This may leave you feeling isolated. Your partner may also need to adjust to the impact of your treatment on this aspect of your life. Again, keeping communication open and talking about how you both feel is essential to overcoming any fears or worries that you may have.

Cancers of the head and neck may bring with them not only the shock of having cancer, but the added trial of coping with major changes to the way you look, speak and feel about yourself as a result of treatment. It is only natural to feel sad and upset and sometimes these emotions can be overwhelming.

Cancerbackup has information on the emotional effects of cancer, which you may find helpful.

There are many organisations who can help you. A trained counsellor can listen to your problems, and give information about how other people have managed in a similar situation. Some organisations provide counselling. You can contact the Cancer Counselling Trust or ask your doctor to refer you for counselling.

Joining a group specially for people with facial disfigurements may take away the feeling of having to cope alone, and will put you in touch with people who really understand what you are going through from their own experience.