As Alice Hines reports at The Cut, ‘“incels” are going under the knife to reshape their faces, and their dating prospects.’ What they’re discovering after the swelling goes down is that the work they need to get done is on the inside: no plastic surgery can fix a poor self image or a skewed world view that dictates that life’s problems and roadblocks will magically evaporate with a surgically enhanced jawline.

After his first surgery with Eppley, he tells me, he returned to the Netherlands to wait for the swelling to go down. He was happy with his rhinoplasty revision but couldn’t figure out whether his new jaw was too big. Some days the results seemed perfect. Other days one side looked horrifically large. “Just realized my face is slightly too flat,” he wrote one morning. “Should I fly back to the U.S.?” Eppley pressed him to wait. To feel calmer, Truth4lie listened to long videos of rain sounds.

“My self-image fluctuates all the time,” he wrote on the forum as he waited. “I want to live in a plastic surgeon’s office. I just want to have a bed in one of his labs. Just a bed, a small kitchen, and an internet connection. I want to feel pure within my body and self-validate by looking in the mirror and seeing the flawless skull. When detecting a tiny deformity, I call the surgeon and he’ll be there immediately, along with his assistant and a knife in his hand to cut me open.”

He would come back to Indianapolis three more times that year, staying at the same Holiday Inn off the side of the interstate near Eppley’s office for weeks at a time. For the first revision, in January 2017, Eppley shaved off part of the original silicone implant that Truth4lie thought was too big.

The time in his life when Truth4lie remembers being happiest was that spring, after his second surgery. Before he began to notice new flaws, he spent a brief few months when he felt transformed into a new person. He contacted an old friend in a neighboring town and rebuilt his relationship with his parents. When he took pictures of himself or looked in the mirror, he felt calm. People’s reactions to him appeared to change. They seemed to make eye contact more and smile, though Truth4lie couldn’t be sure if it was all in his head.