Illustration: Eddie Guy

Truth4lie was 27, depressed, and living in a student apartment after a year in a psychiatric hospital on suicide watch when a friend showed him Neil Strauss’s pickup-artist guidebook, The Game. Together they practiced lines from the book, planning to use them on girls in nightclubs. “Would you like to kiss me? I didn’t say you could.”

In real life, pickup artistry made Truth4lie anxious. One rule stated he needed to initiate conversation with a woman three seconds after seeing her, which felt like taking an exam. Still, he tried the techniques for a few years, with middling success. Eventually, he stumbled on a forum called Sluthate, where anonymous men gathered to “discredit the effectiveness of pickup art.” In one post, a user described coming to the realization that it didn’t matter what he said because of the way he looked.

The user uploaded a selfie, and other Sluthate posters agreed, mocking the flaws in his face. They congratulated him for “taking the black pill,” shorthand for waking up to the tragedy of being ugly. Ugly people, especially ugly men, they said, are destined to lead unhappy lives and die alone.

Reading this, Truth4lie felt exhilarated. In the mental hospital, counselors had told him the roots of his depression and anxiety were repressed childhood traumas. In therapy, he relived getting in physical fights as a kid with his dad and the time he punched his sister in the head. Cognition determined emotions, the counselors told him. By changing his mind-set, he could change his behavior. But what if his problems weren’t inside him but outside? Looks can’t be changed with a mind-set adjustment; neither can the cruelly superficial world that values them above all else. The realization was awful and great all at once, as if someone were finally telling him the truth about himself after a lifetime of fake validation.

“The difference between a mirror image and non-flipped image of myself drives me crazy,” he typed one night, after spending hours comparing his phone’s selfies to his reflection. “I see all my asymmetries … How can it only be my brain?”

Friends and family said he had body-dysmorphic disorder, a condition the International OCD Foundation says affects about one in every 50 people. Psychiatric manuals describe it as an obsession with perceived flaws in one’s appearance that others don’t see or notice. But Truth4lie’s imperfections were perfectly noticeable to other forum users: weak jawline, feminine nose, small frame, thinning hair. To Truth4lie, their assessments explained why he hadn’t fit in in high school, why his ex didn’t love him, why women he looked at on the street didn’t make eye contact.

Truth4lie had for a while tried to write a novel about his time in the psychiatric hospital. He read Camus, who said that life has no great meaning. He pondered nihilistic theories posited on the forums he frequented. He discovered terms like “oneitis,” a disease of romantic obsession that enslaves men, and “hypergamy,” an evolutionary principle that pushes women to seek mates above their status. In a post-monogamy society, that means a tiny percentage of genetically superior alpha guys hoard most hetero sex. There were infographics to back it up, Tinder experiments with precise data. Beyond that, there was biology: Genetic wiring controls most everything about life, the forums’ users argued, ensuring the misery of people like him.

The forums’ posters blamed their plight on women’s rising social power. Once upon a time, women without careers married for stability; today they inevitably spent their 20s riding a “cock carousel” of the hottest guys they could land, settling for an ugly or average-looking man only when they were old and used, i.e., above 30. Even then, women could hardly be depended on for loyalty. Showered with attention on dating apps, favored by divorce courts, beloved by HR diversity initiatives, women had become a privileged class. The forums rarely mentioned wage gaps, pregnancy discrimination, or sexual violence, except in jest.

“Truth4lie” was an early user name; over the next few years, he’d use others. His depression lingered well into his 30s. He started an online editing business and moved into his parents’ house in a small village in the Netherlands, where he knew almost no one. Most days, he would work from home, post on the forums, then eventually dress — leather jacket, torn jeans, fingerless leather gloves — and take a walk around the village, silently cataloguing how many people glanced at him or returned a smile.

The sight of certain women began to bother him. When a woman he hired turned out to be beautiful, he fumed online: “An 8/10 girl works for me since today. I’m going to dominate the hell out of her. Trust me, I’m going to kill her confidence.” Women with babies ignited anger, too. “Every time I pass by a pram, it fills me with disgust to know that she has ruined her body and chose to reproduce with another guy,” he wrote. Other users responded with gifs: angry WWE faces, a cackling Nic Cage. “Seeing women taking care of their sons is the only situation in which I don’t hate them,” agreed one user named Biebercel.

The posters called themselves “incels,” short for “involuntarily celibate.” On one forum where Truth4lie posted — Lookism, which succeeded Sluthate — there are 10,000 registered users. They were on other websites, too (incels.me, incels.co, r/braincels), although it’s impossible to know who was posting on multiple accounts. Incels called women like the one Truth4lie had hired “Stacies.” Alpha men had a name, too. They were called “Chads.”

You know, those guys who are “praised day and night for their top-tier genetics, making a shit-ton of money, getting insane amounts of validation, never having to worry about paying the rent or any of that bullshit; all they think about is their next football match and coming home and having a threesome with two supermodels, supermodels that puke at the thought of them touching you.” That’s how one incel with a Pepe frog as his avatar described Chads, posting a picture of Lucky Blue Smith and Jordan Barrett backstage at a Balmain fashion show.

Truth4lie’s friends hated Chad, but they were also convinced their lives would improve significantly if they could somehow become Chad. They tried “gymceling” and “steroidmaxxing” (incel-speak for bodybuilding and taking steroids). They tried jelqing (penis-stretching exercises) and mewing (chewing hard foods to bulk up the masseter muscles, said by British orthodontist Mike Mew to augment the jawline). They tried pulling on their faces to reshape them. They got into skin care.

Some wanted more elemental improvements. More than pudgy flesh or pocked skin, it was their bones that made incels unfuckable, they believed. Their quarrel was with the very collagen that had ossified in their mother’s womb, the calcium phosphate with the potential to outlast civilizations, maybe even souls — or to be weeded out of the gene pool. “The difference between a Chad and an incel is literally a few millimeters of bone,” reads one meme.

To transform skull and skeleton could be done only with great expense and pain. It would take surgery. Some incels spent years researching procedures. More and more, they congregated around a single name: Barry Eppley, a cosmetic and reconstructive surgeon in Indiana.

“I had a dream: to meet the great Dr. Eppley,” wrote Truth4lie in one of over 1,100 Lookism posts mentioning the doctor. “I finally met the man, the true master artist, a superior human being. He should be mentioned with the likes of Mandela, Shakespeare, Luther King, Descartes, and Mother Teresa. He is the Einstein of Aesthetics,” he wrote. “He’s changed thousands of incel lives for the better.”

Naturally Occuring Chads (clockwise from left): David Gandy, Jordan Barrett, and Lucky Blue Smith. Photo: Mike Marsland/Getty Images (Gandy); Clint Spaulding/Patrick McMullan (Smith); Sylvain Gaboury/PMC (Barrett).. Naturally Occuring Chads (clockwise from left): David Gandy, Jordan Barrett, and Lucky Blue Smith. Photo: Mike Marsland/Getty Images (Gandy); Clint Sp... more Naturally Occuring Chads (clockwise from left): David Gandy, Jordan Barrett, and Lucky Blue Smith. Photo: Mike Marsland/Getty Images (Gandy); Clint Spaulding/Patrick McMullan (Smith); Sylvain Gaboury/PMC (Barrett)..

When we meet at his office in Carmel, a suburb of Indianapolis, Dr. Barry Eppley says he has never heard of incels. This surprises me. How could someone become an incel celebrity unwittingly?

On the walls of his consultation rooms hang black-and-white photos of beautiful humans. The men have zygomatic arches hanging like precipices over their caved-in cheeks. Their jaws are wide and sharp, as if drawn by protractors. They have long eyelashes and full lips that never smile.

“I call it the male-model look,” Eppley tells me, sitting on his right hand and gesturing with his left. He is 63 and wears a paisley tie, monk-strap loafers, and a white coat and speaks with a mischievous ease. “Chiseled features, an angular, sculpted face. It’s been the standard for the annals of time. Now there’s a practical way to actually achieve it.”

Cosmetic surgery among people who identify as male rose 325 percent between 1997 and 2015 in the U.S., according to the American Society for Aesthetic Plastic Surgery. Eppley, who is boarded in oral and maxillofacial surgery as well as plastic surgery, is one of a handful of doctors explicitly targeting young men with procedures to transform the face and body rather than to reverse aging. It’s a burgeoning demographic: Patients fly here from around the world, looking for something their local surgeon doesn’t perform, often a procedure Eppley invented. He does around 450 surgeries a year — eight to ten a week.

He performed his first custom facial implant in 1997 while on the faculty at Indiana University, practicing plastic surgery at the hospital there. A machinist from Terre Haute had wanted his jawline augmented — and wanted to design it himself. He and Eppley worked together, carving a model out of clay. Eppley now designs custom jaws with CAD, the software used by architects and engineers. “Some people may call my practice on the edge,” he tells me, “but it’s only cavalier if you don’t have the background, working at the university and doing free flaps and complex cases and these sorts of things, which 99 percent of plastic surgeons haven’t done.” (“Free flaps” are a type of tissue transplant used in reconstruction after trauma.)

Eppley’s range of services includes shoulder widening and narrowing (the clavicle bones are broken, then reconstructed), deltoid and quadriceps implants, and rib removal. Some 10,000 blog posts on his website respond pragmatically to patients’ queries: “Do Neck-Muscle Implants Exist?” They could. “Can My Face Be Changed to Look a Lot Like Someone Else?” Perhaps, pictures needed. “Am I Too Old for Skull Reshaping at 57?” He’s had patients who are over 70. “What Is the Maximum Size of Testicular-Enlargement Implants?” The largest Eppley has done so far is seven centimeters in diameter.

We are sitting in his empty office on a Saturday when he shows me one. “You dissect the existing testicle out through a small incision,” he explains with a tinkerer’s enthusiasm. “Then we take our little wraparound. Clever design. Uh, it’s hard to describe.” Here he hands me a blob of gummy silicone. It’s too large for me to get my fingers around and has the texture of fine sand. “Then we put it back in. Point of the story is, you double the size of somebody’s testicles.”

Eppley christened it the “clamshell.” Urologists typically use implants made of saline for patients who have lost a testicle because of cancer. Eppley dreamed up a way to improve the feel and to appeal to those whose testicles function. “All aesthetic surgery comes from reconstructive surgery,” Eppley tells me. “Like everything in life, you just apply one situation to another.”

Eppley’s not sure exactly why a patient would want testicles of dinosaur-egg size. But that’s true of many of his procedures, which he tends to design in response to patients’ requests. If his practice had a slogan, it would be “We don’t care why you want it,’’ he tells me. “And I suspect patients seek me out because they know I won’t ask them. I don’t see it as my job to cast a judgment.”

That was certainly true of Eppley’s most famous patient, Pixee Fox, a Swedish model and body-modification artist, who put his practice on the international map after Eppley helped her realize her dream of becoming a “living cartoon.” He gave her a “wasplike” waist, achieved by removing the outer half of ribs 10, 11, and 12. Eppley has since removed hundreds of ribs in waistline reductions. The technique borrows from the bone harvesting used in rhinoplasty and jaw reconstruction but with tinier, more cleverly placed incisions.

Often his rib-removal patients are transgender and will get hip implants in the same trip. Transgender female patients make up 10 to 15 percent of his practice. He performs facial-feminization surgery on around 25 patients a year. He does far more facial-masculinization surgeries — on over 100 patients annually — although all but one or two of them are on cisgender men.

Since Eppley’s clients come from all over the world, he first connects with most of them through video-chat consultations. I watch him field a half-dozen calls. One patient has a skull deformity, another has a rare type of tissue degeneration, and several seek “manlier” noses and head shapes.

“What makes a head shape manly?” I ask. Turns out it depends on whom it belongs to. One recent patient asked for a more angular skull with a peak at the top; another requested the exact inverse, to have his naturally peaked skull rounded. The first patient was black, and the second was white; Eppley suspected cultural standards were at the root of the difference. Some Eppley specialties — like a wide jaw or prominent brow — are universally male, triggered by the hormone testosterone during puberty. Others are arbitrary. Eppley credits the fashion industry for popularizing angular “male model” cheekbones, for instance. Custom implants allow him to adapt to trends more rapidly than other surgeons, who mostly use standard shapes.

While Eppley consults with patients, his wife, Andréa, the practice’s COO, sits in their shared office and works on an Excel spreadsheet. She manages the finances; Eppley tries to stay in the dark about the cost of the procedures he performs. Andréa has a short blonde pixie cut, a lineless face, and fantastically high cheekbones (they’re “genetic,” she tells me). She says she’s noticed a shift lately in the type of face male patients are looking for. It’s still masculine, but now they want a dash of the feminine, too. “It’s breathtaking bone structure with prominent, full lips,” she says. “A lot of people are headed in androgynous directions.”

Dreams of Chad: On the incel forum Lookism, users regularly Photoshop each other’s selfies to show what they would like if transformed into Chads.

On another visit to Eppley’s office, I meet Matthew, 31, who has flown in from the East Coast for a checkup on his third round of chin implants. He has also gotten a rhinoplasty, temple implants, and mouth widening from Eppley. “Women today are definitely pressured more to look a certain way, but if you’re a man, getting work done is more stigmatized,” he says, asking me not to use his last name.

Matthew isn’t an incel. He knows what one is — he stumbled on their forums while researching Eppley and found them “degrading” to women. He is bisexual and hoped cosmetic surgery would help him date more. He saw it as within the normal, if expensive, range of body improvements, like dieting. He also wants to be famous: “I became obsessed with a lot of models around my age who had that real chiseled bone structure,” he recalls. There was one in particular — Colton Haynes from Teen Wolf — who spoke in a monotone voice that reminded Matthew a lot of his own. Haynes never went to college, while Matthew has a master’s in engineering. “These people have all these followers on Instagram,” Matthew says, “and you’re like, Why can’t I have all these followers?”

Matthew has striking blue eyes with pale lashes, and, thanks to the procedures, a wide jaw and jutting chin. “I’m definitely more happy with the way I look now,” he tells me, although his life is far from transformed. He lives with his parents and works at Best Buy, an arrangement he originally conceived to help save up for surgery. He’s now planning new procedures, including one to fix what he describes as a bump on the tip of his nose, although I don’t notice it.

Most of Eppley’s patients are happy with their results in one go, Eppley tells me. But cases like Matthew’s are not uncommon: Roughly 25 percent of his surgeries are revisions of his own work or another doctor’s. That’s higher than most doctors’, because implants often require more adjustments than other types of procedures. Eppley also rarely turns anyone away if he believes he can operate safely and effectively, even if the patient’s perception of a flaw seems out of sync with other people’s. “His appearance is something that he has control over,” Eppley says of Matthew. “Someone might say, Why does it matter, the tip of my nose? But it matters to him.”

Incels began discussing Eppley’s results around 2014 on Sluthate. They were particularly interested in the custom facial implants designed by Eppley and a team of engineers at the Colorado firm 3D Systems, which are then manufactured, usually in silicone, by a California company called Implant Tech. Patients participate in the process down to the millimeter.

When I show an incel forum to Eppley, he at first seems confused by the anonymous usernames. We look at a thread by a user named Saiyan who has posted images of his designs for Eppley cheekbone implants and post-op selfies. Finally, it seems to dawn on Eppley: “That patient has done more to promote that style of implant than anyone I know,” he says. He has fielded requests from dozens of patients who specifically reference Saiyan’s photographs. He hadn’t known where they’d found them.

“Indianapolis is not a hotbed of plastic surgery,” says Eppley. “This practice is only possible because people really do a tremendous amount of research, and typically patients have been on many, many forums.” His staff regularly posts dispatches from the operating room on the practice’s YouTube and Instagram, and the surgeon spends hours every week answering emailed questions from patients and transforming the results into SEO-optimized blog posts.

Eppley’s “whatever you want” philosophy is certainly part of his appeal. Some surgeons will not operate on patients they believe may have body dysmorphia. “To me, that’s a red flag when someone has 200 pictures of themselves on their phone,” says Joe Niamtu, a cosmetic surgeon in Virginia, who declines to operate on many young male patients seeking sculpted faces. “The risk is they’ll never be happy.” Niamtu has referred some patients to Eppley.

On forums, incels argue that the diagnosis is often a kind of reverse discrimination and that women seeking invasive procedures to fix relatively small flaws are not greeted as skeptically. “Social media and ease of access/exposure to plenty of top 3% chaddy hunks has literally set the bar much higher for men,” wrote one user. Body dysmorphia “was invented by oldcel psychologists who grew up in the 50s and had NO problem to find a looksmatched or even better-looking wife,” noted another.

But even Eppley’s learned to be more cautious. In 2009, he sued a former patient who was waging an online war on his practice, creating dozens of SEO-hogging sites (e.g., Dreppleysucks.com). Her face-lift revision had resulted in a permanent breathing problem, she claimed to filmmakers in the 2006 HBO documentary Plastic Disasters, although she never filed a medical-malpractice suit and doctors who subsequently examined her found no surgery-related abnormalities. Shortly before the court ruled in Eppley’s favor, the patient committed suicide. Eppley now trains assistants on how to monitor patient communications for signs of mental instability. But he doesn’t turn away those he suspects of having body dysmorphia. “Many of my patients have it to some degree,” he tells me. “These procedures can be really transformative.”

More Photoshopped selfies from Lookism.

“Nature isn’t fair,” Truth4lie, who is half-Dutch and half–North African, tells me. “Some races are more attractive than others,” and biology, he says, determines beauty, not cultural norms.

In 1993, a 34-year-old neo-Nazi made an appointment with a Chicago plastic surgeon and murdered him, saying later in court that he was motivated to protect “Aryan beauty.” Incels tend to venerate the same European features, but they also revere the surgeons who bestow them. Only a handful are white supremacists — “stormcels,” as they’re known. Far more are like Truth4lie: not white, but convinced that most paragons of male beauty are.

In forum posts, incels classify Chads by phenotype (“Keltic Nordid,” “Gracile Mediterranid”) and style (jock, lumberjack, vampire, pretty boy). They repost scientific research on the importance of symmetry and harmony in universal standards of beauty. They discuss the Golden Mask, a Platonic ideal of a face designed by a California surgeon using the ratio of phi.

Truth4lie’s preferred Chad was a common incel favorite: David Gandy, the face of Dolce & Gabbana’s Light Blue cologne ads, in which the British model has a bronzed six-pack, a plump Speedo, and crystal-blue eyes. (That Stefano Gabbana and Domenico Dolce are gay designers best known for an aesthetic of homoerotic high camp was an irony most incels missed.)

The more Truth4lie read about Eppley, the more the doctor seemed capable of turning even Truth4lie into a Chad. He remembers one widely shared photo showing what it said was an Eppley patient with a new chin, a new jaw, a new forehead, new temples, and a new skull. “It was like Eppley created a whole new person,” Truth4lie recalls. “Incels have this idea of an ideal superman, and Eppley is the one who does that crazy stuff.”

The first time Truth4lie saw Eppley was during a video consultation one summer afternoon in 2016. He was living in an apartment his parents owned. His bedroom was what he calls “typical incel,” i.e., “trillions of fruit flies multiplying, cigarettes and ash on the floor, dirty clothes all over the place, not a glimmer of light.” He took his laptop to the garden outside.

Truth4lie’s jaw wasn’t severely recessed, Eppley noted, peering at the videoconference feed of the dark-haired 35-year-old side by side with pictures he’d sent by email. Eppley said he could fix his slightly weak chin, asymmetry, and lack of vertical length with a custom jaw implant based on a CT scan of Truth4lie’s skull. (Truth4lie wouldn’t send me pictures of himself, but I found a few online, although I wasn’t sure if they were pre- or post-op. He has short dark hair and dark eyes, a cupid’s bow on his upper lip. He is squinting into the camera. He reminds me of Joseph Gordon-Levitt with a wider face.)

Incels have this idea of an ideal superman, and Eppley is the one who does that crazy stuff.

The surgery came with risks, Eppley explained: infection, malposition, asymmetry. In young men getting multiple procedures, the likelihood that one would need to be revised was high. And it was impossible to precisely predict, even for an experienced surgeon, how large or small an implant would look once it was covered with soft tissue. Truth4lie understood, he told the doctor. He made a deposit and booked a date for the surgery, which would cost $18,500, plus the price of a trip to Indianapolis from the Netherlands.

The operation would include a rhinoplasty revision. Truth4lie had his first cosmetic surgery when he was 19 from a local surgeon who transformed his naturally concave “Arabic” nose into a bunny ski slope, a result Truth4lie had come to see as a botch. Eppley would give his nose a shape that Truth4lie considered “more masculine” — aquiline or Roman, straight with a slight curve at the tip.

That October, Truth4lie would take the 11-hour flight to Indianapolis, his first trip to America. He was more nervous about being unable to shield himself from judgmental glances at the crowded airport than about the procedure. When he pulled up to Eppley’s office in a suburban medical park, the parking lot felt like another ocean. Everything in America was too big.

A nurse had him read some paperwork. The procedures would take six weeks to heal, and the swelling might continue even longer. When Truth4lie woke up from the anesthesia in Eppley’s surgical center, the room was dark. He felt no pain. Later, Eppley came in, removed the bandage from Truth4lie’s nose, and handed him a mirror. The appendage looked straighter, more male. As Truth4lie left the surgical center, he made eye contact with the nurses and staff, trying to gauge their reaction to his new face.

Back at his hotel, he ordered room service and watched TV. His jaw was still swaddled in bandages, and his mouth was filled with blood. When he removed the bandages, his jaw was not yet swollen. He admired its width and dreamed of a new life.

“I hope everything goes well and this will be a real change,” he wrote on the forum. “But where do I need to begin? I need women, lots of women, to make up for my miserable life. I need a new social circle, a new identity, a new life. I’ve been thinking of leaving my country. I want to live in hotels in tropical countries and live a playboy life there, only fucking hot blonde European girls. I have the money, I have the freedom. I need to go and leave this goddamn rotten place, need to leave everything behind, my old life.”

“I think you are expecting too much from just some jaw implants,” replied another user.

Another Chad. Photo: Guillaume Roemaet. Makeup by Meghan Yarde; Hair by Ro Morgan; Casting by Felix Cadieu. Photo Assistant: Kevin Drelon. Creative Producer: Lisa Christine. Model: Mike Gioia at Soul Artist Management.

In 2014, a self-described incel named Elliot Rodger, who called himself a “supreme gentleman,” wrote in a manifesto that the world had failed to provide “the beautiful girlfriend I know I deserve” before he killed six people and injured 14, carrying out a shooting spree at an Isla Vista, California, sorority house. He had been a user on the forum Pick Up Artist Hate (puahate.com), a precursor to Sluthate. In the past decade, seven mass killings have been attributed to incels or adjacent online misogynists.

On Lookism, the forum where Truth4lie and Saiyan posted about Eppley, users half-jokingly encouraged each other to “go ER,” a reference to Rodger. It was that, suicide, or surgery, they said. “If you don’t have Masterfaggot levels of coping to get you through each day to stop you from going ER, then you had better have cosmetic surgery scheduled very soon,” wrote a user named Invisible.

Incels I spoke to framed posts like this as a kind of dark humor, helping them face painful truths about the world with a shield of irony. But trolling also seemed like a gateway to extreme ideas. When incel Alek Minassian drove a van onto a crowded sidewalk in Toronto in 2018, killing ten, he prefaced his crime with a Facebook post praising “the Supreme Gentleman Elliot Rodger.”

Cosmetic surgery seemed to serve a similar function to trolling but on a grander, more permanent scale. Incels said it would help them to live more normal lives and alleviate loneliness and depression. Just as often, it seemed to carve their prejudices in bone.

“Getting treated better after surgery feels sickening,” wrote one user, LegendOfBrickTamland. Brick had gotten a new jaw, nose, and cheekbones from a surgeon in California, costing him around $30,000, and still he was furious at women and the world. “It’s like, I am the same fucking person, and yet I am somehow better because I spent some money and had a man cut my face up. Might as well just go with prostitutes. At least it’s an honest exchange.”

Relax and try to enjoy life, replied another user, who had also undergone surgery. “I was mostly just happy people seemed to smile at me more, make better eye contact, and wanted to hang out more.” A month later, that person authored his last forum post under his user name, which perhaps suggests he’d left the forums for good.

Much like women getting breast implants, South Koreans getting eyelid surgery, or bodybuilders taking steroids, the posters on incel forums seem at first to be motivated by the undeniably relatable desire to look better — and therefore be treated better. Natalie Wynn is an academic turned “one of YouTube’s leading B-list transsexuals” (her words). On her YouTube channel, ContraPoints, she comments on far-right internet culture while sipping wine and sporting 18th-century cosplay. Her most popular video is on incels, and she grants the group more sympathy than you’d expect. “I’m just as obsessed with bones as the goddamn incels,” she says at one point, noting that she’s about to pay “luxury-car amounts of money” for facial-feminization surgery. Some transgender people are against that surgery, she tells me by phone, because “they think we’re trying to pass and look cis, which is only a thing that we’d want to do in a really transphobic society.” But is it right to blame individual trans people for trying to be happy? “To me, it seems not the point.”

Unlike transgender people who pursue surgery, of course, incels tend to be perpetrators, rather than targets, of violence and discrimination. Still, the positions of some incels I talked to echoed Wynn’s analysis. PostSingularityVirgin, a 21-year-old Canadian, started reading incel forums when he was 17. Soon after, he dropped out of college to save up for cosmetic surgery, which he has yet to get. He believes people like him are the future; in the next century, cosmetic surgery will be widespread and affordable to everyone, he tells me. “I feel like inequality in humans is like the greatest source of misery,” he says. “Wealth inequality, how you’re treated because of the way you look. A lot of those things are being eliminated by technology.”

But in a way, PostSingularityVirgin is an exception. He recently found himself questioning why a girl in his life didn’t seem to fit the descriptions of women he’d read about on incel forums. They met a few months ago on the webcam service Omegle. Every night, they talk on Skype, trading Futurama and SpongeBob references and concocting an imaginary family: He has a stuffed pig named Billy, and his girlfriend pretends she’s its mom. Sometimes they get naked and stare at each other’s bodies through the screen. PostSingularityVirgin doesn’t know if he believes in love, but he loves talking to her.

For other incels, the anger they held on to even after their surgery suggests their motivation may be something closer to what feminist writer Jessica Valenti has described: “Incels are not a community of sad men that reflect a societal problem with loneliness. They’re a community of violent misogynists that reflect a societal problem with sexism and sexual entitlement.”

Mike, a tour guide in Austria in his mid-30s, has spent so much time on incel forums that he “doesn’t know anyone in real life anymore.” But he’s not technically an incel, he says: He’s slept with 50 women in his life, though only “10 percent were hot.” “An average man has to swipe about 114 times on Tinder to get one match,” Mike said when we talked on WhatsApp. On the forum, meanwhile, he has read about “how many matches and messages women get, even women with gross deformities, women with disabilities, morbidly obese women.”

In conversations like this, it was difficult to empathize with incels — they had so little empathy for anyone else. It’s not as if straight men are the only ones who experience punishing standards of hotness and social-media alienation. But only incels react with bile.

“How is it living as a hot/normal woman knowing you can order a hot fuckboi from Tinder whenever you want? Do you see it like that?” Mike asked me. His obsession over sleeping with ever-hotter women reminded me of pickup artistry: This was sex as a game to win, in which the other person was the chump. Incels weren’t always seeking love or acceptance as much as conquest.

Mike recently got a jaw procedure called BSSO, plus a hair transplant. After the surgeries, he met two girls at his other job, teaching comedy, whom he considered “cute,” and he took this as a sign of success. Now he’s investing in cryptocurrency in hopes of getting more procedures with Eppley. In a recent forum thread, he posted a selfie specced out with angles and degrees, measurements of his features; he then found a photo of Tom Cruise and gave it the same treatment. (Mike’s jaw angle was 69.02 degrees; Tom’s was 76.31.) “I want to solve this woman thing,” he told me.

Ironically, as Mike and his friends were obsessing over “GigaChads” who looked like models, the real-life fashion industry was beginning to court more eclectic faces, whose curves and acne and wrinkles and grooming seemed only to enhance their beauty. The Chad face was, if anything, a bulwark against that kind of progress: Its retrograde look was the point.

When I discovered his real-world identity and tracked him down, Truth4lie at first denied he was the user from the Lookism forum. Then he came clean.

“I feel ashamed about everything,” he told me. “I’m talking to a woman, and I said bad things about them. I’m actually a nice person in real life.” He declined to speak further, preferring not to be reminded of this dark chapter in his past.

A few minutes later, he changed his mind and called me. By that time, Truth4lie’s account on Lookism had been dormant for roughly a year. One of his last posts, from June 2017, announced he was leaving the online community for good. “Slowly slithering back into society, because looks = NT,” he wrote, using an acronym for “neurologically typical.” In Truth4lie’s view, mental illness was a by-product of his outward appearance; if he were better looking, his depression would disappear.

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.

But by May, he’d returned for a second revision, during which Eppley replaced the implant altogether to correct a small asymmetry. Another revision corrected for a shape that Truth4lie found, once again, too big. After his last revision with Eppley, over the summer, Truth4lie developed an open wound that took months to close.

On the phone, Truth4lie told me he had recently had his fifth jawline-implant revision, this time with a local surgeon in Holland. “Do you say, ‘I’m happy with how I look now?’ ” he asks. “Or do you go deeper down the rabbit hole with the chance to fuck up everything with another procedure because you can always be better looking?”

He says he doesn’t hate women anymore. But he hasn’t left behind most of the theories about life that he was exposed to on incel forums. Sometimes when he notices a woman making eye contact with other men in the street, the entire world seems to narrow to a harsh, suffocating plane of power dynamics, in which sexual attraction determines all. “Every time I try to talk myself out of things I used to believe, of the black pill, it feels like I am moving away from the truth,” he tells me. It’s hard to want to live when that happens.

The second time we speak on the phone, Truth4lie tells me he has just been released from the hospital after attempting suicide. His last jaw-implant revision was still monstrously swollen, and he was so anxious about it that death seemed easier than looking at his face in the mirror.

He swallowed pills, then read on Google that his final hours would be slow and painful. So he called an ambulance. When he woke up in the hospital, it felt like being reborn, joyous, akin to the dopamine rush he always felt after being operated on.

“The prospect of a better surgery result is keeping me alive,” he tells me.

In the months since we first spoke, Eppley has been trying to come to terms with his incel celebrity. He seemed pensive, if not exactly shocked, when I asked him about it recently. “I’ve often wondered why some of my patients are the way they are. I’ve been dealing with them for years, unknowingly,” he says. “I just take them as some of our challenging young male patients, but this certainly explains some of their behaviors. Psychologically, this is an abnormal group.”

I ask him what he thinks about Truth4lie’s case. “It’s easy to look back on something and say we shouldn’t have operated,” he tells me. But screening for someone who will never be happy is difficult. “My job is not to be a psychiatrist sitting in a chair. You’re serving a need, and you don’t know the depths of that need.”

He considers the question of whether the surgeries could end up reinforcing incels’ misogyny beyond his purview: “A doctor who puts in 500 breast implants, there will be someone who says, ‘He’s a terrible person. He’s making women sick for profit.’ ” Someone who operates on transgender patients will be told, “ ‘He shouldn’t have a medical license. That’s against God.’ ”

But breast implants and gender affirmation don’t reinforce patients’ hatred of other groups of people, as incel’s procedures might, I point out. “How is it any different?” Eppley says. “You have no idea what someone’s motivations are, whether that’s trying to be more attractive and feel better about themselves” or something more nefarious.

Eppley stops short of saying anything that might discourage incels from continuing to seek him out. “I have zero positive or zero negative things to say about them. They’re just people. The only thing I care about is that on an individual-patient basis, are they happy?”

Eppley’s career has given him plenty of opportunities to study the nature of human appearances, and over time, he’s had a few insights. He believes each of us is actually three people: how we see ourselves, how others see us, and how we actually are. Eppley will turn 64 this August. He has blue eyes, plenty of crow’s-feet, and a mane of hair that does indeed channel Einstein’s. “I don’t have any pictures taken of myself,” he tells me. “I prefer to walk around with an illusion of what I look like.”

*This article appears in the May 27, 2019, issue of New York Magazine. Subscribe Now!