Altered body image is a potential and actual source of considerable distress, particularly following facial disfigurement, and social functioning is reported as a major area of difficulty by sufferers. However, the area of facial disfigurement has received comparatively little attention from researchers in health care. Two current models of disturbed body image are examined, and it is contended that both require development in order to be of use in responding to the difficulties experienced by disfigured people. A fear-avoidance model of exaggerated pain perception, which has clear treatment implications, is described, and it is shown how this model may be modified to offer a framework for the understanding and treatment of the psycho-social difficulties of disfigured people. In particular, it is suggested that the avoidance present following disfigurement is phobic in nature, and special attention is given to the roles of avoidance and confrontation in mediating these difficulties. Implications for intervention and the shortcomings of the model are described.