There's a reason Carrie Underwood's 'gruesome' injury has kept her out of the spotlight

Carrie Underwood is facing the camera again after what she called a “gruesome” accident that made her “look a bit different.”

On Friday, the country star Instagrammed a faraway shot of herself rehearsing for the April 15 Academy of Country Music Awards. On Wednesday, she had shared a black-and-white image in the studio, exposing only half her face.

Underwood, 35, has largely stayed out of the spotlight since November, when she fell on stairs and reportedly broke her wrist.

A few days after Christmas, Underwood surfaced in an Instagram selfie that showed her face concealed with a scarf. “When in 5 degree weather, wrap your @caliabycarrie scarf around your neck and face…you keep warm AND look like an awesome winter snow ninja!” she joked in the caption.

Then on New Years’ Day, in a private message to her fan club obtained by People magazine, Underwood said that along with breaking her wrist, she sustained injuries to her face that were serious, requiring “between 40 and 50 stitches.”

She wrote, “There is also another part of the story that I haven’t been ready to talk about since I have still been living it and there has been much uncertainty as to how things will end up. It’s crazy how a freak random accident can change your life.”

“In addition to breaking my wrist, I somehow managed to injure my face as well,” Underwood added. “I’ll spare you the gruesome details, but when I came out of surgery the night of my fall, the doctor told [Underwood’s husband] Mike that he had put between 40 and 50 stitches in.”

Admitting that she was “not quite looking the same,” she said: “I am determined to make 2018 amazing and I want to share things with you along the way. And when I am ready to get in front of a camera, I want you all to understand why I might look a bit different.”

Some fans have dismissed Underwood as being “shallow” for keeping a low profile, and talk show host Wendy Williams even suggested that the singer was hiding to recover from a face-lift, angering Underwood’s fans.

Whether you’re famous or not, facial injuries carry weight beyond the physical effects. People disfigured with facial scars or asymmetry score significantly higher for anxiety and depression, according to a study published in the Journal of International Oral Health. Other research shows that facial trauma patients experience body-image issues, posttraumatic stress disorder, marital problems, increased risk of alcoholism, and “lower satisfaction with life.”

“People with facial injuries often undergo what we call ‘cosmetic anxiety,’ and it can greatly affect one’s self-esteem,” Gerald Young, PhD., the founder and editor-in-chief of the journal Psychological Injury and Law, tells Yahoo Lifestyle. “For celebrities, the feelings can stem from not only a desire to preserve their aesthetic but also their public persona.”

Humans are driven to focus on the face. “Faces are salient markers of who we are physically, and our species inherently categorizes facial models — even babies do it according to race, gender, and attractiveness,” says Young. For the latter, facial symmetry is traditionally associated with beauty, and because women are often judged harshly for their appearance, injuries can result in traumatic feelings.

But cosmetic anxiety is not always about vanity — any changes to one’s face can feel deeply personal. “We often develop identities associated with our positive personality traits, and if one’s physical appearance changes, it can affect how they view themselves,” says Young. And that’s in addition to any psychological factors that accompany the injury, such as anxiety, shame, or posttraumatic stress.

Young says there are two common approaches to helping such people: Directly treat any psychological disorders that result from the injury or tailor coping mechanisms to the individual. However, he says: “The question is, how can one move forward looking different and still be themselves at the core?”

Read more from Yahoo Lifestyle:

• Carrie Underwood Shares New Photo Five Months After Getting Facial Stitches, and She Looks So Happy

• Carrie Underwood Shares a New Selfie Post-Fall, and Her Fans Couldn’t Be More Supportive

• Carrie Underwood’s Husband Wishes Her a Happy Birthday — and Teases Her for Throwback Hairstyle

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