Social media is still buzzing about Madonna’s appearance at the Grammys, where the 64- year-old pop star looked as if she had opted for elective plastic surgery. Madonna has previously responded about ageism by saying, “I never apologized for any of the creative choices I have made nor the way that I look or dress and I’m not going to start.” Her body. Her choice.

But in our culture consumed by appearances of ourselves and others, the unwarranted debate seems far from over. And that feels like an attack on Madonna and on me.

When I was 8 years old, I saw one of the world’s most famous plastic surgeons. Before I could see the doctor, I suffered through countless tests, including having my little head taped down to the cold steel of an X-ray machine. I never once questioned why I was put through such torture. Even as a little girl, I knew this was the price of beauty.

The surgeon specialized in children with facial deformities, like me. I have hypertelorism, defined by an abnormally large distance between eyes. In addition, I have a lazy eye and an asymmetrical nose. In an article my parents read before the appointment, the doctor was quoted as saying, “Almost normal is not normal enough.” As I looked around that hospital waiting room at the two dozen other kids around me, “normal” seemed like an impossibility. Most were younger than me. One had a skull half formed. Another had a missing nose. The youngest one appeared to have an additional face growing out of a cheek. I can still recall each image so clearly, engraved in my memory like a black-and-white horror film.

The surgeon emerged from behind an exam room curtain like the great Oz himself. He did not say hello or make niceties. He simply pointed to my face and asked, “What are you doing here?”

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Before anyone could answer, the doctor motioned for my parents to sit down as he projected a slide of a sad, scared looking young girl whose hypertelorism was far more severe than mine. Her eyes literally sat on separate sides of her head near her temples. The next slide was of the same girl, post surgery. She appeared a year or two older and, most important to every adult in the room, she looked completely normal.

What I noticed was that she still looked sad.

The doctor proudly explained how he peeled back her face and then cracked her skull. I have no recollection of what he said next. I have replayed that conversation in my head thousands of times in the past 50 years. I can remember the smallest details of that day down to how scratchy the material was on the outfit my mom bought me. But, I cannot remember one word after “we cracked her skull.”

All I knew at that moment was that I did not need to be there and I would never allow a doctor to crack my skull for me to appear more normal. I was normal enough.

But that was not the end of the discussion about my face. The comment I heard most growing up was, “You’d be beautiful if …” Once a plastic surgeon resident stopped me on the street and offered to “do” my face. Ummm, no thanks.

My outward response to all this was a visceral and vocal condemnation of anyone who had plastic surgery. I saw and spoke of those who altered themselves as losers, which left me by default the victor. But my internal response was far more dark. As I got older I went from feeling shame around my appearance to all out self-loathing. In high school, I gained weight, which provided me a way to simultaneously disappear and fit in. It was easier to be everyone’s fat and funny friend than just to be plain funny looking.

Then, I grew up.

I went to college. I discovered other ways of seeing the world and ultimately myself. I began to openly acknowledge my experience and ask others to share their own. I realized if we are to have an honest conversation about beauty and choice we must hold the multiple truths that at times feel fundamentally at odds.

We must both fight against external messages and messengers so people don’t alter themselves — physically, spiritually or emotionally — to fit into someone else’s definition of normal. Advocating for a person’s right to choose goes far beyond just reproductive justice.

For me, self-healing included coming out, which led to the added bonus of finding and allowing love. I began to work out religiously and found mental and physical strength. And the more I let go of ideals and items I had been taught should make me beautiful — such as most make-up, dresses and high heels — the more I found my own sense of beauty. These days, I exude self assurance in my sensible shoes, tattoos and all things Patagonia.

As someone who was once told my face “resembled a Picasso painting,” I understood early on that traditionally defined beauty was not attainable for me. Now well ensconced in middle age, I see how unsettling it is for friends to feel like they “have begun to disappear,” to go from being stared at for their beauty to completely looked through because of their age. And while I will always carry with me the pain I felt of having never been conventionally attractive, I now find myself most grateful for not having to struggle with losing that way of being seen.

For sex symbol Madonna, her calculation on what to do with her body is quite contrary to mine because I imagine our relationship to how we look has been so different. Her ever changing appearance is one of the ways she guarantees she will never become invisible. Just the opposite. Madonna’s continuing transformations — music, hair, branding — are part of her brand. The public is unable to look away.

And while there is a much-needed dialogue for us as a society on how public figures’ actions impact young people, this does not happen via Twitter posts or vicious memes. Rather this is part of a larger and ongoing conversation about the value each of us individually and our world collectively places on fame, beauty and being “normal.”

Jackie Kaplan-Perkins is a community builder, storyteller and changemaker based in Chicago.