The Italian term “sfregio”—meaning “scar” or “disfigurement”—carries with it a legacy of violence, punishment, and social commentary. In Renaissance and Baroque Italy, particularly in the southern regions, sfregio was a calculated act of facial mutilation, often carried out to humiliate and mark an individual permanently. These injuries, inflicted with knives or blades, were designed to be publicly visible and socially damning. They occurred primarily in the context of revenge, romantic jealousy, or honor disputes.

Among the most emblematic cases is that of Maddalena Antognetti (1579–?), a celebrated Venetian courtesan known for her wit and beauty. She is believed to have modeled for Caravaggio in works such as Madonna dei Pellegrini and Madonna dei Palafrenieri [1,2]. According to historical accounts, she became the victim of a sfregio attack by a jealous lover. The facial wound inflicted on her was not merely an act of violence but a deliberate attempt to erase her identity and social capital, which were closely tied to her physical appearance (Fig. 1) [3]. Despite this, Antognetti reportedly resumed her position in society, a testament to her resilience in a world that left little room for scarred women.

Medical treatment in that era was limited. Surgeons and barber-surgeons cleaned wounds using wine or vinegar, crude antiseptics thought to reduce infection. Suturing was basic, employing silk or linen thread with little knowledge of sterilization or tissue preservation. Pain was managed with opiates, mandrake, and willow bark, while healing salves containing honey, animal fat, marigold, and comfrey were used to treat wounds. Despite these efforts, scars were expected, and in the case of sfregio, intended.

Reconstructive attempts were rare and mostly accessible only to the wealthy. Surgical methods were experimental and often exacerbated the disfigurement. Some victims sought cosmetic camouflage. Women applied ceruse, a lead-based white pigment, to conceal scars and even out complexion—though at great cost to health. Veils and wigs became tools of dignity and survival. Men, conversely, sometimes embraced their scars as markers of bravery, particularly when attributed to duels or military service.

Art from the time, especially that of Caravaggio, reflected the visceral reality of disfigurement. His hyper-realistic portrayals of saints and sinners alike emphasized raw, emotional suffering [1,2]. In a society where honor and shame dictated fate, the face became a battleground for social power. Sfregio left not only physical scars but deep psychological and societal ones.

The resonance of sfregio extends into the modern world. Though no longer a common practice, its echoes are visible in acid attacks in South Asia and the Middle East, where women are disfigured for perceived transgressions of honor. In Latin America and urban centers across the globe, gang violence sometimes includes facial scarring as a method of punishment, initiation, or domination. These acts mirror the logic of sfregio: public, humiliating, permanent.

Modern reconstructive surgery stands in stark contrast to the historical void of care. Today, a range of advanced techniques—Z-plasty, W-plasty, laser resurfacing, tissue grafting, and dermal fillers—allow surgeons to restore form and function (Table 1). But more than that, reconstructive surgery today incorporates the full person. Psychological support, peer counseling, and patient-centered outcomes are now standard components of comprehensive care. Patients may choose whether to conceal scars or integrate them as part of their identity.

Understanding sfregio’s historical context allows modern practitioners to appreciate the emotional weight of facial trauma. Reconstructive surgeons do not merely treat tissue; they engage with the patient’s self-concept, social standing, and dignity. The symbolic burden of facial scars persists, though modern attitudes are slowly evolving. Campaigns that depict scarred faces with empathy and strength help combat stigma. Likewise, visual storytelling, social media, and advocacy groups play vital roles in reshaping public perception.

As reconstructive surgeons today repair faces, they also participate in a broader act of healing—restoring social visibility, self-worth, and autonomy. Sfregio reminds us that the face is more than flesh and bone. It is a cultural symbol, a personal canvas, and often, the first and lasting impression upon which a life is judged.