I think they keep trying to change what they see in the mirror in hopes they will like what they see inside. Anyone going to the extremes of the two in these two pics will endure enough pain in the quest to change who they are. If they stop, they will have to accept what is, an unfinished product. I think those that do tats on their face are sending the message, don't look at me, look at my tat.
I used to be one that quickly judged someone by their appearance until I was in the store one day at the grand opening and my license and description of my car were announced over the PA. I went outside to see a cop and a young woman and the cop explained to me that the young woman had hit my car while leaving her parking space and had come to find a police officer her to report it. I was dumbfounded that someone would do that and not just drive off, my cynicism needed to take a break. And then my quick to judge the book by it's cover needed one also. The young woman had half her head shaved and a tat of a peacock wing and the side with hair was a brilliant purple. She had various piercings and tats and had I seen he in the store I would have thought 'what a freak'. But now that I had met her and seen the type person she is, I wondered 'what is it she doesn't like about herself that she's had all of these changes? 'Doesn't she look inside'?
I guess it is similar to eating disorders. No matter how skinny Karen Carpenter got, she couldn't stand what she saw in the mirror and tried to change it the only way she could. Man, this mean old world is tough enough to handle without adding the self torture of self loathing to it.