Living with disfigurement can constitute a psychologically challenging position for both adults and young people alike. The present paper explores the potential implications of living with disfigurement for identity through the novel application of identity process theory, a socio-psychological theory of identity threat, to the topic of disfigurement. The theory argues that individuals need to perceive appropriate levels of self-esteem, distinctiveness, continuity, self-efficacy, meaning, belonging and coherence, and that insufficient levels of these principles will induce identity threat. Firstly, the paper outlines those principles most susceptible to threat among individuals living with disfigurement. Secondly, it considers strategies which may be implemented by the threatened individual as a means of coping with identity threat associated with disfigurement, as well as the efficacy of these strategies. The primary focus of the paper lies within the identification of what threatens identity and how health care institutions can facilitate and encourage effective coping strategies among individuals living with disfigurement.