Cosmetic surgery is becoming more and more popular amongst both women and men. But few take it to the extremes that Dennis Avner does. Better known by his Native American name of Stalking Cat, he has had his appearance surgically altered so that he looks like his tiger totem. All of his teeth have been removed and replaced by tiger-like fangs. His lip has been split to look like a cat's. He has 18 piercings on his upper lip to attach whiskers. To all this add nose and brow implants, pointed ears, and tattoos galore. Some of the procedures are uncomfortable, says Stalking Cat, but “This is me. This is who I am.”

Now 47, Mr Avner grew up in Michigan in a Native American community. He was once a sonar submarine technician in the US Navy and later a computer technician. He now lives in a small island community near Seattle. A well-known figure on American tabloid TV, Stalking Cat may be a victim of body dysmorphic disorder, says Glenn McGee, the editor of the American Journal of Bioethics. “It is possible to have a coherent view that is nonetheless detrimental to one's well-being,” says Dr McGee. “This is a patient who's being harmed by medicine in the interest of his tradition.”

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