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Anime and Manga
- A downplayed example, Kazundo Gouda in Ghost in the Shell: Stand Alone Complex: Second Gig, a villain who has a horribly mangled face and strangely-shaped head due to an accident. Although the damage was not voluntary, it's explicitly pointed out that he could repair his face using the world's futuristic technology and his wealth, but makes the choice not to. He claims it helps make him more memorable.
- The Six Paths of Pain in Naruto are covered in so many body and facial piercings it's not even funny.
- Batman villains Black Mask and Professor Pyg have both shown an eagerness to scar or otherwise mutilate their victims' faces. To say nothing of the Joker...
- Victor Szasz leaves no survivors but what he does leave is a carved line on his own flesh for each life claimed.
- The Cenobites from Hellraiser franchise are an iconic example, being an order of extra-dimentional Sense Freaks who seek to share their "pleasures" with those who can solve the Lament Configuration puzzle box.
- Darth Maul in Star Wars: The Phantom Menace, who has his entire face covered in black and red ink to present an imposing appearance.
- Karl Ruprecht Kroenen from Hellboy, so very much.
Professor Bruttenholm: Suffered from a masochistic compulsion commonly known as surgical addiction. Both eyelids surgically removed, along with his upper and lower lip. The blood in his veins dried up decades ago. Only dust remains. What horrible will could keep such a creature as this alive?
- Milton Dammers the obsessed FBI Agent in The Frighteners opens his shirt at one point to show that his chest is covered in scarification, presumably from his time spent undercover with various cults.
- This trope is utilized frequently by the Deadites in Evil Dead (2013). All three female characters who become possessed mutilate themselves in horrific ways: Mia splits open her tongue with a box-cutter; Olivia cuts open her cheek, exposing her jaw; Natalie shoots several nails into her face with a nail gun before turning it on her friends.
- In a rare heroic example from Return of the Living Dead 3, reanimated Julie cuts her own flesh, drives sharp objects through it, and even suspends weights on cords running through her hand, all in a desperate attempt to distract herself from the Horror Hunger that spurs her to eat her boyfriend's brains.
- The New Jedi Order trilogy from the Star Wars Expanded Universe presents the Yuuzhan Vong, an extra-galactic species who revere pain as a way of life. Many of their religious ceremonies involve cutting, piercing, and scarring, that they might better experience the pain they believed their gods suffered to create the universe. Promotion ceremonies involve having their limbs and organs removed and replaced with artificially grown versions.
- Just about every vampire in the Necroscope series, especially in the "Vampire World" books. The Vamps there deliberately twist and torture their own flesh to make them as horrific as possible, it is something of competition amongst male vamps to see how can have the worst.
- Hemalurgy in the Mistborn books involves pounding metal spikes into your body. The Steel Inquisitors, who use Hemalurgy the most, have railroad-sized spikes driven through everything but their noses, including two so far into their eye sockets that the points come out the back of their heads — and they're just as painful as they look, even years or centuries after they're installed.
- In Chasm City, Orcagna has a large square hole cut through his abdomen.
- The Blood Pact opposing Gaunt's Ghosts during the Sabbat Worlds Crusade are so named because they ritually cut their hands against the jagged edges of their patron's Power Armor to seal their loyalty to him and their solidarity as fraternal warriors. They also tend to engage in further scarification, cutting chaotic glyphs into their faces and scalps in order to demonstrate their dedication to the Ruinous Powers. Even those tend to be covered up by the iron masks they wear which are shaped into grotesque and monsterous faces.
- In The Sword-Edged Blonde, Andrew Reese was disfigured, broken, and deformed, being physically twisted into a new shape which left him in permanent pain but unable to die. It was a punishment after he drunkenly tried to rape someone who was actually a goddess in human form and was then dumb enough to take his anger out on an animal she cared for.
Live Action TV
- Members of Clan Tzimisce in Vampire: The Masquerade that make heavy use of their clan Discipline, Vicissitude to modify their bodies are prime examples of these.
- This is true of many Phyrexians in Magic: The Gathering. In fact, one such creature, Elesh Norn, is known as the "Grand Cenobite." It should be noted that Elesh Norn appears to have had her skin flayed off beneath her vestments, and apparently does this to others she "converts" as well, that they may be better remade in the image of the Father of Machines.
- Pathfinder's Golarion setting has Zon-Kuthon, the Midnight God of Torture (and Hellraiser homage), whose cultists follow in his footsteps and inflict as many painful disfigurements as possible on as many people as possible. Taken Up to 11 with the Joymaking ritual, where a favoured cultist is stripped of every non-essential body part and interred, alive, in the temple.
- One of the many, many horrific things the Dark Eldar do to the unfortunate people they capture.
- Soulblighter, The Dragon and Dragon Ascendant from Bungie's Myth: The Fallen Lords and Myth II: Soulblighter, respectively. He walks about stripped to the waist to display a long snaking scar on his torso where his heart was removed in a magical ritual that made him Nigh Invulnerable. More obviously than that, his nose and lips were cut away from his face, leaving him with a permenant rictus grin.
- The monsters in Amnesia: The Dark Descent. They were all once men, subjected to a Painful Transformation and subsequent modification, such as the removal of their jawbones and hooks and other jagged pieces of metal being shoved through their flesh to use as weapons.
- It's sequel, Amnesia: A Machine for Pigs, does this as well with its Pig Men. They are made to drink an elixir which subjects them to an initial Painful Transformation as their body burns with fever, voiding bowels and blood, followed by horrible vivisection to turn them into something more than a pig, but less than a man, all pliant to the will of The Machine.
- Star Wars: Knights of the Old Republic II: The Sith Lords featured the villain Darth Sion, a Sith Lord who learned to better draw on The Dark Side through his own pain. Medical scans indicate that every bone in his body has been shattered and re-knit together, and his skin is grey and leathery, with many cracks running across it as though calcified and broken. Ultimately, it is the strength in The Force he gained by doing this that is all which holds him together anymore.
- BioShock: the splicers are not an example, as their deformed bodies are the result of accidental mutation. However, anyone worked on by Dr. Steinman is. The mad plastic surgeon would deliberately reshape people's faces and bodies into grotesque forms to fit his insane standards of "beauty". This is a guy who found, for example, symmetry to be horrific.
Dr. Steinman: "I will be known as the Picasso of plastic surgery!"
- Can and has happened in Runewriters. From what has been shown so far, it appears that certain runewriters can change their own and/or other peoples' bodies in various ways, such as giving them tentacles for hands, or sealing someone's eyes or mouth shut by "healing" them. Adding to this is the fact that the spells can be miscast, creating unexpected results such as becoming permanent.
- In Maggot Boy, one of the things that marks Owen Wright as an undead Enfant Terrible is the fact that he appears to have torn his own face off and stitched it back on piecemeal.
- In the 2003 Teenage Mutant Ninja Turtles series, Baxter Stockman was punished by the Shredder by having parts of his body removed for every failure. Bit by bit he became more and more disabled until by his later appearances he was a Brain in a Jar with one eye still attached that looks around. However, he built increasingly powerful robot bodies. Of course, he was more likely to use them against his Bad Boss than against the Turtles (though whenever he seems to be winning, his ambition returns and he's perfectly willing to smash everyone to try and become top dog.) Far and away the darkest thing about the most Darker and Edgier TMNT series.
- Foot binding. Causing painful, permanent deformity to children against their will in the interest of "beauty" is pretty much the definition of this trope.
- Female genital mutilation is Exactly What It Says on the Tin, and makes even the above seem like an unwanted tattoo by comparison. Often performed with no anesthesia and instruments such as scissors, with less effort taken toward keeping things sanitary than you'd want from the guy at Starbucks who pours your coffee. It's less a medical procedure and more someone who sorta knows a thing or two about medicine cutting you up with whatever stabby implement is on hand. Hellishly painful, done from days after birth to just before puberty. Death from the procedure itself and/or its complications (to avoid Walls of Text, let's just say there are a lot of potential complications, and every last one is horrific) is exceedingly common, and underreported. The idea is that the parts removed are 'male' and a girl is cleansed by their removal.
- Male circumcision may count, since it is usually done in infancy, without the ability to give consent. In almost all cases it is much less harmful than the female variant; but there are some that consider it an abuse and mutilation nonetheless. As for why it's done, let's just say the arguments can run the whole range from reasonable to insane and let's leave it at that.
- Under the code of Hammurabi, a man whose wife was caught cheating could choose to have her nose cut off, instead of having her executed.