THEATRE Orlan, ICA, London

She may have had more face-lifts than Nancy Reagan, but for Orlan it's not a vanity thing, it's an art thing. Judith Palmer saw her in the flesh

Six years ago, on her 43rd birthday, a petite, chic Frenchwoman went to visit a cosmetic surgeon. Nothing so very strange in that. How many other femmes d'un certain age were also flicking through the Vogue small ads, hearts set on un lifting?

But this particular Parisian was Orlan, an avant-garde artist, who had already changed her name for art, and was now embarking on her most audacious plan yet, to remodel her own face as the ultimate act of self-portraiture. Nine operations, a new chin, a new forehead and two horns later, Orlan is back with an exhibition of gory photographs in Newcastle, and a lecture and new performance at the ICA.

And here she is in the flesh, the charnel queen. Inscrutable and dour. Dressed in black, skin sear as a corpse, lips a blackberry-stained pout, eyes hidden behind diamante-studded shades, not a hair out of place in her crisp blonde bob. But perched on top of that haughty majestic head, like an extra-terrestrial toupee, teased and backcombed to new heights of silliness, sits a bright blue quiff. Could this woman have a sense of humour after all?

"I'm sorry to have to make you suffer," she says at the start of her lecture, with a sad shake of her head. And we the audience grit our teeth and prepare to take our medicine like good little girls and boys. Nasty, nasty medicine. Emotionless, Orlan reads from her meticulously prepared script, while behind her a 12ft screen relays the documentary carnage of her seventh operation / performance.

The uncut film shows Orlan fully conscious on the operating table under local anaesthetic, waving at the camera crews who are beaming the whole carnivalesque spectacle live to art galleries around the globe. The surgeon snips, swabs, and peels back her lipsticked face, while a smiling Orlan reads aloud from her favourite psychoanalytic texts or answers the stream of faxes and phonecalls from adoring artlovers. It's big, it's close-up and it's exceptionally unpleasant: a living autopsy. Several people leave. I wouldn't mind being one of them.

"It's OK?" queries Orlan, looking up at the screen and momentarily ceasing her relentless definitions of "carnal art", her theories on beauty, blasphemy and female re-empowerment. "Art is not for decorating apartments," she declares, "we already have aquariums, plants, curtains, furniture for that. I say: art can, art must, change the world."

Her arguments are cogent, her prose pithy and lucid, but boy, does this woman like the sound of her own voice. We hear a lot more of it during her new live performance, Woman with head...

The curtains part, and there, balanced on a chrome tabletop, is the disembodied blue-tufted head of Orlan. Its lips move and her voice booms out, endlessly reading the same passages of Kristeva and Artaud we heard in the operating theatre. The initial effect is stunning, a sharp restaging of a Victorian illusionists' mirror trick, known as The Sphinx. But illusions are only meant to be fleeting and after a few minutes, I can work out how it's done. But then, don't all Orlan's ideas work best in theory? Is it necessary to try to make the word flesh?

First a wire, then a glimpse of leg, then a familiar ringed hand, sneak out from behind the mirror. Lost in the sound of her own voice, Orlan reads on, as oblivious to her exposure as the Wizard of Oz in his Emerald City.

`Totally Wired' continues to 13 May (0171-930 3647)