My experience has been that absolutely no one cares, as long as they could be construed to be "somewhat similar".

Ex - People change hair color, lose a boat load of weight, wear eye-color changing contacts, drastically change hair styles (facial and normal) etc...

No one bats an eye at an ID that "only sorta vaguely resembles you" outside of a very limited subset of places (the only one I can actually think of is Customs while traveling).

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So my take is that as long as the gender appears similar and the ethnicity seems "close enough"... the store is still going to sell you alcohol, the bar is going to let you in, and the movie theater is going to sell you tickets.