¶ … Social Acceptance of Elective Cosmetic Surgery: A dangerous addiction to perfection

Reconstructive surgery has its uses, such as restoring the face or body of someone disfigured in a car crash or other accident, or helping someone with genuine physical limitations (such as a harelip) which can have major negative medical and social consequences. However, the majority of reconstructive or plastic surgery is performed for purely cosmetic purposes in the United States. At best, its availability and acceptability puts people at needless physical risk; at worst, it subjects patients to needless dangers and even disfigures them. The pursuit of perfection has dangerous medical, economic, and social consequences.

There is no question that the use of cosmetic surgical procedures (and nonsurgical cosmetic procedures such as Botox) is increasing. According to Haas (et al. 2007), "approximately 11.7 million cosmetic surgical and nonsurgical procedures were performed and Americans spent $13.2 billion on these procedures, an astounding 457% increase since 1997" (Haas 2007). Although the industry often portrays this as an empowering decision of women to exercise control over their bodies and the aging process (and the majority of patients remain women), the motivation for cosmetic surgery has been linked to low self-esteem and body dysmorphic disorder in personality surveys of patients (Haas 2007). One follow-up study of plastic surgery patients found that patients had higher anxiety scores than those in a control group and higher rates of social phobia (Newell 2007).

Plastic surgery has an old history. "Written evidence cites medical treatment for facial injuries more than 4,000 years ago. Physicians in ancient India were utilizing skin grafts for reconstructive work as early as 800 B.C."("History of plastic surgery," ASPS: The Early Years). But the techniques used in modern plastic surgery did not gain common currency until the first and second world wars, in which the physical damage and destruction done to the faces of people in warfare required the need for such techniques. Ironically, a surgery born to 'normalize' people and help them transition back to peacetime became a way for otherwise unscathed people to seek physical perfection. By the 1990s and 2000, plastic surgery was becoming common, even being performed in off-site facilities. Botox parties, where the facial line-relaxing drug would be administered in-house, became increasingly common. "Following the FDA's approval of Botox® in 2002, ASPS members performed an average of 1.1 million such injections a year through 2006" ("History of plastic surgery," ASPS: 2000s).

Cosmetic surgery at first was something kept under wraps, but as celebrities such as Joan Rivers and Phyllis Diller grew more open about their use of the procedures, combined with the proliferation of images of women with clearly surgically-enhanced features, the acceptance of having an 'altered' body grew even more common. In fact, users of plastic surgery even gained celebrity status. Fifty-one-year-old mother Sarah Burge, for example, grew famous for becoming a talk show regular as the 'Human Barbie,' based solely on the number of elective cosmetic procedures she had undergone. Burge "holds the Guinness World Record for undergoing the most plastic surgeries" (Duerson 2012). Rather than condemned, Burge is praised for her pursuit of her goal of 'perfection,' as if this is something laudable, like climbing a mountain or making a scientific discovery. Shows such as Nip/Tuck also created the impression that plastic surgery was part of a 'normal' response to human aging or imperfection.

The 'world upside-down' attitude regarding plastic surgery common in the culture is also manifest in the expressed attitudes towards teens who are bullied because of their looks. Rather than blaming the perpetrators, the 'solution' is seen as getting the child plastic surgery, not common civility. For example: "when Nadia Ilse returns to school she won't just be toting a new bag, or uniform. The high school pupil is preparing to return to classes with a new-look nose, chin and ears after undergoing plastic surgery, aged 14. The teenager from Georgia, who has been haunted by taunts of 'Dumbo' and 'Elephant Ears' since the age of six, had the surgical treatment in an attempt to curtail the abuse and end her misery" (Goddard 2012). As presented in the media, this was seen as an empowering act by the girl and as a triumph over her bullies. However, in actuality, this act was anything but: first of all, it is important to note that not only physically 'different' teens are bullied. To suggest that her physical alteration meant the end of her victimization seems facile. Secondly,...

Before, the concept of plastic surgery as 'youth enhancing' tended to skew the demographics to older women. However, "Last year, 230,000 teenagers had cosmetic procedures, according to the [American Society of Plastic Surgeons] ASPS" (Goddard 2012). Lest it be assumed that the increase in patients is due to medical need alone it is important to stress the culturally-constructed nature of the demand for surgery. "Whereas patients in America can present themselves directly for plastic surgery, in Britain GPs form a front line that perhaps screens out more cases" and there has been no corresponding increase in the demand for elective plastic surgery amongst young people in Great Britain (Goddard 2012).
However, America is not the only society which is obsessed with altering the body: in Brazil, plastic surgery is also increasingly becoming common and seen as a necessary and acceptable way of dealing with aging. In 2009, a former Miss Brazil named Solange Magnan died after buttock-enhancing surgery at age 37. Otherwise healthy, Magnan died due to complications from the surgery known as deep vein thrombosis (DVT). "While DVT is not common with cosmetic surgery…operations on the pelvis, buttocks and legs carry a much higher risk of causing the condition" (Tutton 2009).

Cosmetic surgery can thus be interpreted as a very socially-constructed addiction: the more it is normalized, the more it seems desirable, and the more one's own, personal flaws are exaggerated. Parents often subsidize their children's surgeries in the hope of making their children's lives 'better' or more 'normal' by making the young people conform to social standards of perfection. This is despite mounting medical evidence that surgery for the very young is extremely unwise, given that teens' bodies are still developing. Too-large or too-small breasts or a nose that does not seem 'perfect' while the teen is still young may look different on the body of a fully grown adult. Additionally, the adult might not be as obsessed with imagined flaws as a teen -- or a roomful of the teen's friends. Instead of encouraging character-building, however, plastic surgery is validated as a way of dealing with unpleasant feelings and a sense of not fitting in with one's peers.

And it is not just teens that may be mocked for not looking 'perfect.' Older women who do not look twenty years younger than their age may also find themselves pressured to get plastic surgery and demonized as 'letting themselves go' if they do not. Said one woman: "a friend who is vehemently opposed to plastic surgery confessed that what makes its increasing popularity so hard on her is the possibility that she will age naturally while everyone around her appears to stay young. It's so unfair, she mournfully, and quite accurately, points out. It is unfair. Many of us will decide to have surgery just to keep up with the surgeries of others. Surgeons reported to me that this is often how they get patients" (Blum 2005). Patients may fear losing jobs or being regarded as less competent if they 'look their age.'

Normalizing elective cosmetic surgery is particularly damaging given the very real risks associated with the procedure. Tissue death, infection, and the risk of bleeding are inherent to any surgical procedure (Marcus 2010). Ironically, despite the fact that breast enhancement is supposed to make women feel 'more womanly,' many women actually lose sensation in their breasts. "Numbness after breast surgeries of any type is the most common. Loss of sensation in the nipple in particular occurs anywhere from 10% to 70% of the time, says Dr. Nahai, president of the American Society for Aesthetic Plastic Surgery (ASAPS)" (Marcus 2010).

Cosmetic surgery is not usually covered by insurance which can drive poorer patients, desperate to emulate wealthier celebrities and peers, to even more dangerous cut-rate procedures. "Toxic levels of anesthetics have been known to cause respiratory failure in some patients. In some rare instances, high levels of topical lidocaine have led to death. In others, imitation Botox, or other imitation fillers not approved by the FDA, have left patients in comas for up to several years, and eventually dead" (Marcus 2001). Other risks, while less dire, are that the procedure will not be long-lasting enough to justify the risks of the expense. The…