Image: The “Darnley Portrait” of Elizabeth I of England. Wikimedia Commons, the free media repository.
I was recently made aware of ‘My Beautiful Mommy’, a book written by a plastic surgeon, Michael Alexander Salzhauer. It's aimed at preschoolers, and its intention is to ‘help kids understand the process of plastic surgery’. On the whole, I think that educating children prior to a parent’s surgery is a good idea, to help them cope with subsequent absences, bandages, and general disruption to family routine. However I do have some questions about this particular book. It may not be meant to glamorise plastic surgery, yet in the text ‘Mommy’ asserts that a nose job will make her look prettier, despite her child’s assurance that she is already pretty. What message are we sending children here?
Cosmetic surgery is big business. Defined as ‘a procedure performed to reshape normal structures of the body or to adorn parts of the body, with the aim of improving the consumer’s appearance and self-esteem’, it is a rapidly growing industry which is difficult to quantify. Australia is in the top 10 when it comes to the number of plastic surgeons (USA and Brazil are first and second) and, according to the Australian College of Cosmetic Surgery, we spend over $1 billion on cosmetic surgery annually, including over $350 million on wrinkle-reducing botox injections alone—our most popular procedure. The global cosmetic surgery market is expected to reach $43.9 billion by 2025. Even teenagers are accessing surgery; I was told of one girl whose mother was giving her a breast augmentation for her 18th birthday.
What is going on? Surfing the net, I saw advertisements that promised a ‘boost to your confidence’, with ‘no substitute for perfection’. A survey of surgeons by the American Academy of Facial, Plastic and Reconstructive Surgery reported that looking better in selfies for social media was an incentive for patients of all ages getting surgery. Further influencing factors are the normalisation of cosmetic surgery by the media, freeing more people to pursue procedures, reduction in costs and improved results. I was glad to see one government website at least suggesting that exercise and dietary changes can also improve your appearance (liposuction is our fifth most popular procedure), but it was immediately followed by ‘How to choose a qualified surgeon’.
I was pondering the idea of what ‘improving’ your appearance might involve when I started watching a movie about Queen Elizabeth I. Her white powdered face ‘look’ was striking, but I preferred the ‘before’ version. Will future generations look at the pouting lips and wrinkle-free profiles of twenty-first century beauties with similar consternation?
It makes me sad that so many people are discontented with their appearance. But is there an ethical problem? Despite intuitions that it is wrong to change our God-given appearance at the level of a Michael Jackson, would we question tweezing one’s eyebrows, which may have a similar goal? As a doctor, at times I have questioned whether some procedures are a valid use of medical skill. You could argue that our expertise should be used to treat disease, not to ‘improve the consumer’s appearance and self-esteem’. But in the world of modern medicine, it is difficult to build a case against human enhancement. We might say that a mastectomy for breast cancer is acceptable, but breast augmentation (fourth most popular) is not. But what about removal of wisdom teeth? Wearing glasses for short-sightedness? Music lessons? Where do we draw the line?
In a society with private medicine, disposable incomes and leisure (and smartphones), the boom in cosmetic surgery should not surprise us. In a world that has discarded the one true God, our longing for acceptance and fulfillment will seek satisfaction through other gods. The more this is done, of course, the less perfect the rest of us will feel.
And spare a thought for the young girl, having been read ‘My beautiful Mommy’, staring at her (inherited) countenance, and wondering whether she also needs a nose job to be pretty.
Dr Megan Best is a medical doctor and bioethicist at the Institute of Ethics and Society at the University of Notre Dame Australia. She is the author of Fearfully and Wonderfully Made.
 Australian Health Minister’s Advisory Council, Cosmetic medical and surgical procedures: a national framework (2011). Australian Health Ministers’ Conference.
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