Cosmetic medicine is a godsend for those who would otherwise have to live with some form of disfigurement. But the same technology developed to heal can also be used to enhance appearance, raising a host of questions and opportunities for health care workers and potential clients.
Plastic surgery restores form and function to visible organs. The word ‘plastic’ means ‘reshaping’, from a Greek word meaning ‘the art of modelling’. Techniques to reshape broken noses are detailed in the Edwin Smith Papyrus, a transcription of an ancient Egyptian medical text dated to the Old Kingdom from 3000 to 2500BC. Anaesthesia, antimicrobials and aseptic techniques have enabled plastic surgery to become commonplace today. As it has to do with form, plastic surgery often involves skin. Skin is the largest organ of the human body and has many functions. Importantly, skin is the medium through which our form interfaces with others.
Medical interventions are done on tissues that are functioning abnormally, that is, tissues that suffer pathology, such as a disfiguring burn. They aim to prevent, relieve, or cure suffering. Cosmetic medicine, however, may be defined as interventions on tissues that are functioning normally in order to enhance appearance. These procedures are not done to prevent, cure or relieve pathology. They do come with some risk. The procedure could go wrong or not satisfy the client. These procedures also come at a cost. When health care workers (HCW) are involved, they have to ask whether these interventions fit in with why they became a HCW. A believing HCW has to ask whether these interventions are willed by God, and whether a living should be earnt from them.
Is enhancing appearance for its own sake a good thing? We do this all the time, choosing clothes that don’t ‘clash’, cutting and shaping hair to look neat, and so on. Appearance counts. Being pleasing to look at can be an act of charity. Looking more ‘normal’ helps people to be accepted: fixing a cleft palate enables a babe to suck and so to live, but repairing the accompanying cleft lip may also help them integrate better into society. Donning the right professional outfit, like a nurse’s uniform, instils confidence and tells others who we are and where we fit in our interaction with them. These interventions reflect the truth of who we are inside, and ultimately it is what’s inside that counts. There can also be less well-intentioned motivations behind adopting a certain appearance. Appearing as what we are not, or to hide what we truly are, may be to live a lie. Altering our appearance may be motivated by a desire to entice others to sin, for power or for prestige.
Yet when these interventions involve the human body itself—cutting, injecting and manipulating tissue, or ingesting medication—we move to another level, and need to think seriously about why we want them and whether they’re necessary. These interventions carry real health risks. They require appropriately trained and accredited professionals and industry regulation, which are subjects of a recent regulator review.
Our true image
The drive to enhance our appearance or image raises the question: what is our true image, our identity? Does God have anything to do with this?
God is our creator, and we are ultimately His. We are stewards of our lives and abilities and even our appearance—not the owners— and we will be asked to account for how we have used these good things for the Kingdom of God. If altering our appearance is motivated by a desire for prestige or power over others it will not be looked on favourably in the Last Judgment (Luke 17:1-4).
The most important relationship we have is with God. The Bible tells us that we are made in the image and likeness of God (Genesis 1:26), not in our physical appearance, but our immaterial, or spiritual, life and being. Yet He created us to work in the material world, and to serve and love Him in the ups and downs of each day, finding fulfilment in discovering and doing His Will in His world. We relate to others through our union with God, helping them also to work for the kingdom of God.
God made humans free to do what we should do—a good use of freedom—but also free to use our freedom badly to do what we should not do—that is, sin. Unfortunately, the first man and woman did sin, and disorder resulted. Work became hard. Using others for one’s own ends became common. Concupiscence was unleashed—including the lust of the eyes, where the material world became more attractive than the spiritual; and the lust of the flesh, where sensuality rebelled against reason (1 John 2:16). Appearance had become a cause of leading people away from God.
A Saviour was needed. The purpose of the Bible is to narrate the Redemption. The Old Testament has stories that revolve around image and appearance. Job loses everything, even his physical appearance, but still does not curse God (Job 2). He accepts this as God’s Will for him. Samson is seduced by the appearance of Delilah and is imprisoned (Judges 13-16), which is how addicts describe their predicament. David is captivated by the appearance of Bathsheba. To cover up his crime, David arranges the murder of Uriah, her husband. David is finally corrected by the prophet Nathan, who risks his life to do so (2 Samuel 11, 12; 1 Kings 1, 2). Uncontrolled desire leads to sin, but it also creates opportunities for believers to love God by revealing the truth, as in the case of Nathan with David.
The New Testament also has stories that revolve around appearance. In Matthew 23:27 Jesus says, ‘Woe to you, scribes and Pharisees, hypocrites! For you are like whitened tombs, which outwardly appear beautiful, but inwardly are full of dead men’s bones, and of all uncleanness.’ It’s what’s inside that counts!
During His Passion, Jesus sacrificed everything—including his appearance: ‘He had no beauty or majesty to attract us to Him’ (Isaiah 53:2-3). Much more than this, though, by accepting suffering on the cross in obedience to the Father’s Will, Jesus opened the way for our redemption by paying the price of our iniquity. Through grace, we are now free again to live according to God’s Will, and be with Him forever.
Considering cosmetic surgery?
I would encourage anyone considering cosmetic procedures to reflect on their motivation. If it is primarily for the sake of appearance, ask yourself why? Is it necessary? It may well be that those chasing a purely cosmetic solution will never be happy with their lot. But perhaps the motivation is not clear-cut. Is it primarily to fix pathology, with a possibility of also getting a better cosmetic outcome? Is it better to pay for an experienced plastic surgeon to cure a facial skin cancer rather than get a free service at a public outpatient clinic by a junior doctor on their learning curve? Other considerations may also come into play. What if my income is directly related to my appearance—a television newsreader, for example? Does that justify the expense? There are many questions that need to be carefully weighed.
What about the believer? Is there a faith motivation? The lesson of the cross tells us it’s what’s inside that counts. Enhancing ourselves to impress or captivate others may be using people to increase our own status or power, or playing to their weaknesses and encouraging them to sin. This is clearly not a responsible use of our talents and opportunities. Enhancing our outward appeal at the cost of our inner beauty is not what God wants for his people.
Working in cosmetic surgery?
For those of us who are HCWs, our vocation is to help patients in their need. If we are approached to do cosmetic interventions, defined as interventions on tissues that are functioning normally, and done solely to enhance appearance, the problem we need to address may not be in the tissue but in the client’s attitude to appearance.
It is sometimes claimed that tissue augmentation can make clients more confident and therefore better able to succeed in their careers and in life. But couldn’t this equally be a justification for not performing the procedure? The needed intervention by the HCW then becomes an opportunity to help the patient discover that it is what is inside that counts. This is the apostolate of cosmetic medicine—a first world problem that allows us to bring the light of God to others. Where a believing HCW doesn’t take this opportunity, they may be led into cooperation in evil—assisting clients to become too focused on the transient material rather than the spiritual. Our income from these procedures may then be tainted.
Materialistic utilitarians will call this paternalism and accuse us of imposing our views on others. However, if we don’t use this opportunity to help our patients, and just do what everyone else does, our failure to act according to our beliefs makes us hypocrites. We may not be imposing our views on others, but we would be allowing the world to impose its values on us.
Behaving with integrity may cause us to lose face amongst our colleagues. However, we know that if we value our esteem among men more than with God, then we do not deserve to be saved (Luke 16:15). It may also be that we lose income. Sections of the cosmetic industry are driven by money. However, performing these services may make our patients more addicted to the lust of the eyes and flesh. Could you be at peace knowing that your income is based on this? Loss of income may be the better choice. Yet it is comforting to know that those HCWs who refuse to prescribe abortifacients or contraceptives for reasons of conscience never have a problem with income—their attitude of ‘values before money’ inspires trust and therefore patronage. Matthew 6:31-34 sums it up well:
Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the Gentiles seek after all these things, and your heavenly Father knows that you need them all. But seek first the kingdom of God and His Righteousness, and all these things will be added to you.
The HCW-patient consultation is a private affair where lifelong attitudes can be imparted, learnt and changed. That is why health is so powerful. We can help people overcome many addictions, like smoking, gambling and drugs. We can also help prevent a client becoming a cosmetic surgery junkie.
Is there a list of what is right and wrong in interventions that have a cosmetic impact? Unfortunately, it is not that simple. It is up to every HCW— with each patient—to exercise their conscience in applying the norms of action to each case, bearing in mind that the primary intention is to relieve pathology. This is why it is hard to legislate in this area.
What is most needed to help cosmetic interventions find their proper place is HCWs who are well formed—on the inside! We need to be prepared to use our conscience, our position and our talents, with a warm humanity that understands others and does not judge, in the service of the Kingdom. This will not make us popular with some patients, and likely not with the industry. But if we do this we will help many to find the truth that they are made in the image and likeness of our Father God. As St Josemaria Escriva advises, we will drown evil in an abundance of good, as ‘for you on earth there is but one evil, which you must fear and avoid with the grace of God: sin’.
Professor Gerald Fogarty is a radiation oncologist with an interest in skin conditions, and Master of Warrane College, UNSW. www.drgeraldfogarty.com
 Melvin Shiffman, Cosmetic Surgery: Art and Techniques (Springer, 2012), p20.
 N. Khunger, ‘Complications in Cosmetic Surgery: A Time to Reflect and Review and not Sweep Them Under the Carpet’. J Cutan Aesthet Surg. Vol.8(4), 2015, pp189-190.
 www.health.nsw.gov.au/patients/cosmetic/ Publications/review-cosmetic-procedures. pdf (accessed April, 2021).
 St Thomas Aquinas suggests that the image is absolute and has to do with our immaterial or spiritual faculties, particularly the intellect and will. These belong to the soul. Likeness has to do with the grace that allows us to share in God’s life, and can increase and decrease, and even be lost. (https://sites. google.com/site/aquinasstudybible/home/ genesis/st-thomas-on-creation accessed April, 2021).
 Josemaria Escrivá, The Way (Gracewing, 2002), Point 386.
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