Cosmetic and plastic surgery overview

¶ … beauty" is as old as humanity itself. From earliest times, worldwide cultures altered their appearance based on what was desirable by that society's standards. Both female and male Egyptians wore makeup to enhance and shape their eyes. Small feet remained a standard of beauty in China, even after footbinding was outlawed. Throughout parts of Africa, obesity of the buttocks was associated with erotic desirability and fertility. In the U.S., as with other Western nations, consumer demand for cosmetic surgery goes back to WWI. Yet even when negative factors are associated with the procedure, most individuals still go ahead. For example, medical problems with breast implants may have motivated some women to defer this procedure, but on the whole the majority is willing to take the risk. Nearly 300,000 American women had breast augmentation solely for cosmetic (not for reconstructive) purposes last year. The answer is not to outlaw such cosmetic procedures -- those who want to get them done will do so even in an unsound black market. Rather, physicians and mental healthcare providers need to become more aware of the overall psychological needs of the patients as well as better inform and educate them to make well-thought-out decisions.

Cosmetic surgery is found very early in human history. In 600 B.C., a Hindu surgeon reconstructed a nose by using a piece of the cheek (Feldman 61). In the late 1900s, John Orlando Roe, a Rochester, New York, surgeon worked on noses so individuals could "pass" for another culture or race. Although Victorian society stressed that beauty came solely from internal qualities of character and health, by 1921 most Americans saw physical beauty as an external, and thus alterable, quality (Haiken 3).

Plastic surgery advancements in World War I soon impacted the society at large. In 1931, Dr. John Howard Crum performed the first recorded public face-lift. After WWII, doctors began to market the procedure. Husband-hunting girls, divorce-aversive wives, and even career women had to look their best to succeed; in the youth-oriented postwar culture, looking good meant looking young. Affluent 50-year-olds were willing to spend their hard-earned money to change their appearance (Feldman 63).

Since then, cosmetic surgery has become highly desirable by men as well as women: For example, penal enlargement is now very common. "Penile enlargement, if performed by a qualified and experienced surgeon and realistic expectations are stressed, is safe and effective," said Whitehead, an associate clinical professor of urology at Albert Einstein College of Medicine, New York, and president of the American Academy of Phalloplasty Surgeons (Urology Times 35).

And as far as the 'cosmetic' issue goes, if a woman who feels her breasts are unattractive can take advantage of the numerous options in cosmetic breast surgery from augmentation to reduction to lifting, why can't a man have the same cosmetic options in terms of penile enhancement?" Enhancement phalloplasty and girth enhancement have been discussed in the literature for many years and have been in use for about a decade (Urology Times 36).

Over the years, a variety of negative factors has not deterred individuals from going under the knife. For example, the first silicone breast implant was marketed in 1963, and several decades later the FDA released a report showing polyurethane foam can break down into the body and form a carcinogen. The agency also issued a warning regarding the alarmingly high rate of saline implants that split open and require additional breast augmentation surgeries. This type of damaging information has not discouraged most women from getting implant; in fact, increasing numbers of teenage girls are also having their breasts enlarged. "I tell these women about all these complications and more, and they still want to do it. They say they want to look better in clothes and feel more confident and less self-conscious. It's a very powerful motivator," says Leroy Young, a plastic surgeon in private practice in St. Louis, Missouri (Feldman 70). Even the U.S. government has promoted breast implants, at the taxpayers' expense: According to the Army, between 2000 and 2003 its doctors performed 496 breast enlargements (women must pay for the silicon implants) (Schaler 29).

Health safety does not seem to have an impact on those desiring cosmetic surgery, nor does the comments of authority figures. In 1958 Pope Pins XII warned that operations for mere "vanity" or to enhance the "power of seduction, thus leading others more easily into sin," or "to hide a criminal from justice" were not in keeping with the church's teachings (Feldman 66). Some Christian and Jewish clergy agreed. However, not even the clergy could fight the studies saying that people with better looks had a greater chance for success (Feldman 66).

Last month, the FDA reneged on its earlier findings about breast augmentation; after a 14-year ban, it decided that silicone implants do not pose any serious health risks, but warned that breast implants will not last a lifetime: Within four years, about 20 to 25% of women who receive the implants for augmentation can expect to have additional surgeries due to hardening of the breasts, shifting of the implants, sagging, and less commonly, ruptures (Kotz). In addition, as much as 15% of women with either silicone or saline implants experience side effects such as breast pain, swelling, or capsular contracture, a hardening of the breast around the implant.

After the FDA announcement, feminist contingencies tried to tell fellow "sisters" that they should still stay away from the still-questionable silicone implants. Instead of agreement, a number of other women's groups told the feminists to cool it: Let women make a decision about their own bodies! As history has shown, individuals are not going to be persuaded to change their minds regarding a "beauty" treatment, regardless of continued warnings. Breast implants increased tenfold in frequency and about a third in size even after FDA commissioner David Kessler outlawed the silicone gel (Kotz).

If individuals, such as these women, want to weigh the risks against the gains, and make decisions about their bodies, can anything else be done to help the situation? Doctors from Erasmus University say that things can, and should, be done from an ethical standpoint (76-78). They analyzed the part that beauty plays in Western society and made some recommendations: One of these is to recognize how important appearance is and not to downplay its overall impact. Another suggestion is for mental health professionals to become more involved in the process of a person choosing cosmetic surgery. They recognize that many individuals are doing so, because of other factors such as low self-esteem or the desire to fulfill expectations. Research also shows that the correlation of women who have breast augmentation and suicide is much higher than the norm.