In Defense of Cosmetic Surgery

Once they were born with it. Then it was Maybelline, and now it’s the surgeon’s scalpel that Dubliners use to attract each other. One million euro is spent on cosmetic surgery every week in Ireland. But just as the surgeon sharpens his scalpel, so society sharpens its claws, ready to tear strips off the men and women who have made survival of the fittest a double entendre for our times. By Caomhan Keane and Leah Sullivan

Is dying your hair any more moral than boosting your bust? Is lifting your face so different from shedding your waist? In a world that pushes us to put our best foot forward, shouldn’t we applaud, rather than mock or envy, those who wish to take the next step?

The Irish are – let’s admit it – one of the ugliest races in Europe. It is hardly surprising that we are reluctant to discuss this subject with any candour. Yet in private, at least, more and more of us are taking the matter into our own hands. In a 2005 TNS/MRBI poll, one in five women said they would consider a breast uplift or enlargement, liposuction or a tummy tuck. One in ten men said they would consider cosmetic surgery, in particular, eye-bag removal or a tummy tuck. According to Marie Loftus, the publisher of Rejuvenate, ‘Ireland’s first magazine about cosmetic enhancements,’ at least 50,000 of us have undergone non-surgical treatments and around 7500 have had surgical procedures. “It’s a huge growth area,” says Loftus. “It used to be that people talked about property at dinner parties. Nowadays it’s this.” Yet for many people, it seems “perverse” or “weird” to go through the rigours of surgery for the sake of looking good.

That is a misnomer. There is no real sense in which cosmetic surgery can be described as perverse. We all ascend the same ladder; a nip and a tuck may make all the difference in getting to the next rung.

Life rewards the beautiful. In 1993, a study called ‘Beauty and the Labor Market’ by economics professors David Hamermesh and Jeff Bidle concluded that “plain people” suffer a pay penalty of five to 10 per cent, compared with “average people,” while good-looking people enjoy a five per cent premium.

More recently – in 2007 – Dr. Daniel Hammermesh of the University of Texas found that beautiful people are chosen over ugly people as mates and employees. “Average people,” who are hired and promoted less often, earn less than average incomes; beautiful people, more than average. Looking at the college graduation photos of alumni of an unnamed American law school, Hammermesh also found that the better-looking grads had more success in life, particularly in terms of earnings. And by asking foreigners to judge Finnish election candidates on their appearance, he found that the outcome at the polls correlated with the candidates’ beauty.

We can’t just blame society for this one. Biologically, outer beauty – which despite the adage that it is in the eye of the beholder, is actually quite definable – is an indicator of health, strength, good genes and intelligence. Yes, even intelligence. It therefore makes biological sense to pick a beautiful person over an ugly person as a mate, a friend or an employee.

If, as these findings suggest, you could improve your social status, get a better job and have your choice of sexual partners by becoming more beautiful, cosmetic surgery begins to make perfect sense. Yet as a society we still regard it with suspicion.

Picture the most attractive person you know. Now imagine that he or she looks this way as a result of cosmetic surgery. Your perception is almost certainly altered, tainted somehow. We set the standard of beauty and then deride others for living up to this ideal. Herein lies the hypocrisy. We believe that for beauty to be true, for it to be ‘real’, it must be natural, effortless. “We like to think of beauty as being God-given, natural, and when we learn that it has been artificially constructed, you think of it as being fake,” says Patricia Casey, Professor of Psychiatry at UCD.

Until very recently, cosmetic surgery was widely dismissed as an American solution to American problems of superficiality and individualism – something for rich wives and expensive hookers. Not anymore. It is one of the fastest growing industries in the world, and Ireland is no exception to this rule. Yet there remains a profound dichotomy between perception and reality.

The standard position on a person who has had cosmetic surgery or a cosmetic medical procedure may be summarised as follows: a vain woman who has had her insecurities exploited by a greedy and unscrupulous doctor, at the behest of a society with an unhealthy obsession with youth and beauty. Her action perpetuates a trend that objectifies women, that undermines her struggle to be judged on something other than her appearance and condemns us all, by implication, to strive for an unattainable and homogenous aesthetic ideal.

This standard view is reflected in our obsession with celebrity surgery, the ‘before and after’ pictures carefully scrutinised in trashy glossies. We are desperate to know who has been cheating at the game of life. At the heart of our prejudice lies a form of snobbery or resentment. When someone undergoes cosmetic surgery to change their appearance to their social and biological advantage, they are changing the rules of the game. Some call them losers or cheats. Others call them players.

In truth, what we are really debating here is a question of degrees. Surgery is different to buying a new suit for an interview, dying one’s hair or attacking a bottle of fake tan. But how different?

“There is a line in the sand,” says Dr. Casey, “beyond which I think it is psychologically unhealthy to go, and I think that going to the extreme of having an aesthetic procedure, running the risk of having infections, is quite different from putting a cream on your face every night in the hope that it may or may not make your skin a bit softer.”

Ultimately, however, a face cream, a chemical peel and a nose job are means to the same end: all of us spend money in order to alter an appearance on which we will, whether we like it or not, be judged. And in making cosmetic procedures the subject of our derision, we vilify those who conform to our own rules.

Let us concede, for the moment, that there may be an argument in defence of cosmetic surgery. Where do we draw the line? At what age should young people be allowed to undergo treatment? And who should be considered a ‘viable’ candidate?

According to Dr. Patrick Treacy of the Ailesbury Clinic in Ballsbridge, as many as one in ten people who approach him have Body Dysmorphic Disorder, a syndrome in which the sufferer obsesses about a certain aspect of their appearance. Cosmetic treatment for these people is rarely beneficial and it often makes symptoms worse. Professor Casey, who works as a senior psychiatrist at the Mater Hospital in addition to her duties at UCD, describes BDD as a condition “where someone sees abnormalities that don’t really exist, so a person might think that their ears are too big or too small…what happens when they have surgery is that they shift the preoccupation with the disfigurement to some other organ of the body.”

Casey says most surgeons are not qualified to identify BDD. “I think that surgeons should be working a lot more closely with psychiatrists to identify these people,” she says, adding that it is uncommon that patients are referred to psychiatric specialists in Ireland before being considered for surgery.

Dr. Treacy feels a distinction needs to be made between designer cosmetic surgery and what is considered normal morphic surgery. “There are things that are done for purely aesthetic reasons – say a girl who wants to move up a breast size. That isn’t necessary for her secondary sexual development, it’s just her own feeling on the way she should look. So whenever you have this primary image, I don’t think teenage girls should be operated on before 18… Absolutely not.” (Rhinoplasty, or nose jobs, and otoplasty, or ear pinning, are the most popular procedures conducted on teenagers.)

Professor Casey goes further: anyone under 50 is, she says, probably too young for cosmetic surgery. “It’s when people do it for egotistical reasons – they’re the group I’m concerned about and they are a sizeable group. They want to be perfect, and are not able to deal with minor imperfections.

“There are certain extreme cases where people have a very noticeable disfigurement that might lead to bullying in school or if someone has a very abnormal facial structure, then one might consider plastic surgery. It’s where nobody else is conscious of the problem and it’s more to do with ego than disfigurement, that’s the problem.”

While the most common age of a cosmetic surgery patient is 41, that figure is coming down. Many Dubliners now have surgery at an earlier age, in order to maintain one appearance throughout their adult life – to continue walking in the Youth Corridor. This process, known as ‘dropping,’ avoids the obvious change in appearance if the work is performed later in life.  “It is better to prevent rather than cure,” says Dr. Peter Prendergast, surgeon and medical director of the Venus Medical Beauty Clinic in Dundrum. “That is to say, it is better to prevent lines rather than to treat them, because the end results are better.”

Once a commander of great respect, wrinkled skin is now seen as a disease people seek to eradicate, a fault that needs correcting before it taints the fountain of youth. Ageist? Yes. But then, so is society. Attracta Pedden had a tummy tuck in 2007: “I suppose it depends on your own attitude to life. I’m a young-at-heart person, a bit mad – but there are people out there who are willing to let themselves go and get frumpy.

“There’s a certain amount of sour grapes out there,” she says. “Begrudgery. Whether they think ‘Who the hell does she think she is, at this stage of her life?’ or whether they think ‘I wish I could have been that brave,’ I don’t know.”

“Cosmetic surgery doesn’t change your appearance,” says Carmel Barton, a 55-year-old bank teller who had her eyes done with Euromedica (for whom she now works). “It just makes you about 10 years younger, fresher looking, but you don’t have that look of surprise about your eyes or anything like that.” Barton takes about 20 Irish people a year to Wroclaw in south-west Poland for a variety of procedures – face and brow lifts, tummy tucks and breast augmentations are the most popular.

An estimated 10,500 Irish men and women fly off for a little sun, sand and surgery every year. And that number looks set to increase: this is one of the most expensive countries in Europe in which to get cosmetic enhancement. Hence groups such as Reva Health, Gorgeous Getaways and Surgical Attractions now offer a range of procedures in exotic locations. Money is not the only factor. Abroad, customers can go out and about a day after surgery without having to fear what the neighbours think.

There are, however, additional risks in having surgery overseas. Dr. Treacy wouldn’t recommend that his patients fly for at least 10 days following surgery to prevent the risk of clotting – they should, at least, wait until their stitches are taken out. “Surveys show in the past year alone, 44 per cent of doctors have seen a patient who has encountered problems with surgery abroad. That figure rose to 90 per cent in the last seven years. We had three people here in the clinic who encountered problems after surgery in Morroco.”

Surgical proceedures that are elected to be carried out abroad are currently not covered by the VHI. Other concerns include the level of training foreign doctors receive, the language barrier and the legal quagmire should anything go wrong. Carmel Barton refutes this point by pointing to the less-than-perfect situation here in Ireland. “A lot of the surgeons are just there for the day of the operation and then they’re gone. If something goes wrong [in Ireland], you can’t go back and knock on the door and they’re there to deal with it. They’ll say ‘Everything was done properly during the procedure so this is something that happened afterwards.

“Euromedica won’t relieve people or take any responsibility for them until all the sutures are removed. They can’t force people to stay but they have to sign a release saying that Euromedica are not responsible for them if they decide to leave before the 10-12 days.”

Barton opted to go abroad due to the cost of surgery in this country. “I always wanted to have my eyes done, but I couldn’t afford it… When you threw in the dental work I was getting done, what worked out as €25,000 here to have done, I had it done for less than €10,000 in Poland.”

The biggest issue in the cosmetic surgery industry is the fact that it is unregulated. While the Irish Medical Council publicly disapproves of the sudden growth of private cosmetic clinics, at the moment any dentist, psychiatrist or orthodontist who decides to start injecting Botox into his patients can do so with the law on his side.

The Irish Medical Council has a list of qualified plastic surgeons: they have undergone an official training scheme with a standard exit exam. They are on the register of medical specialists which is available on the Medical Council website. Although plastic surgeons may occasionally undertake cosmetic procedures, most of their time is spent performing on those with a medical need: reconstruction after an accident, birth defects etc.

As far as cosmetic surgery goes, it’s a minefield. There is no obligation for those who practise it to have the same level of training as plastic surgeons. The better ones will have plenty of experience and may have trained at a reputable hospital, but there is no equivalent list of cosmetic surgeons with the Irish Medical Council. There is no one qualification or certificate a potential patient can ask for to prove a doctor’s skill. And as for cosmetic medicine – Botox, lip injections – this can be performed by any doctor, and in some cases, even a nurse.

Dr Treacy, who is head of the Irish branch of the British Association of Cosmetic Doctors – Note: the individuals cited in this article are all competent, qualified professionals – says Ireland has Third World legislation. “To use the analogy of a car, anybody can get a licence to drive a car and can drive anywhere and drive over anybody. Standards of care are not being reached by most people practicing surgery at the moment.”

“For example, in Ireland we have instances of some clinics boiling their instruments in pressure cookers. It is absolutely outrageous. These are hollow instruments used to take fat out of people and they are being put in preasure cookers that you would buy in Tesco. It is an absolute joke.”

“We have instances where laser equipment [is being used] with no laser safety officer, no safety regulations and no reflective surfaces, and carried out by people with maybe one day’s training. The only way to combat this is the insurance companies … but a lot are working without insurance.

“What the government needs is a system of tight marks. Once places have the right number of support services, staffing services, the right type of facilities in terms of theatre equipment and all the rest, they’ll be given a licence, so whenever they advertise somewhere the advertisers will be able to say ‘show us your Irish Health Care stamp.’”

Dr Treacy also believes change needs to come from within the medical profession itself. He argues that the Royal College of Surgeons should take cosmetic surgery as seriously as the consumer. “They have lagged behind in this and, as a result, most of the courses to do with facelifts, etc are add-ons, after students get their normal qualifications. This aspect of medicine needs to be put into the normal part of medical training with normal exams – doctors going through normal resident programmes, seeing the problems and dealing with them at that level.

“Many doctors practising cosmetic procedures have just done a weekend course and few have had relevant formal training,” says Dr. Keith Robertson, who practises in Cosmedico and at the Whitfield Clinic in Waterford. “They’re doing threadlifts, Botox and injecting fillers... If you say that you’re a plastic surgeon and you’re not, the Irish Society of Plastic Surgeons will get on your case. That is not the case with some people who describe themselves as cosmetic surgeons.”

Robertson adds, “You’re safer going to someone who describes himself as a plastic surgeon than someone who describes himself as a cosmetic surgeon, because the term plastic surgeon requires a greater level of training. The ideal, of course, is to find someone who describes himself both as a plastic surgeon and a cosmetic surgeon.” [Robertson claims he is one of the few surgeons in the country who has extensive training in both cosmetic surgery and plastic surgery.]

“In short,” concludes Robertson, “it’s a really, really confusing area.”

No one denies that cosmetic surgery raises a host of ethical, legal and medical questions. Unfortunately, much of the media coverage that the subject receives is designed to produce hysterical headlines. There is little sober analysis of pros and cons, and few measured reflections in the context of society’s attitude to beauty.

No matter how long you attest that we are all born equal, it is undeniable that people who have the social advantage of beauty are born more equal than others. In denying others the concrete advantages of physical beauty, we too play God. We judge people who do no more than adhere to the rules of human nature. From the cradle we are taught: all that is good is beautiful. When we praise someone’s appearance, what we are really praising is the imagined goodness we associate with his or her beauty. But the attraction is slighted when we discover that the beauty is a result of cosmetic tampering. Having set the standard, we deride people for living up to it.

As long as we encourage ugly ducklings to blossom into swans we cannot reasonably chastise those who seek a little help along the way. As long as we value youth and appearance and promote self-improvement in all its guises, as long as human beings are hardwired to value these things and there are people to perform the necessary medical procedures, cosmetic surgery will remain a fact of life.

Maybe you reject this argument. Maybe you still think that nose jobs are pathetic, or that the whole subject has got nothing to do with you. That doesn’t exempt you from the moral implications of our collective negligence. Just as patients must be made to comprehend the irreversibility and enormity of a permanent physical alteration, society also has a responsibility. For a wilful ignorance – fuelled by snobbery or self-righteous disdain – about the dangers of a “wildly unregulated” industry is inexcusable. Vulnerable people must be protected from unscrupulous practices. That is our collective responsibility.

Wake up, people. This ain’t no time for beauty sleep.

A (very modern) Mother & Child Scheme

Last year Attracta Pedden (58)  and her daughter Jo-ann (24), who  both live in Rathgar, decided to have cosmetic surgery. Together.

ATTRACTA It’s something I was thinking about for 20 years. Ever since I had my last child, my stomach never went back to its natural shape. I tried to lose weight but I could never get rid of my tummy. I realised a diet wasn’t going to get rid of it and exercise wasn’t going to get rid of it and even though I’d eat healthily, go to the gym – I’d walk everywhere – it just wouldn’t go. So around four or five years ago I thought, ‘Maybe I’m going to have to do something about this.’

It was my daughter who said, “Mum I’d love to do something about my boobs.” And I said, “If you’re going to do something about your boobs then I’ll do something about my tummy.” In the beginning it was kind of like a joke. But the more research I did the more serious I became about it.

JO-ANN It wasn’t a case of me just wanting bigger boobs. I wanted cleavage. Because I had none before. I mean, I did what I could with chicken fillets and bronzer and push-up bras and the like but, as you do, you get drunk and the chicken fillets are turned into missiles. And I just thought to myself, ‘Wouldn’t it be so much simpler if I actually had boobs?’

ATTRACTA I didn’t make a final decision about it until I spoke to a doctor and got a professional opinion. I had to undergo blood tests and get letters from my GP and my specialist who I see for my asthma. Then the surgeon said he’d go ahead with it if I wanted it. So I decided I would. It was now or never.

JO-ANN We decided that we’d have our surgery done abroad as it was cheaper. I spoke to a few different people who have had the surgery done and one girl said she had paid €6,200 at Advanced Cosmetic Surgery to get her boobs done. [At Mills and Mills Medical in Marbella] we got 11 nights’ accommodation included in the price – and a chauffeur from the airport! I had my boobs and my lips done and it was €4,700, all inclusive.

ATTRACTA Some of my friends said, “My God, you’re brave, I would never have that done because I wouldn’t be brave enough.” To me it’s nothing to do with bravery.... Work wasn’t at all happy about it. Nothing to do with my welfare, it was just that I was going to be off for a while. But of course they didn’t say it out loud. They were annoyed that I just announced I was having it done without discussing it with them... They weren’t supportive and they’ve never really asked me how I am or anything.

JO-ANN My daughter is eight and she came out [to Marbella] with us. She kept telling people that mammy’s getting her boobs blown up and her lips blown up so we had to sit her down and explain to her what was going on.

When we came back everybody was like, “Oh what did you have done?” and I was like “My boobs and my lips” and they asked “What did your mum have done?” and I was like “She had a tummy tuck” and there was a silence and then [they said] “I hope you didn’t get your daughter anything.” We laughed and said we’d leave it a few years.

ATTRACTA The first thing you need to do is find a surgeon with the right attitude. My surgeon wouldn’t do anything he felt I didn’t need. A very mature approach to it. As it becomes more popular, you’re going to get the cowboys out there. It’s something that should be taken very, very seriously because you’re going to get a lot of young girls who’ll get loans to get certain procedures done and I think the surgeon is going to have to be very realistic about it and tell them, “You don’t need that… Come back in 10 years.”

JO-ANN It was sore… But it wasn’t excrutiating. It was like doing 1,000 press ups and I can’t even do half.  But I was discharged after a day and I was able to walk around the town with [Mum] so it wasn’t that painful.

It’s not a walk in the park. You have no sensation under the breast cause they cut all your nerve endings and that can last up to three months. When all the nerves start healing you start to get shooting pains and twinges in them for up to three months. There is also a risk that the sensation will never come back in your boobs and you can loose all sensitivity in your nipples.

ATTRACTA I’m absolutely delighted that I had it done and I don’t know why I didn’t have it done three or four years ago. I’m thrilled with the result. I wouldn’t be a skinny person, but I wouldn’t be fat either. The weight I was carrying was all in front, and now it’s gone.

JO-ANN The life expectancy of implants is 20-25 years, then you have to get them redone, but other than that I wouldn’t really consider more surgery…When I get older maybe I’d consider Botox. But I’d probably only do non-invasive – I wouldn’t go off and get my boobs made bigger and bigger all the time.

ATTRACTA I didn’t really think Jo-Ann needed it, but then I’m not 24. When I was 24 we were hiding our cleavage, now they’re flaunting it and really, now that I see how succesful it was, she really does look so much better and I think she was so brave to do it.

She’s got much more skip in her step. It’s been good for her. It’s been good all round. It’s been a positive experience for both of us.

Comments

[Daniel]

I have been providing dental treatment abroad for mostly english and irish clients through my english-speaking clinic in Piestany spa, Slovakia for the past 4 years now, and can only say that the requests that we recieve for implants, crowns and veneers is rising massively. Finding a cost-effective alternative is only possible if you go abroad for treatment. that is why I set up http//www.dentalholiday.co.uk to make sure I could reach such clients.

[Dr. Gordon Patzer]

Caomhan and Leah,

No defense needed for Cosmetic Surgery

Your article articulates volumes of truth and realism. It is perfectly on target with my knowledge and perspectives based on more than 30 years of formal scholarly research about physical attractiveness phenomenon. At the same time, it has been my good fortune the past many years to travel around the world speaking about realities of physical attractiveness that extend far beyond the eye, and I do disagree strongly with one statement in your article.

To begin, enhancing one’s inherited looks allows people to benefit from a reality or phenomenon that society finds discomforting to admit. No matter how much or how little that people do in pursuit of better looks, theirs actions simply reflect a continuum ranging from routine to less routine efforts and possibilities. Accordingly, cosmetic surgery really should not need any defense.

Second, despite the power and pervasiveness of the effects caused by a person’s physical attractiveness, too many people around the world tend either to not consciously realize it or they deny the reality. But, yet, the evidence is as plain to see as the proverbial cliché states about the readily seen nose on a person’s face. It is reality that people of different levels of physical attractiveness are perceived differently and treated differently throughout life, literally from cradle to grave. And, their different consequences nearly always favor those of higher physical attractiveness with life benefits and disfavor their counterparts with opposing life detriments.

Finally, a few years ago I was honored to be a visiting professor for several months at Trinity College Dublin, The University of Dublin. (Trinity College is recognized as a truly top-tier university, wit recent rankings or 53rd internationally and 13th in Europe). As a privileged American living in Ireland, I saw first-hand, up-close that the Irish in no way represent a people with any less physical attractiveness or any more physical ugliness than reflected throughout Europe and the United States.

Nevertheless, at the same time, it did strike me that the Irish as a group with whom I met and talked about realities of physical attractiveness, were one of the most adamant to deny or, maybe better said, one of the most reluctant groups to admit the reality of physical attractiveness in every person’s life.

Dr. Gordon Patzer
author of "Looks: Why They Matter More Than You Ever Imagined"
http://www.GordonPatzer.com

[Leah Sullivan]

While I agree with you that Irish people are probably not much less physically attractive than other nationalities (the statement saying otherwise was not written or agreed upon by me), there is truth in the argument that the Irish are "one of the most reluctant groups to admit the reality of physical attractiveness in every person’s life." While I generally disagree with appearance based prejudice, I feel that this is not necessarily a good thing in Ireland, as I think it stems from the sexual and emotional repression that comes from living in a country with a history of the oppressive force of Roman Catholicism. When the sexual attraction is a heinous sin, then an acknowledging the indicators of fertility as a sign of attractiveness is socially unacceptable, and to be reserved for drunken lunges in pubs at the weekend. Though this, thankfully, is slowly changing.

Or perhaps your impression of the Irish as an attractive race was based entirely on your Trinity-centric experience - I should know, I go there!

Theoretically I have no argument with cosmetic surgery, but I would have issues with it becoming a standard practise. Beauty standards are all relative, and ones beauty is only ever measured in comparison to the beauty around it.Thus if everyone gets cosmetic surgery, it solves none of the problems of lookism. For beauty to be beauty, it must be exceptional, rather than the norm.

Leah

[natalie]

Just wanted to let you all know - my sister had a breast reduction at [a well known cosmetic surgery clinic] in Dublin in October 2006 and they totally botched it. She is STILL having to get procedures done to try and rectify the total mess they made of her. I cannot state this strongly enough. If you want to have a medical procedure done GO TO A REAL HOSPITAL.

[Stephen Mcculley]

Great post,

An enjoyable read!

SM

[denver plastic surgery]

Really liked this post. I will have to bookmark this site to tell my friends.

[Cosmetic Surgery Philadelphia]

Great article. I had to pass this on to a few of my colleagues.

[Cesar Caldera]

Instead of doing the full blown cosmetic surgery route, we focus on providing affordable laser hair removal treatments using the Candela GentleLASE laser.
Once a plastic surgery patient is done with their surgery, they can come to us to polish up their upgrade