debate cosmetic

7/27/2019 Debate Cosmetic

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point

The compulsion to change one's body is often a symptom of a deeper mental instability. It should be

treated as a problem, not encouraged with surgery. Research indicating that breast augmentation

patients are four times more likely to commit suicide compared to other plastic surgery patients raises

questions about the mental health of women who choose implants1. It's only a plaster patched over a

much deeper problem. There are also studies that show negative psychological effects on patients after

their surgery has been completed. For example, a recent analysis 37 studies on patients' psychological

and psychosocial functioning before and after cosmetic surgery by social worker Roberta Honigman and

psychiatrists Katherine Phillips, MD, and David Castle, MD, found several predictors of poor outcomes,

especially for those who hold unrealistic expectations or have a history of depression and anxiety. The

researchers found that patients who are dissatisfied with surgery may request repeat procedures or

experience depression and adjustment problems, social isolation, family problems, self-destructive

behaviours and anger towards the surgeon and his or her staff 2.

1American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed.).

Arlington, Va: American Psychiatric Association Press; 2000. available

athttp://www.breastimplantinfo.org/what_know/teencosurgery.html (accessed 11/6/2011)2 Plastic and Reconstructive Surgery (Vol. 113, No. 4, pages 1,229-1,237) (accessed 11/6/2011)

Counterattack

COUNTERPOINT

However, the vast majority of people who have cosmetic surgery have one procedure and never look

back. They're made happier and more secure in themselves because of it. In fact, the same study by

social worker Roberta Honigman and psychiatrists Katherine Phillips, MD, and David Castle, MD, also

suggested positive outcomes in some patients, including improvements in body image and possibly a

boost in their quality of life as well1. Therefore, it would be wrong to say that cosmetic surgery can be

psychologically damaging as a rule. Many studies have shown that patients have higher self-esteem after

surgery. For example, in a recent study by Sarwer found that a year after receiving cosmetic surgery, 87

per cent of patients reported satisfaction following their surgery, including improvements in their overall

body image and the body feature altered. They also experienced less negative body image emotions in

social situations2.1 Plastic and Reconstructive Surgery (Vol. 113, No. 4, pages 1,229-1,237) (accessed 11/6/2011)

2 Dittman, Melissa,. Plastic Surgery: Beauty or Beast? (accessed 11/6/2011)

POINT

Sometimes we must accept those dangers, as they come in the course of necessary medical procedures.

But with elective surgery – procedures people don’t need, but rather merely want – the risks can’t be

justified. These risks apply both to the surgery itself, and to the long term. For example, leaking silicone

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breast implants have been a widespread problem and can lead to death. Silicone gel can leak from the

implant into healthy breast tissue and go other parts of your body, such as the lungs and lymph nodes,

where it could be impossible to remove. Studies published in 2001 by scientists at the National Cancer

Institute raised questions about the long-term safety of breast implants. One study found that women

who had breast implants for at least eight years were twice as likely to die from brain cancer, three times

as likely to die from lung cancer or other respiratory diseases, and four times as likely to commit suicide,compared to other plastic surgery patients A second study found that women with breast implants for at

least eight years were 21% more likely to be diagnosed with cancer compared to other women their

age.[1] There is also the risk that the person having the surgery will be dissatisfied with the results.

[1]What you need to know , available

athttp://www.breastimplantinfo.org/what_know/having_problems.html (accessed 15/6/2011)

improve this

COUNTERPOINT

The risks of cosmetic surgery are negligible.In actual fact, the American Society of Plastic Surgery

estimates that there is 1 death in 57,000 procedures, while a study in the medical journal Plastic and

Reconstructive Surgery put the mortality rate slightly higher, at about one in 51,459 operations.[1] To

put this in perspective, your chances of being injured in a motor vehicle accident are about 1 in 1,000 inany given year and there is about 1 maternal death for every 7692 live births.[2]Therefore cosmetic

surgery is a lot safer than people perceive. Furthermore, cosmetic surgery is becoming safer and safer. It

is increasingly strictly policed and sky-high legal pay-outs by bad surgeons have ensured that

practitioners take more and more care.[3]Technology in surgery and in implants and so forth is forever

improving. For example, new non-invasive procedures are being developed such as Liposonix and

UltraShape Contour. These procedures use focused ultrasound devices which aim to achieve targeted

reduction of fat tissue by focusing ultrasound energy that causes permanent disruption of fat cells

without damage to the epidermis, dermis or underlying tissues and organs.[4]Procedures such as this

would decrease the risk of infection.

[1]DeBenedette, Valerie,. Risks of Cosmetic Surgery.

[2]ibid.

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[3]£7m payouts for plastic surgery errors .

[4]Technology briefs: Focused Ultrasound Body Contouring.

POINT

Only those that can pay for it get it. The most popular surgeries include breast augmentation, liposuction,

nasal surgery, eyelid surgery and abdominoplasty.[1] There surgeries cost between £3,000 and £5000,

between £2,500 and £6,000, between £3,500 and £4,000 and between £2,000 to £6,000

respectively.[2] So if it has the advantages the opposition claims, the rich will look good, and the poor

will not.

[1]Cosmetic Surgery.

[2]Cosmetic Surgery prices.

improve this

COUNTERPOINT

You can spend your money how you like. Why shouldn't people be allowed to make the personal choice

to change their appearance with their own cash? Furthermore, the appearance division the proposition

seeks to suggest between rich and poor is much more dependent on quality of diet. Diet is a universal

factor that affects complexion, height, etc.1, while cosmetic surgery is a relatively insignificant factor in

statistical terms and one that only affects the particular thing on which surgery is conducted.1 Physical benefits of a balanced diet (accessed 11/6/2011)

POINT

The state of Queensland in Australia has a ban on teenagers having plastic surgery. This prevents anyone

under 18 having cosmetic surgery unless it is to correct deformities or disfiguring injuries, as well as




















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allowing for procedures to improve medical, psychological or social well-being. This potentially leaves

difficulty drawing the line for what is allowed1. A much more comprehensive ban would avoid this.

Cosmetic surgery is already to some extent regulated. In the UK it is regulated by the GMC and practising

surgeons have to be enrolled on its specialist register. At the same time all invasive cosmetic surgery and

laser treatments are regulated. A healthcare commission inspects all registered establishments and can

revoke licences. As such it would not be difficult to expand these regulating bodies to be making surethat cosmetic surgery is only performed when as in Queensland it is to correct deformities and disfiguring

injuries.1http://abcnews.go.com/Health/BeautySecrets/story?id=4694079&page=1 ">, Childs, Dan, Australian

State Bans Cosmetic Surgery for Teens, (accessed 25/8/2011)

improve this

COUNTERPOINT

The desire for cosmetic surgery is driven not by external pressure to seek the acceptance of men, but theinternal desire to look and feel better about oneself. There are many who find that their appearance truly

troubles them and that improving it would greatly enhance their quality of life. Operation Smile, which

fixes oral and facial deformities found in poor children across the world, is doing "cosmetic

surgery."[1] You can survive with a hare lip or a cleft palate. But your quality of life – your self-esteem,

employability, acceptance in a traditional society, etc – is much better without one. Following this

principle, breast reduction or augmentation or the removal of acne scars can be just as important. For

example, Carole Wrigglesworth's breasts shrank after breastfeeding baby girls and as her breasts shrank

so did her self-confidence. As a result she opted to have a breast enlargement surgery and reflecting on

the experience, Carole has absolutely no regrets — ―I feel sexier, more confident and extremely proud of

my body.[2]

[1]Operation Smile

[2]Carole Wrigglesworth's breast enlargment.

POINT

There is considerable evidence that women's attractiveness is judged more harshly than men's. For

example, in a study by Adams and Huston, 1975, participants were asked to rate the attractiveness of

photographs of people of varying ages. They found that although attractiveness ratings of both men and

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women declined with age, the rate of decline for women was greater.[1] Researchers report that

women’s magazines have ten and one-half times more ads and articles promoting weight loss than men’s

magazines do, and over three-quarters of the covers of women’s magazines include at least one message

about how to change a woman’s bodily appearance—by diet, exercise or cosmetic surgery.[2] These

views about appearance are damaging because it leads to seriously unhealthy lifestyles that women think

they need to look beautiful. For example, in 2003, Teen magazine reported that 35 per cent of girls 6 to12 years old have been on at least one diet, and that 50 to 70 per cent of normal weight girls believe

they are overweight.[3] Cosmetic surgery sends the message that the prejudices some have about

appearance are valid.

Before the makeover, DeLisa Stiles--a therapist and captain in the Army Reserves--complained of looking too

masculine. But on Fox's reality TV makeover show, "The Swan 2," she morphed into a beauty queen after a slew of

plastic surgery procedures--a brow lift, lower eye lift, mid-face lift, fat transfer to her lips and cheek folds, laser

treatments for aging skin, tummy tuck, breast lift, liposuction of her inner thighs and dental procedures. The Fox show

gives contestants plastic surgery and then has them compete in a beauty pageant, which last year Stiles won.

"The Swan" and other such plastic-surgery shows, including ABC's "Extreme Makeover" and MTV's "I Want a

Famous Face," are gaining steam, but some psychologists are concerned about the psychological impact on those

who undergo such drastic cosmetic surgery--and also on those who don't and may feel inadequate as a result. While

such radical transformations are rare, some psychologists plan to investigate the surge in cosmetic procedures and

whether these surgeries have any lasting psychological consequences.

The number of cosmetic procedures increased by 44 percent from 2003 to 2004, according to the American Society

for Aesthetic Plastic Surgery. Plastic surgeons conducted a record 11.9 million procedures last year, including

nonsurgical procedures like Botox and surgical procedures like breast augmentation or liposuction (see chart).

How do such procedures affect patients psychologically? A recent analysis of 37 studies on patients' psychological

and psychosocial functioning before and after cosmetic surgery by social worker Roberta Honigman and psychiatrists

Katharine Phillips, MD, and David Castle, MD, suggests positive outcomes in patients, including improvements in

body image and possibly a quality-of-life boost too. But the same research--published in the April 2004 issue

of Plastic and Reconstructive Surgery (Vol. 113, No. 4, pages 1,229-1,237)--also found several predictors of poor

outcomes, especially for those who hold unrealistic expectations or have a history of depression and anxiety. The

researchers found that patients who are dissatisfied with surgery may request repeat procedures or experience

depression and adjustment problems, social isolation, family problems, self-destructive behaviors and anger toward

the surgeon and his or her staff.

Overall, there are more questions than answers regarding psychological effects of cosmetic surgery: There are few

longitudinal studies and many contradictory findings, researchers note. Many studies also contain small sample sizes

and short follow-ups with patients, says Castle, a professor and researcher at the Mental Health Research Institute of

Victoria in Victoria, Australia.

"We really need good, large prospective studies of representative samples of patients, using well-established

research instruments," Castle says. "While most people do well in terms of psychosocial adjustment after such

procedures, some do not, and the field needs to be aware of this and to arrange screening for such individuals."

In particular, the extent to which cosmetic surgery affects patients' relationships, self-esteem and quality of life in the

long-term offers many research opportunities for psychologists, says psychologist Diana Zuckerman, PhD, president

of the National Research Center for Women and Families, a think tank that focuses on health and safety issues for

women, children and families.

"These are fascinating issues for psychologists to look at--from the cultural phenomena to the interpersonal

phenomena to the mental health and self-esteem issues," Zuckerman says.

In addition, plastic-surgery issues will increasingly affect clinician psychologists, and the area will offer new roles for

them--such as conducting pre- and post-surgical patient assessments, says psychologist David Sarwer, PhD, director

of the Education, Weight and Eating Disorders Program at the University of Pennsylvania. He has studied

appearance-related psychological issues, including cosmetic surgery, for the last 10 years.















"As the popularity of plastic surgery continues to grow, many psychologists likely already have--or will encounter--a

patient that has thought about or undergone a cosmetic procedure," he says. Therefore it will be increasingly

important for psychologists to be able to talk with patients about their appearance concerns and what may make

some one a good or bad candidate for cosmetic surgery, he says.

Research directions

Equally pressing, however, is the need for research that sheds light on plastic surgery's psychosocial effects, many

psychologists agree. To help fill in the gaps, researchers suggest further studies on the following questions: Does plastic surgery make patients feel better? Studies have shown that people report increased satisfaction with

the body part they had surgery on, but results are mixed on whether plastic surgery boosts their self -esteem, quality

of life, self-confidence and interpersonal relationships in the long term.

In a recent study, Sarwer--also an associate professor of psychology at the Center for Human Appearance at the

University of Pennsylvania School of Medicine--found that a year after receiving cosmetic surgery, 87 percent of

patients reported satisfaction following their surgery, including improvements in their overall body image and the body

feature altered. They also experienced less negative body image emotions in social situat ions. The study, which was

supported by a grant from the Aesthetic Surgery Education and Research Foundation, appeared in the May/June

issue of the Aesthetic Surgery Journal (Vol. 25, No. 3, pages 263-269). Sarwer and his colleagues plan to follow up

with the patients next year.

However, Castle's team found in their literature review--besides some positive outcomes--a link between plastic

surgery and poor post-surgical outcomes for some patients, particularly for those with a personality disorder, those

who thought the surgery would save a relationship and those who held unrealistic expectations about the procedure.Some studies have even gone as far as linking dissatisfaction with cosmetic surgery procedures to suicide. For

example, in one study, the National Cancer Institute found in 2001 that women with breast implants were four times

more likely to commit suicide than other plastic surgery patients of the same age as the women who underwent

breast implants, says Zuckerman, who in April testimony to the Food and Drug Administration (FDA) urged the FDA

to deny approval of silicone gel breast implants because of a lack of longitudinal research ensuring their safety.

The other three studies on the topic found the suicide rate to be two to three times greater. Neither of the studies,

however, identified a causal relationship between breast implants and suicide. Some researchers speculate that

some of the surgery recipients may hold unrealistic expectations of it or have certain personality characteristics that

predispose them to suicide.

How does cosmetic surgery affect those around the recipients? Physically attractive people often receive

preferential treatment and are perceived by others as more sociable, dominant, mentally healthy and intelligent than

less attractive people, according to research by psychologist Alan Feingold, PhD, in the March 1992 issue of

APA's Psychological Bulletin (Vol. 111, No. 2, pages 304-341)."It's not like looking good doesn't have real advantages--it does," Zuckerman says. "If some people get plastic

surgery and other people don't, is that going to put the people who don't at all kinds of disadvantages, such as in

finding a job or spouse?"

Nearly 30 years ago, many mental health professionals viewed patients who sought cosmetic surgery as having

psychiatric issues, but many studies since then suggest that those who seek cosmetic surgery have few differences

pathologically with those who don't have surgery, Sarwer says.

Most people are motivated to undergo cosmetic surgery because of body-image dissatisfaction, says Susan Thorpe,

a lecturer in psychology at the University of Surrey in Guildford, Surrey, who conducts cosmetic surgery research.

"They want to look normal--that is, they don't want to stand out in an obvious way or to have features which cause

comment or make them feel self-conscious," Thorpe says. "They also want their physical appearance to be more in

line with their personalities and feel that they want all the bits of their bodies to match."

What effect does plastic surgery have on children and teenagers? In 2004, about 240,682 cosmetic procedures

were performed on patients 18 years old or younger, and the top surgical procedures were nose reshaping, breast

lifts, breast augmentation, liposuction and tummy tucks. However, very few studies have been conducted to examine

the safety and long-term risks of these procedures on adolescents--an age in which teenagers are still developing

mentally and physically, Zuckerman says.

When does changing your appearance qualify as body dysmorphic disorder (BDD)? BDD, first introduced in

the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1987, is characterized by a

preoccupation with an aspect of one's appearance. People with BDD repeatedly change or examine the offending

body part to the point that the obsession interferes with other aspects of their life. Several studies show that 7 to 12

percent of plastic surgery patients have some form of BDD. Plus, the majority of BDD patients who have cosmetic



surgery do not experience improvement in their BDD symptoms, often asking for multiple procedures on the same or

other body features.

Sarwer often works with plastic surgeons to help them identify such psychological issues as BDD, so surgeons then

can refer patients to mental health professionals. He encourages them to look for the nature of the person's

appearance concern, such as whether a patient has an excessive concern with a body feature that appears normal to

nearly anyone else. Part of that also includes accounting for patients' internal motivations for surgery--are they doing

it for themselves or out of pressure from a romantic partner or friend? And, he encourages surgeons to ensurepatients hold realistic expectations about the procedures, rather than expecting the surgery to end long-standing

personal issues.

Psychology's role

Apart from research, psychologists can find clinical roles in aiding cosmetic surgery patients too, such as helping

plastic surgeons conduct such assessments. For example, they can help plastic surgeons identify patients who may

not adjust well psychologically or psychosocially after surgery, researchers say.

Castle says that empirically based screening questionnaires will help plastic surgeons select cosmetic surgery

patients likely to experience positive psychosocial outcomes.

Sarwer has teamed with other psychologists and plastic surgeons to develop such screening questionnaires, which

are included in the book "Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical

and Ethical Perspectives" (Lippincott Williams & Wilkins, 2005). The book, to be published this month, features a

chapter on how to help both surgeons and mental health professionals screen for BDD, as well as explore the

relationships among physical appearance, body image and psychosocial functioning.Sarwer believes more psychologists will begin to examine issues related to cosmetic surgery because of its

increasing popularity and the link between appearance, body image and many psychiatric disorders, such as eating

disorders, social phobia and sexual functioning. "Scientifically, we're just starting to catch up to the popularity of

[cosmetic surgery] in the population," Sarwer says.

And, as more studies commence, Castle says they need to characterize the population being studied, clearly identify

outcome variables and use standardized and state-of-the-art measures.

"There may be strong cultural pressures that are so unrealistic in terms of how we're supposed to look," Zuckerman

adds. "Psychologists should...figure out why this is happening and what we need to know to make sure that people

aren't going to be harmed by this."

How safe is cosmetic surgery?COMMENTS (1)

By Sonya McGilchristBBC News health reporter

Cosmetic surgery procedures rose by 5% last year

http://www.bbc.co.uk/news/health-12415412#dna-comments







Continue reading the main story

Related Stories

UK 'buttock injection' woman dies

Warning over UK cosmetic surgery

Cosmetic surgery is becoming increasingly popular - there are now around100,000 operations in the UK each year.

But for those tempted to improve their looks surgically, how safe are theprocedures?

Claudia Seye Aderotimi's tragic death in Philadelphia this week followed anoperation using an unapproved substance.

Liquid silicone was injected into her buttocks in a procedure designed to enhanceher bottom.

The operation is believed to have been arranged over the internet and took placeat a hotel near Philadelphia International Airport.

But now that cosmetic surgery is becoming more common, are the risksassociated with even standard procedures being under-estimated?

'Have-a-go' surgeons

Last September, a report by an official review body, the National ConfidentialEnquiry into Patient Outcome and Death found many centres in the UK offeringcosmetic surgery were failing to assess and care for patients properly.


The risks from cosmetic surgery, as with any surgery are great”

Fazel FatahPresident, British Assocation of Aesthetic Plastic Surgeons

Patients were at risk from a culture which saw teams "have a go" at operationsthey rarely performed.

The report by the National Confidential Enquiry into Patient Outcome andDeath looked at 361 sites in the UK. It found that some teams were tooinexperienced to be offering some cosmetic procedures.

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http://www.bbc.co.uk/news/world-us-canada-12401032


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With the exception of breast enlargement operations, the majority of sites werenot carrying out enough procedures to keep their skills up.

To be safe, sites should be carrying out more than 20 operations a year - in order to give them enough experience.

But only a fifth had managed this for breast reductions and a quarter for facelift.

Other problems identified by the report included psychological evaluations oftennot being carried out, and more than half of the operating theatres not beingproperly equipped.

Monitoring before and after treatment was also not sufficient in many cases.

Regulation Last October, the Care Quality Commission (CQC) was put in charge of regulating the cosmetic surgery industry in England.

All independent clinics and hospitals that provide cosmetic surgery must belicensed with the CQC to provide services.

A spokeswoman for the CQC said that even with enhanced regulation, patientsshould take care.

"Cosmetic surgery of any sort should not be undertaken lightly. It's important to

remember that all surgery, including cosmetic procedures, involves risks."

She advised would-be patients to find out as much as they can about theprovider and the procedure.

The CQC now has the powers to fine and prosecute cosmetic surgery centresthat are not up to standard and gives advice on its website for people consideringcosmetic surgery.

Plastic surgeons should also be registered with the General Medical Council(GMC).

'Trivialised' The British Association of Aesthetic Plastic Surgeons (BAAPS) representsaround a third of cosmetic surgeons in the UK.



Its president, Fazel Fatah, said that problems arose because of the attitudetowards cosmetic surgery.

"It has become trivialised to the extent that people do not understand that theyare having surgery - and undergoing the same risks as with any other operation."

He said that the boundaries between cosmetic medicine and cosmetic surgeryhad become blurred and that people now believed that cosmetic surgery wassomehow simple.

However good surgeons should go through all the risks with any patient, and givethem time to change their mind.

"Complications can include infection, bleeding, thrombosis and clotting of theveins," Mr Fatah said. "A patient needs to weigh-up the benefits against therisks."

Some cosmetic surgical procedures are more risky than others. As with other surgery, longer operations that involve a general anaesthetic are more risky thanthose that need only a local anaesthetic.

A tummy-tuck is one of the surgical procedures which has higher complicationrates because mobility is restricted after surgery.

The buttock augmentation procedure that Ms Aderotimi had is not very commonin the UK, though there are some surgeons who perform the operation.

However, the liquid silicone with which she was injected is not used here assurgeons realised years ago that it could cause problems. Solid silicone implantsare now used instead.

Cosmetic surgery 'holidays'

However, going abroad for treatment has become an increasingly popular optionover the years as it can be cheaper.

But surgeons warned it could also be riskier.

A survey by BAAPS in 2009 found that a quarter of surgeons said they had seenan increase in the numbers of patients who had experienced complicationsstemming from cosmetic surgery "holidays".

The organisation advises anyone thinking of going for surgery abroad to thinkcarefully and beware of internet sites offering to set up patients with surgeons.



Fazel Fatah said quality standards in the UK, set by the CQC were high, but thiswas not the case in all countries.

"If you go abroad for surgery it is much harder for you to research a surgeon'srecord or the safety of the hospital you will be visiting, even if they are members

of that country's association of surgeons.

"Aftercare will also be much harder - it can take weeks, even months for someone who has had cosmetic surgery to realise that there is a problem. Bythat time they are back home again."

Cosmetic surgery views sought after bimplant scare

COMMENTS (223)

By Michelle RobertsHealth editor, BBC News website

Sir Bruce Keogh, head of the review: "There are some pretty grubby practices going on"


Related Stories

Q&A: Breast implants health scare

PIP implants not toxic - report

Woman's pain after PIP implants











http://www.bbc.co.uk/news/uk-england-nottinghamshire-16444350









People are being asked for their views on the cosmetic surgery industryafter the recent PIP scandal, where thousands of women were given breastimplants containing substandard material.

The review, requested by the health secretary, will look at whether tighter

regulation is needed in England.

And it will ask if people are given enough information about surgery.

About 7,000 women in England are having checks for faulty breast implants andhundreds have now had them removed.

Although the unauthorised silicone filler used in the PIP breast implants is notthought to be toxic or cancer-causing, there were safety concerns.


I am concerned that too many people do not realise how serious cosmeticsurgery is and do not consider the lifelong implications it can have”

Sir Bruce KeoghNHS Medical Director

They were found to have double the rupture rate of other implants.

Around 47,000 women in the UK have PIP breast implants, mostly done privatelyrather than on the NHS.

Lessons to learn The problem came to light at the end of 2011, shortly after the Frenchgovernment recommended all women with PIP implants have them removed as aprecaution.

But there were warnings made by surgeons to UK authorities about adverseeffects for many years before this.

Prof Sir Bruce Keogh, who is leading the English review which will report in early2013, said: "The recent problems with PIP breast implants have shone a light onthe cosmetic surgery industry.

"Many questions have been raised, particularly around the regulation of clinics,whether all practitioners are adequately qualified, how well people are advisedwhen money is changing hands, aggressive marketing techniques, and whatprotection is available when things go wrong.






"I am concerned that too many people do not realise how serious cosmeticsurgery is and do not consider the lifelong implications it can have. That's why Ihave put together this review committee to advise me in makingrecommendations to government on how we can better protect people whochoose to have surgery or cosmetic interventions.

Cost an issue "We want to hear views from everyone, particularly people who have experienceof the cosmetic surgery industry or of other cosmetic interventions - good andbad - so we can learn what works best."

A poll by ComRes of 1,762 people shows that many people consider the cost of surgery more important than the qualifications of the people doing it or how theywill be looked after.

Two-thirds of those questioned considered cost as a factor when decidingwhether or not to have cosmetic surgery. Half said they would take thequalifications of their doctor into consideration and less than half would consider the quality of their aftercare when reaching a decision.

And as a result of the PIP breast implant scandal, almost half of women who saidthey would have considered cosmetic surgery before, say that they are now lesslikely to have it.



Background and context “Cosmetic surgery” (also known as “plastic surgery”) is surgery that is unnecessary from a medicalperspective, but is carried out to improve appearance. Cosmetic surgery is an ancient practice. In the8th century BC, the Indian surgeon Sushruta Samhita described what is known today as rhinoplasty(surgery to the nose) and otoplasty (to the ear).

Body alteration more generally has been carried out by all peoples, from tribal tattoos to the neck-extending Kayans of Thailand. But modern medicine has made the possibilities of cosmetic surgery farmore extensive.

Anaesthesia has made procedures less unpleasant and less dangerous. In the aftermath of each of the

two World Wars, cosmetic surgery leapt forwards as the demand for reconstructive surgery created

skills and techniques that could be as easily applied to (perceived) improvements to image as to

medical necessity. Consequently, cosmetic surgery has become increasingly popular. In 1948, fewer

than 300 board-certified plastic surgeons were in practice in the USA; today the number is more than

4,000. In 2004 12 million cosmetic operations were conducted in the USA alone. Where America hasled, much of the world has followed. Television shows and newspaper supplements are now devoted to

cosmetic surgery and makeover programmes advocate it. Today more and more parts of the body can

be “improved.” Once the possibilities for surgery were relatively restricted, now almost anything can

be the subject of cosmetic surgery. To name but a few, common operations include abdominoplasty (a

“tummy tuck” or reshaping/firming of the abdomen), blepharoplasty (eyelid surgery), buttock

implants/reductions, chemical “peels” (removal of acne scars and sagging skin), chin and cheek

augmentation, lipectomy (or liposuction – removal of fat from the body), and rhytidectomy (a“face

lift”) Among the most popular procedures are the otoplasty and rhinoplasty mentioned earlier, and

finally and most commonly, surgery for the breasts: both mammaplasty ("breast

enlargement/reduction") and mastoplexy (“breast lift”) – collectively known as “boob jobs.” Cosmetic

surgery to genitalia is increasingly common. This article considers only cosmetic surgery carried out

purely to improve appearance, and does not address plastic surgery for medical reasons, for examplepost-disfigurement reconstruction or remedial surgery.

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Argument #1

[ ]

[Edit]

Yes

We live in a world that is image obsessed, and

this kind of procedure panders to that. We should

promote the idea that appearance is not as

important as character. People should be content

with themselves and not be so hung up on their

looks.

[ ]

[Edit]

No

That’s nice. But given that the reality is that

we’re judged on our appearance all the time, it’s

perfectly rational to want to look good. Nobody’s

forcing anyone to have cosmetic surgery – the

market is driven by demand.

[Edit]

[ ]

[ ]

[ ]

[ ]

[ ]

Argument #2

[ ]

[Edit]

Yes

There are dangers involved in any kind of

surgery. Sometimes we must accept those

dangers, as they come in the course of necessary

medical procedures. But with elective surgery –

procedures people don’t need, but rather merely

want – the risks can’t be justified. These risks

apply both to the surgery itself, and to the long

term. For example, leaking silicone breast

implants have been a widespread problem and

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No

We should not restrict freedom of choice.

Certainly there’s an element of danger involved.

But we let people box. We let people bungee

jump. They undertake these dangers for fun or

for money. Why shouldn’t we let people

undertake dangers in the pursuit of beauty, and

higher self esteem? Furthermore, cosmetic

surgery is becoming safer and safer. It is

increasingly strictly policed and sky-high legal

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can lead to death. Once, paraffin was often

injected into the face to smooth wrinkles, with

disastrous effects. Silicon often finds its way into

other parts of the body, such as the lymph

glands, and can prevent the early detection of

breast cancer as doctors often think real lumps

are silicon leakage. Who today knows the full

future implications of injecting the highly

dangerous poison Botox into one’s face?

pay-outs by bad surgeons have ensured that

practitioners take more and more care.

Technology in surgery and in implants and so

forth is forever improving. The scare stories the

proposition talk about are the worst examples of

thirty years ago – they’re nothing to do with

cosmetic surgery today.

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Argument #3

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Yes

To attempt to dress cosmetic surgery in the flag

of feminism is absurd. If anything, cosmetic

surgery is the latest phenomenon in the long

history of the objectification of women in society.

Women are driven to meet male standards of

beauty, exaggerating their shape and seeking to

remain youthful lest their partner leave them for

(often literally) a younger model. Today many

operations are arranged by male partners rather

than by the women themselves. Cosmetically-

enhanced celebrities are redefining definitions of

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No

This freedom issue is particularly important to

women, who have historically been subjugated by

men, their bodies regarded as owned and for the

use of men. Cosmetic surgery – the ultimate

control over one’s body, perhaps – is the latest

stage in the emancipation of women and their

ability to decide what happens to their bodies.

Cosmetic surgery is empowering.

























































attractiveness for new generations, leading young

girls who would have been considered naturally

beautiful in past decades to see themselves as

plain and to seek their own surgical remedies.

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Argument #5

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Yes

Doctors should heal, not waste their talent on

appearance. Precious talent and resources are

spent on this frivolous activity. Surgeons should

do medical operations that are needed, not

cosmetic procedures that are desired.

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No

People pay handsomely for cosmetic surgery. It

costs the state nothing, except in situations in

which the operation is necessary medically.

Cosmetic surgery can turn a profit for hospitals

that is put towards more general medical areas.

And doctors receive training and practice in

difficult techniques which can then be used to

help patients in genuine need.

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Argument #4

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Yes

The pressures of appearance apply particularly to

women. Pregnancy and ageing have predictable

effects: they should be accepted with grace, not

fought against. The messages sent when some

women have procedures are firstly that the

prejudices some have about appearance are

valid, and secondly that those women secure

enough not to contemplate going under the knife

are “letting themselves go.”

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No

If women or anyone else are secure enough not

to bother with cosmetic surgery, then fine. But

there are many who find that their appearance

truly troubles them and that improving it would

greatly enhance their quality of life. If they can

afford it, let them.

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Argument #6

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Yes

The black market argument applies to everything

illegal. Of course that risk exists, but the number

of those undertaking the activity will be smaller,

as you concede. Lack of legal safeguards and

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No

Cosmetic surgery happens because people want it

– often, desperately. If banned, cosmetic surgery

will flourish on a black market. It will still happen,

but it will be very expensive (and therefore only

















































































































medical accountability, and the probability that

only badly qualified doctors will offer illegal

operations will deter almost everyone from

risking black market surgery. Fewer operations

must be desirable if it is agreed that the activity

concerned should be banned. Black market

activity will be vigorously policed – and after all,

its usually pretty obvious if someone has had

surgery.

available to the very rich) and it will be much

more dangerous as it will be done by

unscrupulous doctors and outside all the safety

precautions the legal environment provides.

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Argument #7

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Yes

Cosmetic surgery is addictive: look at Michael

Jackson, or Lolo Ferrarri, who got breast implant

after breast implant despite the harm it did her

body. The compulsion to change one’s body is

often a symptom of a deeper mental instability. It

should be treated as a problem, not indulged and

encouraged with surgery. It’s only a plaster

patched over a much deeper problem.

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No

This is patronising, insulting and wrong. The vast

majority of people who have cosmetic surgery

have one procedure and never look back. They’re

made happier and more secure in themselves

because of it. It’s fine to oppose cosmetic

surgery, but don’t falsely portray those that have

it as being mentally unstable.

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Argument #8

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Yes

Pointing to accidental side-benefits of cosmetic

surgery will not cover up the fact that its

intention is to make money, not make people

better. If a fraction of the efforts pumped into it

went into proper medicine, the medical world

would be much more advanced than it is today.

And the fact that the benefits arise from chance

merely serves to highlight the greed that

constitutes the essential nature of cosmeticsurgery: those benefits ought to be all of

medicine’s aim, not an accident resulting from it.

Certainly people make money and careers in

normal medicine, but they are giving treatments

that aim to make people well, not look different.

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No

The development of cosmetic surgery over the

years has been intertwined with that of

reconstructive and more general medical surgery.

Cosmetic surgery has greatly aided reconstructive

surgery. For example, maxillofacial surgery, or

surgery of the jaw, has developed with insights

from both plastic surgeons and oral surgeons. It’s

impossible to say in some areas who contributed

the greatest advances, the cosmetic or themainstream. To shut down cosmetic surgery

would be to cut off a valuable outlet for research

and discovery. The market can sometimes create

great benefits: people work hard in pursuit of

profits and often their work can help us all. Plenty

of people make a good living from normal

medicine and they are not criticised, the same

should be true for privately provided medicine:

there’s nothing wrong with turning a profit.

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Argument #9

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Yes

There’s a fair debate to be had here about what

we all know we mean when we talk about

cosmetic surgery. Balloon-breasted Barbie-doll

models and self-indulgent collagen boosters are

the issue, and trying to squirm out of defending

them by pointing to sad children is pretty weak.

Because the answer is obvious - hare lip

correction is legitimate surgery. Collagen

injection to hide aging is not.

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No

How do you define cosmetic surgery? Much of the

“cosmetic” work done greatly improves not just

appearance, but quality of life. Operation Smile,

which fixes oral and facial deformities found in

poor children across the world, is doing “cosmetic

surgery.” Sure you can survive with a hare lip or

a cleft palate. But your quality of life – your self

esteem, employability, acceptance in a traditional

society, etc – is much better without one.

Following this principle, breast reduction or

augmentation or the removal of acne scars can

be just as important.

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Argument #10

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Yes

If the opposition is right and plastic surgery is

desirable, then such surgery is unfair. Only those

that can pay for it get it. So if it has the

advantages the opposition claims, the rich will

look good, and the poor will not.

No

You can spend your money how you like. Why

shouldn’t people be allowed to make the personal

choice to change their appearance with their own

cash? Better that than ask others to contribute

through the state. Furthermore, the appearance

division the proposition seeks to suggest between

rich and poor is much more dependent on quality

of diet. Diet is a universal factor that affects

complexion, height, etc, while cosmetic surgery is

a relatively insignificant factor in statistical terms

and one that only affects the particular thing on

which surgery is conducted.

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Argument #11

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Yes

In fact, often, people look appalling after plastic

surgery. Celebrities with “trout pout” overblown

lips, or absurd, balloon-like breasts, are only the

most well known examples.

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No

That might be true. Let people choose what

happens to their bodies for themselves. For every

horror story, there are hundreds of people who

are happier with their appearance after surgery –

whether you prefer their new appearance or not.











































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