I work for a dermatologist who focuses his practice on medical dermatology. While all treat many of the same medical conditions, an ever-increasing percentage of dermatologists devote a substantial portion of their time to performing cosmetic procedures, from Botox and filler injections, chemical peels, and laser treatments to surgeries: facelifts, chin implants, eyelid modifications, and so on. The sign on the door of the medical practice I work for, however, reads ‘Diseases of the Skin’.

To me, this is a reassuring message, as if to say to all who enter ‘We are here to try and cure what ails you.’ It contrasts sharply with the message I get from cosmetic dermatology and surgery ads: ‘We agree that you’re ugly and need to be altered.’

Now, of course, this is only what I read into those ads, especially in my more sensitive moods. I don’t for a moment speak for anyone else, including the doctor I work for. ‘Diseases of the Skin’ is a simple statement of fact, conveying the information that he specializes in certain areas of dermatology and nothing else.

I’ve thought about the issue of cosmetic medical interventions, aka, ‘getting work done’, quite a bit over the years. The idea of using surgery and other invasive procedures to permanently alter a person’s body because they and others have decided they don’t like and can’t accept how they look makes me very uncomfortable, even angry on their behalf in case others have led them to feel that way. I admit right now, I have a longstanding bias against most forms of plastic surgery and cosmetic dermatology, and even the de facto social requirement that women wear heavy makeup, binding clothing, and hobbling footwear to be successful in many fields of work, especially in the performing arts and public media, and to ‘make a good catch’ as it used to be commonly called. Oh, and these women are often effectively required to ‘get work done’ at some point, too. While these procedures (CMI’s for short) are performed on men too, over 90% are performed on women, so I’ll continue to address cosmetic interventions as if it’s primarily a woman’s issue, though most of my comments apply to men as well.

So why worry about any of it? Is it any of my business what other women freely choose to do with their bodies? Are are my objections just personal, rooted in some sort of insecurity, just ‘sour grapes’ towards other women who are willing to do what I’m too lazy, cheap, or tomboyish to do?

As to the first, I don’t believe our life decisions have nothing to do with others; in fact, as I often argue, our choices so often affect other people in some way that we should make it a habit of assuming that they do. But whether or not deciding to have a cosmetic procedure performed is a purely personal choice, it’s an important topic for public discussion, since there are so many risks and ramifications to financial, physical, and mental health, and so many moral issues to consider. And when it comes to freedom of choice, I’m not at all convinced that the pressure women feel to conform to certain standards of beauty, especially the perception that they must have cosmetic procedures in order to have the kind of life they want, can meaningfully be referred to as real freedom.

As to the latter, I’ve occasionally wondered if elements of some or all of those things influence my attitudes on the subject. Of course I sometimes feel insecure in the presence of particularly beautiful or glamorous people, especially as a teen, but I’m quite sure everyone experiences these feelings from time to time. I also refuse to wear makeup primarily for two reasons: I loathe the scent, feel, and taste of it, and I’m not willing to spend the time it takes to put it on and touch it up all the time. But this is also normal, I know plenty of women who wear little or no makeup. Still, perhaps, my youthful ‘sour grapes’ got the whole ball rolling on my mostly negative attitude towards cosmetic interventions, it’s hard to say. But at this point, I’ve considered the case for and against cosmetic interventions, especially those undergone for the sake of simple vanity, so many times that I’ve thought out a wide range of arguments, and though I’m not sure I’ve drawn rock-solid conclusions, the objections remain. I’d like to share them with you, dear readers, and see what comes of them.

I’ve often shared my concerns with the dermatologist I work for, but his attitude toward the whole issue of CMI’s is much more tolerant than mine. Some weeks ago, he gave me a cutting of an article published in the Journal of the American Medical Association in April of this year. It’s the abstract of a study whose purpose is ‘to introduce the concept of facial profiling to the surgical literature and to evaluate and quantify the changes in personality perception that occur with facial rejuvenation surgery’. The study seems, on the face of it, to provide some scientific evidence against at least some of my objections. So what are they, anyway? Well, the study gives me a good starting point.

It goes like this: the researchers gave people pictures of 30 white women who had undergone various kinds of plastic surgery, and gave the participants a mixed assortment of the before- and after-procedure photos. They then had the participants rate the people in the photos for several personality traits, including attractiveness and femininity. As you may have guessed, the study found that the people who had received plastic surgery were rated significantly higher in several four positive traits: attractiveness, femininity, social skills, and likeability. They rated the people in the photos for other traits, too, some positive and some neutral, but there were no significant statistical differences for those. By the way, I was surprised to find the researchers didn’t ask the participants to rate for traits usually considered negative, unless ‘aggressiveness’ counts.

As I read the abstract, however, I didn’t find much that told against my objections; rather, several problems with the study leapt to the eye.

First, the study had a very tiny pool of subjects whose pictures were rated, and an even tinier pool of participants doing the rating, which may render it little more than a record of statistical outliers. It is difficult to fund a study, and the small size may not necessarily render it useless, since the researchers may very well have conducted this small study just to see if their hypothesis had any merit at all. Still, it seems hard to be convinced by such thinly tested results.

Secondly, and I think especially problematically when it comes to perception, the participants only looked at still pictures. I’ve frequently observed that those who have had ‘some work done’ often look rather odd in person: Botox-paralyzed brows don’t harmonize well with the expression of the the rest of the face; various parts of the body don’t match in age appearance, with smooth cheeks and perked breasts accompanying evidence of age and softening in other parts of the body; eyebrows often end up arched alarmingly and eyes narrowed by being tightened too many times; the corners of the mouth curve artificially, Joker-like, whether the person is smiling, talking, or at rest; scar tissue often adds a stiff and often texturally incongruous look to surgically altered areas of the body. A still photo reveals only a small fraction of the actual alterations in appearance and movement that are caused by CMI’s.

As to measuring attractiveness, femininity, sociability, and the like: many of these are mostly or entirely culturally ingrained stereotypes of what a (white) woman ‘should’ look like if she is likely to possess these traits. But the cultivation and perpetuation of many of these stereotypes is one of those things I object to the most in the first place. What sorts of surgery did these few women choose to have and why did they select those particular ones? What results were they trying to achieve: to look like a typical Hollywood starlet or socialite, or to look like their own younger selves, or to express their own idiosyncratic ideals of beauty? And as to those involved in the study itself: Why were only white women chosen, and why these particular set of personality traits? Did the raters also perform other tasks to help determine what they think an ‘attractive, feminine, and socially skilled’ person ‘looks like’ in the first place, and why they assume that’s how they look?

Now, the authors of the study, at least in this abstract, seem to try not to make too many preemptive value judgments on these points. They merely state that the results of this study indicate that receiving plastic surgery can alter one’s likelihood of being perceived in certain ways by other people. I don’t critique this study to claim the researchers are wrong in their predictions, but to point out various ways in which I think the study is unsuccessful in demonstrating what they want it to. The study was just too small; the participants did not have an adequate opportunity to observe what recipients of plastic surgery really look like since they saw only stills; and the way the participants were asked to rate the photos, as well the way the researchers selected the traits and photos themselves, probably influenced the outcome to a significant degree, revealing at least as much about the researchers’ biases, or tendencies to ‘facially profile’, as anything else.

I’m also going to stop here and make this clear: I’m fully aware that CMI’s, like the field of dermatology as a whole, have many wonderful, life-enhancing applications, repairing all manner of disfigurements caused by disease and injury, from tumors to severe acne to burns to the ravages caused by severe weight-gain and -loss. People with such disfigurements, and those born with physical traits that are very unusual or exaggerated, may have a very hard time getting a job, promotions, and dates, and feeling as if they can live freely without the constant distractions that come with having a very unusual appearance. Try as one might, it’s extremely difficult to keep stares, startled or disgusted looks, and other negative reactions to one’s appearance from damaging one’s peace and overall happiness. CMI’s, in these cases, can provide enormous benefits by normalizing appearance and thus ease feelings of stress and isolation, remove unwanted negative attention, and open up opportunities.

I also want to make it clear that I’m not critiquing the human desire to be beautiful or to ornament ourselves. The human species is an imaginative, creative, and playful one, after all, and I am the first to admire a fantastic costume, a gorgeous shade of lipstick, or a flattering haircut. What I’m critiquing is the obsession we have with fitting into very narrow, culturally-derived stereotypes of what it means to be attractive, the ways in which we oblige one another to do so, and our blasé attitudes towards these procedures regardless of their effects on our financial, mental, and physical health.

Cosmetic dermatology treatments and plastic surgery are expensive. They may also be addictive, or signify and likely exacerbate underlying mental health problems. (I found conflicting information on this point, since few rigorous studies have been done; while a large percentage of recipients of cosmetic procedures display observable and well-documented behaviors consistent with addiction, it’s still uncertain if the procedure-seeking is a primary or secondary symptom.) They are also often unpredictable in their results, and sometimes dangerous. People can suffer allergic reactions to the chemicals used, or the skin can burn, scar, or be discolored. We all tend to heal and to scar at different rates as well, even in different parts of the same body, and often there’s no way to predict ahead of time how the procedures will turn out, how well the results will harmonize with one’s overall appearance, and how much they will affect the natural mobility and expression of the face and body.

The story of the twenty eerily near-identical Korean beauty queens that went viral a couple of years ago is a case in point, a story which I found disturbing in the way it reveals the degree to which an obsession with artificial beauty standards can overrun a culture, destroying even its acceptance of the way its individuals naturally look. One of the most popular cosmetic procedures these Korean beauty queens choose, after all, is eyelid surgery to make their eyes look less ‘Asian’ and more ‘western’. A quick internet search will reveal innumerable horror stories of individuals who become obsessed with cosmetic interventions, and their addiction to ‘getting work done’ leaves them scarred, deformed, even disabled.

Anecdotally, I tend to be very conscious of such things because of my years of training in observing the details of the human body. Drawing was among my favorite pursuits as a child and young adult, and I studied figure drawing and painting in my first go-around in college. My fascination with the human form, combined with my sewing hobby and my years as a buyer, seller, and tailor of denim and vintage clothing, led me to choose the career of dressmaker and independent fashion designer for many years. I assisted people in choosing the proper fit in clothing (and still do!), and designed and created patterns and custom pieces to fit various figure.

And over time, the detailed observation and assessment of bodily forms gave me a deep appreciation of the wonderful and fascinating variety inherent in the human species. Noticing how the features and foibles of a person’s appearance express their personality and life story has become such a deeply ingrained habit in me that I just can’t turn off. Automatically, I assess the proportions of the faces and bodies I see, and note how the ways people carry themselves, their bodily attitudes and ways of speaking, denote their mood and general personality. A gesture, an expression, a moment’s pose, the way the hair falls across the shoulders or the hand rests on a surface, will sometimes strike me as the perfect subject for artistic representation. I’ll draw, paint, quilt, or snap a picture in my imagination, or decide which other artist would choose this as their subject. What rich offerings to the imagination does the variety in human appearance bring! In so many ways, it’s strange to me to decide that wrinkles and other body folds, those curves and lines that lend interesting shape and dramatic texture to a face or body, are ugly and must be eliminated, or that all bodies should be tucked, sucked, and otherwise molded into a narrow and far less interesting range of forms. I remain very grateful for the wonderful training I received, and thank all of those who helped me to recognize the true beauty and interest there is in this world.

And in my day to day life, I regularly have the opportunity to closely observe the results of regular recipients of cosmetic interventions and the personality traits that often accompany them. The dermatology practice I work at rents out a cosmetic dermatologist’s office one day a week to see patients local to that area. When it’s my turn to accompany the doctor to that relatively wealthy suburb, I find myself in the position of closely observing the physical results of cosmetic intervention when that doctor’s patients come in to purchase skin care products, as well as their behavior towards those of us behind the front desk. And what I observe is not always pretty, to say the least. These women are often curt, demanding, complaining, and chatter at long length about every little real or perceived flaw in their appearance that they’re eager to ‘cure’, whether or not that European-formula sunblock-concealer or skin serum costs sixty dollars per tiny bottle, and many with the stiff, tight faces of the sort I described earlier, oddly inexpressive and of indeterminate age. They have very often not, in my view, purchased beauty, good social skills, or an aura of happiness with the faces they now wear.

There’s an actress I’ve long thought very lovely, and I admired her since I first saw her, self-confident and wry, in an early 90’s movie. A few years ago, I was glad to see her act again in a certain miniseries, and while I still enjoyed her acting very much, I watched in dismay as, between each season, her face was altered more and more until I found myself cringing a little during her scenes. Having clearly ‘gotten some work done’ time and time again, her once very expressive face stiffened, stretched, and morphed into an ever more mask-like appearance. Now, I find her nearly unrecognizable. Do I fault her, and so many others like her (yes, some men too)? Sometimes I think yes, sometimes no, usually somewhere between the two, but my intention is not at all to pick on people in her position. I don’t really know what it’s like to feel that you have to choose between staying in a profession you know and love and having to remain looking as young and smooth as possible. Like all people at at some point in their lives, I do know the deep discomfort of perceived bodily dysmorphism, a feeling particularly common in our culture as we so often compare our own appearance unfavorably with cultural standards of beauty. But in her case, as with so many others, I find the surgical, ahem, ‘enhancements’ a failure, not at all conducive to her fully expressing her talents or growing into new roles she could explore.

So far, we’ve considered the practical and artistic downsides to CMI’s. But what I find even more problematic are some of the ethical implications, the ways in which these practices can help create, instill, and perpetuate some undesirable character traits if we are concerned with respect, tolerance, and appreciation for ourselves and our fellow human beings.

For one thing, participating in the project of creating a world of beauty-conformism can be socially irresponsible. There’s an idea, commonly held by liberals, that if a person wants to do something with their own body, it’s nobody else’s business. In short, people should be allowed to do whatever they like, without being subject to moral judgment or criticism of any kind, unless it harms other people directly and only in certain ways. I think this view is mistaken, or at least shortsighted. While I’m a fellow liberal and lover of freedom, it’s also true that our actions more often than not can and do affect others, indirectly, directly, or in the aggregate, and judging our own and other’s actions in light of this fact is essential to caring about doing the right thing. When individuals make personal decisions in matters of what they buy, how much they consume and waste, how their actions affect public safety, how much they contribute to pollution and future overpopulation, how courteously, fairly, and respectfully we treat our fellow human beings in our day to day dealings with them, and so on, we see that our personal decisions really do impact other people. Participating in a harmful or potentially harmful practice of engendering beauty conformism, for example, can be as irresponsible as participating in the wasteful and polluting practices of a hyper-consumerist culture. In their concern for liberating people from the oppressions and encroachments of others as well as from government, many confuse liberalism in politics with the idea that we shouldn’t value certain things over others, and that we shouldn’t make judgments about might be better ways to think and act.

So when we keep buying into this view that the only people that count are the ones that look good (whatever we mean by that) and help perpetuate it by choosing cosmetic interventions for ourselves, we help create a world that’s less free. By doing so, we do our part to foster the view that women (and men) should all ‘look good’ in more or less the same way if they expect to get ahead in the world, and if they don’t, they can expect to be sidelined in their careers or even in life. For myself, I already feel this way about the expectation that we women must alter the appearance of our faces with makeup and increase the sexiness of our foot, butt, and leg shape with high heels in order to be feminine and attractive, so the Beyoncé and Miley Cyrus brand of hyper-sexualized ‘liberated grrrrl power’ doesn’t feel like freedom or empowerment to me. While I enjoy looking at cute shoes as much as anyone, we’ve gone beyond that: sexiness in women virtually equals high heels, blond and/or straight-to-wavy hair, and/or revealing skirts, if cultural mirrors such as Cannes File Festival organizers or Fox News policy-makers are to be believed. How much more oppressive is the social pressure such as that experienced by my aforementioned admired actress: whether or not she liked her own face as it was, it’s not ‘good enough’ in a culture that values the trappings of youth, such a smoothness, slimness, and sexual availability, real or manufactured. It’s the image that counts, not the person. To me, there’s something dehumanizing in all of it, something that smacks of the same old oppression that corseted Victorian women and foot-bound Chinese women experienced, whether they bought into the whole thing or not. By the way, I’ve also long wondered how men would deal with it if the fashions they were expected to wear and the beauty-alterations they were expected to undergo were as uncomfortable, binding, and camouflaging as women’s.

Another problem with CMI’s is the way they can reinforce one of our most self-destructive habits, an obsession with looks that all too often comes from equating worth with beauty, and equating beauty with fitting into a few narrow aesthetic stereotypes. We have become quite a vain and self-obsessed culture. While a certain amount of vanity may be useful in helping us stay fit, clean, and well-dressed at appropriate times, overall it’s limiting and even self-destructive. How many hours we waste when obsessed and disturbed by perceived imperfections in our appearance, and how much beauty and interest we fail to see in the world when our perspective is so unforgiving, so narrowed, so unimaginative! The person overcome by vanity draws into themselves; their world becomes small, their preoccupations dull and trite, and their problems loom large because they are no longer contrasted with the real problems outside the world of their own narrow range of interests. Acting on that vanity to often entrenches it ever more deeply into our character through habituation and reinforcement, justifying our vain preoccupation to ourselves by expending our money, time, even suffering satisfying its demands. And when we instill in ourselves the value that our looking a certain way matters so much that we’ll go through all that expense and pain to to attain it, it seems we also change the way we habitually perceive other people. Perhaps if we can’t appreciate or respect ourselves if we don’t look good enough, we might soon find that others who don’t look good enough by our own or society’s standards aren’t worthy of our appreciation or respect either.

It seems as if we want to get closer to creating a world where people are more generous, tolerant, and celebratory of one another, a good place to start is with one’s own face and body, and then to extend that disposition outward. If we can’t come to terms with our own appearance, to learn to appreciate one’s own self with its own set of quirks, wrinkles, spots, lines, bulges, colors, etc, how can we do that with other people? Each and every one of us enjoys the good fortune to be born into this world, so why do violence to the very body that makes our existence possible? Why not instead habituate in ourselves an attitude of gratitude to the body which gives us everything we have? And do we really want a world of clones and lookalikes anyway, or would we rather be in a habit of enjoying the marvelous richness and diversity of the world is that we’re so lucky to find ourselves in? And anyway, who decided that only the smooth, slim, and young are worth looking at? Definitely not the artist, the loving grandchild, the parent, the friend, or the kindest and noblest part of our own characters.

Perhaps it would be much better for us to habituate ourselves to looking at the world differently. Perhaps it’s better to decide it’s not up to others to conform themselves to our expectations of how they should look, just as it’s not up to others to impose their expectations on us. Perhaps we could train ourselves to look at people whose appearances do not conform to narrow stereotypes of beauty, ourselves included, and react not with the desire to change them, but to accept and appreciate them. Perhaps we could open ourselves up appreciating to more types of beauty, such as perceiving the lines and spots in an aged person’s face as the writing and punctuation of an interesting life story, or the prominent curves and angles of a nose as the proud badge of one’s ethnicity that also lends drama to one’s features, or the softened tummies and breasts of mothers as the tokens of the new life they bring into the world, and not as ugly flaws.

When we think about CMI’s generally and to consider whether we should do this to ourselves, maybe we should ask: is it really a good thing to chose to spend the time and money and take these risks in order to alter my looks to fit in with these contrived standards of beauty? And yes, they are contrived, as we can see by observing rigid but often non-overlapping beauty standards throughout the world and throughout history, as well as contradictory and changing societal attitudes towards the aged. Or might it be better to forgo all of that in favor of internalizing a more open and appreciative attitude towards the variety inherent in the world? Is it really a harmless thing to perpetuate in ourselves and others the kinds of attitudes about physical appearance that lead us to seek cosmetic interventions in the first place?

In a world struggling with racism, sexism, nationalism, ageism, celebrity-obsession, commodification of human beings, and all other kinds of racial and gendered bigotry, based on assumptions about who a person is and how desirable they are based on the color, shape, and smoothness of their body… should we think it’s generally a good idea to carve these expectations into our own bodies and burn them into our own skin?

What do you think?

Sources and inspiration:

‘2013 Plastic Surgery Statistics Report’. American Society of Plastic Surgeons website.
http://www.plasticsurgery.org/Documents/news-resources/statistics/2013-statistics/plastic-surg…

‘The Dangers of Plastic Surgery Addiction’, Jun 26, 2015, Jim Brantner, MD Plastic & Reconstructive Surgery website. http://jimbrantnermd.com/the-dangers-of-plastic-surgery-addiction/

Dimiero, Ben & Eric Hananoki. ‘”I Can’t See Her Legs!”: Roger Ailes’ Rampant Sexism’. Jan 13th 2014, Media Matters blog. http://mediamatters.org/blog/2014/01/13/i-cant-see-her-legs-roger-ail…

Griffiths, Mark D., Ph.D. ‘Cosmetic Products: Can People Become Addicted to Plastic Surgery?’ Sep 2, 2013. Psychology Today website, https://www.psychologytoday.com/blog/in-excess/2013…

Nolan, Steve. ‘Has Plastic Surgery Made These Beauty Queens All Look the Same? Koreans Complain About Pageant “Clones”‘. Daily Mail.com, April 25th 2013.
http://www.dailymail.co.uk/news/article-2314647/Has-plastic-surgery-20-Korean-beauty-pageant…

Reilly, Michael J, Jaclyn A. Tomsic, Stephen J. Fernandez, et al. ‘Abstract: Effect of Facial Rejuvenation Surgery on Perceived Attractiveness, Femininity, and Personality’. JAMA Facial Plastic Surgery Journal. May/June 2015, Vol 17, No. 3. http://archfaci.jamanetwork.com/article.aspx?art…